Options for care for elderly parent. Advice please.

boogieman

My mum is 92 and lives on her own. Recently she had a fall and broke her hip. She’s been in hospital for the last couple of weeks and looks like she’s ready to be discharged in the next week or so. 

My wife and I are obviously concerned about her going back to her house and being by herself. Moving in with us isn’t an option, so it looks like we’ve got three other ways we can go. 

1. Have carers visiting the house. She has enough savings to take her over the limit so that she’d need to pay for this herself. How do we organise this? How do you know who is trustworthy and will do a good job? She lives on a red route with no parking at the house so that’s going to complicate matters even more. 

2. Buy into or rent an assisted living place. How does this work? Any pitfalls? What should we be looking out for? Mum is quite independent and could do her own cooking but would need the odd bit of help getting into a bath etc. 

3. Full time care home. I know this is the expensive option and we’d need to sell her house to fund the care. Again, what should we look out for and are there any pitfalls? How would we pay for her care in the short term if we need to sell her house? Do they let you defer payments?

I have to say the hospital team have been pretty useless with advice. Yesterday I asked for a meeting with the team who decide on the release but nothing has happened yet. One Occupational guy advised me yesterday that they don’t even visit the house to see if it’s safe and to assess what Mum might need to go home. I thought this would be at least a minimal requirement for her safe release home? He couldn’t offer me any leaflets and said the online government guidelines vary from borough to borough, so there was no point even looking. Is this bullshit? 

So, anyone been through this who can give me some ideas what to do? Or any ideas of associations I can approach for unbiased advice? Googling just throws up lots of ads for private nursing homes.

Thanks guys. 

rolls1392

My mother broke her hip several years ago.
After a short stay in  hospital we had a meeting with hospital reps and social services where a care package was discussed.
She had to pay for her care,but it was means tested.
She had carers attending 4 times a day. 
Worked well for a while till her dementia caused a change of plan.
Good luck.

Sporky

My mum's had some bone issues; she doesn't want to move out so has a carer in twice a day (once a day at weekends, I think) who make sure she eats and does assorted chores. This approach seems to work well for her.

boogieman

Sporky said:

My mum's had some bone issues; she doesn't want to move out so has a carer in twice a day (once a day at weekends, I think) who make sure she eats and does assorted chores. This approach seems to work well for her.

How did you sort out the carers Andi? I wouldn’t know where to start in finding someone. 

ESBlonde

My story is similar to @rolls1392 .

One think to look to is the value in your mothers home. If she puts it into a trust NOW then over the next 7 years the amount the state can obtain decreases with time. So if she avoids a care home for 3 years more value is protected for her/her estate. But getting carers in is done by social services doing an assesment and they typically commence the service before putting it out to a private contractor usually within about 6 weeks. They still subsidise and your mother pays the top up. Meals on wheels service is about £4.50 a day and ensures a hot meal is delivered every day (or when you decree) and someone to say Hi/check things are OK. They are not there to  attend to her needs but wouldn't walk out leaving her laying on the bathroom floor for example.
So regular carers as needed (probably starting with first thing in the morning and or last thing at night) can be increased as applicable.
When the time comes for a care home I suggest you do two things. 1 visit anywhere that you are considering. 2) Contact the local mayor of the region, it is part of thier duty to visit all care homes. Ask them where they would put thier mother/like to be themselves, That can be telling and creates a different perspective on whats important.

EricTheWeary

As an individual been there, done that and got the T shirt. The T shirt that says we stumble from crisis to crisis because my 90 year old mother is unhappy with anything we have tried to sort.
When my father died 8 years ago my brothers very much wanted a single, simple solution as to how my aging ( and increasingly blind) mother could be cared for. This didn’t happen, probably never will now. At the moment she has a paid for carer each morning then someone ( next door neighbour, my cousin, my sister or me - my one brother is now deceased and the other lives a long way away although both my sister and I have two hour round trips to visit her) who checks on her each evening. There is also a gardener and a cleaner once a week. She can heat up ready meals and eats a lot of biscuits. 

