Advice on getting care for the old or otherwise ill or disabled..

[Peasgood]

1 hour ago, headgroundsman said:

I hate to think what it is like for people that really need help urgently 

That is the worrying thing isn't it.

In Mum's case she had me and my brother to sort things out for her and to care for her etc (as I believe family should where they can) but what about the poor souls that do not have that backup there for them? Plenty of folk could fall into that category for all sorts of reasons, simply distance can easily be the issue. Brother lives close to Mum's and I am 10 miles away, couldn't have done much if I was 100 miles away or even abroad.

Brother and myself are self employed, no employer would have been able to let us have the time out we have  taken. We can afford the time out too, we have to but that is definitely not the case for all.

Things have been a bit crap alright but we have also been incredibly lucky in lots of ways in that we have been able to cope for the most part. It was the stress of dealing with "the system" that put a major strain on us. Brother did end up in hospital with suspected heart attack/stroke (turned out not to be fortunately) and I really don't think I was far behind.

[john87]

4 hours ago, Baldbloke said:

Your doctor at your nominated surgery is the one who should be arranging a care package as well as just in case medication and even a syringe driver if required later on. At least that’s how it works up here.

It can be done through our out of hours service but should be done by the patients doctor within the community.

A hospital discharge usually just involves instructions and drugs to serve long enough for the patients doctor to do his or her job.

Likewise, any referrals for additional services and even hospital admission is routine for the patients doctor to organise. It’s just a sad fact that inadequate care packages are sometimes in place, or a patient suddenly goes downhill quickly and needs emergency help (or an hospital admission) such as ours in out of office times.

I think you are looking at things from the NHS perspective and not social care [which can be residential or in a service users own home]

 

A doctor would organise follow up care from the NHS as you say. This is because a local authority is banned by law from providing medical care unless it is "incidental and ancilliary" to the provision of accomodation by them.

 

Insofar as a doctor would arrange a care package in the english or welsh sense, the only part they would play in this would be to telephone social services, or at least that is how it works in england and wales..

 

In scotland, are the NHS and social services separate entities as they are here, or are they one and the same?? If so, that would change things a lot..

 

john..

[john87]

3 hours ago, headgroundsman said:

As i understand it a community OT will assess someone's needs. My experience of Community OTs however is woeful, When i needed help following an operation on my right shoulder it took them 8 weeks to call to make an assessment. Baring in mind i am paraplegic and a full time wheelchair user having one shoulder needing rest is difficult. I was back working full time in my job as head of the grounds at a hotel when they called, Needless to say i was less than impressed. When i move house i asked them to come to assess the property to see what i needed to be able to get in, sleep and make an assessible bathroom. Someone turned up after 5 months and his first words were " I think we have let you down". I was already having the bathroom and downstairs bedroom done. I was lucky that there was an annex with a wetroom but they did not know that. I have just spent 3 months in hospital an they asked for the community OT to come to see if i need anything extra. They phoned the other day, a month following my discharge to say they had received the referral and they will be getting back to me sometime to arrange a visit. Good job i have recovered well and am fitter and stronger than last year. I hate to think what it is like for people that really need help urgently 

Your needs would initially be assessed by a social worker, who would then do a referral to the OT..

 

The decision on whether to meet your needs is PURELY down to the social worker, HOWEVER, in a case like yours where they involved an OT, the part the OT would play, would be to make the decision as to what equipment you might need.

 

So for example, someone alerts your need to social services.

 

A social worker is appointed, does an assessment [whether you realise or not] and they have the FINAL say as to whether your needs are to be addressed.

 

They decide that assessment by a specialist is needed, and so, in cases that involve mobility issues, they will do a referral to the OT. [As the law states that assessments have to be carried out by a suitably qualified person]

 

The OT decides that you do have needs getting upstairs [for example] Now, where assessment is carried out by a specialist, in the event of disagreement, the views of the specialist prevail.

 

This means that if the OT decided that you needed a very expensive stairlift, even though social services managers would choke, you would be getting a stairlift, as that would be the verdict of the specialist and their opinion prevails as i explained..

 

Your first port of call when seeking help [unless you were assessed as eligible for NHS CHC [continuing health care, which is unlikely AND the assessment must be carried out prior to your discharge from hospital] UNLESS you are seeking strictly medical intervention, [in which case you would go to a hospital] is always social services, an S9 care act 2014 assessment in england, and an S19 assessment under the terms of the social services and well-being act 2014 in wales

 

Clear as mud innit..

