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.
‘Unanimous view’
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.”
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I’m intrigued to know how the figure of £9,000 a week is reached. Presumably, staff costs are the greatest proportion. Given what domiciliary care workers are paid, even if there were two workers present around the clock, how does anyone get anywhere near this figure? Something doesn’t add up here.
I am surprised he does not qualify for continuing healthcare funding.
I agree Continuing Healthcare assessment appropriate. But I am also struck that no mention is made of thousands of older people in the same boat, because residential care is cheaper than care at home. Is their case not as important? Why?
Completely agree with the above. Whether or not he has capacity how can ithis level of funding be justified, when other equally if not more vulnerable adults can not have a POC at £9,000 per week. Choices are hard, but this is reality.
Castonparade, you are right he should be eligible for free NHS Continuing Care, however, they are still entitled to meet his need in the most cost effective manner, this will not be at home.
Clearly the issue of capacity to choose where to live is effectively a none starter, as he will not have a choice.
It is a sensible outcome to place him into a care home even if her does not or cannot consent. The state cannot provide all needs, in many countries he would simply be allowed to die. It would also seem that the man has not helped his own cause by unreasonable behaviour, alcohol and drugs.
Choice always meets the hard reality of resources and the hard reality is resources always win.
I would like to know how he fell off the roof, was it a work related injury and if so he may have been awarded compensation which could pay towards his care at home if he had sufficient amount. I sgree with previous comments regarding CHC funding.
A man Called horse,
I too might resort to alcohol and drug use if this was the bleak outlook for my future
I agree with Catsonparade this has to qualify for continuing healthcare funding . I think there has been some agreement made between Councils and the NHS as this is not the only incident where this has happened.
As the Council’s system is also means tested it also results in the person having to Pay if they have sufficient assets whereas any NHS involvement would not be means tested
I do not understand the legalities behind this decision perhaps CC could look into this ?
I think it will be tragedy if this man is deemed to have capacity and is still not allowed to decide where he wishes to live.
If he has capacity to accept the risks involved with returning home with a true personal health budget of £3000, then he should be allowed to do so. Otherwise, he would be unlawfully deprived of his liberty in my opinion. Although I do agree that the council or health should reasonably only have to pay the cost of his current package of care that meets his needs. With this amount of money, he should be able to meet the majority of his needs by having. 24 hour presence and substantial amount of targeted hours of 2:1. The agency wanting to charge £9000 for this care if taking the advantage of this man’s situation. This does sound like a CHC case, so I’m unclear why the council had to go to court with this.
Why is this man under the local authority? Surely with needs that high he should be under Continuing Healthcare (CHC) ?!
2:1 support at £15 per hour for 24 hours per day for 7 days costs approximately £5000, not £9000, which is in my experience unprecedented. PA support would cost less again. This man needs a strong independent advocate and/or an innovative, skilled and progressive provider. Also, prior to 2010 ILF would have been available to provide a national resource to supplement the cost to the Local Authority.
Shocking. It just sums up what we have become as a nation when money comes before humanity and compassion for a vulnerable person with such complex needs.
With regard to CHC funding, if he meets the criteria, will still only consider the most cost effective option and therefore I feel this man would not be funded for a care package at home for £9000 per week. He would only meet CHC if his needs, for example are unpredictable and do not respond to intervention etc. I agree however that in terms of choice for this man, it comes down to costs and therefore he has no other option but to remain in a care facility.
Regardless of who pays the cost is absurd and highlights the profit margins that care agencies (and care homes) expect and get – often a 50% profit margin.
We can’t be too judgmental of care companies and the charges that a lot of the organisations pay. Carers have been undervalued for a significant number of years being paid for the time they are in a persons property rather than the full hours that they work. Believe me, I did this job before I qualified as a social worker. I had to work unrealistic hours to come out with enough to financially support myself, I can’t imagine how difficult it would be if I had kids. I rarely made enough in a day to meet minimum wage requirements.
Central government needs to stop imposing cuts to local authority budgets while at the same time wanting us to provide a personalised service. The budgets they expect us to work with do not reflect how much care actually costs and the quantity that is needed to provide a quality service where citizens and domiciliary workers are valued and treated with dignity and respect.
We as a collective also need to tackle how these budgets are dished out. I live in a Northern city and my local authority is run by opposition parties to the Tories and it is fact that cities that have opposition parties in power receive less funding rather than funding that reflects the need of those citizens.
poor chap. However, in addition to his very substantial care needs, we are told he has personality and behaviour problems arising from his head injury. And that if he was to be looked after at home, his needs are such that he would require two carers in situ permanently, and additional carers to support him during the day. I don’t think this is feasible. You cannot replicate hospital care to someone with these kinds of needs, safely, at home. I think it was right to uphold the LA’s decision.
This man sounds like he needs skilled intervention, given his high physical needs as well as complex personality and behavioural difficulties. Is that perhaps where the £9k a week has been accounted for, for skilled intervention rather than say the more straightforward 2:1 caters? In my experience, I would imagine he is receiving the skilled interventions presently in the inpatient setting which can be very difficult to replicate in the community. It is stated that this man longs to return home to be with his possessions……..bring what is most wished for to his present setting. I agree, difficult decision though it may be, but resources are finite, whether LA or CHC. He does not sound unduly upset about the decision, stated ‘merely’ disappointed, by his appointed solicitors, who are also a costly resource.
I’m surprised that he doesn’t get continuing health care funding (although whoever is responsible for funding is going to be in this position ). Also, how on earth is that weekly cost calculated? Even specialist care at home can’t be this much (& a high percentage of the cost would be agency fees I guess rather than care staff). Staff who are specialists are few and far between and consistency could be difficult to manage in the community.