Not Understanding Funding

[AnneF]

Hi @AnneF

The home I visited yesterday are pricey 😳😳 It is a dementia specialist but they have worked hard not to make it austere. They had numerous quiet areas. The manager acknowledged that private clients are funding LA ones - so it’s worth a punt that the ones you have chosen might be acceptable to LA If they have a similar arrangement- grossly unfair as she acknowledged. It may be that you can be accepted as a private client and then she is transferred to LA when funds require. I would always ask - you never know.

I will certainly try that route, thank you - and good luck with finding a new placement for your mum, do please update on your journey. I hope the home your mum is currently in giving you enough time to find a suitable alternative.

The care homes on my shortlist have made it clear that they do not accept local authority funding on its own, at least not until the client has been there for a minimum number of years. It may be possible to ask if they would accept local authority funding until my asset is sold and top ups can then commence - but I think it unlikely.

I have a second meeting with one of the preferred homes tomorrow morning to get all of my questions answered and to see if there is a feasible way forward. I have another meeting planned for next Wednesday with another of the homes on my shortlist.

Unfortunately I haven't yet found a home which will accept local authority funding on its own and which would meet my mother's needs. I am in a panic because they are now wanting to discharge my mum from hospital ASAP into a home which the aforementioned social worker believes will meet mum's needs (we will not be given a choice), and then the financial assessment will determine if she is just over the upper limit (in which case we will be billed for the time she has spent in that home) and if over the limit we then apparently have a choice on where to put mum - but only if the care home we choose can be flexible on funding until I can make the topups. I am struggling to find a way forward.

I'm looking at the financial assessment forms which are vast and could take me weeks to fill in given the information I need to collate. I'm almost hoping she will turn out to be a self funder for a few months because that would at least give us choices and get mum settled somewhere before she drops under the upper limit and we need to involve the local authority and start figuring out the top ups. It would buy us a bit of time, in other words. Financially there isn't much of a difference between being a complete self funder and being under the upper limit (losing pensions to the LA cut) and topping up.

 

[AnneF]

I have just had a telephone call from the local authority placement team telling me they are discharging my mother into a care home tomorrow. They are not giving me any time to look at the home. That said, it's a home I have been warned off and would not in my opinion meet my mother's needs (requires improvement and has a poor reputation). The person I spoke to tried to insist that it meets my mother's needs based on the social worker's visit to my mother in the hospital. The social worker did not visit my mother, she made a quick phone call to the ward. I was not involved at all.

I then told the placement officer that I have been looking at care homes and I have shortlisted a couple of them which accept local authority contributions with top up. I was told that would not be possible because the local authority does not have a contract with either of those homes. I believe this to be complete nonsense - my understanding is that providing the home accepts local authority with top up and meets my mother's needs present and future, then they cannot refuse to allow us to use mums personal allowance towards it. All that matters is that I can pay.

I did carefully manoeuvre the conversation by suggesting the placement they have found is likely to be the cheapest one available. This worked like a charm and the placement officer then disclosed the amount they would be paying per week. This brings me entirely within the top up figure provisionally agreed with one of the care homes who I have now had discussions with.

I'm feeling quite stressed and currently the manager of our preferred care home is going to speak to the placement officer and come back to me within the next couple of hours.

 

[canary]

Is this a Discharge to Assess (D2A) placement?
If so, it will only be temporary (max 6 weeks) while she is assessed in a care home setting to see exactly what her needs are.

 

[AnneF]

Is this a Discharge to Assess (D2A) placement?
If so, it will only be temporary (max 6 weeks) while she is assessed in a care home setting to see exactly what her needs are.

No, it's a permanent placement. The home they want to discharge her to is notorious for poor standards of care and has a requires improvement rating in all areas. On various websites carers who have worked there are saying it is unsafe. I cannot let my mum go there. In fact there is no need for her to go there because I have already had the discussions direct with the care home about the top up and I have workable figures. The care home also said that the top ups would be made to them therefore it is a private arrangement.

 

[AnneF]

The placement officer also told me that in our local authority topup arrangements are 'unheard of' and not something they will consider. I know people who are topping up for their parents so that seems an odd thing to say.

 

[Dave63]

The following link is for the Governments Adult Social Care Framework. Not sure if it's any help? Page 10 details your rights regarding choosing a home paid for by your council.

