Compulsory move to a nursing home

[Chris S]

One of my aunts has Alzheimer's and has been in hospital for over 12 weeks. There is nothing else medically wrong with her and they want to discharge her to a care home. My other aunt, who has power of attorney over her affairs, agrees with this but doesn't like any of the nursing homes that they want to move her to. The social workers are now threatening to discharge my aunt to a care home of their choice. I assume this is correct. Is there anything to stop them doing it?

 

[T4tomo]

One of my aunts has Alzheimer's and has been in hospital for over 12 weeks. There is nothing else medically wrong with her and they want to discharge her to a care home. My other aunt, who has power of attorney over her affairs, agrees with this but doesn't like any of the nursing homes that they want to move her to. The social workers are now threatening to discharge my aunt to a care home of their choice. I assume this is correct. Is there anything to stop them doing it?

Social worker is correct, you either find your own care solution or they find one for you. It might sound harsh but she is "bed blocking" a stretched NHS. The if you find a nice one you like, you might not be able to get it funded. Adult social care is pretty farked but none of the politicians will ever fix it as its not a vote winner....

 

[Electric_Andy]

Tough call but choose the best of what you are offered. The alternative will be at the hospitals' convenience which will probably be the top of the list, first one they get through to on the phone, that kind of thing. Their priority may not be what is most suitable, but what is quickest and easiest to book

 

[Drago]

Social workers are, in my professional experience, often arrisholes. I once had to threaten one with arrest for obstruction to get them to grudgingly do their job.

What they want to do and what they are lawfully entitled to do are usually poles apart. Unless its changed in the last 8 years they don't have the statutory powers to override a decision about adult residence without resorting to a court. To do otherwise would be abduction. While they may make a place available they cannot force your aunt to go without a courts authority.

Before it gets as far as anyone else making a decision theres a question of your Aunt's capacity. If it hasn't been medically established that your aunt is incapable of making the decision then SS can foxtrot right off. Remember, SS aren't automatically entitled to confidential medical information regarding your aunt so the hossy can be instructed not to divulge that data until either instructed otherwise or a court orders it.

As a practical matter if your Aunt is otherwise medically fit then its not right to keep her in hossy. If your other Aunt doesnt like what's on offer then it's entirely within her right to find somewhere else and sort out the funding. If she cant do this then, whether she likes the homes or not, ask her what is the practical alternative?

Suffice to say SS dont have any statutory powers to force the issue at this point, but there are variables all over the shop at play that I dont want to know about and I'm not expert enough to advise upon, so half hour with a solicitor would be beneficial to try and find a solution acceptable to all parties.

Hopefulky it gets resolved swiftly and amicably, best of luck.

 

[VinSumRox]

Seems reasonable, there is no need for her to be in a hospital bed if she is medically fit.

 

[Oldhippy]

They are unable to do this in my opinion. I had a resident recently who whilst frail and very forgetful she was not deemed unable to make a choice where she lived. Family and I jumped in and arranged care company to come to her home daily for food and personal care. I believe her condition may fall under 'Continuous Health Care' which is not tested on assets. SS are loathe to do this in many cases due to cash supply however. Fight it if you are able, no one deserves this dismissive attitude. If the old were fluffy puppies everything would be available to them after a lifetime paying in to the system.

 

[fossyant]

They are unable to do this in my opinion. I had a resident recently who whilst frail and very forgetful she was not deemed unable to make a choice where she lived. Family and I jumped in and arranged care company to come to her home daily for food and personal care. I believe her condition may fall under 'Continuous Health Care' which is not tested on assets. SS are loathe to do this in many cases due to cash supply however. Fight it if you are able, no one deserves this dismissive attitude. If the old were fluffy puppies everything would be available to them after a lifetime paying in to the system.

Frail and forgetful is easier to manage at home, but alzheimers is a different kettle of fish.

OP's aunt needs to act quickly and find somewhere she likes and or is easy to get to for visiting.

MIL was all there mentally but despite not being frail, couldn't get herself up. After a fall and a lengthy hospital stay, then to a halfway home, she had to move into Nursing Care. We did the rounds and found her something suitable.

She used to moan about being there and constantly said she wanted to be home, putting great emotional pressure on the whole family. There was no way she could go back home. We'd managed to keep her there for a good 8 years after FIL died with carers and us. But the loss of being able to get out of bed or chair without a hoist (which needs two care people) made the decision. Only nursing care could keep her safe.

 

[si_c]

Seems reasonable, there is no need for her to be in a hospital bed if she is medically fit.

Worse, there are a number of issues. A huge problem is deconditioning - hospital is objectively the worst possible place for someone who is otherwise healthy to be - elderly patients in particular with get worse physically the longer they are in for, your Aunt has been in for 12 weeks, that is a very long time to be in hospital.

Then there is the effect of bed blocking - hospitals are again the worst place for someone who is medically fit to leave to stay as they'll be using significant resources (think about £500 per night) and stopping someone else from being admitted (it's almost always emergency admissions which are blocked, electives are just cancelled). One of the single biggest reasons that Emergency Departments are so full and the NHS is struggling is the lack of discharge to appropriate social care.

