All posts in Articles about older people

Person Centred Planning Unwrapped

Many professionals consider their practice is person centred but I often struggle to find evidence to support their claim. So what does being person centred mean and what does it look like?

What Being Person Centred Means

There is no universally accepted definition. The key principle for being person centred is to support and empower people to make choices and have control about how they want to live their life. Person centred planning encourages people to be more involved in decisions about their care so they get the support and services that are appropriate for their needs and preferences. It’s about seeing the person as an individual before their age and disabilities, focusing on their preferences, expectations, needs and circumstances and trying to see things from their perspective.

Being person-centred also means being aware of a person’s emotional and spiritual well-being. Spiritual care is not just about religious beliefs and practices: it also reflects the person’s values, relationships and need for self-expression.

Communication Challenges

We need to be aware that people are sometimes unable to tell us what they want. There are many reasons for this; they may be living with dementia, have a physical disability, severe hearing loss or a mental health condition, which makes communication difficult. We may therefore have to use appropriate communication aids to find out what they want and actively encourage them to participate in their care planning so they can be real partners in making decisions about their care choices.

Getting To Know The Person45281480

When planning in a person-centred way with someone, we need to think about the effect of what we’re doing on the person as a whole. We therefore need to know the person and find out as much information as possible. Before you begin care planning, ask the person (or the person/people who know them well) about themselves and the things that are important to them. Listen carefully to what they are saying (sometimes what they are not saying can be as important) and ask probing questions to check your understanding is accurate.

All too often I am asked to undertake an independent care review and find the Manager and carers know very little about the person, especially if they have dementia and don’t have a family. What did they do for a living? Where did they live when they were younger and what did they enjoy doing? What made them happy? What made them sad? What are their likes and dislikes? and one of the most important questions of all, what is important to them?

Don’t only focus on what keeps people healthy and safe. See the person as well and what matters to them- not just what the matter is with them.

A case study

Being person-centred sometimes requires me to think outside the box to achieve my client’s chosen outcome. The following is a good example.

Mrs M lived with her husband who was her primary carer. She had a number of coexisting mental and physical health conditions, including dementia and severe anxiety. She had a suprapubic catheter tube inserted into her bladder through a small hole in her stomach, which she used to empty her bladder. She was encouraged to empty the bag herself to maintain her independence and this required undoing the tap and bending over the toilet pan.

As she progressed along her dementia journey, Mrs M began forgetting to turn the tap off and her clothes became soaked in urine. She always wore tight trousers and would become hysterical when this happened thinking she had wet herself. Her husband’s health was deteriorating, he was losing his sight and found changing her clothes increasingly challenging.

Mrs M’s GP and District Nurse advised that the time had come for her to move into a care home.

I was asked look at care options with the couple.

When I asked Mrs M what was important to her she told me it was remaining in her own home with her husband. They had been happily married for 64 years and didn’t want to live apart.

The solution I recommended was a small gadget produced by the Bath Institute of Medical Engineering department called a Wander Reminder costing £50. I advised this needed to be fixed to the cloakroom wall at the height where she bent over the toilet pan to empty her catheter.

When Mrs M bent over to empty the bag, a motion sensor would trigger a recorded message to remind her to turn the tap off. I advised the message needed to be changed regularly so she didn’t get used to it and ignore it.

Person centred planning and this £50 gadget enabled Mrs M to remain at home with her husband for a further year.

In conclusion

  • Get to know the individual and recognise their individuality. Decisions should always be made from their perspective
  • People have a variety of different preferences, history, circumstances and lifestyles, so the planning process needs to adopt a personalised approach
  • Find out what is important TO the person as well as what is important FOR them
  • Think outside the box to find solutions for the person to consider
  • Person centred planning needs to focus on achieving meaningful improvements in the person’s life and make a difference to it
  • Look at how the person’s identity and independence can be strengthened
  • The person’s needs are likely to change over time so make sure you review the care plan regularly.

“We cannot care for people unless we care about them and we cannot care about them if we don’t know who they are”

Won’t Listen Or Can’t Hear? How Relative Matters’ gave a Client back the Ability to Engage Again.

Relative Matters were recently requested to review the care of an elderly lady in a nursing home. A care review involves a complete review of every aspect of a person’s life to ensure both their financial, physical, psychological wellbeing and religious/spiritual needs are met safely.

Care Reviews

It is often a complex piece of work because it involves reading the care plan through thoroughly, talking to care staff and other involved people such as families or external health professionals, talking to the person whom the care review is about and observing the environment. This then enables Relative Matters to make appropriate recommendations which can include things such as the purchase of more clothing, education and advice to care home staff on how best to interact or engage with the person, particularly if they have a cognitive impairment or dementia or provision of aids such as ipads to facilitate supported communication with loved ones if they live far away or other aids to enhance their ability to engage.

