Care funding generally and Section 117 of 1983 Mental Health Act

[Emily M]

I have some questions about the funding of residential care and would be grateful if anyone could answer these.

1) I have been reading about 117 of the mental health act and the duty of local authorities to pay for care. The quote is:-

“Section 117 aftercare means that if a patient needs to move from hospital to a care home, their care home fees must be paid for. To be admitted under section 3, their illness must cause them to pose a risk to their own health or safety, or to that of others.”

Does this still apply if the person is coming straight from home and not hospital, particularly as they can still be considered a danger to themselves and others?

2) My mother and step father live in rented property. My mother has a very small pension and around £6,000 in savings. Her husband has his state pension, a moderate occupational pension and not many savings either. My mother will definitely have her care paid for by the local authority BUT, there seems to be a cap on it to slightly less than £600 a week. There are homes that will take her for this amount, however, there will be a greater choice of homes if the family is prepared to top up the amount. My step-father cannot afford to do this. He earns enough to pay some tax, but needs all his money to pay the rent and other daily living costs. The rest of us although comfortable, are not rich and have to think that any savings we have may be needed for our care when we get older, especially as there is likely to be a lot less available in the future. Does not the local authority have an obligation to pay for care if it is difficult to find a home for the capped amount?

3) Am I right in saying that the amount the local authority is prepared to pay differs from region to region and is also different in England, Scotland and Wales?

It seems to me there are a lot of grey areas on this subject and not a lot of fairness.

 

[jenniferpa]

I think the first question is - has your mother been sectioned under a Section 3? Because if she hasn't, then Section 117 funding does not apply.

 

[Emily M]

I think the first question is - has your mother been sectioned under a Section 3? Because if she hasn't, then Section 117 funding does not apply.

No because she is still at home, but I have a horrible feeling it might come. I don't think she will be willing to go, so I am absolutely dreading what will happen. When they tried to get her into respite before she got quite violent. I suppose it is up to the mental health team how they do it.

I am not being heartless nor do I want her sectioned. I just wonder if this happens as a matter of course if a person refuses to go. My step-father is at the end of his tether. I live a very long way away. It is very upsetting for everyone involved and I am just trying to look at all aspects including financial. I really don't know how they deal with these things which is why I am asking for help.

 

[LYN T]

Well first of all she would have to be sectioned under a section 2 for assessment. Section 3 is only actioned if there is a need for further assessment/treatment. However, I recently read through the paperwork I had on my Husband and one time he was sectioned there was talk of further assessment/treatment (no mention of section 3) and he was put on a DOLS. A Dols doesn't trigger s117. A section 2 lasts for up to 28 days. My OH was sectioned 5 times and he was given a DOL 4 times.

 

[Saffie]

My mother will definitely have her care paid for by the local authority BUT, there seems to be a cap on it to slightly less than £600 a week.

If your LA will pay fees of just under £600 a week, you are indeed fortunate.
Average fees for Nursing homes around here are around £1,000 a week and the LA will only agree to fund around £460.
However, perhaps that £600 includes your mother's contributions of her pension as of course, nobody has their fees paid for completely by the LA.

The LA has the obligation to contribute towards the fees for a home that satisfies the needs of the person concerned. Therefore it it does limit choice I'm afraid.

 

[Emily M]

If your LA will pay fees of just under £600 a week, you are indeed fortunate.
Average fees for Nursing homes around here are around £1,000 a week and the LA will only agree to fund around £460.
However, perhaps that £600 includes your mother's contributions of her pension as of course, nobody has their fees paid for completely by the LA.

The LA has the obligation to contribute towards the fees for a home that satisfies the needs of the person concerned. Therefore it it does limit choice I'm afraid.

When I say £600, it was £500 and something. I didn't quite catch the figure, but think it was nearer £600 than £500 - it might have been £550 - I just can't remember. It is all a bit of a shock that she is really going. I have been told it will be enough. The main concern is that she is cared for, it's clean and one would hope that care should be to a standard in all the homes - Mum will not notice how plush her surroundings are. How on earth do people play for these fees when they don't have the money?

 

[Emily M]

Well first of all she would have to be sectioned under a section 2 for assessment. Section 3 is only actioned if there is a need for further assessment/treatment. However, I recently read through the paperwork I had on my Husband and one time he was sectioned there was talk of further assessment/treatment (no mention of section 3) and he was put on a DOLS. A Dols doesn't trigger s117. A section 2 lasts for up to 28 days. My OH was sectioned 5 times and he was given a DOL 4 times.

