Care Home Fees- questions about LA contribution

In December of last year my fathers arm was broken by a private ambulance firm who were contracted by his local NHS trust. A serious incident review has been undertaken and they have admitted liability (the driver has been sacked). We have appointed a solicitor but are told legal action could take several years.

In the meantime my father remains an inpatient. The OTs have said he needs double handed care which his existing care agency can’t provide. The council have said they can’t find any other agencies to provide double handed care, the costs of the proposed new care package would exceed their limit, that they don’t provide night care for the over 65s and consequently want him to go into a care home.

Neither my father nor I want this to happen. I am , however, keen to be prepared for all eventualities and whatever may lay ahead in the future so have been researching local care home facilities. A couple of questions have arisen that I hope you (I’m not experienced in this area at all) might be able to advise me on:

  1. how do you make a case for a nursing home rather than a care home? I think my father will need nursing care (he has complex medical needs incl. end stage renal failure for which he requires dialysis three times a week; he’s hemiplegic following a stroke; blind ; deaf; has chrons disease, diabetes etc). The council keep talking about care homes (I assume because they are cheaper?) and the hospital mention nursing homes (trained people to check him after dialysis etc) Do any of you have experience of making such a case and who decides?
  2. My father has less than £14k in savings and no property (he had his stroke in his 40s and we’ve spent everything on his care so far). The council have said he would qualify for their full assistance but I don’t know how much this would be. I am keen that if he ever does have to go into residential care that it is somewhere that can meet his complex needs. I know that cost doesn’t indicate the quality of care and that resources are tight but I just want to get a rough estimate of what they might pay so I can look at places in that ball park area. Does anyone have experience (especially in London ) of what the Council might be willing to pay for? I know they will want the cheapest /easiest possible option but as my Dad has so many needs I want to ensure that anywhere he does end up can meet them. I would be very grateful for your advice and details of any experiences you may have had. Thank you.

Hi Faye … a holding reply before the calvary arrive.

Care homes fees … AGE UK on this thorny subject :

Paying for permanent residential care | Paying for a care home | Age UK

Has CHC / NHS Continuing Healthcare been suggested / offered / even mentioned ?

The council should arrange whatever dad needs, as it should all be recoverable from the insurance company.

The insurance company or the solicitor acting for dad needs to talk to the council as soon as possible.

From what you have told us, regardless of who pays what, dad should be assessed for NHS Continuing Healthcare immediately.

Thank you. Apparently any claim could take up to three years and the hospital want to discharge my father next week. He has been assessed under the continuing care assessment and whilst he has high needs in all areas and severe in one he is not priority so does not qualify.

The only advice I can give is to be as hands on as possible.

Talk to as many carers and nurses in each home you visit, go at different times as while care levels might be excellent at 9 in the morning, they will suffer in the night. Talk to the management, a very important issue for me, bad management will drain down to the carers.

Then tell the Council where you want your Dad to be placed, who knows, they might actually listen and if they don’t you can give concerns about where he is being placed.

Faye, have you checked the criteria for CHC funding yourself. Severe needs and high do count. May be worth seeking more advice on this. Age UK have a fact sheet or you could even go to one of their offices. I’m going through this again so am researching quite a bit.

Main CHC / NHS Continuing healthcare thread no help here ?

yes Chris, there is help, however, sometimes looking at other sites, or face to face chat, can be beneficial, ( or even more confusing admittedly!)

If anyone spots an additional source … shout … I’ll add it to the main thread.

It’s vital that the thread evolves to reflect what’s actually happening in the real world.

Hi Faye
Re part 2 of your question. No council pays the going rate for any Home, they only pay discounted rates, and few Homes will say they accept Council funded residents. However do not let that deter you.
In an ideal world the Council should give a list of Homes to look at and each of those Homes should have a room available to Councils BUT Homes are full and cost more. So Councils play a game where they tell you to look and then say the Home you like doesn’t offer their rates and they will then ask you for a TOP UP because you chose the Home.
This is wrong as if there no rooms available at their rate, they are the one’s who have to pay the difference Not you. DO NOT agree to or sign any top up agreement or contract. The Council should allow Dad enough to cover his needs

Councils may also try to bully you by saying thing as like Dad will have to share a room, or that the only room is in the worst home.

But none of this will come into play if Dad gets CHC funding

Good luck, keep fighting and being assertive. Still visit Homes to get a feel and a view but don’t discuss finance, that’s Councils job

No one should EVER be asked to share a room. Everyone should have their own room, unless they specifically ask to share with a partner or close friend. I’m sure this is in the CQC rules somewhere but don’t have time to find where right now.

Care homes … shared rooms ?

