Steps from Hospital to Residential Home

[Exning]

Have a horrid feeling of wading through a process blindfold. Keep asking but no one will give me a simple step by step to the stages necessary to go from hospital to actually getting a place in a residential home.
I get the impression that Clinicians and Social Workers are making it up as they go along.
My particular problems started when a decision was made that MIL was unable to return home as care plan could not be enhanced to make her safe. Fair enough...a decision we had always thought inevitable at some stage.
I immediately asked for guidance as to what I should do ....still waiting....
My advice....from.the mistakes I have already made, and probably still making,is to following at the very least.
-Ensure the Powers of Attorney is in place and fully registered.
-Check and action the steps needed to activate the Welfare POA.
- Get clear unambiguous assessment asap of the type of Residential Care the health professionals think is needed.
-Get Social Worker assigned asap.
-Get Social Worker to formalise and agree with the need for Residential Care.
-Use given care needs assessment to check out suitability of Residential Homes.
-Visit more once and ask questions....lots of question..
-Don't rely on CQC reports. Good report could make home complacent. Poor report may have resulted in faults being addressed and prevented in future.
-If you are initially self funding don't be bullied by Social Worker to accept home you do not feel comfortable with.
-With the knowledge gained ensure Social Worker fully aware of your preferred Residential Home(s).

That's where I have got to......making loads of errors on the way....wish I had followed the steps I now know should have been taken....

The process is continuing and I am going to make more mistakes unless someone can give me an idea of the next issues I am going to encounter.....

 

[marionq]

You sound very well organised. I would be doing the mundane stuff like sewing on labels and filling a toilet bag. In fact I keep an overnight bag for my SIL with all new nightgear etc just in case she needs to go into hospital. If she ever needed anything more complicated I would just cave in. I also have a small weekend bag for my husband with three of everything just in case. The only person I haven’t prepared for is me!

 

[Jessbow]

Once you have selected a possible placement, they will want to asses the potential resident in person to make sure they feel they can meet her needs.

Give yourself a realistic timeframe in which to complete above, the hospital will not wait an undue length of time once the decision has been taken. There comes a point that they can ( And will) move her on

 

[Kevinl]

If you're self funding you're unlikely to get anything other than an assessment from social services and although they're legally obliged to do one if requested they can take their time.
Social Services can't advise about homes, they're not allowed to recommend homes and the ones I've spoken to rarely if ever go inside one other than when they have someone with no family and so social services have to act as next of kin., so social services won't bully you into a choice oh home as you're a self funder.
I think you're wildly over estimating the help social services will provide which at best will be a list of the local care homes and over to you.
Residential homes don't come in "types" each is individual, so will do medication, some won't some will take incontinent people some don't and the list goes on like that, nice homes stay nice by getting rid of any challenging residents and all homes do an assessment of a potential resident so it's them that makes the decision on who they take and who they don't.
As you say you'll be "initially self funding" then it implies that the funding won't last for long, if it does run out and the LA have to start funding they'll offer you one home in their budget so if you want to keep her in the same place and it's over the LA budget you'll have to pay a top up or she'll have to move.
Sorry to sound so negative but if you're self funding then the SS probably won't want to know and even if the SS are funding it's still up to the family to find the home not them.
K

 

[Nicnoks]

If you're self funding you're unlikely to get anything other than an assessment from social services and although they're legally obliged to do one if requested they can take their time.
Social Services can't advise about homes, they're not allowed to recommend homes and the ones I've spoken to rarely if ever go inside one other than when they have someone with no family and so social services have to act as next of kin., so social services won't bully you into a choice oh home as you're a self funder.
I think you're wildly over estimating the help social services will provide which at best will be a list of the local care homes and over to you.
Residential homes don't come in "types" each is individual, so will do medication, some won't some will take incontinent people some don't and the list goes on like that, nice homes stay nice by getting rid of any challenging residents and all homes do an assessment of a potential resident so it's them that makes the decision on who they take and who they don't.
As you say you'll be "initially self funding" then it implies that the funding won't last for long, if it does run out and the LA have to start funding they'll offer you one home in their budget so if you want to keep her in the same place and it's over the LA budget you'll have to pay a top up or she'll have to move.
Sorry to sound so negative but if you're self funding then the SS probably won't want to know and even if the SS are funding it's still up to the family to find the home not them.
K

