Hoping for mother to be assessed as needing to be in a care home?

Muttimuggle

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Dec 28, 2021
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I have been visiting Mum in a Council run Rehab Centre for over 3 weeks now where she was admitted after her hospital stay. Mum broke the neck of her femur by falling down the stairs(at the same time as one of her carers was present in the house). Mum has, so they say, a total of a 6 week stay there....(although that does not seem to have been strictly adhered to by some of the other residents anyway).

Throughout her time there Mum has not made an awful lot of improvement. She is still brought to me in a wheelchair. Thankfully they are reporting that she is doing more (painful) steps throughout the day. This is being instigated now by carers. The physios seem in short supply. My mother used to walk unaided in her own(large) house although numerous adaptions have been added - rails and things - and she used to regularly go for an independent walk with a rollator from home. I don't think it looks like she is getting that amount of mobility back. She had 2 privately organised home care visits per day before and then my support for the rest. I have an absent, largely invisible but critical, brother . POA is "in the pipeline" but held up by a backlog with the Office of the Public Guardian. My mother is nearly 91.

Whilst in the Rehab Centre and even in the hospital Mum has been calmer, less stressed about all the routine things which she was driving herself to do when living at home...and complains of less back pain. She will not openly admit it but she is happier amongst people and "goings on" than she was living alone in her house. She has since said to me many times that she wants to sell her house and move into a nice place. She means a care home..and even suggested one where she used to visit her friend. She has been out of her house because of a prolonged stay in hospital due to covid since July 16th. Her house is becoming in a state of disrepair and I am operating largely alone as her relative carer.

So I have been busily researching and visiting many types of local care homes. I have been looking for the best and most suitable. She would be initially self funding. I also have been trying to save her money by getting her home landline phone switched of, emptying and defrosting the fridge and freezer, insuring her house for "Unoccupancy", etc etc.

Here's my question and my worry now....after reading what you said, Jaded'n'faded and also Canary about SS wanting to try the person on 4 care call visits a day with home adaptions. And my fear is that such a trial would end up in an unsafe disaster. Last week I visited her within the Rehab Centre where a Social worker was making a preliminary visit to her. She seemed unaware of much of Mum's history, of her many falls and of her dementia diagnosis. She was intent on finding out what she was used to doing at home and what adaptions she already had because her role, she said, was to assess her for going home. I intervened here hand said that Mum didn't want to go home. The Social worker said that she could go home but she would have to have 4 care calls a day and her bed downstairs. My mum said she didn't want that and I said that at least 2 of my mother's long unexplained falls have been in the night and that my mother (And myself!!!) have been feeling increasingly unsafe in the night. My mother was given a zimmer to use but she forgets, or prefers not to(I really don't know) use it. MY mother even had another fall whilst in this very Rehab centre and had a 24 hour stay in hospital about a week ago.

So here is my list of the "whys".(Why I believe my mother needs to be in a care home). Some of it is about my own mental and physical strain....and whilst writing that I feel guilty I wonder whether or not they will think it is evidence, or not.

  • My mother has had falls in the night where paramedics have had to be called.
  • My mother has had two recent falls whilst a carer was nearby but not watching
  • My mother's loneliness at home is detrimental to her health and, with reduced mobility, I expect this to increase.
  • My brother dissociates himself from involvement with my mother's increasing needs and spends 3 months at a time abroad on holiday. (There were 6 months in total from Nov 2021 to May 2022). My relationship with him has broken down.
  • My mother was since the last eye hospital appointment "borderline partially sighted". She keeps saying her vision is now worse again. I believe this may be true.
  • I suffer from chronic pain affecting my legs which can limit the help I can give.
  • I have another fairly ominous health issue which is being closely monitored, which is of concern and worry to me.
Are these going to be enough to convince them? The social worker said she would assess my mother at the end anyway. If she is self funding and wants to go to a care home she can do this. What happens when her money runs out though? Would the next thing be to re-assess to see whether or not she is eligible to stay?? That would be a nightmare - being told she has to return to a home which I was intending to sell for her, or has been sold!
 