In the document on page 6 it says direct personal allowance payments are not made if you require residential care. Not sure if this relates to your situation?

https://assets.publishing.service.gov.uk/media/5a7af574e5274a34770e8575/Adult_social_care_choice_fwork_draft_APRIL_2013_DH_template_FINAL.pdf

 

[AnneF]

In the document on page 6 it says direct personal allowance payments are not made if you require residential care. Not sure if this relates to your situation?

Thank you.

To be clear, I wasn't suggesting the local authority makes direct personal allowance payments to me. They would simply act as they always do, and I would pay a top up. Nothing remotely unusual about my situation which is why the response seemed odd. I suspect it's because they don't want the paperwork of setting up a contract.

EDIT:
I've just had a call from the senior placement officer which was quite interesting. The one I spoke to previously said that the second care home I had shortlisted does not have any kind of contract with the local authority. I asked this placement officer to doublecheck that and she confirmed that they do.

She said that they cannot discharge my mother from hospital until a contract with a care home is in place, therefore they cannot agree to my mother's chosen setting. I'm struggling to see how this can possibly be true - surely that is an infringement of mum's right to choose and it is not in her best interests if the placement they have offered is unsuitable (which I know it is). The officer said that the client would have to have been in the care home for a long period of time before they would consider making a contribution when the client falls below the threshold (with third party top up). I believe that is untrue, every official fact sheet I have read says this is an optional pathway from the outset providing the care home will enter into a contract and can meet the client's needs. I have confirmed all of this with the manager of the chosen care home who will be assessing my mother tomorrow afternoon.

What I've learnt today is that the local authority will say things which don't appear to be true. Anybody who has taken advice and done their research is likely to be spot it.

Incidentally there is a third care home on my list (but I don't think we can afford the top-up) and I asked the senior officer if they had a contract with this care home, and she said they did. I said that's good news, as it means we have somewhere to fall back on. She immediately said that the contract was "pending" and they could not act on a pending contract.

I have been astounded by the sheer obfuscation in these conversations, they seem to follow no real logic. I would have thought that someone willing to make a third party top up a quality home is freeing up a local authority funded placement elsewhere, for those who are not fortunate enough to have family who can top up for them.

I was told that my mother is now well enough for discharge and is taking up a hospital bed therefore they will not keep any longer than necessary 'just because she wants to choose the setting'. They have said that if I reject the setting they have proposed (which I will, because it is deplorable) then I need to have very good reasons for it - and poor CQC ratings will not be viewed as a good reason. They went on to say that a lot of the homes they use have bad CQC ratings 'but it doesn't mean the homes are bad'. The rating I was looking at is from this year and previous years, so it has shown no signs of wanting to improve. I have of course agreed to go and look at it to tick that box - but I shouldn't have to when I have already found a suitable setting (and 2 reserves) and am in negotiations on topup.

Sorry for the waffling. It's been a dreadful year, I've been suffering from profound exhaustion and stress since February with only one day off so far. I'm struggling to stay on my feet and feel I cannot go on. I think the LA and social workers may have sensed that.

 

[Chizz]

Hi @AnneF
I'm sorry you're having such a torrid time with LA, who will do and say anything to get a patient to the cheapest place. How can CQC ratings be so ignored? !
Keep plugging away for your choice.
Please advise how you get on.

Keep strong. Best wishes

 

[fran47]

I don't think that I have done my wife a disservice by placing her in a care home that accepts the Local Authority rate. It is domestic in scale, a little worn in places, has the clearest demonstration of what personalised care really means and is far from being a 'fleapit'. It saddens me to hear places described in this way. There is a money-oriented category of care home that styles itself as 'luxury' or 'hotel quality' and is aimed at people who wish to do the 'best' without necessarily knowing what this means. As dementia progresses, fancy surroundings and similar bells and whistles become less important to the person with dementia. Needs increase and become more basic. Staff who really care and bond with the residents are more important than superficial luxuries. We all want the best care for our loved ones but that isn't always found by simply paying more

 

[fran47]

thanks for this ,i have been reading the posts on the forum and started to get a little guilty ,i admitted my brother yesterday to a dementia care home near me ,and yes like you say this is a little worn in places ,but the reports i have had is that the carere are wonderful and that matters above all to me

 

[AnneF]

thanks for this ,i have been reading the posts on the forum and started to get a little guilty ,i admitted my brother yesterday to a dementia care home near me ,and yes like you say this is a little worn in places ,but the reports i have had is that the carere are wonderful and that matters above all to me

Do not feel guilty, you are protecting your brother.

