How do they decide between a nursing home or care home?

[Grandaughter 1]

My Grandad has been in respite at a nursing home since Christmas. When he went in the staff seemed to think that it was with a view to being permanent. Now we'll not too sure.

His 6 weeks is up on 23 February and now the social worker is saying he doesn't need nursing care just a care home. However a district nurse went in to see Grandad to do a review and she said that he does need nursing care!!!

They said something about having a meeting. Do they just discuss this and let us know or what!? They also mentioned something about having to get permission for funding for the nursing home as they might not give it if they don't think he needs it. (nursing home is private not council)

As a family we'd rather he stayed put as it will be unsettling to move him. Also since he's been there his health has improved loads and he hasn't had any falls.

Can anyone tell me how they decide where Grandad should be?

 

[Michael E]

I think this is the crux of the pay or no pay situation for lots of people with Alzheimer's.. Seems to be the same in many EU countries and certainly here in France.

I think the question is: does the patient need nursing care = receiving injections, having blood temperature taken, pulse monitored. Having variations on the medications according to the results of temperature, pulse, blood pressure. All these things are definitely nursing orientated.

On the other hand, cleaning, washing, feeding, dressing, undressing, toileting, bedding etc are all the work care workers can do - do not need medical training.

So if your dad is better then financially that's worse ---- He needs caring for not medical nursing..

All that is my interpretation of the rules as they seem to be applied and dealing with folks with long term illness there is inevitably a grey area between care and nursing.......... I think.

 

[noelphobic]

I think this is the crux of the pay or no pay situation for lots of people with Alzheimer's.. Seems to be the same in many EU countries and certainly here in France.

I think the question is: does the patient need nursing care = receiving injections, having blood temperature taken, pulse monitored. Having variations on the medications according to the results of temperature, pulse, blood pressure. All these things are definitely nursing orientated.

On the other hand, cleaning, washing, feeding, dressing, undressing, toileting, bedding etc are all the work care workers can do - do not need medical training.

So if your dad is better then financially that's worse ---- He needs caring for not medical nursing..

All that is my interpretation of the rules as they seem to be applied and dealing with folks with long term illness there is inevitably a grey area between care and nursing.......... I think.

Just because someone is in a nursing home rather than a care home it doesn't mean their care will be paid for. My mum is in a nursing home and she is self funding.

Mobility is an important issue when deciding whether someone should be in a nursing home or a care home. If someone is in a wheelchair then they usually need to be in a nursing home. Also, whether they have medical problems apart from the dementia (as though that wasn't bad enough on its own!)

I would think the decision as to what type of home was most suitable would be made by social workers after discussion with medical staff. If someone is going into residential care and the local authority will be fully or partially funding them then it 'goes to panel' and a decision is made whether funding will be provided.

It would be a great shame if he had to be moved when he is settled and doing well.

 

[Grandaughter 1]

I agree it would be a shame to move Grandad as he appears to be settling.

Grandad doesn't need any nursing care in respect of medication etc, however he is very unsteady on his feet due to the parkinsonism aspect of his illness. He needs someone constantly following him around as he was having constant falls at home where Nan couldn't aid him on her own.

Funding wise I was led to believe that the council contribute £286 per week towards his care and he has to pay the rest as a top-up. Does that sound right to you all? Obviously a nursing home means that the top-up would be more than a care home - not sure how much though.

 

[Michael E]

[/Mobility is an important issue when deciding whether someone should be in a nursing home or a care home. If someone is in a wheelchair then they usually need to be in a nursing home. Also, whether they have medical problems apart from the dementia (as though that wasn't bad enough on its own!)

Thanks for that! I thought I had the definitions cracked but plainly not! the post before mine (I type too slowly) from Nada seems more authoritative...

NHS continuing care
Very occasionally, someone with dementia who needs intensive care may be eligible for free continuing NHS care, usually in an NHS nursing home or in an NHS-funded bed elsewhere. To find out more, ask your GP or consultant.

I guess you have to be pretty sick to get 100% nursing care and the dosh... Glad I found that out - bet it is the same here..

 

[noelphobic]

Funding wise I was led to believe that the council contribute £286 per week towards his care and he has to pay the rest as a top-up. Does that sound right to you all? Obviously a nursing home means that the top-up would be more than a care home - not sure how much though.

If he is assessed as needing nursing care then he may also qualify for a contribution from the PCT towards the nursing element of his care. There are 3 levels, my mum being on the middle one.

As far as top ups go, then that is a bit of a contentious issue. If his capital is below the limit at which he would have to pay his own fees, then the local authority is supposed to pay for him. The top up fees should only come into play if you 'choose' a home that charges above what the council is prepared to pay. Also, if the resident has little or no capital then they are not supposed to pay the top up fees themselves - their family are supposed to pay it for them! If they can't or won't then I don't know what the answer is.