Lyn, it is all very confusing. I wondered what you meant by DOL, then remembered that Deprivation of Liberty was mentioned. When I mentioned Section 3, it was in response to something I had read on line that had originally appeared in the Financial Times. I thought once someone was sectioned with Alzheimer's that was it - after all they are no going to get any better are they? It is an absolute minefield.

 

[LYN T]

Lyn, it is all very confusing. I wondered what you meant by DOL, then remembered that Deprivation of Liberty was mentioned. When I mentioned Section 3, it was in response to something I had read on line that had originally appeared in the Financial Times. I thought once someone was sectioned with Alzheimer's that was it - after all they are no going to get any better are they? It is an absolute minefield.

Ha! It is as you say a minefield. The distinction is how the AD presents itself. A very grey area. If the presentation of the sufferer can be proved that there is a complex condition (in my opinion AD is always complex) it's unpredictable and intensity then there could be a primary care issue. But boy do you have to fight to prove that. I was told in no uncertain terms that my OH needed 24 hour care and I could no longer be the person who provided that care, I was assessed by people who deemed that I had 'carer breakdown'. They did that with no reference to GP notes-actually I had no GP as I didn't have time to see a GP-I'm sure you know what that's like.

It's an out and out fight. I don't know if that will ever change. It's not right but it's what we have to deal with.

Love

Lyn T XX

 

[katek]

Re DOL / section 3 - Just today attended a tribunal meeting at my Dad's NHS unit at which the solicitor 'representing' him was arguing the case whether to lift his section 3 in which case a DOL would have to be applied for. The doctor argued that a section 3 gave them more scope to use restraint they need to administer care, and the social worker agreed.

As Emily rightly says, the patient with AD is not going to get better. However, as the illness progresses, the way that it presents itself can change, meaning someone like my father may no longer fight off carers, and would therefore no longer need to be sectioned. This was an important part of the discussion at the meeting, and although the section may be lifted at some point in the future, the panel agreed that it should stay for now, which my mum and I are happy with. What worries us more is that if he does become more compliant with care, he will have to go to a nursing home where they may not be able to cope with him as well as the NHS unit.

Emily - on your question of how do people afford it - by selling their house (unless the spouse still lives there) and/or using their savings until they reach a point where social services will help towards the cost. If, like my late sister who was in care, they don't have savings/assets, then social services will fund them - to a certain limit. The £550 you quote is, as someone else commented, quite generous. Although the 'standard' fee is around £1,000 on average, this higher rate, paid by the self-funders, actually helps to subsidise those on LA funding.

 

[Emily M]

Ha! It is as you say a minefield. The distinction is how the AD presents itself. A very grey area. If the presentation of the sufferer can be proved that there is a complex condition (in my opinion AD is always complex) it's unpredictable and intensity then there could be a primary care issue. But boy do you have to fight to prove that. I was told in no uncertain terms that my OH needed 24 hour care and I could no longer be the person who provided that care, I was assessed by people who deemed that I had 'carer breakdown'. They did that with no reference to GP notes-actually I had no GP as I didn't have time to see a GP-I'm sure you know what that's like.

It's an out and out fight. I don't know if that will ever change. It's not right but it's what we have to deal with.

Love

Lyn T XX

Thanks Lyn.

You must have gone through hell. It is my step father who is bearing the brunt and he has his health issues. Some hospital letters have "disappeared" and he has missed appointments. I live a long way away from them so am not there everyday. It's only really got very bad in the last 3 months or so and Mum has started deteriorating very quickly. Primary Care - people with advanced AD are very sick. If it was any other illness we would probably not be having this discussion.

Best wishes EM

 

[Emily M]

Re DOL / section 3 - Just today attended a tribunal meeting at my Dad's NHS unit at which the solicitor 'representing' him was arguing the case whether to lift his section 3 in which case a DOL would have to be applied for. The doctor argued that a section 3 gave them more scope to use restraint they need to administer care, and the social worker agreed.

As Emily rightly says, the patient with AD is not going to get better. However, as the illness progresses, the way that it presents itself can change, meaning someone like my father may no longer fight off carers, and would therefore no longer need to be sectioned. This was an important part of the discussion at the meeting, and although the section may be lifted at some point in the future, the panel agreed that it should stay for now, which my mum and I are happy with. What worries us more is that if he does become more compliant with care, he will have to go to a nursing home where they may not be able to cope with him as well as the NHS unit.

Emily - on your question of how do people afford it - by selling their house (unless the spouse still lives there) and/or using their savings until they reach a point where social services will help towards the cost. If, like my late sister who was in care, they don't have savings/assets, then social services will fund them - to a certain limit. The £550 you quote is, as someone else commented, quite generous. Although the 'standard' fee is around £1,000 on average, this higher rate, paid by the self-funders, actually helps to subsidise those on LA funding.

