Care package decisions

[Ryn66]

My 87 yr old father is due to come home after a month in a NHS room in a care home. He has vascular dementia with limited movement and tremors. The therapists have got him as far he can go, standing with a standing aid and then using that aid to move him from bed to chair. Their advice was a care home or a 2 carers 4 times a day package at home. We want him home. Mother is 85 and just had a hip replacement but very independent and strong willed. My problem is how do we manage dad’s care? We will have to pay. My family live on a farm, we are all neighbours so close by, running a farm and 2 other businesses on site between us. Are we kidding ourselves that we can manage his care between us (4 adults) or do we go straight in and pay with carers from the start. We have no idea of what it will cost.
We are trying to create a micro environment downstairs which will contain a suitable bed, chair and commode. Any advice? TIA

 

[canary]

I cannot advise you on what to do, but my immediate thought is that your mum will not be able to move your dad without risking injury to herself until her hip replacement is fully healed and even then it will require two people to move him, even with a standing aid. What will happen if your dad needs the commode when there is nobody apart from your mum with him?

Are you sure you will have to pay? Has your dad had a financial assessment?

 

[Jaded'n'faded]

The downstairs living/sleeping is a start. But much depends on what he's like and what he can and can't do. Is he incontinent or will he need toilet prompting all day/night? Can he feed himself? Can he communicate? Does he sleep through the night?

Your mum may be strong-willed but she'll need to be physically strong too if she's to help move him. If therapists have advised it needs 2 people to move him, will there always be 2 people there to assist? Are you all happy doing personal care? (And will he allow it?) Then there will be meds supervision and all the extra laundry, preparing food, etc. I don't see how you'll be able to do all this and run the farm/businesses too, especially if he's up at night requiring attention then as well.

Your mum may say she wants him home but would he not be better in a care home, where she could visit as his wife rather than as a sleep-deprived, worn out carer?

 

[Ryn66]

If we organised 2 carers to come in 4 times a day, what would it cost?
He is incontinent, he can feed himself on good days. Mum knows she can't help physically. I do the cooking, laundry etc already. I think it will be a care home eventually but we promised to bring home.

 

[try again]

Carers costing 20 per hour. 4 visit x 2x 30 mins. That's 80 a day. Scale up or down according to area.
Have you looked at the availability of carers in your area? Some areas are very poorly serviced. I guess a quick Google will answer the question better.
Nearly everyone promises no care home, few manage it. My cousin did with a lot of help from carers and family for her father .
Never Hold yourself to a promise, you can only do your best and that might mean a care home in the future

 

[canary]

If we organised 2 carers to come in 4 times a day, what would it cost?

Phone up a few care agencies and ask

 

[Banjomansmate]

The Banjoman lived in a village but the Council still found it difficult to find a care firm that could provide just one carer three times a day, especially in the winter with icy weather.
I live on the edge of a small town and my neighbour’s daughter works a couple of days a week as a carer. There are several properties locally that she doesn’t like going to by herself and sometimes her Mum has driven out with her because they are out down dark lanes and at the end of tracks.
I think you may find it difficult to get carers in and will find it too much to cope with by yourselves, especially if Dad has toileting accidents and there is a lot of cleaning up and washing to get done.
Practically a move to residential care sounds a much more logical choice, especially if he goes directly from his current NHS position.

 

[Chizz]

My 87 yr old father is due to come home after a month in a NHS room in a care home. He has vascular dementia with limited movement and tremors. The therapists have got him as far he can go, standing with a standing aid and then using that aid to move him from bed to chair. Their advice was a care home or a 2 carers 4 times a day package at home. We want him home. Mother is 85 and just had a hip replacement but very independent and strong willed. My problem is how do we manage dad’s care? We will have to pay. My family live on a farm, we are all neighbours so close by, running a farm and 2 other businesses on site between us. Are we kidding ourselves that we can manage his care between us (4 adults) or do we go straight in and pay with carers from the start. We have no idea of what it will cost.
We are trying to create a micro environment downstairs which will contain a suitable bed, chair and commode. Any advice? TIA

Hi @Ryn66
Usually, when a patient is discharged from hospital, the OT assesses what equipment is needed - such as a bed and mattress, a commode or a toilet frame, a walking frame etc, etc., in conjunction with the physiotherapist.
Usually the local authority health dept have a home rehabilitation dept - they come and assess the help needed for the patient and any family carer. They usually pay for the carers for the first 6 weeks. Then before the 6 weeks is up, they would want to carry out a financial assessment. If your dad, in his own name, has assets (excluding home where mum has a right to live) in excess of £23,250 then he would be regarded as a "self funder" and would be required to pay for his care. As already stated this is likely to be in the region of £20 - £30 per hour - so that 2 carers at a a time for 4 x 30mins visits per day = £80 to 120 per day. You should ask the care company appointed by the hospital/local authority what their charges are for a self funder. You can also research the charges from other care companies in your area.
If you dad has assets in his own name of less than £14,500 the local authority will pay for the care. If the assets in his name are between £14,500 and £23,250 then he has to make a contribution to the care cost and local authority make a contribution.
If the occupational therapist has recommended 2 cares for 4 visits per day, then it seems sensible to follow this, unless you believe, 3 visits per day could be coped with for your dad's needs. which is primary object.

2 carers per visit are always required when moving and/or lifting and/or turning a lying down patient is concerned, or using a hoist to lift a patient (eg from a bed to a chair).

You may well have to consider a residential care home as @Banjomansmate has suggested.

