Challenging council over care

Have you discussed this with them? Does the home you prefer have a contract with the council? If there is a small top up might that be worth paying fir your mum to be somewhere where you are happy.

If the smaller home cannot provide care within the council’s contract rate, and from her savings/estate she isn’t able to pay top up fees, then unfortunately that home won’t be an option for your mum, and you won’t achieve anything by challenging them. Have you asked the Council whether there are any other homes without top up fees that you could look at, as an alternative?

But as I understand is the council has to provide a safe and reasonable option otherwise they have to pay for the more expensive home. Does anyone have any experience of dealing with this?

All care and nursing homes are inspected and have a rating by CQC.
It would be very difficult to prove that a home was unsuitable if it meets the criteria that the council has assessed for your mother’s health needs. Importantly, as has been said the home you choose would need to have a contract with the Council to provide care at a price the Council will agree to.

I do know in my town there is only one care home within the Council price range. I think many Council’s allowances fall short of what many Home providers will accept. It’s a sad state of affairs.

The larger home is one of the safe and reasonable options surely marshy36, unless there’s evidence that it provides an unsafe standard of care? It will be regularly inspected by the Council, and the Healthcare Inspectorate so you could look up reports.
The best I think you’ll be able to expect if you can produce concrete evidence that the larger home can’t meet your mum’s needs is that the Council will find another one that doesn’t have top up fees which does meet them. My previous role was NHS, but was heavily involved in complex placement cases, and I’ve never known a case where a family was able to successfully argue that the council had to pay top up fees to place their family member in their home of choice. The only circumstances when they paid top up fees was if the person’s needs were so complex that they needed a specialist placement, falls would not fall in that category. Hopefully somebody who has recently worked in the field for a Council will be able to advise you.

Thank you great advice

It will be cqc inspected...so deemed safe...if she needs nursing care have they done a CHC assessment? I did for this with my aunty and she got all her care free.

Just a word of experience about NHS CHC. It is notoriously difficult to get, and is dependent on assessment of advanced nursing needs. Your aunty was lucky LOUISA as is my mother who is in receipt of this. It is also reassessed every few months.

The nursing home that the council wanted to send my OH to made me sit and weep in my car on the car park after I saw it.

The room he was allocated was down a service lift - with those metal expanding grid doors - along a very narrow dark corridor with gloss painted brick walls, and tucked away at the end out of touch with anyone, virtually below ground, with a small high window with a fire escape running diagonally across it - cold lino floor and metal hospital bed. Needless to say this place was CQC inspected. Their threshold for deeming a home unfit is very low, as they have nowhere to send the residents if they shut it down. I know - on one very rare occasion this was done I, and a team of other social workers, had to fly in and find homes for 20 bewildered tearful residents - not something I wish to relive.

I went home from this grim place and put our house on the market. No way was he going there, after decades of serving the community as a GP. It was an insult to him, to us and to any poor soul who finished up in that room. My rage still surfaces 3 or more years later. [I eventually found him somewhere beautiful - carpeted single room, nursing bed disguised as a normal bed, French doors onto lovely patio and garden, fully adapted en suite, carpeted wide corridors with small sitting rooms set up like home, a library, a bar, a spacious coffee area ......]

To the OP I would say think of 2 things:

Your Mum might qualify for full funding under the NHS Continuing Health Care Funding rules - give these guys a ring: www.beaconchc.co.uk/ They are very busy, but their advice is free. Has your Mum had an assessment for this funding? If not ask for one. They will try and fob you off - I know this only too well; stand your ground. If your Mum's need for nursing care is due to a Primary Health Need, and she has physical and mental deficits then she qualifies. Insist on an assessment being done and make sure you are there and have taken advice beforehand. If you want to pm me, I can take you through this.

I have never heard of a council agreeing to pay the top up - frankly they don't have the money - unless there are specific items that you can list in detail as not being suitable for your Mum. Go round the home, write down the exact dangers you can see, talk about vulnerable adults, safeguarding etc. - hit them with the buzz words. Be specific.

Farzanah

Just a word of experience about NHS CHC. It is notoriously difficult to get, and is dependent on assessment of advanced nursing needs. Your aunty was lucky LOUISA as is my mother who is in receipt of this. It is also reassessed every few months.

I got this for my OH after he was refused at two assessments. I won an appeal where the panel agreed it straight away and could not believe he had been refused.

Just because they resist paying it and it is difficult to get, does not mean that people do not qualify. It is part of the game to avoid paying it. I had history and knowledge in the field and simply would not lie down under their ploys. Unfortunately there must be tend of thousands of people who qualify but who get fobbed off. Imagine being very elderly and trying to get the best care for your spouse ands being made to go through all that - most people just cave in, and who can blame them? It is enough to have a loved one in this sad situation without having to fight for proper care.

I do agree with you Luckygirl and after many refusals my mother was only awarded CHC because it appeared she was dying earlier this year. She hasn’t yet died but hasn’t improved either and is still in receipt of it.

I’m sure many people do fit the criteria for CHC but are refused because the budget is tight, and it is soul destroying battling, causing stress to oneself and loved one. Appeals must provide plenty of business for legal firms. It’s not cheap either.

I take CQC ratings with a pinch of salt too, after viewing lots of places. It’s can be a minefield. Even the better places are struggling with shortage of staff now.

I agree with what you are all saying, but in this case it’s unlikely because it appears from what marshy36 said in her original post that the Council have already accepted responsibility for funding her mum, which they wouldn’t do unless she had either already been assessed for CHC and didn’t meet the criteria, or it was clear she wouldn’t be eligible. As you rightly say, their budgets are extremely tight, and they don’t accept funding responsibility without confirming their eligibility criteria is met. This is one of the reasons for delays in discharge to care homes.

