Care - decisions to make

katykatems

New member
Apr 16, 2024
6
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Hi all

My brain is overloaded so I'm going to dump here and hope for a few opinions or perspectives.

Mum has mixed dementia, middle stage I think. She lives at home with 24 hour care - a day and night sitter because she doesn't sleep. My brother was staying with her for 4 days or so a week since Christmas but last month he had hit carers breakdown and can't continue. We had hoped at this point Mum would agree to move to a Care Home but she is dead against the idea. She won't even try a Respite stay. And so the care costs are astronomical - £7500 a fortnight. Mums savings are disappearing and will be spent out in approximately 2 months.

I am waiting SS involvement, and apparently they will be in touch with me in the next 3 weeks to do a financial assessment, capacity assessment and Best Interests Meeting. I don't know what to expect will happen, but I've been told that often SS swoop in at the last minute or at crisis and within a few days Mum could be moved. I'm wracked with worry as assumed up until this morning that this is probably inevitable as the only option is for her to move to sell the house (though what does that even look like when she's refusing??) SS told me they would only fund a maximum of 4 care calls a day at home, which is obviously not enough.

However I had a call with a lady from Care Rights earlier today who told me that there are options for Mum to continue with care at home. She said occasionally the LA will provide 24 hour care, equity can be taken from the house, or there's a Discretionary Deferred Payment Agreement that can be considered to allow her to pay the care costs.

Now I feel out of my depth. Mum is so terrified of moving, she's settled at home with the current care workers and the progression of her dementia has slowed, her anxiety has lessened and she's put on weight since she's had 24/7 care. She is managing well at the moment, albeit I do worry about her quality of life because she never goes out and doesn't engage in anything at home - her mood is often low. I feel like it would be best to continue at home, even if just for a short while longer, however the care costs are so high, I'm worried that it would be a mistake financially further down the line. I'm also worried it's going to be lots of work to make that happen, and that I'll come up against opposition rather than support from SS, and I'm not sure I'm mentally up to the workload. I'm running on such little capacity with a toddler and 6 year old also to take care of.

I do have LPA, thankfully managed to get that sorted just before Mum lost capacity.

Any thoughts would be much appreciated. I feel so isolated and worried.

thanks
 

SAP

Registered User
Feb 18, 2017
1,438
0
Hello @katykatems this sounds very stressful and the hauling thing is that nothing ever prepares you for this and the lack of support avalaible.
Carers Rights are correct in what they tell you however the reality is that the majority of LAs will not pay for 24 hr care at home, it’s just too expensive even if they did agree to a deferred payment. Your mums might just don’t bank on it.
You say that you mum no longer has capacity. As hard as this sounds you can use the LPA for health and welfare to place her in a home . The chances are that she would never agree anyway due to the dementia so someone has to make the decision for her.
Social services very rarely swoop in and remove someone unless there is a safeguarding issue. Currently there shouldn’t be a crisis because she has 24hr care. So the best thing to do is to go to the best interests meeting and do the financial assessment. Don’t be worried about this they are done for everyone needing care as soon as services see they may need to have an input. Then you will know what the options are and what will happen once your mums saving dip below the £23,500 ( in England) .
You say your mum is isolated and low maybe being in a home with company will lift her mood and give her a new interest in life. Anyway at some point her assets are going to have to be cashed in to pay for her care so either way this is inevitable. The majority of carers are not financial experts, we become that with experience unfortunately. Never forget that you are just doing the best you can with what you have got in a system that is not fit for purpose.
Hopefully now you are on here you won’t feel quite so isolated.Youcan also see if there is a carers centre local to you for support and advice.
 

katykatems

New member
Apr 16, 2024
6
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Hiya, thanks so much for reading and advising. I've been told that the LPA doesn't mean anything if the person physically refuses to leave their house. Do you have any idea what might happen in this instance?
 

Dave63

Registered User
Apr 13, 2022
448
0
Hi @katykatems

The first thing social services should do is carry out a care needs assessment before any financial assesssment to determine who is responsible for paying for that care. It's not uncommon for social services to jump straight to a financial assessment before understanding what a persons care needs are. It could turn out that she has health needs which may make her eligible for CHC funding which would mean all costs of her care would be paid for by the NHS. If she is already receiving 24/7 one to one care and has health needs then it may be possible she is eligible.

The correct order is:

Care needs assessment ---> If health needs identified then a CHC checklist should be done --> If no health needs then a financial assessment to decide if and how much she should contribute.

Some links to useful articles about assessments:



 
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Dave63

Registered User
Apr 13, 2022
448
0
Hiya, thanks so much for reading and advising. I've been told that the LPA doesn't mean anything if the person physically refuses to leave their house. Do you have any idea what might happen in this instance?

No idea how this is handled but I did find an article regarding it.

 

SAP

Registered User
Feb 18, 2017
1,438
0
This is where mental capacity comes in. If your mum lacks mental capacity and social services believe she has to go into care they can enforce it via the court of protection. So if it came to it she could be placed in residential care where she would be placed under a DOLS to keep her there and more importantly safe. Now this all sounds quite scary but it does not need to be like that. A little bit of sleight of hand and love lies can get a person into a care environment under the guise of a holiday etc. In my mums case the home she went into wanted to see both LPAs to ensure that I had the right to decide she needed care and this was backed up by a social worker who stated mum no longer had mental capacity.

Advice for attorneys: health and welfare

Having an LPA over someone's personal welfare may mean you need to make decisions about the healthcare and welfare of the person you're looking after.

If you have this power, you may have to decide:

  • where the person is to live
  • whether a care home or a nursing home is best for them, and which one
  • whether the person can continue to live at home with help from social services
You'll be able to decide if the donor should:

  • receive healthcare treatment
  • not receive a particular healthcare treatment
  • stop receiving a particular healthcare treatment
Some people who have a progressive illness sometimes make a decision about whether they'd want a particular treatment in the future.

They write down or tell others these wishes while they're mentally well, or have "mental capacity".

If the donor made a decision to refuse future medical treatment (known as an advance decision) in advance of losing their mental capacity, you cannot override their decision unless the LPA was made later and specifies that you have the power to do so.

What health and welfare power of attorney cannot do

A health and welfare LPA does not come into force until the donor has lost the capacity to make decisions for themselves.

There are some decisions you as an attorney cannot make for another person.

You cannot:

  • refuse any medicine prescribed by a responsible clinician if the person has been sectioned or is on leave from hospital
  • make decisions about where they should live if the donor is under a guardianship order
  • make a decision about life-sustaining treatment without checking whether the person has made an advance decision about this
    (From https://www.nhs.uk/conditions/socia...th and welfare LPA,to make your own decisions. )

If on the other hand your mum still has mental capacity then neither you OR social services can make her move it’s as simple as that. So whilst the LA may be jumping the gun a bit with the financial assessment they will have to make a decision on her mental capacity before any care decisions can be made.
NB it is extremely common for LAs to want financial info before they do anything , it’s not right but it happens all the time.
 
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