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Alternative to a care home

Discussion in 'I care for a person with dementia' started by Broomie, Oct 29, 2015.

  1. Broomie

    Broomie Registered User

    Oct 29, 2015
    23
    Hi all, I am looking for some advice around what alternatives to residential care there may be.
    My father in law has advanced Alzheimers and is unable to care for himself and he needs to be supervised 24\7. His wife fell recently and broke her femur in two places and so is currently in hospital. When she is discharged both she and he will require care. Currently my wife and her siblings are caring for their father and they have discussed having him temporarily placed in a home while their mother recovers. The view of the majority is that they don't want to do this, so my question is what support is available to my father in law to enable him to remain at home and will relieve my wife and her siblings of providing him with 24 hour care themselves?

    Grateful for all advice. Thank you.
     
  2. Delphie

    Delphie Registered User

    Dec 14, 2011
    1,257
    Hi :)

    If he's self funding then there are many agencies that can provide various levels of care at home, from a few short visits to full time. Obviously it's possible to employ carers without going through an agency, but that can be tricky as you'd have to check references yourself and then get into the whole 'employer' business, unless you find someone self-employed but, to be honest, I know that HMRC can take a pretty grim view of that, so I wouldn't necessarily advise it.

    If he's not self funding then their local authority will, if they assess a need, provide some level of support at home but it won't be a great deal, certainly not enough if the current carers want to take a big step back. LAs have tight budgets and will usually go for the cheapest option to provide whatever support needed, and providing 24/7 or close to that care at home is the most expensive option.

    Just to give you some idea, when I was looking into all this for my mum, a full time carer for her at home would've cost about £1000 per week.

    In the end I decided against it but not for financial reasons. I think when it comes to this sort of care many hands and many eyes are better than just one stranger behind closed doors, if you know what I mean. And I didn't want to impose that one relationship on my mum. She's been in a care home for a while and has a degree of choice as to how and who she interacts with.
     
  3. Chuggalug

    Chuggalug Registered User

    Mar 24, 2014
    8,007
    Norfolk
    Clive; when this was discussed with me; it was said that my husband really needed 24 hour care. The only option offered for that was a care home, as visiting carers don't do night shifts. My two hospital social workers lovingly said that I needed to sleep, too!

    I could have had carers coming here to help up to four times a day, but we'd be alone overnight, every night. In their eyes, this wasn't a good option. I could have asked for that kind of care, but I would have had to cover nights alone. I'm not in perfect health with my arthritis, and, because of other long-term problems, we all felt it best that hubby was looked after. I was told I could take him out on trips to shops and the like. I'll have to look into that a bit further. Husband is thriving where he lives, and I'm utterly grateful for the good care he receives. The home is lovely; the carers are like family, and the management superb. It's not a bad thing to ask, even for a few weeks' respite until his wife recovers enough to cope again. Broken bones are no joke, as I know you're aware. I do hope she heals soon. Much love and luck, xxxxx
     
  4. Broomie

    Broomie Registered User

    Oct 29, 2015
    23
    Thanks Delphie.

    He wouldn't be self funding so we would be looking at the LA to provide support. While the family have been providing the 24 hour cover, whether they can do it long term when their mother is discharged I'm not so sure. My concern is that they will burn out, particularly if one or more can't cover due to ill health. My view is that a temporary placement in a home would be best, until their mother is mobile, but they won't consider that.

    It's a difficult situation.
     
  5. Bessieb

    Bessieb Registered User

    Jun 2, 2014
    108
    Hi CliveBroom,
    I had a similar situation earlier in the year where my Father was in hospital and it was obvious that both of my parents would need 24/7 care when he was discharged. They were 150 miles away from me with no family support so I asked SS for all the options.

    They gave me 2 options:

    - Residential Care for both

    - A 24 hour care package at home for both. A 24 hour care package involves a small team of carers from an agency providing care in home. Social Services wouldn't fund this if they were not self-funding as it would be considered too expensive but if they are Self-funding then this is an option. Quite an expensive one but might be the right route for your parents. SS got three quotes from agencies for me on this and the best quote they gave me was £910 a week. This was for both parents though. From other posts on TP I think this is very similar to quotes others have been given.

    It really depends on particular circumstances as to whether this will work for your parents. In the case of my parents we decided it wouldn't work as my Father can be quite challenging and we didn't feel he would like someone else being in the house overnight - and that it would actually be very difficult for one carer to look after both my parents. So with a heavy heart we moved them to a (beautiful) CH.

