1. j2o

    j2o Registered User

    Apr 12, 2015
    4
    Hi hope someone can offer me some advice on CHC funding and choices of care, My Mother has Lewy Body Dementia and is currently in hospital as she fell and broke her arm, her condition has deteriated & she is no longer mobile & very confused. She is due a full assessment this week but I am extremely concerned that the NHS & Social Services can make the decision to put her in a nursing home if she does get full funding as she lacks mental capacity and we do not have poa on her welfare. The family would like her cared for at home but if she needs 24hr care this will obviously be more expensive than a nursing home. Has anyone been in this situation and got 24hr care at home? I am worrying myself sick thinking the decision will be out of our hands. We have also been told we cannot top the payment up for care at home or in care.
     
  2. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,439
    Hi and welcome to Talking Point.

    I have to say, I would be extremely surprised if anyone (NHS if you got CHC or LA if not) would pay for 24/7 care in her own home. I'm not saying it has never happened, but I've never come across it.

    If she did get CHC (and I'm afraid that's a big if) generally what you have been told is correct: you are not permitted to "top-up" this type of payment (although did I read somewhere that this is changing?). If the LA is paying (because she lacks assets) then you could top-up, although you should consider this option very carefully - top-ups can be a tremendous drain financially.

    If you really wish her to remain in her own home, you are only likely to be able to do this if you (or she) either has the wherewithal to pay for 24/7 care, or a family member takes over the care.
     
  3. BeckyJan

    BeckyJan Registered User

    Nov 28, 2005
    18,972
    Derbyshire
    This is a Society factsheet on 'paying for care' which you may find useful before the assessment for your Mother.
    http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=2710

    The assessment should cover whether or not your Mother could be recommended for CHC and also they will determine what type of care she needs, for example nursing and/or dementia unit.

    This may help you to understand more about CHC - it is very complex!
    https://www.gov.uk/government/publi...inuing-healthcare-and-nhs-funded-nursing-care
     
  4. nitram

    nitram Registered User

    Apr 6, 2011
    19,023
    Male
    North Manchester
    #4 nitram, Apr 12, 2015
    Last edited: Apr 12, 2015
    "...you are not permitted to "top-up" this type of payment (although did I read somewhere that this is changing?)..."


    Not seen anything about this, it would be a massive change in that it would be allowing somebody to pay to upgrade an NHS service.

    What is changing though is first party top-ups for people receiving LA funding for residential care. Currently they are only allowed at the discretion of the LA where a deferred payment scheme is in place. After April 2016 first party top-ups will be allowed for all. The cynical in me thinks that this is to enable the LA tariff to remain low meaning that self funders will get less allocated to their annual and lifetime caps.

    EDIT
    Not only self funders, everybody would get less allocated.
     
  5. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,439
    Nitram you're probably right that that was what I was thinking of. :) Mind you, with the parlous state of the NHS I suppose everything is a potential option. And of course, you can top-up care under CHC provided the services or facilities you are paying for are over and above the assessed care needs, provided by different personnel and preferably, in a different location.
     
  6. j2o

    j2o Registered User

    Apr 12, 2015
    4
    Thanks for comments. I will check all links and read before meeting.
    My Mother is self funded so if she doesnt get CHC will we have the option to keep her at home and pay for the care required even though she lacks capacity & LA/SS can make best interst decision??
    I am new to talking point so forgive me if I do something wrong!
     
  7. katek

    katek Registered User

    Jan 19, 2015
    191
    J20

    I really feel for you and the situation you are in, which sums up the failings of the whole system.

    IF (as jenniferpa says, that is a very big if) she were to get CHC, that could be delivered at home - "..in any setting" as the NHS guidelines state. However, in practice, that is extremely rare, mainly because so few people are actually awarded CHC anyway. Those who do get the funding in their own homes are likely to be on end of life, very short term care and not suffering from long-term conditions, despite the precedent set by Pamela Coughlan (google this for more information).

    When CHC is not awarded, the patient may well qualify instead just for funded nursing care (currently about £109 a week), but that can only be paid if you are in a nursing home, and is therefore of no use at all if, like your mother, you want to stay in your own home.

    The other option, as jenniferpa says, is for a family member to care for her at home. Without knowing anything of your circumstances, it is impossible to say how feasible this would be. Moreover, if you mother did need some nursing care, the system doesn't seem to allow for this, as I said in the previous paragraph.

    I imagine you will do your best to push for full CHC if you believe your mother qualifies. Read up about the Coughlan judgement to learn what the real benchmark for this is (rather than the one set by CCGs), but be warned - it is no easy task to argue that against the full force of the NHS panels.
     
  8. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,439
    If your mother is sef-funding and she no longer has capacity, I urge you to apply for deputyship. You're unlikely (unless you are in Scotland in which case it is known as guardianship) to be granted this for anything other than finances but it will allow you to pay for the care. I'm not saying the LA couldn't take this decision themselves, but if she is self-funding and there is no suggestion that her proposed care is inadequate, the LA are unlikely to take this decision out of your hands.

    I'll say this though: think very carefully about this. A lot of people who reach the stage that your mother appears to be at do really require someone with them 24/7 and this can be a strain financially and physically. If she can afford to pay for it, by all means try it out, but don't a assume a care or nursing home is necessarily the "wrong" option. Too many people are forced, generally because they don't have the finances to pay for residential care and are thus reliant on LA funding, to stay in their own homes with inadequate care visits when they are lonely, afraid and unsafe.
     
  9. j2o

    j2o Registered User

    Apr 12, 2015
    4
    We have looked into 24hr live in care and it is v expensive, plus an extra carer would be required to help with hoisting during the day but this is what my Mother would want and has never wanted to go into care, it breaks my heart to think they can make that decision for us.
     
  10. j2o

    j2o Registered User

    Apr 12, 2015
    4
    We have looked into 24hr live in care and it is v expensive, plus an extra carer would be required to help with hoisting during the day but this is what my Mother would want and has never wanted to go into care, it breaks my heart to think they could make that decision for us.
    We do have poa only on finances and Ive been told a deputyship is very unlikely to be awarded for welfare & if it was , does it give us the rights to decide on her care ?
     
  11. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,439
    If it was granted and if the decision for her care was safe, generally yes. But as you know it's unlikely to be granted. I'm glad to hear you have a POA (is it an EPA or a LPA?)

    As I said above, if your mother is self-funding, it do think it's pretty unlikely that the LA will take a position one way or the other. They might, though, if they felt that 24/7 at home care, even paid for by her, would be expend her assets so quickly that they would almost inevitably end up paying for her care. A lot will depend just on how much she has in terms of assets TBH. And of course, if they feel she would be unsafe at home they could (in fact in my view should) weigh in on the subject. But the Mental Capacity Act does require them to take the views of family into consideration.
     

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