Care assessment

All about caring
1

Hi,

My MIL is a carer for her husband.

Following 10 days in hospital, he was discharged, without any needs assessment, but there was emergency care put in place, 3 carers to visit for 30mins a day. (hospital discharge was very mismanaged causing great stress for the family)

After a few days, a nurse from the team came and did some form of assessment, although my MIL doesnt know what it was for.

THe assessment was done by a lady who typed into a laptop, was there for hours. What was slightly weird isa that she asked very few questions, only every 10 or 15 mins or so -basic questions, like: ‘when was his last eye test’, ‘what is his blood pressure etc’. Finance was also asked about to see whether care would be self funded.

As far as we can make out, this was a care assessment, but we dont know.

Now the team are saying ‘weve put a package of care together and you have to pay for it’ -which Ive told my MIL she has no need to accept any such package and we should have been warned.

My question is: do we have a right to see this assessment?

2

I believe the care plan should include the assessment and you ought to be given a copy.

You don’t say how your FIL is. Was he offered a reablement package for 6 weeks, free of charge, or was he deemed not to benefit from such a package?

Did social services do a carer’s assessment for his wife?

3

Hi Rosemary,
many thanks for your reply, some more info:

My FIL has lewy body dementia with parkinsons.

the difficulty is the sudden decline -before Xmas he was able, just, to walk the dog with us. but beginnging of Jan, he couldnt get out of bed and was taken to hospital -it turned out to be delerium due to a chest infection.

the big problem is that the illness is very variable and the parkinson aspect causes freezing episodes, so walking from lounge to loo could take 3mins or 45mins.

yesterday he couldnt get off the loo, the carer arrived and her solution was to call an ambulance -which we stopped and helped him up. I realise carers dont lift, I get that, but waiting 2 hours for an ambulance isnt a solution

Yes he was offered a reablement package for 6 weeks, but the carers come in, only have 30mins max to stay and if that coincided with a ‘slow’ moment just go before anything gets done.
he has only been at home for 12 days and the care team are trying to stop as soon as they can.
FIL has a serious incontinence problem at night -completely soaking sheets and so much it runs onto the floor -thats with incontinence pants + bed pad

OT has been in, we do have commode, perching stool, loo seat rails and after some fighting a hospital bed.

Continence team have been requested but it seems they could be many weeks

KR
Robin

4

The continence nurse should be attached to the GP practice.
Dad is entitled to SIX WEEKS of free reablement care, make sure he gets it!
If the carers want to stop before then, complain!

5

Definitely speak to the gp. I recall the continence nurse fell under the district nurses who are under the GPs direction.

Has your FIL claimed a council tax rebate since he was diagnosed with dementia?

I have friends with PD and was diagnosed with Parkinsonism for over 20 years. As you say, your FILs condition is a permanent, progressive, incurable disabling neurological condition with multiple life altering symptoms and is unpredictable. Have you considered applying for NHS CHC (Continuing Health Care)? Please look up the threads on CHC on this for for details.

6

Hi bowlingbun,
thank you very much for your post.

A new worrying development has arisen:

The nurse in charge of the reablement team rang my MIL and told her that:

“we have arranged a care package for you with a care agency, which you must accept by Friday or I shall contact social services and report it as a safe guarding issue”.

my FIL was discharged from hospital on 17th January.
so far the reablement team have been providing care for 12 days

If anybody has any advice I would be most grateful, my MIL is very worried, she feels she is being bullied.
the nurse apparently was rather unpleasant -I know what it is all about: Money

I would like to get back to the nurse tomorrow and Im trying to understand what rights we have.

TIA

7

If MIL thinks she is being bullied, would she like you to take over dealing with this?
Then you can give the nurse your email address, and ask her to put everything in writing so you can show it to mum. (Then you have evidence if needed of exactly what was being proposed.

You can then reply by asking “Why are the current free reablement team being withdrawn before the end of 6 weeks, as laid down by the 2014 Care Act?”

When is the NHS Continuing Healthcare Assessment going to be completed? (No one should contact Social Services until this assessment is completed, and you and mum should be involved in this.
Please can she clarify why she intends to contact the Safeguarding Team. What abuse is she alleging? (!)

When is mum’s Carers Assessment going to be completed? A written copy should be sent.

8

Hi Rosemary -thank you very much for the advice.

The diagnosis we have is dementia, I think one scan showed had a confirmation of lewy body dementia. My research shows that these are umbrella terms and that with lewys, the cognitive decline shows before the physical -which is the case. However the physical signs are very much the freezing symptoms typical of parkinsons.
I have considered CHC and Ive downloaded the assessment criteria.

If you spot my post above regarding the enabling team nurse threatening my MIL with reporting to social service, I would be most grateful for your advice.

Thank you very much for the help you have given, it is a very stressful time -not helped by the fragmented and unhelpful NHS services (I still appreciate the NHS and its staff, just frustrated by how the elderly requiring social care are falling through the cracks.

TIA Robin

9

Hi bowlingbun,
Thank you for your wise advice, I shall do that!

your prompt reply is much appreciated. :slight_smile:

10

(So very frustrated that ive just lost my lengthy response!:cry:)

I agree with BB to get responses to questions by email. Bowlingbun is very knowledgeable, I would question the six weeks being a 100% entitlement, although it appears to be very common.

It appears from the NHS webpage on reablement (Care after illness or hospital discharge (reablement) - NHS) that reablement is initially for up to six weeks to help the caree recoup strength and abilities with activities of daily living.

I’d check the careplan that he’s actually been on formal reablement. It could be that social services has reassessed him and decided that he is unlikely to benefit from reablement and cut it short, if he’d ever been on it!