In this particular instance, the lady in question was withdrawn, and in discussion with care staff, Relative Matters were advised that because of her poor hearing she was choosing to disengage. There was some concern about the decline in her mood as a result. Comments such as;

“We know she can hear things but she’s choosing not to be involved”.

“You can’t engage her if she doesn’t want to be engaged”.

“She’s choosing to give up”.

Whilst for some people this may be the case, in this specific case, things just did not add up – her friend who visited frequently kept reporting she can talk and be involved if given one to one time, and her Solicitor who commissioned Relative Matters was saying the same. The inference was that the home had given up on her and that she had been labelled as someone who had withdrawn.

Our intervention

Relative Matters made enquires with the service that completed the hearing test, and were advised that the lady had been issued with new hearing aids, but that she had severe to profound hearing loss and standard hearing aids (although they were high powered ones) would only minimally help due to the specific type of hearing loss that the lady was experiencing. So, it was clear she wasn’t choosing to disengage, she just couldn’t hear!!

Relative Matters never give up on a person; the first tack in addressing this issue for the lady was to rephrase what care staff was saying in an attempt to re-educate them that the person is still inside the lady. In many discussions with various care staff members, when Relative Matters were told “she chooses not to respond to you” this was rephrased as “she has severe to profound hearing loss so it is likely she is really struggling to hear what has been said. We will keep trying to give her every opportunity to engage with us”.

Breaking down pre-conceived labels or thought patterns about people is so important. If you can change an established thinking pattern, just by rephrasing a negative statement into a positive one, this can have astounding positive effects.

On further investigation, advice was sought from the local Action for Deafness service about whether there was any device that may assist so that all opportunities had been explored and exhausted. It was identified that a personal listener device may work for the lady. Relative Matters swiftly acted to escort the lady for assessment and amazingly, one of the personal listener devices worked first time.

Fitting a personal listening device

When asked by the assessor at normal speaking pitch if she could hear, the lady said; “No I can’t hear!” Which of course she could as she heard the question at normal speaking pitch, but that her wry humour which Relative Matters had been told she possessed was coming to light immediately! The magical part is that the lady smirked and even managed a chuckle! Sharing a joke was priceless after being unable to fully engage with her in ‘normal’ conversation up until this point.

Facilitating engagement

The device has transformed the lady’s ability to engage. To capitalise on this, Relative Matters provided some education with care staff to ensure they fully understood the importance of the lady having it with her and on at all times. Within 24 hours, Relative Matters received an email from the care home Manager stating she had come downstairs, engaged in a game of dominos, had been invited to a poetry session but was most insistent she had no interest in going!

This demonstrates how this lady was given a wonderful opportunity to re-engage, have choice in what she engages in, and be able to communicate again.

Our Occupational Therapy consultant and dementia specialist, Liz Tremlett, undertook this piece of work and wrote this blog post.

Relative Matters Ltd

Relative Matters is an independent consultancy for older adults made up of a small, dedicated team of health and social care professionals, all of whom are fully insured, registered with the Health Care Professions Council (HCPC), and public disclosure certified. Working together they offer an unprecedented knowledge-base of the local care market and ensure care is highly personalised.

Keeping the older population protected during the colder months

wintermittensmugWith autumn here and winter creeping ever so closer, there is certainly a nip in the air. With this weather comes certain obstacles, especially for elderly people. As a younger person, there are plenty of things you can do to make these chilly seasons a lot more enjoyable for them.

Avoiding Slips and Falls

The first thing you can do to help your elderly friend or relative is to find a good, sturdy walking stick or mobility aid. This will not only reduce the strain on the legs and the knees, but it will also provide that extra bit of stability for a whole host of outdoor activities.

Many people believe it is only the height of the user that determines the walking stick height. But in reality, people come in all sorts of shapes, sizes and proportions. The secret to measuring your walking stick is by following this method:

walkingstickmeasure

Walking Stick Measure

Once you have helped them choose the perfect walking stick, make sure you accompany them on a couple of walks as they get used to the conditions. If you notice they are struggling, perhaps invest in a sturdy ferrule to put at the bottom of the stick.

If they have a garden or driveway, make sure it is gritted each week, as the bags can be too heavy for an elderly person to lift. You could also buy them a handrail if they have slippy steps at the front door.

The Right Clothes

Having the correct indoor and outdoor clothing is essential. Make sure they are a wearing at least a couple of layers as this is more effective than just one thick layer. Thick shoes for outside and nice warm slippers for indoors will keep their toes from freezing. Thick socks, gloves, a hat, and a scarf will ensure their face avoids a chill, as well as protection from illnesses.

