We’ve just been asked if there could be any ulterior motive behind an unhelpful care home manager suddenly wanting to take a resident with severe dementia (Mrs P) to a Christmas pantomime.
It’s an unusual question, and our answer may sound cynical, but we’ve heard too many cases of maladministration in the care funding assessment process to advise anything other than caution…
Mrs P’s family is in the middle of applying for NHS Continuing Care funding to cover her care fees. It’s been a tortuous process to date, and the care home manager has been very reluctant to help. Plus, it’s taken over a year so far just to get through the first stage.
It would almost certainly be traumatic for someone with advanced dementia to be taken to a noisy, chaotic pantomime, and so could there be a hidden agenda behind the care home manager’s desire for Mrs P to go?
Generally speaking, a care home gets paid more per week directly from the resident than it does if the NHS is paying. So if Mrs P’s family succeeds in securing NHS Continuing Care funding for her, the care home will lose out financially. There is a clear conflict of interests.
To protect its revenue, one option for the care home is to ensure the daily care notes for Mrs P show that her health needs are not as bad as the family makes out – and that she is more able that previously thought. In Mrs P’s case it certainly sounds as though the care home manager is aware of that – and so anything that is subsequently mentioned in the daily care notes about a Christmas outing and about how much Mrs P ’enjoyed it’ will certainly count against Mrs P when the NHS reviews those care notes for funding purposes.
So be cautious. It’s a pity that families have to look at potential ulterior motives in issues like this because, of course, there are many helpful care home managers out there.
Our advice to Mrs P’s family was to stop the care home taking Mrs P to the pantomime – and to explain their reasons purely from a dementia point of view. Plus, we suggested they ask the care staff to write those reasons in Mrs P’s daily care notes, to emphasise that her cognitive impairment prevents her being able to join in such events – all of which is perfectly true.