 

[tom73]

I can fully understand the situation i've had to sort this out for an Aunt a few years ago. In my case the social worker was the one holding things up. Lucky I know my way round the system so forced things to a head.
As has been said 12 weeks is a long time and the longer it go's the worse worse your aunts heath will get. It's well known that older people go down hill quick longer they stay in hospital. I'm guessing she is still mobile and able to eat ect unaided ? I'm sorry to say it but if she is , she won't be for much longer. My wife has seen it all too often they go into hospital and end up staying longer than needed. They are never the same once they do get discharged. Nursing staff together with other hospital staff will try to keep them as independent as possible. But they can't do every thing or spend all day going it. They simply don't have the staff for that.

Have they said she need's a nursing home or a care home ? They are not the same, They tends to be less nursing homes than care homes in most areas. So it maybe worth checking just what her care needs are , It may help widened the search.Some care home will take people who have very basic nursing needs if they can be managed by DN's visiting the home. Due to the Alzheimers what ever home she go's to will need be be EMI registered. Which many or may not limit the number in your area. Has your aunt looked or asked about if some respite care/ step down care place can be found , as a stop gap before moving in into a home ? Not all areas have them so it may not be an option or suitable.

It's not an easy situation to be in the whole of social care is a total mess. But your aunt really has to find a home fast as it's not doing anyone any favours. As others have said bed blocking is a massive issue and a drain on hospitals with massive knock on effects. Even an empty hospital bed costs well over £800 a day. I'm not saying the hospital will in your anuts case , but some hospitals have in the past gone to court and had fit to discharge patients evicted. As for social services they will force the issue if they need to.

 

[accountantpete]

Round here the procedure is very simple. You get her on the waiting list for one of the good nursing homes and in the meantime get her into a Care Home on a temporary basis if that is suitable.

 

[Richard A Thackeray]

Worse, there are a number of issues. A huge problem is deconditioning - hospital is objectively the worst possible place for someone who is otherwise healthy to be - elderly patients in particular with get worse physically the longer they are in for, your Aunt has been in for 12 weeks, that is a very long time to be in hospital.

Then there is the effect of bed blocking - hospitals are again the worst place for someone who is medically fit to leave to stay as they'll be using significant resources (think about £500 per night) and stopping someone else from being admitted (it's almost always emergency admissions which are blocked, electives are just cancelled). One of the single biggest reasons that Emergency Departments are so full and the NHS is struggling is the lack of discharge to appropriate social care.

We've seen this from both sides, & it's a bind!
My wife trained as a Nurse, & spent some time (about 3 years) as a Senior Bed Manager, at the local Hospital (we were together for 11 years before I started there), so had to cancel elective surgeries/arguing with the surgeons/consultants as to why as there was no bed for the patients after surgery/planned admissions, as either;
- A&E patients had gone into them overnight (or more likely, patients moved to be 'outlyers', from the assesment wards, who'd still probably be discharged after consultants rounds?)
- previously discussed elderly discharges, were kept in the Hospital, due to the funding, or relatives not being happy about the residential/nursing homes arranged/offered

Then, after a few years, working for a consultancy firm engaged in PFI builds, & going it alone (with 1 business partner) to do the same, they also had domicilary care company ('home care')
The amount of times, they'd struggle with social workers/families/councils (for funding packages) made her give it all up in the end & sell the business/TUPE the staff

Last time I saw the figures, across the Trusts hospitals, there was (circa) 200 'bed-blockers'

 

[craigwend]

Firstly sorry to hear this. Something is not 100% about the description you have given, but that is understandable with the confusion caused in these situations. I wonder if the 'threat' to be moved is to a 'step down bed' in a care home, until a permanent residential (or nursing home can be found) place can be found, it is the hospitals responsibility to discharge, though moving into care will involve SS and a social worker will have been tasked to give this information (probably)Nobody can be moved pragmatically without a court order generally. Ultimately the final decision will be your Aunts who has Power of Attorney (Assuming for both 'care and finance?') Sometimes due to a lack of choice a temporary solution has to be found. (Will she be self funding or SS / NHS And benefits?

 

[Pat "5mph"]

My other aunt, who has power of attorney over her affairs, agrees with this but doesn't like any of the nursing homes that they want to move her to.

I work in a hospital, I see this all the time.
Your Aunt, the one with power of attorney, needs to act fast because hospital environment for Alzeihmer's patient really is not suitable.
They get bored and angry, forever wanting to escape, to go"home", they can get really distressed.
They don't understand why they are there, there's nothing for them to do, they cannot go out for a walk or a coffee because there's no one to take them.
There aren't activities planned for them to redirect their frustration.
Ward staff is mostly auxiliary nurses, they do personal care but a lot of dementia patients don't need that, they do need specialist care.
Why not move your Aunt to a home that ticks most of the requirements of your other Aunt, meanwhile she can search for the "perfect" home.