 

john..

Edited February 21, 2022 by john87

[Baldbloke]

I think you are looking at things from the NHS perspective and not social care [which can be residential or in a service users own home]
 
A doctor would organise follow up care from the NHS as you say. This is because a local authority is banned by law from providing medical care unless it is "incidental and ancilliary" to the provision of accomodation by them.
 
Insofar as a doctor would arrange a care package in the english or welsh sense, the only part they would play in this would be to telephone social services, or at least that is how it works in england and wales..
 
In scotland, are the NHS and social services separate entities as they are here, or are they one and the same?? If so, that would change things a lot..
 
john..

Yes, correct. I’m coming from who organises medical needs. Sure, OH provides the handrails, raised toilet seats and other kit, but it tends to be clinicians who initially refer onto social services when there’s a need.

Yes they’re separate departments but just a few years ago there was a change up here where we were notified of our dept being partnered with the local Council, although we remain NHS employees. Social care is accessible through note referrals or a call to someone whose on call. This happens when we arrive at someone’s home at 2am and need to go through the rigmarole of contacting them because the single mother is requiring hospitalised and there’s no one to look after her baby and kids. Or, when a carer is the one of a partnership and is desperately needing hospitalised and the other partner is stuck in a wheelchair.

[john87]

5 minutes ago, Baldbloke said:

Yes, correct. I’m coming from who organises medical needs. Sure, OH provides the handrails, raised toilet seats and other kit, but it tends to be clinicians who initially refer onto social services when there’s a need.

Yes they’re separate departments but just a few years ago there was a change up here where we were notified of our dept being partnered with the local Council, although we remain NHS employees. Social care is accessible through note referrals or a call to someone whose on call. This happens when we arrive at someone’s home at 2am and need to go through the rigmarole of contacting them because the single mother is requiring hospitalised and there’s no one to look after her baby and kids. Or, when a carer is the one of a partnership and is desperately needing hospitalised and the other partner is stuck in a wheelchair.


 

Yes, here in theory it is the same. [Wales] The NHS and social services are supposed to work in unison and even carry out a joint assessment ["the unified assessment process"]

 

To bad though, that in the area of my expertise, mental health, the assessment required by law for NHS purposes under the "Mental health measure" is completely different to the one that social services have to do by law under the SSWBA, totally different domains of assessment..

 

What will happen, and i expect you have seen this already, is people getting stuck in the middle, with no support, while the two halves of the "team" argue over whose responsibility it is to meet the need..

 

The entire thing is a complete mess..

 

john..

[headgroundsman]

20 hours ago, john87 said:

Your needs would initially be assessed by a social worker, who would then do a referral to the OT..

 

The decision on whether to meet your needs is PURELY down to the social worker, HOWEVER, in a case like yours where they involved an OT, the part the OT would play, would be to make the decision as to what equipment you might need.

 

So for example, someone alerts your need to social services.

 

A social worker is appointed, does an assessment [whether you realise or not] and they have the FINAL say as to whether your needs are to be addressed.

 

They decide that assessment by a specialist is needed, and so, in cases that involve mobility issues, they will do a referral to the OT. [As the law states that assessments have to be carried out by a suitably qualified person]

 

The OT decides that you do have needs getting upstairs [for example] Now, where assessment is carried out by a specialist, in the event of disagreement, the views of the specialist prevail.

 

This means that if the OT decided that you needed a very expensive stairlift, even though social services managers would choke, you would be getting a stairlift, as that would be the verdict of the specialist and their opinion prevails as i explained..

 

Your first port of call when seeking help [unless you were assessed as eligible for NHS CHC [continuing health care, which is unlikely AND the assessment must be carried out prior to your discharge from hospital] UNLESS you are seeking strictly medical intervention, [in which case you would go to a hospital] is always social services, an S9 care act 2014 assessment in england, and an S19 assessment under the terms of the social services and well-being act 2014 in wales

 

Clear as mud innit..

 

john..

