A man who was left with severe injuries after falling from a roof has been told he cannot return home from a specialist hospital unit because a council is “unable and unwilling” to fund the 24-hour care package needed to ensure his safety.
The 32-year-old man’s care costs would rise from £3,000 per week to just under £9,000 per week if he moved home from the unit, the Court of Protection heard.
The local authority said this level of funding represented approximately 1.5% of its annual adult social care budget and was therefore “unsustainable in the long-term”.
The court heard that the decision had come as a blow to the man, but he had agreed that the rise in costs was “steep” and “even he thought it was too much”. However, he added: “I think it’s a bit unfair to leave me in a care home just because of how much it costs.”
It has yet to be determined whether the man has capacity to make decisions on where to live, but Justice Holman warned that even if he is deemed to have capacity, there may be “very little room for capacitous choice” because of the limited options available to him.
‘Care package unravelled’
The man suffered spinal injuries after falling from a roof in 2011 and is now tetraplegic. He also banged his head during the fall and suffered frontal lobe damage. He needs support to get in and out of bed, go to the toilet and perform daily living tasks. When in bed, he also needs to be frequently turned to avoid the development of bed sores.
The court also heard how the fall had affected the man’s personality and some of his thought processes. “It is not in issue that he has from time to time resorted not only to considerable consumption of alcohol, but also the use of hard illegal drugs,” the judgement said.
The man was provided with specially adapted accommodation in his hometown after the accident, but his level of disability meant he could only live at home with “very considerable care and support” provided by the local authority and other agencies, the court heard.
His care package involved the permanent presence of at least one carer at any given time.
The court heard how the man’s care package began to “unravel and break down” for reasons connected with his personality and behaviour, which meant those caring for him became increasingly reluctant to support him. He later developed severe, septic bed sores and was admitted to hospital in December 2015 for serious treatment. He has remained there since.
“He longs to return to live in his own home, where many of his possessions still are, and he frets at not being able to do so,” the judgement said.
At a hearing in July 2016, Justice Holman ruled that it was in the best interests of the man for a one month trial of care at his month to be “considered and explored” by the local authority.
A meeting of 19 professionals involved in the man’s care took place the following month. There was an “almost unanimous view” that the trial at home could not realistically be contemplated or undertaken. However, the treating psychiatrist “conspicuously” disagreed, the court heard.
The local authority then looked for care agencies that would provide the care package at home. Staff had assessed that two professional carers would need to be present at all times and deliver round-the-clock care to meet the man’s needs.
“But in parallel, as I understand it, the local authority feel, and/or the possible care agencies feel, that a single carer could not safely be left alone with this patient,” Justice Holman said.
One care agency offered to provide the care package at just under £9,000 per week.
‘Firm and final decision’
The local authority has now taken “a firm and final decision” that within the overall budget available to them, they simply cannot, and will not, provide funding at this level, the court heard, but will continue to fund his care in the specialist unit at the hospital.
The head of safeguarding and learning disabilities said in his letter to the court: “I appreciate that the current funding request is for a month’s trial only, but if it is successful and in his best interests to return home, the cost will continue.
“It would be unfair to [the patient] to allow the trial in the knowledge that there is a real risk that the care package would not continue to be funded after the trial.”
Justice Holman said of the council’s decision: “It is obvious that the resources of the state and of local authorities are not infinite. The state and local authorities do have to take very difficult funding decisions regarding the overall allocation of scarce and finite resources.”
The man’s solicitor told the court that he “was not angry with the news that the local authority would not fund care, but he was disappointed”. The man has since suggested that the council consider paying him the weekly sum they pay the hospital so he can use the funding to arrange his own care. Justice Holman described this suggestion as “completely unrealistic”.
‘Very sad reality’
However, the question still remains whether or not the man lacks the mental capacity to decide where to live. Two psychiatrists involved his care have taken the view that he does lack capacity, but this has only been determined by the court on an interim basis.
Another hearing is scheduled to take place later in the year to determine whether or not the man lacks capacity, but Justice Holman warned that he had “considerable concern and misgivings” at the prospect of the hearing when there may be very little point to it.
He said he was concerned “at the prospect of incurring yet further tens of thousands of pounds of expenditure of public funds on some abstract determination of capacity if, realistically, there is no choice in the way forward for this particular patient in his circumstances.”
A new hearing has been set for late November, at which Justice Holman will decide whether there is any “real point or purpose” in the longer hearing taking place the following week. The local authority will be required to consider the man’s request of a reduced care package.
Justice Holman concluded: “The very sad reality of this case and the plight for this person is that, for the rest of his life, he will inevitably be almost totally dependent upon the state for the provision of all his most basic care and needs. It has to be accepted that that care and those needs can only be provided for within a framework that is realistically financially viable.”