    Good luck with the decision making
     
  6. Bessieb

    Bessieb Registered User

    Jun 2, 2014
    108


    I went round this loop with SS and they wouldn't provide / fund 24 hour cover, even temporarily. You might be lucky in a different area but I think LA policy is generally the cheapest option and this is generally the contracted rate with LA care homes.
    If family is prepared to cover in the daytime another option might be an overnight carer? I was quoted £100 a night for this (again the LA won't support so would have to be family funded) but it does work out slightly cheaper
     
  7. Delphie

    Delphie Registered User

    Dec 14, 2011
    1,257
    Yes, and what a shame they won't give it a go. I can honestly say that my mum is doing very well in the care home. It took her a while to settle but it was worth it.

    Good luck.
     
  8. canary

    canary Registered User

    Feb 25, 2014
    10,783
    Female
    South coast
    Hello Clive and welcome to TP

    If you are reliant on SS for funding then Im sorry to say that usually the maximum that SS will pay for care in your own home is 4 visits a day. Some people have got more, but TBH as SS will see that family is involved then I doubt you will get more. They may offer day care which might give the family a bit of a break, but I really doubt that you will get anything overnight unless it is a care home.

    I can understand your concerns and yes, carer breakdown is a very real phenomenon. Unfortunately, if the people who do not wish him to go into a CH even on a temporary basis are the ones who are doing the overnight caring then TBH I dont think there is much that you can do. I suspect that it may all go pear-shaped though, so you might want to ask SS for a list of care homes and just go and have a look at them in case something is required urgently.
     
  9. Broomie

    Broomie Registered User

    Oct 29, 2015
    23
    Dear all,

    Thanks for all your advice. One last question how would we identify the local care homes that SS would fund?

    Thanks,

    Clive
     
  10. canary

    canary Registered User

    Feb 25, 2014
    10,783
    Female
    South coast
    You ask them :)
    They should give you a list. Then go round and have a look at them. Dont worry if it looks a bit tatty - what is needed is good care, cheerful carers and a homely atmosphere.
     
  11. jasmineflower

    jasmineflower Registered User

    Aug 27, 2012
    335
    Hi
    I may be wrong but I think your MIL should automatically be assessed for and receive a 6 week care package before she can be discharged.

    No doubt if I am mistaken someone will correct me. Perhaps this could be a point where your wife and siblings can reassess how much support they can offer?

    J x
     
  12. canary

    canary Registered User

    Feb 25, 2014
    10,783
    Female
    South coast
    You are quite correct Jasmine, but it still wont cover 24 hr care.
     
  13. Broomie

    Broomie Registered User

    Oct 29, 2015
    23
    Yes they are arguing that their mum needs a care package but their father needs 24 hour care and that doesn't appear to be available.

    My own concern is that my wife's brothers and sister will take the decision not to place their dad in a care home and then this requirement to provide 24\7 care will continue indefinitely. It feels unfair that they can take this decision and by virtue of that my wife will, against her wishes, have to continue providing this care with no end in sight.

    Is it unreasonable for me to say that I'm not happy for her to do this?

    Thanks for all the advice everyone
     
  14. Beate

    Beate Registered User

    May 21, 2014
    11,744
    Female
    London
    Your wife will not have to provide any care if she does not wish to do so. No person has a duty of care towards another. The duty of care lies with the state. Brutally said, if your wife does not wish to do any caring, and that is her right, she can simply refuse to do so. The onus will then be on the state and/or her other siblings. If they are happy to provide the care themselves, fine. If they are not, they will soon come round to the idea of a care home. To be honest, you are not even talking permanent at the moment, only temporary, which is called respite. Every carer has the right to respite and it is short-sighted to refuse it, or any other help that Social Services could offer that would lighten the burden. I am afraid you and your wife will have to be a bit more vocal with others involved in what it is you are prepared to do and not to do without outside support.
     
  15. Broomie

    Broomie Registered User

    Oct 29, 2015
    23
    Thanks Beate,

    The problem is that there are already arguments over who is doing what and they're all tired from providing 24 hour care and it won't get easier when their mum is discharged. All we are suggesting is that he is temporarily placed for a couple of months while their mum recuperate. I can see one or more of thembecoming ill over this. But they are, currently, adamant that they don't want that.