Have a horrid feeling of wading through a process blindfold. Keep asking but no one will give me a simple step by step to the stages necessary to go from hospital to actually getting a place in a residential home.
I get the impression that Clinicians and Social Workers are making it up as they go along.
My particular problems started when a decision was made that MIL was unable to return home as care plan could not be enhanced to make her safe. Fair enough...a decision we had always thought inevitable at some stage.
I immediately asked for guidance as to what I should do ....still waiting....
My advice....from.the mistakes I have already made, and probably still making,is to following at the very least.
-Ensure the Powers of Attorney is in place and fully registered.
-Check and action the steps needed to activate the Welfare POA.
- Get clear unambiguous assessment asap of the type of Residential Care the health professionals think is needed.
-Get Social Worker assigned asap.
-Get Social Worker to formalise and agree with the need for Residential Care.
-Use given care needs assessment to check out suitability of Residential Homes.
-Visit more once and ask questions....lots of question..
-Don't rely on CQC reports. Good report could make home complacent. Poor report may have resulted in faults being addressed and prevented in future.
-If you are initially self funding don't be bullied by Social Worker to accept home you do not feel comfortable with.
-With the knowledge gained ensure Social Worker fully aware of your preferred Residential Home(s).

That's where I have got to......making loads of errors on the way....wish I had followed the steps I now know should have been taken....

The process is continuing and I am going to make more mistakes unless someone can give me an idea of the next issues I am going to encounter.....

 

[Nicnoks]

It’s a pretty grim process to go through. We’ve done it with Mum, for the first 4 years after diagnosis it was a constant battle to get any support and the last four years haven’t been much better until we were given a social worker who was amazing - without her I would have had a breakdown.

What you need to know is that the care needs assessment will identify what needs are met/unmet, you will need a support plan which follows on from the needs assessment. Make sure they prepare a support plan as that clearly identifies what care is needed. You may also have to get a mental capacity assessment done as if you MIL is like my mum and presents well she may be deemed to have capacity and if so she can refuse to go anywhere apart from home irrespective of you POA.

Following that, research your care homes and make a decision on which one you would like. IF they have availability they will then do an assessment and tell you whether they will take your MIL. We were refused by 2 of our first choices.

Use you social workers knowledge to help you select the appropriate care home - choose the wrong one and you could end up with a further distressing move. Our social worker had a meeting with mums CPN where it was agreed that residential EMI care would be better than nursing EMI care. we then picked homes and she advised whether she would support our choice or not. The final decision was ours.

Finally, when you have done this ask your LA what their rate is for residential care - bear in mind that dementia EMI rate is higher than straight residential. If you are self funding initially you will pay more but if it’s a home your LA place into then the home should accept their rate of funding when you no longer pay privately. If they don’t you either have to top it up, move your MIL to a council funded home or FIGHT them to keep her where she is.

I hope some of this helps - the whole process is a minefield.

 

[Exning]

Your just confirming the lack of clear steps that need to be taken to go forward.
Can't accept being booted out of hospital if professionals, medical or Social Workers have failed to give clear steer of the person's needs.
Yes all homes are different and all have their criteria. So get objective assessment of what you need to ensure you can see whether you get a chance of matching up.
Infuriating to go in blind without the necessary information
Someone give out a matrix of steps to help..I'm just giving a few I would suggest are helpful
If you are self funding are you saying the Local Authority will not have to be involved at all until the money has run out?
Certainly not the case in Scotland where LA involvement in the process results in about£10K
Worth the hassle involved for that contribution

 

[Kevinl]

Certainly not the case in Scotland where LA involvement in the process results in about£10K