Thanks katek

Quite informative, especially your second paragraph - I am beginning to see how it works - endless meetings and assessments Mum and step-father do not own a house and don't have much in savings. From what people are saying funding seems to vary from region to region. There have got to be many people without any assets that have to be paid for in full. Successive governments have failed to address this issue.

 

[Karjo]

Re DOL / section 3 - Just today attended a tribunal meeting at my Dad's NHS unit at which the solicitor 'representing' him was arguing the case whether to lift his section 3 in which case a DOL would have to be applied for. The doctor argued that a section 3 gave them more scope to use restraint they need to administer care, and the social worker agreed.

As Emily rightly says, the patient with AD is not going to get better. However, as the illness progresses, the way that it presents itself can change, meaning someone like my father may no longer fight off carers, and would therefore no longer need to be sectioned. This was an important part of the discussion at the meeting, and although the section may be lifted at some point in the future, the panel agreed that it should stay for now, which my mum and I are happy with. What worries us more is that if he does become more compliant with care, he will have to go to a nursing home where they may not be able to cope with him as well as the NHS unit.

Emily - on your question of how do people afford it - by selling their house (unless the spouse still lives there) and/or using their savings until they reach a point where social services will help towards the cost. If, like my late sister who was in care, they don't have savings/assets, then social services will fund them - to a certain limit. The £550 you quote is, as someone else commented, quite generous. Although the 'standard' fee is around £1,000 on average, this higher rate, paid by the self-funders, actually helps to subsidise those on LA funding.

Katek, what you fear in that the nursing home may not cope has happened twice to my poor old mum. In hospital on a section 3 for 10 months I was desperate to get her out and settled, but unfortunately it was out of the frying pan and into the fire! The nursing home placement eventually failed after months of "torture" for us both, though I don't feel resentment to the nursing home as they knew she needed more care than they were being paid for under section 117.
Another 8 months followed in another much better assessment hospital and she settled pretty well but they were obviously desperate to get her out. I just could not see how anything was changed other than being in a better staffed environment as they could not get the meds down her but heh ho she had to go.
She was given notice of eviction immediately at the next home. It was an unbelievable nightmare. This time there was really nowhere to go and I thought she would end up in a police cell. To be honest i was in such a state I thought this may be the best thing for her as the hospital refused to take her back!
Anyway things some how suddenly came together and one to one care was provided and though mums distress was not eased , at least she could not harm anyone ( except the odd poor carer) or herself. Things have stayed that way for a few months now while they try again with the medication . Mum is still mostly as anxious and unsettled as ever but I certainly feel a bit more confident though appreciate that they cannot continue this degree of funding. I am not entirely sure quite who has stepped up with this funding, but I am certainly grateful, I think it is shared between SS and CHC, but I get the feeling this is certainly a bit exceptional. Anway I know there is not going to be a happy ending to all this but for now I can breathe a slight sigh of relief. Sorry to hi jack the post but just wanted to share this in case it is of help to anyone.
BTW the first time mum went from hospital she was on section 17 leave for a couple of weeks which meant her bed was kept incase it failed.(though this was lifted by the time she was evicted). And please also remember if someone is on a section 3 their care is paid for by SS when discharged from the NHS under 117 aftercare, though sometimes the care provided is obviously not adequate and so leads to the sort of problems experienced by us.

 

[katek]

Karjo

Sorry to hear about your experience, and don't apologise for 'hijacking' as you put it! The whole thread, including your post, has been very informative. I have only just learnned that discharge following DOL is not funded, whereas following section 3 it is. Therefore when a reduction to DOL was being discussed at our meeting, I was unaware of the financial implication of it as well should my father ever be discharged, which we hope we won't.

Since any discharge is far from imminent, our meeting was about the difference between DOL and section 3 in terms of the scope of restraint staff are allowed to use, and we were just relieved that staying on section 3 allows them to continue to care for him as well as they do. He has had a very tortuous journey to get here, and your experience shows how it could have been even worse. We know from his year of self-funding, how disastrous being somewhere with fewer and less well trained staff can be. We just hope and pray that we never have to go through it all again, and that he can just now remain where he is.

 

[Karjo]

Karjo

Sorry to hear about your experience, and don't apologise for 'hijacking' as you put it! The whole thread, including your post, has been very informative. I have only just learnned that discharge following DOL is not funded, whereas following section 3 it is. Therefore when a reduction to DOL was being discussed at our meeting, I was unaware of the financial implication of it as well should my father ever be discharged, which we hope we won't.