Jaded'n'faded

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Jan 23, 2019
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High Peak
Hi @Muttimuggle I like your list - it would be good to give this to the SW doing the assessment but I'd leave out the one about your brother. Maybe just say your brother is away and cannot help. And add something about your mum being so much better with people around her 24/7 and mention that she favours the care home idea.

If your mum is willing to move into care and is self-funding for the time being, you shouldn't have any problems - it's what she thinks/says to the SW that is crucial. Obviously a care home is the right place for her but SS will usually try people at home with 4 care visits first before insisting. However, your mum would be happy to move to a care home - yay! Four carer visits at home is cheaper than a care home from the point of view of SS. They always say they are acting in the best interests of the person but I have my doubts (as do many others!) and think that budgetary concerns come first! But in your case, this won't apply because your mum is willing and she will be paying.

By the time her funds run out, I doubt SS would try the same thing again as she will already have been in the home a while and will have settled. (And her dementia may well have progressed so it's obvious to all she doesn't have capacity to decide where she lives.) But if you've moved her into somewhere expensive, they won't pay and may well want her moved to a cheaper home. So that's the next thing to think about. Have you found a place you like that would take her yet? You don't need to wait till the assessment is finished to start looking. You could also go ahead and sell her house - that's what we did...
 

Muttimuggle

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Dec 28, 2021
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Hi @Muttimuggle I like your list - it would be good to give this to the SW doing the assessment but I'd leave out the one about your brother. Maybe just say your brother is away and cannot help. And add something about your mum being so much better with people around her 24/7 and mention that she favours the care home idea.

If your mum is willing to move into care and is self-funding for the time being, you shouldn't have any problems - it's what she thinks/says to the SW that is crucial. Obviously a care home is the right place for her but SS will usually try people at home with 4 care visits first before insisting. However, your mum would be happy to move to a care home - yay! Four carer visits at home is cheaper than a care home from the point of view of SS. They always say they are acting in the best interests of the person but I have my doubts (as do many others!) and think that budgetary concerns come first! But in your case, this won't apply because your mum is willing and she will be paying.

By the time her funds run out, I doubt SS would try the same thing again as she will already have been in the home a while and will have settled. (And her dementia may well have progressed so it's obvious to all she doesn't have capacity to decide where she lives.) But if you've moved her into somewhere expensive, they won't pay and may well want her moved to a cheaper home. So that's the next thing to think about. Have you found a place you like that would take her yet? You don't need to wait till the assessment is finished to start looking. You could also go ahead and sell her house - that's what we did...
Oh thanks so much Jaded'n'faded. Your insights are helpful. Yes, I was wondering that, about SS trying to save on funds! I suppose they are mindful of not knowing how much the person with dementia's has to pay in private funding? They may wish to not encourage a care home in case the funds run out faster than they want. I am still assessing the amount my mother has in income and bits and pieces and may, because I don't yet have POA, have to take her to her bank. I know she currently has enough but the whole thing is a big hurdle to me. When my mother has had the courage to tell my brother her wishes(I believe she has not been telling him because she feels she might disappoint him), I will have to discuss this with my brother and his wife.They previously had more of a handle on her finances, albeit from a distance, because my sister in law used to work in a bank.
I have been visiting care homes, yes. Off to another, possibly the last to look at, this afternoon.
 

jugglingmum

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Jan 5, 2014
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Chester
It might be different where you are but where I live (Cheshire West - so homes in Ellesmere Port and Chseter and nearby rural villages - the home is in a rural village) I struggled to find a home with a vacancy.

I needed to move my mum fairly promptly (It actually took 6 weeks from when the care team at her sheltered extra care advised they could no longer provide her with an appropriate level of care).

I only looked at homes with vacancies as little point if I was moving her promptly to do anything else. In my area homes don't seem to operate waiting lists.

(I employed a private social worker to do the leg work and find homes with vacancies - for the sum of £270 well worth it compared to a weeks fees)

If you are looking at a prompt move you might wish to enquire about current vacancies.