As I work for social services ( although not quite this kind of thing) I’ll give it a go at saying something useful: 

  Your local social services have a legal obligation under the Care Act 2014 to provide an assessment even if your mother is self funding ( I forget the exact figure but about £23k in assets then she has to pay - even if she has no or limited assets she would be assessed for a contribution ). They should offer general advice, stuff like lists of approved care homes and care agencies. Some of this may be on their website anyway. 
They can help you source carers from organisations they already use so they are vetted and at better rates than you can usually arrange yourself. Social services are alllowed to charge an admin fee ( I forget what exactly but sub £100 ) to arrange this ( they don’t have to charge this fee but probably will).

They might also help you access Occupational Therapy services for adaptations to the home or other relevant services but I wouldn’t hold your breath waiting.
Ask social services about Telecare who are the people who do fall alarms and stuff like that ( and a key safe can be very useful if she hasn’t got one and is returning home, although where I work that’s a separate department). They tend to have separate funding which is a bit more forthcoming and although they charge it is capped so your mother can have as many aids as they can provide within a single fee.

 With care homes you are probably pretty much on your own with the list social services give you and a phone. 
 Might be worth looking at extra care schemes as well. Overall these tend to be the best solution. Extra care means a retirement apartment where she can pay for any extra care that she needs on top, the carers already employed within the building.  Probably what we should all move into at about 70 but would be a big move for your mother at 92 so you’d need to consider the stress of this. Loads of these places now though so you can probably find one near you or where she already lives. 
With all care, nursing and extra care homes and care and nursing agencies  they have to be registered with CQC so you can find information about individual places on the CQC website (CQC.ORG.UK -  there is usually a rating and a recent report). 

Assuming your mother still has mental capacity then her view is absolute in the eyes of social services, they won’t help you set up anything she doesn’t want. That doesn’t always seem to be the best outcome but it’s what the law says. 
There’s a brief over view on the Age UK site and you can contact them for advice.
https://www.ageuk.org.uk/information-advice/care/the-care-act/

There should be a hospital social worker who has to make sure there is somewhere for her to go but they don’t have a high level of involvement ( unless a serious problem has been flagged up seems unlikely that anyone would be visiting her house to check on it’s suitability). Local Social services will have an access team ( or some other such stupid name)you can contact to refer her to the right dept to get an assessment. 

Otherwise word of mouth recommendations on carers, care homes ( sometimes people have a relative or friend who is willing to do it in return for payment),etc. Keep talking with your mother about how she feels and what she wants, really is no point in coming up with what seems like a solution if she hates it. She might want very much to stay at home regardless of how suitable it is, or she may be glad to see the back of it and move out. 

Good luck.

boogieman

Thanks guys.

I’m rapidly coming to the conclusion that this occupational guy has spun me a load of bullshit. He said yesterday that there is no provision for inspecting the house and assessing my mum’s needs for when she gets home, but apparently this is a statutory requirement. He just asked me to email him some pictures and measure the height of the bed, bath etc. so I wonder if he’s taking the lazy way out? Also there is no sign of the meeting he was supposed to be setting up (and he finishes work at 4 so I guess it’s not going to happen today).

We’re going in to the hospital tomorrow so I’ll ask to speak to the social worker/key worker/reablement team to get some answers rather than wasting my breath on this idiot. 

boogieman

EricTheWeary said:

As an individual been there, done that and got the T shirt. The T shirt that says we stumble from crisis to crisis because my 90 year old mother is unhappy with anything we have tried to sort.
When my father died 8 years ago my brothers very much wanted a single, simple solution as to how my aging ( and increasingly blind) mother could be cared for. This didn’t happen, probably never will now. At the moment she has a paid for carer each morning then someone ( next door neighbour, my cousin, my sister or me - my one brother is now deceased and the other lives a long way away although both my sister and I have two hour round trips to visit her) who checks on her each evening. There is also a gardener and a cleaner once a week. She can heat up ready meals and eats a lot of biscuits. 