Farzanah

Just a word of experience about NHS CHC. It is notoriously difficult to get, and is dependent on assessment of advanced nursing needs. Your aunty was lucky LOUISA as is my mother who is in receipt of this. It is also reassessed every few months.

She wanst that lucky farzanah....she has advanced terminal cancer 🙄

People with dementia who have been held under the mental health act 1983 should get CHC under section 17 I think. It’s a struggle fir most people though.
I am sorry about your mum Louisa.

Yes.I am sorry about that LOUISA. It was a stupid thing of me to say.

The council had accepted "responsibility" for my OH's care, but I was clear the responsibility lay with the NHS and pursued this successfully as my post above.

Sorry, I should have made it clearer, what I meant was funding responsibility, rather than responsibility to help find a placement. It’s the funding issue that causes dispute between Health and Social Care.

LOUISA1523

It will be cqc inspected...so deemed safe...if she needs nursing care have they done a CHC assessment? I did for this with my aunty and she got all her care free.

The care home, I work in hasn’t been actually CQC inspected for three years….(i.e. inspectors actually coming into the home, Obviously Covid played a part in that)

Farzanah

I do agree with you Luckygirl and after many refusals my mother was only awarded CHC because it appeared she was dying earlier this year. She hasn’t yet died but hasn’t improved either and is still in receipt of it.

I’m sure many people do fit the criteria for CHC but are refused because the budget is tight, and it is soul destroying battling, causing stress to oneself and loved one. Appeals must provide plenty of business for legal firms. It’s not cheap either.

I take CQC ratings with a pinch of salt too, after viewing lots of places. It’s can be a minefield. Even the better places are struggling with shortage of staff now.

Indeed so.

The problem is that if the NHS paid up for CHC funding for everyone who qualifies, it would go bankrupt. The problem is that under the NHS Act, the government is obliged to pay for care that is based on a medical need, and they have devised a system for avoiding this: complicated criteria for establishing this primary medical need, keeping quiet about it and not having ward staff, GPs and district nurses tell people of their rights, and keeping medical professionals up to speed on their patients' rights.

I have a friend who is battling to get this for her father. The district nurse refused to fill in the form as she said she could not do it, and that the patient was not yet terminally ill - two mistakes there: she is qualified to do it, and you do not have to be terminally ill to get it. So .... off she trots to the GP, clutching the form that I had downloaded for her and she had printed off. It has been there for 10 days now, with the receptionists saying that the doctors have not had time to do this. All this time a massive debt is being run up to pay for the live-in carer and the 4 times a day carer visits on top of this because his needs are so great, and of course the live-in has to have time off. He so obviously qualifies, but my friend is meeting a brick wall. The local CHC, whom she phoned, agree that he blatantly qualifies but can do nothing without the form.

The whole system needs reforming, but no-one will look at it: the NHS fears letting the cat out of the bag and providing widespread information, because they would not be able to afford the deluge of applications; abolishing it would bring it all out into the open and cause uproar. We see ads telling us we might qualify for many different benefits - anyone ever seen one flagging up CHC funding?

In the meantime, there are legal firms making a mint on advice and appeals.

Lots of good advice here for you Marshy 36. I would also say if your Mother does go into this home then ask to see her Risk Assessment and that she is referred to the Falls Prevention Team or whatever they are called in your area. There are many technical things that can be used such as bed and door alarms to track movement and several new IT innovations to track movement. I wouldn't rely on CQC inspections they aren't often enough and very paper based.

I don’t have the expertise that many posters have, but one thing I do know about is unsuitable environment for the care of elderly or infirm people. When we needed to look for a care home for my mother, we looked at some that were far from ideal for a very elderly lady, unable to walk without a walker, recovering from a broken shoulder, with heart failure and other health problems. We looked at one, my husband said he wouldn’t put a dog in it. The home was housed within several houses all joined together with bits of new work. It was basically an old building. The corridors were very narrow, she wouldn’t have been able to fit her walker between the walls in many places, let alone a wheelchair. There were steps and uneven joins in these corridors and so she would have been unsafe trying to negotiate them. There was no lift. There was only two stair lifts which would have required her to turn herself around at the top step in order to sit down on the chairlift, but there was nowhere for her walker to balance so she would have been very unsafe. Then off the chairlift, walk to the next stairs and repeat the whole thing. It was certainly not safe. There were no en-suite facilities and tiny rooms with metal, hospital beds, and little furniture. No televisions were provided and television was my mother’s lifeline when she was old, both at home and in care.
We did find a lovely home for her because she was able to self fund. There are some dreadful homes out there, God forbid I ever end up in one like that.

It is soul-destroying maddyone .... you and I found the means to walk away from these dreadful places, but some poor souls live out the end of their lives in them. It does not bear thinking about.

Maddyone my parents were in a lovely home but I did not expect them to provide TVs. They brought their own with their reclining armchairs.

Yes it is soul destroying Luckygirl.

dragonfly I didn’t expect the home to provide a television, but the one we found did. I expected the environment to be safe, to be pleasant, to provide for all her needs. We took her own walker and wheelchair to the home, along with other personal items, including photographs of the family, ornaments from her flat, gifts we had all given to her over the years, along with clothing and toiletries etc.
However given that many people in care homes are bed ridden, I don’t think it would be too much for them to provide a television in each bedroom. Had there not been one in my mother’s room, of course we would have taken one in, along with her fan for hot summer days, but there was already one in the room. A good care home should provide quality of life, not just care. I’m pleased you also found a lovely home for your parents.