In the end I had a couple of homes with vacancies, one of which I didn't feel was right and also cost a lot more. The more expensive ones I looked at had facilities my mum is never going to use and given she had let her house deteriorate prior to her original move I wasn't bothered by decor. I did decide my mum could afford and would benefit from an ensuite and she is clearly pleased to have an ensuite.

If you think your mum will agree to move to a home I'd go ahead and do this prior to her 6 weeks finishing if you find one with a space . You could use her funds to pay for private physio in a care home if she is likely to work with one. Carers in a good home will try to mobilise her.

Let them know you have POA being processed and see what they say about waiting for the fees. Most will be used to this situation. I presume she owns her house so fees will be covered for a while before you need to go back to SS.
 

Muttimuggle

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Dec 28, 2021
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It might be different where you are but where I live (Cheshire West - so homes in Ellesmere Port and Chseter and nearby rural villages - the home is in a rural village) I struggled to find a home with a vacancy.

I needed to move my mum fairly promptly (It actually took 6 weeks from when the care team at her sheltered extra care advised they could no longer provide her with an appropriate level of care).

I only looked at homes with vacancies as little point if I was moving her promptly to do anything else. In my area homes don't seem to operate waiting lists.

(I employed a private social worker to do the leg work and find homes with vacancies - for the sum of £270 well worth it compared to a weeks fees)

If you are looking at a prompt move you might wish to enquire about current vacancies.

In the end I had a couple of homes with vacancies, one of which I didn't feel was right and also cost a lot more. The more expensive ones I looked at had facilities my mum is never going to use and given she had let her house deteriorate prior to her original move I wasn't bothered by decor. I did decide my mum could afford and would benefit from an ensuite and she is clearly pleased to have an ensuite.

If you think your mum will agree to move to a home I'd go ahead and do this prior to her 6 weeks finishing if you find one with a space . You could use her funds to pay for private physio in a care home if she is likely to work with one. Carers in a good home will try to mobilise her.

Let them know you have POA being processed and see what they say about waiting for the fees. Most will be used to this situation. I presume she owns her house so fees will be covered for a while before you need to go back to SS.
Thanks. Yes, I have found only a couple with vacancies and these both have good CQCs but are registered only as Residential. I am lucky to have a few to visit as I'm in a large city.I was not going to consider Residential as an option, or maybe a temporary option, but having spoken honestly to them both about my mother's dementia diagnosis, which does not manifest in an advanced way at the moment, they seemed fine with this. They may, however, want that final SS assessment to accept her...but given that the SW was suggesting she could move back home with bed downstairs + 4 care calls(even though I know this would be risky) the home might accept with this information on board? I have actually seen and liked another larger home, more expensive, but Mum said she would like something like this, and it is nearer where she used to live so she could still be picked up for church, potentially, by a member of her congregation.There is a waiting list for places. When I pressed the manageress about this she suggested 2 months(?). This more expensive home has a ground floor which takes Residential, a top floor which takes early onset dementia and a middle floor which takes Advanced dementia. If I could get her somewhere else safe and kind first I might get her name down for this one. It is all, however a bit of an unknown. I can only proceed tentatively whilst waiting for her assessment.
Off to see another last Residential, with places, this afternoon. I am hoping this might be a good, safe resting place whilst we wait to see about another potential move(?)
 

canary

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Feb 25, 2014
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South coast
Hi @Muttimuggle

The comments I was making in the other thread referred to someone who would be moving into a care home from their own home. It is always easier to move them into a care home from hospital or respite care because then their needs are documented. It also depends on whether the person with dementia agrees to move into a care home. If they refuse to go then SS will not over-rule them unless they have lost capacity and are at risk of harm.

It is not written in stone, though. My mum never had carers before she moved into her care home although she lived independently in her own home, because she told the SW that she didnt need them and was doing everything herself (no she wasnt!!!). I then tried getting carers in paying for them myself, but mum wouldnt allow them over the doorstep, so that only lasted a week.