Delirium can take weeks or months to subside and can only compound his disabilities and freezing episodes.

I don’t believe the LA can charge until the at home assessment is done and the long term care package begins. Cost depends on your FILs financial assessment.

I suspect the nurse could be obliged to put in a safeguarding report if the LA is prevented from delivering care that they deem necessary for his safety. Really heavy handed, threatening approach.

I’d push for continuing health care.

My mother had a brief period of reablement but was later considered ineligible after a second hospital discharge.

I can’t speak about the Care Act. Do you or FILs wife have POA?

Dont be afraid to ask the LA what’s going on!

11

The free 6 weeks is given in the 2014 Carer Act Statutory duties. No time to find chapter and verse at the moment.

Find out the full name of the enablement nurse, and ask her for her registration number. That should rightly get her worried that you are going to complain about her to the nurses governing body, which you are quite entitled to do if she is saying things that are incorrect.

If the reablement is taking longer, the 6 week period can actually be extended!

Have a look at the thread written by our member called “Pet”. Her husband also had Lewy Bodies dementia.

Nothing you can say or do can halt the progress of this disease I’m afraid (my grandmother and both her sisters had Parkinsons and LBD, so my own fingers are firmly crossed that it doesn’t get me too).

All you can do is make dad as comfortable as possible, and protect MIL. If dad goes home, it will only be to fail repeatedly and go in and out of hospital, not in anyone’s best interests.

If applying for Continuing Healthcare, google “Grogan Case Continuing Healthcare” which might help.

12

I am sorry you lost your long post -Its so annoying when that happens! many thanks for the effort of retyping it

My wife has managed to speak to the nurse who did the care assessment.

you are correct: they have concluded that my FIL has too many issues and cant be rehabilitated by the care they provide, so theyve decided to end the care they are providing: which is only 2 half hour visits per day with no set time, it causes more disruption and is worse than no care to be honest.

We have asked about providing a copy of the care assessment and they are saying: ‘its on our computer system, we dont know any way to send you a copy’…

in addition to the above they have determined that my MIL as not ‘engaged’ with the team and she has a back problem so they consider my FIL to be in an unsafe environment without a suitable external care package in place.
The are even trying to say my MIL may have memory problems, which is 100% incorrect.

By the way, the ‘care assessment’ was done on the day following his return from hospital. My MIL said the questions were very basic, for example ‘when was his last eye test’ etc no assessment of my FIL.

I cant help feeling there is an issue here: my FIL should not have been discharged without the correct assessment which should have included a checklist for CHC.

Robin

13

Good morning, Robin, I think your FIL ought to have come home with a paper discharge plan. The reablement agency (or the interim agency) ought to have completed an assessment and care plan which ought to be in the care record binder.

In my experience, the LA then did another assessment and left financial assessment form to be completed and returned to the financial department.

Interestingly, our financial form essentially had to agree to pay whatever fees were due, without even saying how much they would be. We never did complete that form, and we were not told, in advance, what the cost of care would be!!! We were told when and what level the care would be. After that package started, the new agency supervisor came and did another interview and a few days later, they left completed paperwork in the care plan binder. (The binder showed up with the first care visit.

The LA is trying to pull a fast one by saying they don’t know how to print a copy of their assessment, but I can’t remember us having a copy from the LA either.

In my experience, mum had the worst weeks care whilst on the reablement plan!

We were expecting to have to pay, but were expecting to be told how much, and a contract, before the plan started. That never happened.

I found that it was better to have services provided by the LA and reimburse them, rather than arrange care myself. Worked out cheaper and had the LA to complain to, as well as the agency!

I’ve never been in a position where I’ve refused the services deemed necessary by the council or hospital team. I did question the need for two carers each visit when the agency had often managed with one, and the OT came out to reassess.

As for engagement with the team, a very subjective phrase and most carers I met preferred you to keep your distance! How many people do you need in a small room with hospital bed, commode, transfer device etc? In interview situations, perhaps your FILs wife was more hesitant/confused than usual, or just couldn’t hear or understand the interviewers questions? The latter happened to mum in doctor’s offices and assistants would smile sweetly and think she had memory issues. When I repeated the questions, mum answered straight away!

14

What a lot of incompetent idiots. If they don’t know how to print off an assessment, they shouldn’t be doing the job! My grandson has been doing it since he was about 4 years old. Simples!

The care agency should not withdraw care until alternative care is arranged. After the Needs Assessment, Social Services should tell you how much his Personal Budget amounts to, so you can choose whether to take the money and arrange care yourselves, or have council arranged care.

Make sure the Needs Assessment is accurate, looking at ALL dad’s needs, not reducing it in any way as family might do it instead.

Look at the LA website, search for Adult Services Complaints, and make a complaint about failure to arrange proper services, before all care is withdrawn and you’re left with absolutely nothing.

Also ask the GP to arrange an NHS Continuing Healthcare Assessment.

15

Hi,
My apologies for not replying sooner -my FIL had a chest infection in early February and has been in hospital since then.

“What a lot of incompetent idiots. If they don’t know how to print off an assessment, they shouldn’t be doing the job! My grandson has been doing it since he was about 4 years old. Simples”

We asked for the assessment but were told we couldn’t have it without completing in a request form for the information -it seems like it was a freedom of information form or similar.

because my FILs health has deteriorated since then, we didn’t pursue it as its on longer relevant.

I do have a question about CHC so will start a new thread in the relevant section.

many thanks for all who contributed to this thread, I very much appreciate the advice
KR
Podengo