Since any discharge is far from imminent, our meeting was about the difference between DOL and section 3 in terms of the scope of restraint staff are allowed to use, and we were just relieved that staying on section 3 allows them to continue to care for him as well as they do. He has had a very tortuous journey to get here, and your experience shows how it could have been even worse. We know from his year of self-funding, how disastrous being somewhere with fewer and less well trained staff can be. We just hope and pray that we never have to go through it all again, and that he can just now remain where he is.

It certainly can make a huge difference as to funding if someone goes on a section 3 as opposed to a DOL. It was a surprise to us too but when mum was first sectioned on section 2 we Immediately started looking for a care home for her just to find that all were unwilling to accept her because of her sectioning. We were at a loss what to do but the hospital said she would likely go on a section 3 as she would not take medication to calm her , escaped, smashed windows and was very aware that she was in her opinion imprisoned. The problem with section 3 of course is that the person is held against their will and they are forceably medicated which sounds ok but in reality is very shocking as each medication can have differing effects and forcing someone to do anything and restraining them is obviously unpleasant. To be honest none of the meds really worked but some had serious side effects, some which do not show up immediately.it becomes impossible to know what is dementia, what is side effects and what is just fear and bewilderment. When you consider all this it would not be right to then charge the person for this! We are not the sort of country (yet) that can take somebody from their home, lock them up, forceably medicate them and then deny responsibility for their care because no one can measure what harm or what helphas been done.During my mums time in hospital we saw a lot of people come in but most seemed to accept they needed help, did not try to escape and took medication. They often stayed for a long time until a care home was found, but i think it was classed as being informal and deprivation of liberty, especially if meds could be given. These people would then need to pay for their care.
Some of our relatives are not quite so obliging however, so the mental health act and sectioning is required instead! A very expensive option for the state however, so I am sure things will change at some stage.

 

[katek]

Emily M

Thanks for your comments and I agree with you that successive governments have failed to address the issue of funding.

In your reply to Lyn T, you say that regarding Primary Care, we would probably not be having this discussion with any other illness. However, sadly, people with many other long-term incurable conditions, not just AD, are also forced to pay for their own care, or rely on social services dwindling budgets.

My late sister at the age of 50 had very advanced MS - to the extent that she was bedbound, doubly incontinent, unable to speak or swallow, was fed by tube and had significant cognitive impairment (equivalent to mid stage dementia) to boot - all of which combined to make her totally dependant. She was refused CHC, but because she had no assets, she was funded by social services. However, had she had savings and/or a property, she would have had to pay for all her care. I can't help but feel that is wrong. Had she had any assets, she would dearly have loved to leave something to her teenage daughter after she died.

People do have very divided opinions of the rights and wrongs of self-funding versus public funding for long-term care, but there must be a better way than the present system, which is only going to get worse over time.

 

[katek]

Karjo

I absolutely share your view that it is right for the state to bear the costs (however high) of sectioning and hope that it would never come to the point where this funding is no longer available.

Our limited experience of sectioning has been positive even though, as you rightly say, it does of course involve detaining someone against their will. I can see how in your mother's case it was more distressing as she was aware she was being imprisoned. My father is different in that he is entirely unaware of where he is, let alone why, and is not therefore objecting to the placement itself. Where he does show strong resistance (to the point of needing three carers) is daily incontinence care. The section is to allow this to happen as it would of course be unacceptable to allow him to remain soiled - not only unpleasant, but with health implications as well e.g. skin breakdown. His medication is also given covertly, and has, after much continued modification, largely had fairly good results. However, as you say, the effects can be unpredictable and vary widely from patient to patient.

Out of interest, what is the current situation with your mother?

 

[Karjo]

Karjo

I absolutely share your view that it is right for the state to bear the costs (however high) of sectioning and hope that it would never come to the point where this funding is no longer available.

Our limited experience of sectioning has been positive even though, as you rightly say, it does of course involve detaining someone against their will. I can see how in your mother's case it was more distressing as she was aware she was being imprisoned. My father is different in that he is entirely unaware of where he is, let alone why, and is not therefore objecting to the placement itself. Where he does show strong resistance (to the point of needing three carers) is daily incontinence care. The section is to allow this to happen as it would of course be unacceptable to allow him to remain soiled - not only unpleasant, but with health implications as well e.g. skin breakdown. His medication is also given covertly, and has, after much continued modification, largely had fairly good results. However, as you say, the effects can be unpredictable and vary widely from patient to patient.