I think that the fact that your mum is in reablement at the moment and has said several times that she would like to move to a care home, then so long as she says the same thing to the social worker, I think it extremely likely that there would be no problems with her moving to a care home. The SW has already expressed doubt over her going home (well she could, with 4 carers a day.......)

Personally, I would keep her there for the full length of time before moving her to a care home. Im thinking here about your brother. At the end of her reablement there will be a Best Interest meeting, to decide whether she could return home or whether she needs to be in either a care home or a nursing home. You should be invited to this meeting and this is the point where your list will pay dividends. What Im thinking is that if your mum moves to a care home following a Best Interest meeting, then your brother is far less likely to blame you.

BTW - when you are looking at care homes it is always a good idea to ask what behaviour they would not accept - this will give you an idea of what point they would give you notice to move your mum.
 

imthedaughter

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Apr 3, 2019
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I think if you're self-funding you don't really need the assessment? My dad's home seemed to prefer to assess themselves
 

canary

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Feb 25, 2014
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South coast
I think if you're self-funding you don't really need the assessment? My dad's home seemed to prefer to assess themselves
The period of assessment/reablement/discharge to access (D2A) is not an assessment for an individual care/nursing home. It is a period of assessment following a hospital stay to determine whether the person with dementia is well enough to return home with a care package (usually 4 x carers a day), whether they need a care home, or whether they require a nursing home. This is decided in a Best Interest meeting to which both the person with dementia and their main carer/next of kin/POA are invited and have input.

If its decided that a care/nursing home is needed then the home will also want to assess them themselves - although they would probably request a report.
 

imthedaughter

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Apr 3, 2019
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The period of assessment/reablement/discharge to access (D2A) is not an assessment for an individual care/nursing home. It is a period of assessment following a hospital stay to determine whether the person with dementia is well enough to return home with a care package (usually 4 x carers a day), whether they need a care home, or whether they require a nursing home. This is decided in a Best Interest meeting to which both the person with dementia and their main carer/next of kin/POA are invited and have input.

If its decided that a care/nursing home is needed then the home will also want to assess them themselves - although they would probably request a report.
Ah yes that makes sense. Hopefully common sense will prevail...
 

canary

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Feb 25, 2014
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South coast
Ah yes that makes sense. Hopefully common sense will prevail...
Indeed

I can only say that it did for mum. At the Best Interest meeting everyone was in agreement that mum should be in a care home. Mum by this stage had settled in the care home in which she had a reablement bed, so I asked the care home manager whether she could stay there permanently. She said that it would be a good fit and mum could.
 

SweetPepper

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Feb 3, 2022
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I’ve just been through all of this earlier this month. Briefly, mum fell, not hurt 24 nights in hospital and right for the start I had a CH bed sorted and available (I reserved it), the hospital simply would not listen to what I said and discharged mum home with carers 4 x a day which was hell, mum was very disorientated after hospital and thought the carers were burglars,after 48 hours of refusing food, drink, sleep, she fell out of the shower whilst alone, five hours on the cold wet Lino floor before found, carted off to hospital again and discharged straight into the care home four days later. She was at this point comp,etely doolally with a uti.

If the OT’s and Physios had taken any regard to the many, many times I told them that care at home wouldn’t work mum would have been spared a crashing fall, a uti and yet further delusions etc etc, s9 I am quietly steaming about her treatment. As she is self funding she could have gone straight into the ch after just a couple of days in hospital.. she might not have even declined into sitting in the same chair all day and incontinent.
 

Muttimuggle

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Dec 28, 2021
710
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Hi @Muttimuggle

The comments I was making in the other thread referred to someone who would be moving into a care home from their own home. It is always easier to move them into a care home from hospital or respite care because then their needs are documented. It also depends on whether the person with dementia agrees to move into a care home. If they refuse to go then SS will not over-rule them unless they have lost capacity and are at risk of harm.

It is not written in stone, though. My mum never had carers before she moved into her care home although she lived independently in her own home, because she told the SW that she didnt need them and was doing everything herself (no she wasnt!!!). I then tried getting carers in paying for them myself, but mum wouldnt allow them over the doorstep, so that only lasted a week.