    Thanks for your advice.
     
  16. Quenby

    Quenby Registered User

    Oct 30, 2015
    3
    Hi Clive

    If you search for care homes and your area it should bring up all Homes listed in geographical areas eg. 1 mile from your position, etc.

    You can also go to the cqc website and they will also have a listing of care homes.

    A good care home will welcome you without an appointment. They will be happy to show you around, invite you to take a meal or bring your family member for a trial day.
    They will ideally show you a variety of rooms, walk you through the home explaining the Home routines, what activities are available and how many staff are on.
    They will be happy to provide you with how they will meet the needs of your loved one and have brochures and fees information to hand.

    You should be able to ask questions of the carers/seniors and speak to other Residents (if they are able to do so) and to their visitors.

    The Home should be clean smelling and be welcoming. As another person has said, not all Care homes are new and purpose built so don't judge on the size or state of the building, but look to how the care staff interact, how they welcome you, and how the Residents look (clean, tidy, shaved).

    Good Luck and dont let the LA tell you that you HAVE to have a certain home. It is your choice to make and a good Home will do all of the above and welcome you 24/7 , the only thing they should stipulate is protected mealtimes. This means that they don't allow Dr or district nurse visits, chiropodists etc into the Home at this time, as this is when the focus is on the Residents providing a calm yet happy environment to eat their meals.
     
  17. Broomie

    Broomie Registered User

    Oct 29, 2015
    23
    Further advice please

    Further to my previous posts a decision around my father in law has been made. The view of my wife's siblings and her mother is that they will not be asking for a placement for him, which is their right. However, they are still planning to provide 24\7 care for my FiLfor an indeterminate period and they are expecting my wife to be involved. My view is that 24\7 care is perfectly OK for a short defined period but tobexpect everyone to provide it for an undetermined period isn't realistic or reasonable. My MiL isn't going to be able to care for her husband and so there will need to be someone with then all day and night.

    Am I being unreasonable and selfish is saying that while we willcontinue to assist for a specified short term period, I am not prepared for my wife to be expected assist long term and that a care home should be in the planning.

    As ever grateful for all and any advice because I don't know what to do for the best.
     
  18. Bessieb

    Bessieb Registered User

    Jun 2, 2014
    108
    I think you are being very reasonable. To do 24/7 care even for a short period is a big ask so I think saying how long you / your wife are prepared to be involved for is very sensible and manages everyones expectations - even if it upsets the other sibings in the short term. You could always offer to do the research into care homes to help them if this helps appease them a little.
    Good luck with it - I'm an only child and hate making all the decisions myself but I know that I'm lucky I don't have sibling disagreements
     
  19. Broomie

    Broomie Registered User

    Oct 29, 2015
    23
    Thanks Bessieb,

    My main concerns are twofold, 1. They seem to think that when mum returns home that everything will go back to how they were before and in my view they won't, and 2, they aren't planning beyond tomorrow so there is no rota for who is doing what and when I ask about care over Christmas, we have children and does my wife's sister, they simply say that they don't know. To continue like this indefinitely is, in my opinion, unreasonable but I just want to check that I'm not being unreasonable in wanting to set a time limit on us providing care.
     
  20. Clueless2

    Clueless2 Registered User

    May 14, 2015
    34
    It is understandable why your wife's siblings and mother want to try the approach chosen. Your concerns are also justified. Unless all live nearby, have flexible work lives and very supportive spouses or partners, it will be a Herculean task to achieve.

    However great our love or sense of duty to our afflicted loved one, providing 24/7 care is not for the faint hearted, it is completely exhausting, physically and mentally. The lives of not only those that provide the care are effectively put on hold, but families, grandchildren etc are also impacted.

    Perhaps suggest a review date of beginning of December, or even a couple of weeks? Meanwhile be practical and proactive, research the care homes to get a better idea of what is possible.

    Personally I would have laid good money that my mother, who was so terrified of going into a care home, would never settle in one. Mum took to it like a duck to water; we didn't tell her where she was going, just that we had booked her into a nice hotel for a few days, that her GP wanted her to rest and recover as she had become exhausted, it worked.

    Visiting potential care homes is difficult. Begin now, see what is out there, if the family cope through this crisis, there may be a need for the info you have gleaned in the future. Good luck.
     

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