Out of interest, what is the current situation with your mother?

She is still in the nursing home where she was served an eviction notice within a couple of days of going there. They put her on one to one care at their expense after they gave her 2 weeks notice. This gave a bit of breathing space for us all to calm down and try and sort things. To be honest I don't think anyone knew quite how to deal with things but it got to the day of the eviction when I was told she would stay on the one to one but with regular reviews. To be honest its all a bit of a haze caused by sheer panic and also Mum got very poorly with infections, lack of sleep, not eating etc etc. She then developed some horrid side effects from her meds and lost her ability to speak - well actually she doesn't stop speaking but there are rarely any real words in it, very strange and a bit like chanting that gets louder as she gets angry. She has been started on some new meds but I haven't really noticed any difference. one minute she is a lovely smiling old lady and the next minute she becomes aware of her plight and panics or lashes out. Her next review is soon, so it's fingers crossed all round that she improves and the one to one can be reduced. The nursing home have some lovely staff so I really want her to become settled, as do the staff.

 

[katek]

Karjo

Really feel for you and hope for everyone's sake that she settles.

Once again, it confirms my hope that my father will remain under section where he is.

K.

 

[Emily M]

Emily M

Thanks for your comments and I agree with you that successive governments have failed to address the issue of funding.

In your reply to Lyn T, you say that regarding Primary Care, we would probably not be having this discussion with any other illness. However, sadly, people with many other long-term incurable conditions, not just AD, are also forced to pay for their own care, or rely on social services dwindling budgets.

My late sister at the age of 50 had very advanced MS - to the extent that she was bedbound, doubly incontinent, unable to speak or swallow, was fed by tube and had significant cognitive impairment (equivalent to mid stage dementia) to boot - all of which combined to make her totally dependant. She was refused CHC, but because she had no assets, she was funded by social services. However, had she had savings and/or a property, she would have had to pay for all her care. I can't help but feel that is wrong. Had she had any assets, she would dearly have loved to leave something to her teenage daughter after she died.

People do have very divided opinions of the rights and wrongs of self-funding versus public funding for long-term care, but there must be a better way than the present system, which is only going to get worse over time.

Katek, Thank you for your reply. I am so sorry that the situation with your sister was so dreadful. As you say, there are mixed opinions and it is a very emotive subject. Yes, I agree that the present system is far from ideal. Every so often there are murmuring from one of the political parties on how they will deal with it – some ideas seems OK, some not very fair. No-one actually does anything about it, though. If someone is in this situation it is probably best to be very rich, or if you are not very rich, have nothing at all. A lot of people fall in the middle. Best wishes EM

 

[Emily M]

Katek, what you fear in that the nursing home may not cope has happened twice to my poor old mum. In hospital on a section 3 for 10 months I was desperate to get her out and settled, but unfortunately it was out of the frying pan and into the fire! The nursing home placement eventually failed after months of "torture" for us both, though I don't feel resentment to the nursing home as they knew she needed more care than they were being paid for under section 117.
Another 8 months followed in another much better assessment hospital and she settled pretty well but they were obviously desperate to get her out. I just could not see how anything was changed other than being in a better staffed environment as they could not get the meds down her but heh ho she had to go.
She was given notice of eviction immediately at the next home. It was an unbelievable nightmare. This time there was really nowhere to go and I thought she would end up in a police cell. To be honest i was in such a state I thought this may be the best thing for her as the hospital refused to take her back!
Anyway things some how suddenly came together and one to one care was provided and though mums distress was not eased , at least she could not harm anyone ( except the odd poor carer) or herself. Things have stayed that way for a few months now while they try again with the medication . Mum is still mostly as anxious and unsettled as ever but I certainly feel a bit more confident though appreciate that they cannot continue this degree of funding. I am not entirely sure quite who has stepped up with this funding, but I am certainly grateful, I think it is shared between SS and CHC, but I get the feeling this is certainly a bit exceptional. Anway I know there is not going to be a happy ending to all this but for now I can breathe a slight sigh of relief. Sorry to hi jack the post but just wanted to share this in case it is of help to anyone.
BTW the first time mum went from hospital she was on section 17 leave for a couple of weeks which meant her bed was kept incase it failed.(though this was lifted by the time she was evicted). And please also remember if someone is on a section 3 their care is paid for by SS when discharged from the NHS under 117 aftercare, though sometimes the care provided is obviously not adequate and so leads to the sort of problems experienced by us.

Karjo, thank you for your comments. You are not hi-jacking the post at all. I think many will find your comments helpful. Best wishes, EM