I think that the fact that your mum is in reablement at the moment and has said several times that she would like to move to a care home, then so long as she says the same thing to the social worker, I think it extremely likely that there would be no problems with her moving to a care home. The SW has already expressed doubt over her going home (well she could, with 4 carers a day.......)

Personally, I would keep her there for the full length of time before moving her to a care home. Im thinking here about your brother. At the end of her reablement there will be a Best Interest meeting, to decide whether she could return home or whether she needs to be in either a care home or a nursing home. You should be invited to this meeting and this is the point where your list will pay dividends. What Im thinking is that if your mum moves to a care home following a Best Interest meeting, then your brother is far less likely to blame you.

BTW - when you are looking at care homes it is always a good idea to ask what behaviour they would not accept - this will give you an idea of what point they would give you notice to move your mum.
Thanks Canary. Yes, waiting for the best interest meeting does sound like the safest bet, in view of the unpredictable response of my brother. These posts have somewhat put my mind at rest.I'm on to my next problem now. I am really struggling to see and find a suitable care home and one with current vacancies. I was disappointed that the one i saw today did not seem suitable. I think I'll have to go and re-look at a few and even consider a temporary move whilst waiting for a better one. I feel so responsible and in danger of making a wrong choice...and in any case, any with vacancies now may not have vacancies in 3 weeks at the end of her Rehab stay. You were lucky to be able to keep your mother in the reablement centre. There would not be that option in this centre. Hospital discharged patients are on waiting lists to be sent(as I understand). I think I'll have to post a new thread in a few days about my problem over choosing the right care home!
 

Muttimuggle

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Dec 28, 2021
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I’ve just been through all of this earlier this month. Briefly, mum fell, not hurt 24 nights in hospital and right for the start I had a CH bed sorted and available (I reserved it), the hospital simply would not listen to what I said and discharged mum home with carers 4 x a day which was hell, mum was very disorientated after hospital and thought the carers were burglars,after 48 hours of refusing food, drink, sleep, she fell out of the shower whilst alone, five hours on the cold wet Lino floor before found, carted off to hospital again and discharged straight into the care home four days later. She was at this point comp,etely doolally with a uti.

If the OT’s and Physios had taken any regard to the many, many times I told them that care at home wouldn’t work mum would have been spared a crashing fall, a uti and yet further delusions etc etc, s9 I am quietly steaming about her treatment. As she is self funding she could have gone straight into the ch after just a couple of days in hospital.. she might not have even declined into sitting in the same chair all day and incontinent.
Yes, SweetPepper, I have been following your story because of some of the similarities with my own. I can see why you feel "quietly steaming". I do hope my mother can escape a similar fate. My next problem is finding a care home which looks suitable and which has vacancies at the end of her rehab stay and after the SS assessment. I hope I have some time to organise things because I have already had, with my mother's consent, her house landline disconnected, her freezer and fridge emptied and defrosted and her house insurance changed to to a lower unoccupied version...so she can't go home.
 

SweetPepper

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Feb 3, 2022
266
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If you find one you like ask if you can reserve the room, or go on the waiting list. I was not consulted by anyone at the hospital, no meetings, nothing at all. Hang I. There.
 

Sue741215

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Oct 18, 2019
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One question I would ask the care home is their policy on keeping residents as they deteriorate. The one my mum was in was an inexpensive residential home but they said from the beginning that they would keep her to the end and they kept that promise and attended her funeral - I really felt that the main carers really grew to love her. Not sure if it has been mentioned before but I would also ask about staff turnover - a home with low turnover of staff is likely to be better managed and have more dedicated staff.

I hope you are successful soon - it will be a great relief to you and it sounds as though your mum is still at the stage where she will enjoy the company and activities.
 

Muttimuggle

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Dec 28, 2021
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One question I would ask the care home is their policy on keeping residents as they deteriorate. The one my mum was in was an inexpensive residential home but they said from the beginning that they would keep her to the end and they kept that promise and attended her funeral - I really felt that the main carers really grew to love her. Not sure if it has been mentioned before but I would also ask about staff turnover - a home with low turnover of staff is likely to be better managed and have more dedicated staff.