Is it the case that this is happening in Scotland? I know they do things differently as indeed do Wales and NI.
In England the LA start part funding at £23k and fully fund when the assets are under £13k.
Problem is that hospital care is NHS and social services are public sector and care homes are private sector and it isn't the public sectors job to organise what happens as you transition to the private sector seems to be their position.
Homes work in their own way and the people they take is based on how the existing residents are and how they feel someone might or might not fit in to the existing community.
Currently there are 2 vacant rooms on my wife's unit and they'll probably stay that way for a while. The home works (as do many) on a points system, residents are assessed and given points; incontinent gets a high score, self toileting a low one, same for mobility, feeding, nursing needs and a whole list of other things, this determines the staffing levels. If the rooms went to 2 "high maintenance" new residents then they'd need one more carer on days and one more on nights, that means they'd have to hire 4 or 5 more staff to cover the 168 hours in a week, frankly it's cheaper to keep the rooms empty than hire the staff.
As Nicnoks has said homes turn people down but you'll never know what criteria they've used to make that decision, it's a fluid situation for the home who they will and won't take.
Any plan, needs assessment or whatever won't count for much as the home will do their assessment and they decide if they feel they can meet her needs, a statement of what those needs are might be of interest to the home but that's just a part of the picture.
The only way I could find was to visit the homes and see if I could picture my wife fitting in their based on how the current residents seemed to behave, I could see she wouldn't fit into some as they were too genteel and the home wouldn't take her anyway as she'd been sectioned for 6 months other places I didn't like the look of for different reasons.
if I were you I'd just go out and start looking now, no point in waiting for the cavalry to come, if they ever do.
K

 

[jugglingmum]

Personal care is funded in Scotland, whether at home or in a care home, is that the £10k referred to?

 

[marionq]

Personal care is funded in Scotland, whether at home or in a care home, is that the £10k referred to?

The figures quoted to me here in Scotland were the same as elsewhere. Personal care and nursing care can be claimed by the care home from the govt as I understand it.

 

[Exning]

Thanks for the constructive points.
Am struggling to properly match the needs of MIL and the provision of care provided by homes.
Homes I am looking at seem to be very upfront about methodology they use to judge suitability. Yes it does depend on the current resident needs and demands, making it all the more important that you get as objective and realistic assessment of needs.
I do accept there is a inevitable conflict between the public services person centric ethos and the commercial considerations of the private sector providers of the homes. But it is a reality you just have to get on with.
I still do not understand why when a person is being cared for in a hospital context that the future care needs can not be made freely available to aid selection of suitable home placement.
Behaviour, care needs and health are obviously on a downward path as the journey progresses but an objective 3rd party assessment is invaluable in finding a home that is ideally both available and suitable.
I simply don't understand why someone would say " find a care home" and then not say immediately.:
-This is an assessment we think will help.
-This is the money we would pay if we have to fund.
- This is the type of care you need. ( I still have great difficulty in understanding the real differences between Elderly Residential; Residential EMI; EMI....etc.)

You may find my posts a bit too cold and mechanistic. My wife has the angst over the care and journey of her mum, I try to help by trying to deal with all the bureaucracy in an effective and appropriate way. All I ask for, time and time again, is to get a clear indication of:
-What I have to do
-What information is needed and/or is available
-The stage we are at along the process.

I really don't think that is unrealistic or unfair.

 

[Exning]

Getting there but still having issues over practicalities.
Referred home has today agreed to accept MIL. Now the issue is getting the contract process finalised.
Social Worker sent to contracts team but still not telling me how long it's going to take.
Home has said if this involved a Lancashire hospital my MIL would/could be in the home in a couple of days.
Still no idea how long it is going to take as it involves a Scotland to England transfer.
This should be so simple and mechanistic as everyone wants MIL out of hospital and into home.
Hospital even saying why is it taking so long...remember Social Care in Scotland is supposedly seamless with the Scottish NHS.
Does any one know if in Scotland the authorities will move as quickly as the home in England are suggesting is possible?
Does the contract between the home and Social Care have to be fully in place before the move can be actioned?
I really sympathise with the agencies involved and the pressures they are under. However I am getting the impression that their failure in systems and processes to facilitate moved are causing a lot of their problems.
There are patients in regional hospitals waiting for a community hospital bed which could and should be freed up.
Frustration is becoming the norm.

 

[Exning]

Well I took the pragmatic line and assumed everything would slot into place.
Moved to home on the basis of a one line email from Social Worker saying move could be arranged.
Now 4 weeks later no written confirmation of anything despite continues requests for confirmation and clarification of legal position.......
Other thread explains where we are