As I work for social services ( although not quite this kind of thing) I’ll give it a go at saying something useful: 

  Your local social services have a legal obligation under the Care Act 2014 to provide an assessment even if your mother is self funding ( I forget the exact figure but about £23k in assets then she has to pay - even if she has no or limited assets she would be assessed for a contribution ). They should offer general advice, stuff like lists of approved care homes and care agencies. Some of this may be on their website anyway. 
They can help you source carers from organisations they already use so they are vetted and at better rates than you can usually arrange yourself. Social services are alllowed to charge an admin fee ( I forget what exactly but sub £100 ) to arrange this ( they don’t have to charge this fee but probably will).

They might also help you access Occupational Therapy services for adaptations to the home or other relevant services but I wouldn’t hold your breath waiting.
Ask social services about Telecare who are the people who do fall alarms and stuff like that ( and a key safe can be very useful if she hasn’t got one and is returning home, although where I work that’s a separate department). They tend to have separate funding which is a bit more forthcoming and although they charge it is capped so your mother can have as many aids as they can provide within a single fee.

 With care homes you are probably pretty much on your own with the list social services give you and a phone. 
 Might be worth looking at extra care schemes as well. Overall these tend to be the best solution. Extra care means a retirement apartment where she can pay for any extra care that she needs on top, the carers already employed within the building.  Probably what we should all move into at about 70 but would be a big move for your mother at 92 so you’d need to consider the stress of this. Loads of these places now though so you can probably find one near you or where she already lives. 
With all care, nursing and extra care homes and care and nursing agencies  they have to be registered with CQC so you can find information about individual places on the CQC website (CQC.ORG.UK -  there is usually a rating and a recent report). 

Assuming your mother still has mental capacity then her view is absolute in the eyes of social services, they won’t help you set up anything she doesn’t want. That doesn’t always seem to be the best outcome but it’s what the law says. 
There’s a brief over view on the Age UK site and you can contact them for advice.
https://www.ageuk.org.uk/information-advice/care/the-care-act/

There should be a hospital social worker who has to make sure there is somewhere for her to go but they don’t have a high level of involvement ( unless a serious problem has been flagged up seems unlikely that anyone would be visiting her house to check on it’s suitability). Local Social services will have an access team ( or some other such stupid name)you can contact to refer her to the right dept to get an assessment. 

Otherwise word of mouth recommendations on carers, care homes ( sometimes people have a relative or friend who is willing to do it in return for payment),etc. Keep talking with your mother about how she feels and what she wants, really is no point in coming up with what seems like a solution if she hates it. She might want very much to stay at home regardless of how suitable it is, or she may be glad to see the back of it and move out. 

Good luck.

Cheers for that, much appreciated and all very helpful. Stupidly I hadn’t thought of Age Concern. Doh!  

She has savings over the limit and owns her house so I doubt she’ll qualify for any help. The house is quite ramshackle and needs work, but it’s in London so still worth a fair bit. 

I spoke to her yesterday about options and she says she has no commitment to staying in the house. Frankly we’d rather she moved into a place nearer to us but although she’s agreeable at the moment she’s also been in her house for 50 years so we’ll probably have to get her to move out with a crowbar. I imagine the simplest answer is to get her home with some help for now and then see if she still wants to move. 

Foster

No idea at all if it helps but the previous neighbours to my mum were elderly, the husband died some years before the wife did and she wasn't all that capable of looking after herself - sound of mind but arthritis was such she couldn't hold anything and difficulty walking.

The british legion installed handrails and suchlike for her (for free) because her husband was a veteran of WW2

https://www.britishlegion.org.uk/get-support/independent-living/

No idea about your circumstances but it's something worth knowing about

rolls1392

Plus 1 for putting the house in trust ASAP.
When my mum entry into a home because her worsening dementia, Social Services were utterly ruthless in their efforts to get at my mums assets. 
They threatened, lied and forced us into selling the house cheaply.
Their Financial Assessent people are not to be trusted!