I hope you are successful soon - it will be a great relief to you and it sounds as though your mum is still at the stage where she will enjoy the company and activities.
Yes, thank you...and it will be a relief to find the best one and settle her there. I have now really seen all the possibles but one. I keep hoping that the next one will be just right(or as just -right as possible). It is further out than the others and more expensive but one of her friends she used to know in her dancing years is there - also with some fluctuating dementia as i have been told by her relative. I have booked to go and see this friend who I also knew from my earlier years and also to have a tour of the place. They also have a spare room. I am trying to not get my hopes up too much as nothing has really felt right so far.
 

thistlejak

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Jun 6, 2020
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It is very difficult to choose a care home but one thing to make you aware of is the care home have the final say as to whether they will accept you Mum. We had one on the list for MIL with 17 empty rooms ,as they had just opened a new wing, but they wouldn't have her - 'we cannot meet her needs' is the phrase they use.
 

Muttimuggle

Registered User
Dec 28, 2021
710
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It is very difficult to choose a care home but one thing to make you aware of is the care home have the final say as to whether they will accept you Mum. We had one on the list for MIL with 17 empty rooms ,as they had just opened a new wing, but they wouldn't have her - 'we cannot meet her needs' is the phrase they use.
Oh right! That's good information. Yes, think I have to wait on the assessment by the SW at the end of the re-enablement stay....where so far she has not become that much more able. My mother has gone from always showering herself each morning and walking around the block with a rollator to having help , seated in a shower and getting wheeled sometimes because the walking is so painstaking and slow. They are going to have to be able to deal with that...unless the re-enablement centre keeps her longer and aims for more improvement. You are just not told, but some people, I have knowledge of, have stayed there 3 months, not 6 weeks! I think, however, if they know your aim is to go to a care home they might get you out. It is those going home, maybe, who might sometimes be allowed the extended stay?
 

SweetPepper

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Feb 3, 2022
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I’ve been astonished by my mums swift physical decline, which I put down to the long hospital stay. Yes they were trying to get her up and walking but everything else was brought to her. She has declined even more in the home (only 9 nights!) and now only leaves her chair when going for a shower, she refuses her bed at night. ?
 

Jaded'n'faded

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Jan 23, 2019
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High Peak
Oh right! That's good information. Yes, think I have to wait on the assessment by the SW at the end of the re-enablement stay....where so far she has not become that much more able. My mother has gone from always showering herself each morning and walking around the block with a rollator to having help , seated in a shower and getting wheeled sometimes because the walking is so painstaking and slow. They are going to have to be able to deal with that...unless the re-enablement centre keeps her longer and aims for more improvement. You are just not told, but some people, I have knowledge of, have stayed there 3 months, not 6 weeks! I think, however, if they know your aim is to go to a care home they might get you out. It is those going home, maybe, who might sometimes be allowed the extended stay?
From what you describe, it doesn't sound as though your mum is particularly difficult! (You may think differently...!)

Most homes can cope with all the things you mention, as long as they know that's how it will be. But help with mobility and showering is pretty much par for the course. Ditto incontinence - I don't know if she is...

The sort of things they struggle with are: unpredictable behaviour, maybe violent or aggressive, particularly if the person is likely to bother the other residents. Resistance to personal care. Again, violence of any sort obviously makes personal care very difficult. Other factors might be considerable nursing needs though it doesn't sound like that's an issue. (Not all homes have a nurse present. A place that calls itself a nursing home does - they will have a nurse on the premises 24/7.)

Other things to ask might be funding. Ask the home what would happen once your mum runs out of money. Some places will accept the LA rate (much less than most self-funders pay) if a person has been resident in the home for a couple of years +, paying the full whack. Others won't. Once SS start contributing to her funding, they will dictate (pretty much) where she stays and they may want to move her to a cheaper place that will accept their rate. But that's in the future, and who knows what the future holds...?

Hope that helps a bit!