This may be your experience however my referrals have come directly from the resettlement department at the spinal injury centre.  I have never had a social worker. Also any expensive equipment will be paid for after a means test by the individual if the test suggests they should make a contribution and only then by social services to make up the difference. I know this as i used to give presentations on this subject for the Spinal Injuries Association. It is only not means tested if the person qualifies for CHC

 

[john87]

41 minutes ago, headgroundsman said:

This may be your experience however my referrals have come directly from the resettlement department at the spinal injury centre.  I have never had a social worker. Also any expensive equipment will be paid for after a means test by the individual if the test suggests they should make a contribution and only then by social services to make up the difference. I know this as i used to give presentations on this subject for the Spinal Injuries Association. It is only not means tested if the person qualifies for CHC

 

 

Ultimately, aftercare is provided EITHER by the NHS [as CHC] or by the local authority social services department, under either the care act, or the social services and well-being act, depending on where you live.

 

You would not need to have a social worker, but it would ultimately be a social worker who makes the decision as to whether or not a person has an "eligible" need under the acts, as it them [social services] that will be paying [unless, as you say, you qualify for CHC]

 

As you say, it is only NOT means tested if the person qualifies for CHC, and this is correct with the NHS paying for the lot

 

Otherwise, [if you did not qualify for CHC] it would fall to the LA as part of their duties [or powers if it suits them] under the acts to provide for your needs instead, and so the person would be means tested by the local authority THEMSELVES, [as it is them providing the care] and, depending on circumstances, a person may or may not be required to meet the full cost themselves or contribute a proportion or indeed nothing at all [but this would be unlikely as you would presumably qualify for PIP]

 

john..

[paul1966]

Has anyone experience with live in carers, my dad is currently in a private nursing home due to having repeated falls at home, we don't think he will be safe on his own especially at night, the carer industry is a bit of a minefield anyway and it seems live in carers even more so. The agencies seem to pay the carers they hire about £700 per week but the agencies charge the clients £1300. 

At the minute we are a bit lost really. 

[john87]

2 hours ago, paul1966 said:

Has anyone experience with live in carers, my dad is currently in a private nursing home due to having repeated falls at home, we don't think he will be safe on his own especially at night, the carer industry is a bit of a minefield anyway and it seems live in carers even more so. The agencies seem to pay the carers they hire about £700 per week but the agencies charge the clients £1300. 

At the minute we are a bit lost really. 

Hi There,

 

I do not understand what you are asking. If he is in a private nursing home, how can he not be safe at night?? What is the problem, What do you think needs to be done?? Define EXACTLY what you mean by "live in carer" live where???

 

john..

[Essexlogman]

41 minutes ago, paul1966 said:

Has anyone experience with live in carers, my dad is currently in a private nursing home due to having repeated falls at home, we don't think he will be safe on his own especially at night, the carer industry is a bit of a minefield anyway and it seems live in carers even more so. The agencies seem to pay the carers they hire about £700 per week but the agencies charge the clients £1300. 

At the minute we are a bit lost really. 

Firstly my condolences to anyone who has lost someone or is experiencing this similar situation but 

"A bit lost at the moment" and also not having any control over anything is a horrible situation to find ourselves now personally in, I am just wondering paul1966 was your dad taken to hospital then discharged to a private nursing and was he happy being in there? was it your dads decision to go in and now has decided he wishes to go home? as we are in this scenario now with Mum as she initially went into hospital with fall related injuries as well although on top of that she has mobility issues and is very frail as well, long story short though she ended up contracting two other contagious illnesses  Oh yes and I forgot to mention the other one covid as well being 86 now and recovering from all of that now and being in hospital for three months two of which she has apparently been medically ready to be discharged now, Her partner has seen her three time Me and my Brother have not seen her My Sister got too see her on the day covid was diagnosed so we could not then arrange to see Her. Now it comes to the discharge firstly what we have got to deal with is she does not want to go into a nursing home but wants to go home, Ok fair enough now we are not one to burst someone's bubble hope and all that but their is no way on earth this is going to happen unfortunately Her and Her partner are convinced that it is going to happen, the assessment team have been round to her house and seem to think with a hospital bed, a commode and 2 carers 4 times a day will suffice ( sounds great on paper but with care staff shortages and out in the sticks feel she is a low priority)  but here is the rub the other option would be to go into a self funded private nursing care home closer to her house no problem (which I mentioned she does not want to do) where we could at least visit regularly here is the quandary this is what WE would like and feel the decision is best left to Mum and her partner because it is what she wants all decisions are being made by the NHS and Care Assesment teams so we have had to stop feeling like we are banging our heads against a brick wall and take a conscious step back (as hard as that is) as on the one hand the options seem "clear to us" but not to them I do hope thing's will work themselves out soon Best wishes to everyone