Grunfeld

boogieman said:

My mum is 92 and lives on her own. Recently she had a fall and broke her hip. She’s been in hospital for the last couple of weeks and looks like she’s ready to be discharged in the next week or so.

If your mum's mobility was pretty okay prior to the hip fracture then I'd go for getting her home, with carers, and this is genuinely where regular physio will make a massive difference all other things being equal.  Basically, get her back up to speed.  And it's usually do-able within three months, often 6-8 weeks, even at 92.  Regular physio means daily.  It doesn't have to mean a fully qualified physio either -- just someone with experience and knows what exercises and how to progress.  So I've done this sort of thing where (as a physio) I'll check once a week and leave a plan with an assistant (who's obviously less costly) to do the other days.

If you mum's mobility was declining significantly and the hip fracture was the inevitable result of that decline then I'd be thinking about your mum not going back home, or being prepared to do home+care package indefinitely. 
The devil's in the detail and sometimes people surprise you but that's how it often pans out.

When my mum needed a few adaptations done, like an extra stair rail, and grab rails and stuff I did all that while she was in hospital.  She gave me such a bollocking when she got back, the "I'm not a bloody invalid" spiel, but about 3 months later I got a quiet thank you.

boogieman

Grunfeld said:

boogieman said:

My mum is 92 and lives on her own. Recently she had a fall and broke her hip. She’s been in hospital for the last couple of weeks and looks like she’s ready to be discharged in the next week or so.

If your mum's mobility was pretty okay prior to the hip fracture then I'd go for getting her home, with carers, and this is genuinely where regular physio will make a massive difference all other things being equal.  Basically, get her back up to speed.  And it's usually do-able within three months, often 6-8 weeks, even at 92.  Regular physio means daily.  It doesn't have to mean a fully qualified physio either -- just someone with experience and knows what exercises and how to progress.  So I've done this sort of thing where (as a physio) I'll check once a week and leave a plan with an assistant (who's obviously less costly) to do the other days.

If you mum's mobility was declining significantly and the hip fracture was the inevitable result of that decline then I'd be thinking about your mum not going back home, or being prepared to do home+care package indefinitely. 
The devil's in the detail and sometimes people surprise you but that's how it often pans out.

When my mum needed a few adaptations done, like an extra stair rail, and grab rails and stuff I did all that while she was in hospital.  She gave me such a bollocking when she got back, the "I'm not a bloody invalid" spiel, but about 3 months later I got a quiet thank you.

Thanks Oli. She was pretty mobile before the fall. Most of the issue seems to be because she wasn’t taking her heart meds (she “didn’t like to bother people” when they were running low. Of course she’s now caused a whole lot more bother. Sigh). That caused  her blood pressure to go massively high and she then keeled over and busted her hip. She’s getting around pretty well now but we’ll have to see if she can cope with the steps up to the front door and the stairs to the bathroom, different proposition to a set of dummy steps in the physio dept of course. 

rlw

Sell her house.  Sell your house.  Buy a bigger one.  She lives with you.

Sporky

boogieman said:

Sporky said:

My mum's had some bone issues; she doesn't want to move out so has a carer in twice a day (once a day at weekends, I think) who make sure she eats and does assorted chores. This approach seems to work well for her.

How did you sort out the carers Andi? I wouldn’t know where to start in finding someone. 

Sorry - missed this.

My uncle (hence her brother) went full-trooper and sorted it. I think he did a check with the local council and Age Concern, made up a list of agencies they both approved, rang a couple and then got the one that gave him the most confidence in for a chat; they started a week later.

Some of the carers aren't as good as the others - they're all caring and friendly, but some lack initiative - but the overall difference they've made is astounding. The most important change has been my mum's mood - she went from all gloom and doom and "I won't see Christmas again" to being a slightly slower and wobblier version of her old self. I think most of that was just them feeding her.

She pretty much lives downstairs now but seems happy enough with it.

boogieman

rlw said:

Sell her house.  Sell your house.  Buy a bigger one.  She lives with you.

Not that simple unfortunately. 

