Archive for January, 2012

You don’t have to put mum into a care home

Soon after I set up the Hospital to Home service at Relative Matters, I received a call from my friend Jan. She was in quite a state because she had been told that her mother, who had a stroke a few weeks before, was ready for discharge from hospital and needed to find a care home. While needing a lot of support, her mother did not meet eligibility criteria for CHC funding, or funding from Social Services, as she had savings that put her above the financial threshold. Jan had been given a list of care and nursing homes and asked to arrange her mother’s move as soon as possible as the hospital needed her bed. People who do not qualify for funding from Social Services do not usually receive support from a social worker.

Jan’s mother is a widow and felt strongly that she did not want to live in a care home. I told Jan this was not the time to make a rushed life changing decision and advised that her mother was entitled to 6 weeks intermediate care free of charge, regardless of her means, so we could find a suitable care home for her to convalesce for a few weeks, while we planned her long term care.

I worked with the Hospital Discharge Team and manager of the home to design a care plan that had a rehab element built into it and Jan’s mother moved to the care home a few days latter. The care home was great and played a positive part in building her confidence.

While her mother was in the care home we began recruiting a small team of personal carers. After her mother had been in the home for 4 weeks, and in consultation with Jan and her mother, I arranged an OT and care agency assessments so agency carers could continue with an updated care plan at home, while waiting for the personal assistants to start. (Recruitment of a personal assistant can take around12 weeks, including reference and CRB checks) 

Today a small team of 3 part time carers look after Jan’s mother and she is living happily at home. The carers work less, and therefore cost less, because Jan covers some care at weekends and we use the following pieces of equipment.

  • A community alarm and personal response service
  • A fall detector
  • A bed and chair sensor
  • A computer for shopping etc.

We also arranged for her mother to attend a local Stroke Club where she has made new friends.

As well as respecting her mother’s choice to live in her own home and giving her the best quality of life possible, I saved money by finding the right placement (home support as opposed to living in a care home), maximising her income by applying for higher rate Attendance Allowance , using equipment to improve independence and her mother’s existing support network.

Alan's experience of NHS Continuing Healthcare

Alan Price was 72 when he had a stroke that robbed him of his independence. He had never married, had no living family and had worked on the same farm in West Sussex for many years. Alan loved working outside and was very knowledgeable about farm machinery and became animated when being shown a model tractor and picture of a farm in a book.

Since having the stroke, Alan has been funded by NHS Continuing Healthcare (CHC). NHS CHC is a package of services and support arranged and fully funded by the NHS for people with long-term health needs. Eligibility for continuing healthcare support and funding is determined on the basis that someone’s primary care need is a health need.

Unlike people funded by Social Services, CHC nurses do not case manage patients or review their needs other than to check that they continue to meet the CHC criteria. As a result, I was asked by Alan’s solicitor, who holds a power of attorney for him, to visit Alan at his nursing home to review his care needs and see if there was anything he needed to improve his life. While not having a lot of money, Alan had some modest savings, which could be used for the purpose.

With increasing pressure on the NHS budget, people are inevitably being cared for as economically as possible. This was certainly evident when I met with Alan. He had no care plan identifying his needs and how they were to me met and I found a lack of attention to his emotional, social and spiritual needs. Staffing levels did not allow for any one-to-one time to take him out for example, or for any therapeutic intervention such as physiotherapy or hand massage. However, not everything was about money. I was concerned to observe a number of things that demonstrated a lack of attention to seeing Alan as an individual, such as putting up a beloved picture of the farm where Alan worked on a wall behind his bed where he was unable to see it.

The following is a list of the suggestions I made to improve Alan’s quality of life:

  • Reposition the picture of Alan’s farm so he could see it
  • Buy a DVD recorder and DVDs that would interest Alan, for example Victorian and Edwardian Farm collections and old time music from the 40s and 50s, which he loved.
  • Buy a recliner chair for his room in order that he could sit comfortably while watching his DVDs.
  • Arrange physiotherapy to strengthen Alan’s limbs.
  • Arrange a regular hand massage
  • Arrange for an agency carer to take Alan out once a week.
  • Ask the vicar from the church Alan used to attend to visit him on a regular basis.