 

[noelphobic]

Thanks for that! I thought I had the definitions cracked but plainly not! the post before mine (I type too slowly) from Nada seems more authoritative...



I guess you have to be pretty sick to get 100% nursing care and the dosh... Glad I found that out - bet it is the same here..

I wasn't criticising your definitions, Michael, just adding to them! Also, no disrespect to Nada but the post is authoritative because it quotes excerpts from fact sheets (and Nada referenced accordingly - I'm not making accusations of plagiarism!)

As far as having to be pretty sick to get fully funded care goes, it does appear that there are plenty of people who are literally almost at death's door who are still using their own money for their care!

It does anger me when they talk about 'social' as opposed to 'health' care. It makes it sound as though having someone take you to the toilet is a lifestyle choice!

 

[EllieS]

Dear Grand-daughter

In my experience a Case Meeting will be held at which the close family is invited to attend. This Case Meeting will probably follow an assessment by a Consultant.

If the conclusion is that your Grandad does need Nursing Care the Primary Care Trust may/should be asked to fund the Nursing Home care package.

In my opinion (and I've been fighting my Mum's cause for over 3 years now) if your Grandad is ill the NHS should pay for his care - he is not after all in the home for any other reason .

The choice of home is ultimately up to him or his immediate family - the only question is who pays and how much.

You will probably be advised that if your Grandad has more than £20,000 capital (I think it's £20,000) he will have to pay for the entire cost of his care. When his capital goes below this or a similar figure the PCT contribute toward the cost and your Grandads state pension and any other pension will also have to contribute (minus about £18 p.w. allowance for his personal bits and pieceds). Any difference between the total cost and the PCT & pension contributions are referred to as Top-Up fees. Top-Up fees should be paid for by a 3rd party, ie his immediate relatives.

As I indicated above I am fighting against this for Mum and have recently proved that Mum met the criteria for full continuing care funding for a 9 month period up to August 2005 but they say she is not entitled to it after that time.

In August 05 Mum was given notice by the Residential Home she was in because she absconded on a number of occasions and the police had to be called in to find her. So at that time we were advised that she should live in an EMI Residential Home (ie locked environment to keep her safe). We found a suitable home and that's where she's been ever since.

Of course, she no longer absconds - the door is locked!!!

The home has certainly not cured her, they deal with her needs.

The cost of this care is £750 per week and it is only this care that gives the PCT the luxury of being able to assess her to no longer qualify for continuing care.

The whole issue is completely wrong - not only did modern day elderly people pay for their NHS care, they also fought or did their bit for their country and this is the way they are treated.


I do hope this is of some help to you.

Very best wishes and keep loving!

Eleanor

 

[alfjess]

Hi All
When I spoke to our social worker about, MAYBE, 24 hour care, I asked if SS would recommend, residential care, or nursing home care.
She said that due to the amount of supervision my parents would need, it would be a nursing home, but, would like a meeting with all parties, ie CPN, me, SS, Daycare Manager.
My parents have no mobility problems and other than dementia, no uncontrolled health problems. Mother has no incontinence problems. My Father only at night.
I am confused, why a nursing home?
Alfjess

 

[EllieS]

Morning Alfjess

I think, following the assessment, you should perhaps have a look a suitable residential homes (and Nursing Homes to see the difference) and if they are happy to have your Mum & Dad and make sure that you are happy with the standard and quality of care they are able to give.

However, in my experience a residential home will not be prepared to keep an eye on them anything like every minute!

This is why Mum was a) able to abscond (she was no problem to the home other than this) and b) why the home put her on notice.

Tell the home as it is and you need to be able to trust them to do what they say - visit at different times and look and see how the residents appear. Look with open eyes, sometimes it's possible not to see the glaringly obvious!

It's really hard having to make decisions for your parents - it's a reversal of roles that is not very comfortable isn't it?

Hope this is helpful, sorry if it's not!

Eleanor

 

[Grandaughter 1]

Thanks for all your replies. I've just started a new thread as Grandad has been unexpectadly moved to a care home as he "got out" of the care home.

Just reading your reply EllieS concerns me as now that Grandad is in a care home I assume that he will be less secure than the nursing home and there is still every chance he will "escape"

 

[EllieS]

Dear Granddaughter

Again, in my experience the only way to be sure our loved ones do not abscond is for them to be in a locked environment - which is, let's be honest absolutely horrible, frustrating and somewhat demeaning for them.

As Mum went straight from Residential care home to emi locked environment I have no experience at all of Nursing homes without locked doors, so it may well be (and I really hope it's the case for you) that the staff do keep a very close eye on each of their residents.

I really hope I haven't caused you unnecessary worry - you can do without that!

We should be able to trust in the professionals and maybe you can, and all will be well for your Granddad.

I do hope so, but we can't be all things to all people and can only do our best.

You care so much and my thoughts are with you and your Granddad.

Be kind to yourself

Eleanor