LuttiS

If it's any help depending on what you decide, i'm in the healthcare equipment industry..
So if you decide on the staying in her home route, the OT/hospital should provide the equipment required for her to live independently in her home, not to sure as the actual rules as i'm on the equipment side not the issuing bit.. 

 but anywho, if for any reason you do need equipment pm me a list an i can probably point you to the right places/ sort you out a good deal, also if you want advice on equipment etc i can probably help, or i'll at least know a place that can

boogieman

LuttiS said:

If it's any help depending on what you decide, i'm in the healthcare equipment industry..
So if you decide on the staying in her home route, the OT/hospital should provide the equipment required for her to live independently in her home, not to sure as the actual rules as i'm on the equipment side not the issuing bit.. 

 but anywho, if for any reason you do need equipment pm me a list an i can probably point you to the right places/ sort you out a good deal, also if you want advice on equipment etc i can probably help, or i'll at least know a place that can

Cheers. 

boogieman

An update on this. Mum has recovered well from her hip operation, physio has gone well and she has been pronounced fit to go home with a care package. And this is where it all goes down the pan. 

It was announced last Monday she’d go home on Friday with a care visit arranged four times a day. My wife and I are the only people with a key so we have to be at mum’s house for when she gets back. (We live 50 miles away).  By 4.15pm on Friday there’s no sign of Mum so we ring the ward, only to be told by a nurse that the care package can’t be arranged in time so they’re keeping her in till Monday. Nobody seems to think it might be a good idea to tell us this.

So now I’m driving home, absolutely furious, when I get a call at 5pm from a care agency worker asking me about the “three” calls Mum will need. I point out that we’ve been told it’s four but the nurse at the hospital has already said she won’t be discharged until Monday. There’s an embarrassed silence: this person obviously doesn’t know anything about it. (And who tries to organise something at 5pm on a Friday anyway??!!)) 

So here we are today, at nearly 2pm, with nobody sure if she’s coming home or not. The ward sister has just rung me to ask if I know the phone and fax number for the district nurse? How the fuck am I supposed to know this? I give them the numbers for mum’s GP but they say they’ve already rung that number and they’re closed till 3pm so don’t know what to do. 

No wonder people moan about the NHS, nobody seems to have a clue what’s going on and certainly nobody is following any sort of process. We found the number for the discharge team by the way, but nobody is answering and they haven’t returned our call. What a joke. 

EricTheWeary

District nurses are very special people who have yet to discover the telephone or email. Unfortunately not the only people in the NHS like that ( in my  experience only obvs - although an experience which does include trying to contact someone working in the NHS almost every day). 

Have you considered a key safe on your mom's house? My brother put one on my mother's house and your local authority will probably have a key safe service of you can't .
We use it for the carers and the fall alarm people. If someone visits and hasn't got a key my mom rarely hears them so we can text the key safe number. If I had to call emergency services on her behalf it means they could get in. 

ESBlonde

Another vote for a key safe at Mothers house. Locate it so it can be found by any carers who have been given the code. Some home service agencies will supply and install thier own, but good ones don't cost the earth.

boogieman

EricTheWeary said:

District nurses are very special people who have yet to discover the telephone or email. Unfortunately not the only people in the NHS like that ( in my  experience only obvs - although an experience which does include trying to contact someone working in the NHS almost every day). 

Have you considered a key safe on your mom's house? My brother put one on my mother's house and your local authority will probably have a key safe service of you can't .
We use it for the carers and the fall alarm people. If someone visits and hasn't got a key my mom rarely hears them so we can text the key safe number. If I had to call emergency services on her behalf it means they could get in. 

Actually a guy came round the other day and fitted a key safe. I’ve tried passing the number on to the care team but of course nobody answers the phone. Getting hold of anyone in the NHS really is like trying to contact the dead. 

A friend of mine quit her job in social services last year, precisely because of this kind of issue. Nobody is ultimately responsible for anything, there are different teams for every part of the process, none of them have a common plan and none of them communicate with each other.