Couple of threads on the Alzheimers Society forum on this aspect :

Sharing a room in a care home | Dementia Talking Point

Shared rooms in care homes... | Dementia Talking Point

Thank you for all the responses. To be honest I found some of the links and posts on the Alzheimer’s website terrifying and it’s reminded me that there’s no way, despite all his health problems, that my father is at the moment ready for residential care. I appreciate that this may change in the future.
He has a lovely flat which he is really happy in. Despite issues over some of the carers / patient transport he was managing.There is no way , after 50 plus years of living alone, he could share a room with someone. Whilst he may be disabled and currently has delirium (which we hope will lift out of the hospital setting ) he is of sound mind. I appreciate that some people enjoy the company but he would utterly hate not having any space of his own.
I do want to prepare for the future but find it very hard not knowing basic things like how much the LA might be prepared to pay or how it’s decided whether you need nursing or residential care. It’s all very tricky and it’s all very worrying. Thank you

AGE UK link posted earlier … sets out all the basics … and more.


Try to think of this as a journey, maybe more like a maze?

Sometimes there will be a suggestion, that MIGHT be an option, but then when you start going down that route, you realise that it’s not suitable, a complete and utter dead end in fact.

You may come across a number of dead ends, but each time you will learn something more about what you and dad DO want.

If looking at the residential care has made you realise that because dad has a lovely flat and that going back there is what is his own top priority, then head for that. Next look at what he NEEDS in the way of care, and how that can be achieved.

If the council say that he needs more care than they can provide at the moment, then that is, in law, the point at which NHA Continuing Healthcare should be taking over. CHC can pay for help at home, as well as residential care.

If you have been told he doesn’t qualify for CHC, were you present when that decision was made, and his scores discussed? If not, then that assessment needs to be redone as the first one was unlawful. Challenge it.

If the accident insurance can’t be finalised immediately I’m sure the solicitor should be able to get an interim agreement, as the other party have admitted liability.

Hi Faye,

A confusing maze of information but you are right to be prepared ahead of the game.

Either the local council or the manager of a local care home should be able to give you an indication of the maximum the council will pay. In my own area (London borough) it is around £800 per week.

You are right in that care homes are cheaper than nursing homes but you need to prepare for the fact that sadly your dad will deteriorate. The last thing you would want is to have to move him because his nursing needs are greater than a care home can accept.

The best people to ask advice from are your local branches of Age UK or Alzheimers Society. I have also found incidentally ambulancemen a mine of information!

I would suggest visiting a few care homes and seeing what locally is available. You may never need it but like a boy scout it is best to be prepared. Incidentally when my mum was going into a nursing home, I visited around 20 homes and NEVER saw shared rooms. I did see some without private bathroom facilities but I insisted on that too.

Good luck, Anne

If dad needs two people to help him, then that will be classed as needing nursing care, not social care.

Thank you all so much for your helpful and kind replies. It really does mean such a lot.
I feel so very alone - Dad has now been in hospital for nearly three months and we are under such pressure to just agree for him to be discharged regardless of whether the care in place is right or not. The last meeting had seven reps from the council and hospital and just me (we are trying to appoint an advocate for Dad and now have a solicitor who writes on his behalf) - but it is all so hard.

I don’t know whether any of you have felt like this but I have actually felt quite intimated at times and worried about how safe Dad is when he is alone in the hospital. It seems mad to be even saying this but he’s just in a room on his own - can’t see, hear and has multiple disabilities. I’m not sure how responsive the nurses are when I’m not there - many seem amazing but others have to be honest been rude and aggressive with both of us. When you are a lone carer I think it can be so hard to know how much is in your head because of all the stress and how much is unacceptable behaviour by staff - but I can definitely feel that some members of the ward staff are being funny with both Dad and I. If nothing else I’ve heard them criticising us in hand overs/ in the corridor. A horrid experience! I have tried to be overly nice (bought chocolates, cakes), washed, dressed , fed him etc to reduce the pressure on them but I can feel some just resent us being here and are quite aggressive (a cultural thing? Because I’m here on my own too much?). it’s horrid. It makes you feel like we don’t matter / that we are not part of society/ irrelevant. I’m sorry for offloading but I’m just really struggling at the moment. Thank you for all your help / advice and kindness. It means such a lot.

Faye, I was in almost identical situation a few years ago with my mum. Truly horrible.

Mum’s hospital kept moving her between wards, in the end she was bullied that she said to me "Get me out of here, I don’t care where I go. Every nurse that I see asks me at the beginning of each shift “Do you know when you are going yet?”

They said she was fit for discharge, then started vomiting blood! Then fit for discharge, and she started passing blood. Even when she was in the Medical Assessment ward, on a drip, nil by mouth, and I’d been warned that she would be dead in a week if the bleeding didn’t stop, the OT came over and tried to bully us about discharges! I made a formal complaint about that, and she was made to apologise.

Ask Social Services to give YOU an advocate as well. I have one, it’s great to have someone on my side.

#me too!