The fact the care is good means everything. The place they are trying to discharge my mum to is deplorable and has a very bad reputation, poor CQC reports year on year. She is not going there.

To make things worse I became ill yesterday and through the night, tested positive for covid this morning. Horrible symptoms, can hardly walk. Please stay safe all of you. Needless to say I'm now having to cancel all appointments for the next week which is the last thing I needed, given how the hospital is cracking the whip!

 

[AnneF]

Hi @AnneF
I'm sorry you're having such a torrid time with LA, who will do and say anything to get a patient to the cheapest place. How can CQC ratings be so ignored? !
Keep plugging away for your choice.
Please advise how you get on.

Keep strong. Best wishes

Thank you, some of the places they use truly are awful.

I have already told them I will do a third party top up to a care home of our choice which covers all of mum's needs but they appear to be refusing and lying. I took professional advice yesterday afternoon and was told in no uncertain terms that the local authority must enter into a contract with the care home and cannot restrict you only to homes where they have existing contracts.

Unfortunately today's assessment with our top choice (and tomorrow's meeting with our second choice, and Thursday's visit to the dodgy home) is scuppered because I went down with a nasty dose of Covid yesterday. I feel as if everything that can go wrong will go wrong! The placement team have said they will not keep mum any longer and she will go where they say.

 

[sdmhred]

Oh @AnneF I feel for you, this is terrible with you being unwell too.

i hope you are able to shout loudly from your sickbed as much as you can. You sound on the ball with it…. have u complained to SS.

oh and I suggest you get your mum’s MP involved - ring or email. SS hate them getting involved and decisions can suddenly change…

best wishes to you

 

[nitram]

I took professional advice yesterday afternoon and was told in no uncertain terms that the local authority must enter into a contract with the care home and cannot restrict you only to homes where they have existing contracts.

Some LAs have block booking with homes, maybe this is confusing things.

 

[AnneF]

Some LAs have block booking with homes, maybe this is confusing things.

That should not make any difference to my mother's circumstances. The LA cannot restrict you to homes they have a block arrangement with if a third part will be topping up (or even if that home will accept the LA rate alone). The reason for the top up is to broaden the choice of home beyond those expressly contracted by the local authority. Professional advice confirms the LA must enter into an agreement with your chosen home providing it meets the person's needs. The local authority should not restrict you to homes where they have a pre-existing arrangement.

 

[AnneF]

oh and I suggest you get your mum’s MP involved - ring or email. SS hate them getting involved and decisions can suddenly change…

Thank you very much for the reminder about the MP - I have just written to him.

 

[nitram]

That should not make any difference to my mother's circumstances.

Agree.
I'm suggesting that somebody in the LA is confused about your request,

 

[Dave63]

oh and I suggest you get your mum’s MP involved - ring or email. SS hate them getting involved and decisions can suddenly change…

This is good advice. When we were being led a merry dance by virgin care who were contracted to arrange MDT's following a positive checklist assessment we contacted mum's MP for help. Following her input things began to change. However, it wasn't an overnight solution so if you do raise it with your MP I would copy in the LA as well in the hope it will force them to be less intransigent in their handling of your mums case.

 

[AnneF]

Agree.
I'm suggesting that somebody in the LA is confused about your request,

Indeed. But I believe the confusion was probably deliberate - I could not have been clearer throughout the conversation. The same applies to the conversation I subsequently had with a more senior placement officer later in the day. Every time I established a fact, she would suddenly backtrack.

Anybody working as a placement officer should be well versed on third party topups and the point of them. I'm convinced it's because they wanted mum out today and don't want any additional paperwork. If I'd been involved in the assessments, as I should have been (as set out in the notes), then this might have been averted. I suspect that was also deliberate.

The LA is self-ruling. They rely on the fact that they are a powerful system and there is virtually nothing you can do to counter whatever they decide. Their decisions override everything, the needs of the client, the views of the family, even the views of the doctors. I know from experience that making a complaint is fruitless, complaints have been completely ignored. Emails to the social worker are not returned. There is a complete block on communication and they simply plough on with whatever inappropriate course of action they decide to take. It's frightening.

 

[AnneF]

This is good advice. When we were being led a merry dance by virgin care who were contracted to arrange MDT's following a positive checklist assessment we contacted mum's MP for help. Following her input things began to change. However, it wasn't an overnight solution so if you do raise it with your MP I would copy in the LA as well in the hope it will force them to be less intransigent in their handling of your mums case.

Good points, thank you for that. Can I ask who you copied it to at the local authority?