Full time care always takes longer than you think. Every step takes longer to undertake than you can imagine, especially when the person with dementia cannot follow instructions or resists.

I do not know, but I would think that your 85 yr old mum with new hip would not be able to cope and it would be unfair to expect her to have the energy required. Caring is both physically and emotionally v tiring.

Best wishes

 

[sdmhred]

How was your Dad in the care home @Ryn66?

I looked after my mum at home but the downward spiral with mobility to like your Dad’s prompted us to move to the care home option. I realised that she would have a very limited life at home - literally hoisted from bed to wheelchair and that was about it - and we would both be tied to carers movements.

In residential she has a much fuller life. When her mobility is good she can utilise it - when it’s not there’s staff on hand for when she needs the toilet or she decides she wants to get up - not at their timings. She is also able to participate in the activities she wants to. I still spend much of my time hanging out with her, but I am also free to do my own thing.

 

[Ryn66]

I cannot advise you on what to do, but my immediate thought is that your mum will not be able to move your dad without risking injury to herself until her hip replacement is fully healed and even then it will require two people to move him, even with a standing aid. What will happen if your dad needs the commode when there is nobody apart from your mum with him?

Are you sure you will have to pay? Has your dad had a financial assessment?

Yes, pretty sure. He has savings but I don’t think they will last long. Looking at costs.

 

[Ryn66]

How was your Dad in the care home @Ryn66?

I looked after my mum at home but the downward spiral with mobility to like your Dad’s prompted us to move to the care home option. I realised that she would have a very limited life at home - literally hoisted from bed to wheelchair and that was about it - and we would both be tied to carers movements.

In residential she has a much fuller life. When her mobility is good she can utilise it - when it’s not there’s staff on hand for when she needs the toilet or she decides she wants to get up - not at their timings. She is also able to participate in the activities she wants to. I still spend much of my time hanging out with her, but I am also free to do my own thing.

Dad had a UTI which required hospital care, nhs then moved him to a care home with nhs nursing care because his mobility decreased rapidly, they wanted therapists to work on his standing ability. It’s been a slow process because he has had a couple of episodes of delirium which has set him back. We now have had a week of good days so looking at the next step.

 

[Ryn66]

Hi @Ryn66
Usually, when a patient is discharged from hospital, the OT assesses what equipment is needed - such as a bed and mattress, a commode or a toilet frame, a walking frame etc, etc., in conjunction with the physiotherapist.
Usually the local authority health dept have a home rehabilitation dept - they come and assess the help needed for the patient and any family carer. They usually pay for the carers for the first 6 weeks. Then before the 6 weeks is up, they would want to carry out a financial assessment. If your dad, in his own name, has assets (excluding home where mum has a right to live) in excess of £23,250 then he would be regarded as a "self funder" and would be required to pay for his care. As already stated this is likely to be in the region of £20 - £30 per hour - so that 2 carers at a a time for 4 x 30mins visits per day = £80 to 120 per day. You should ask the care company appointed by the hospital/local authority what their charges are for a self funder. You can also research the charges from other care companies in your area.
If you dad has assets in his own name of less than £14,500 the local authority will pay for the care. If the assets in his name are between £14,500 and £23,250 then he has to make a contribution to the care cost and local authority make a contribution.
If the occupational therapist has recommended 2 cares for 4 visits per day, then it seems sensible to follow this, unless you believe, 3 visits per day could be coped with for your dad's needs. which is primary object.

2 carers per visit are always required when moving and/or lifting and/or turning a lying down patient is concerned, or using a hoist to lift a patient (eg from a bed to a chair).

You may well have to consider a residential care home as @Banjomansmate has suggested.

Full time care always takes longer than you think. Every step takes longer to undertake than you can imagine, especially when the person with dementia cannot follow instructions or resists.

I do not know, but I would think that your 85 yr old mum with new hip would not be able to cope and it would be unfair to expect her to have the energy required. Caring is both physically and emotionally v tiring.

Best wishes

Thank you, lots of good advice . Going to talk to mum again. I know it will be my sister and myself that will be dealing with it all.

 

[Ryn66]

The Banjoman lived in a village but the Council still found it difficult to find a care firm that could provide just one carer three times a day, especially in the winter with icy weather.
I live on the edge of a small town and my neighbour’s daughter works a couple of days a week as a carer. There are several properties locally that she doesn’t like going to by herself and sometimes her Mum has driven out with her because they are out down dark lanes and at the end of tracks.
I think you may find it difficult to get carers in and will find it too much to cope with by yourselves, especially if Dad has toileting accidents and there is a lot of cleaning up and washing to get done.
Practically a move to residential care sounds a much more logical choice, especially if he goes directly from his current NHS position.

We are not too remote but our lane is prone to flooding, as it is today. Another thing to consider.

 

[Violet Jane]

As has been said above, the LA should pay for carers for a period after discharge. This is called Reablement Reablement or sometimes Rapid Response. However, it might not be as long as six weeks. Once no further rehabilitation is possible the funding will stop. Agency fees vary a lot. The agencies that LAs use (which you can use even if the person is self-funding) tend to be cheaper and the carers will come for shorter periods e.g. half an hour. The 'posher' agencies will often not do care visits shorter than an hour.

Dementia, incontinence and mobility problems are a lethal mix and very difficult to manage at home. I think that care at home is only going to work if the family draws up a rota of tasks and there is always someone who can go to the house to help out. Even with carers incontinence will largely be managed by the family as carers do of course have set hours.

By all means try care at home and see. That way, you will know that you have tried it but your father's needs were too much for the family to cope with.