Indoors

Try and keep the temperature inside their home above 18 degrees, as being alone in a cold house can cause many problems, including hypothermia. Help out your elderly friend or relative by providing them with a talking thermometer. This will help them keep on top of the temperature in their home when you are not around.

Also, try and organise it so their heating is serviced each year by a professional. This will make sure everything is safe and cost effective to keep their home warm throughout the cold months.

Perhaps treat them to a lovely home cooked meal like a hot bowl of soup or some shepherd’s pie. This will give you peace of mind that you are doing all you can to ensure they are eating enough.

If you need more information on looking after elderly people in cold weather, check out the NHS guide on winter health.

This guest post was provided by Rachel Campbell, a Digital PR Executive for Ability Superstore (https://www.abilitysuperstore.com/)

Who Is Your Next Of Kin?

Many people think their NOK is their nearest relative but this is not the case. Read why in my latest blog post

Read more

Planning End of Life Care

As its Dying Matters Awareness Week I would like to talk to you about the importance of getting your elderly loved ones to make plans for their end of life care. I have seen what happens when people don’t plan for having an accident, a stroke or an illness such as dementia, which leaves them unable to make decisions such as whether they want life prolonging treatment and how and where they would like to be treated.

This issue is very important to me and although I will be unable to control what happens to me if I find myself in this situation, I want to choose how I live the end of my life and how my funeral is conducted. I have therefore taken out a Lasting Power of Attorney for both my property and affairs and my health and well-being. I am also  one of the 3 in 10 people who have made a will. Why on earth would I want to leave my hard earned dosh to the Government?

Holy spirit dove flies in blue sky, bright light shines from heaven, christian symbol, holy bible story

I would much rather address these matters while I am relatively young and have no intention of dying, although  like everyone else I have no control over that whatsoever. If I leave it too late and am no longer able to make my own decisions, I will not be able to make these plans myself.  Now I can relax, forget about the Lasting Powers of Attorney which will only be able to be used if I am unfortunate enough to loose my marbles so there is no danger of my sons (who are my attorneys)  selling  my home and emigrating with my loot.

Although it is possible to download the LPA forms and will template  from the Internet  and do it yourself I chose not to do this as unintentional mistakes can be made by not considering all eventualities. If you have made your own will and LPAs this only comes to light when it is too late to do anything about it. So find yourself a good solicitor. You will be glad you did.

Here is an example of a situation  I remember from my days of working on night duty at the local hospital. that illustrates my point nicely. I have made up their names for anonymity. To be honest I can’t remember them anyway!

Example of  how failing to plan can cause conflict in a family

Steve lived near his father and they had an especially close relationship. When his father had a stroke Steve was asked whether or not he wanted his father to be resuscitated if his condition deteriorated. Steve told me that his father valued his quality of life and felt that if it was seriously compromised, he would not want his life to be prolonged. However, his brother disagreed and as you can imagine, the situation could have caused a serious conflict within the family. Luckily his father’s condition improved and a decision did not have to be made.

Another example is a personal one. When my father became terminally ill, I knew exactly what his wishes were and had power of attorney to back up decisions I made on his behalf. He died peacefully at home listening to his favourite music, being assured it was OK to let go and reassured that my brother, sister and I would look after our Mother. I cannot stress enough the comfort it gave me to know I was carrying out his wishes just as he would have wanted.

A letter of wishes

I have one last thing to do to ensure my choices are taken into account, I am writing a letter of wishes to be go with my papers, so that my sons know exactly what I want to happen if I have an accident become seriously ill or lose the ability to make decisions for any other reason. Also where and how I want to live if I am unable to make my own choices, how I would like my body disposed of at the end of my life and what I want to happen afterwards.

We are all going to die

As a society we tend to avoid talking about these matters. However, death is a part of life and if they are faced, discussed and planned for we can forget about them, know our wishes will be heeded and acted upon and that we have saved the person or people we have left behind the responsibility of guessing our choices. Don’t leave it too late

Millions leave it too late to discuss end of life wishes. Don’t let an older person you care about be one of them.! The following website offers lots of good information to help you. Dying Matters.Org

7 Important Things You Should Know About Care Needs Assessment

In my previous blog, How To Avoid Negligence Claims – Working With Elderly Clients I outlined ten important questions to ensure practice is sound and person-centred and said that I would explore each one separately. My first considers care needs assessment for older people.

Local authorities must undertake an assessment for any adult with an appearance of need for care and support, regardless of whether or not the local authority thinks they have eligible needs and regardless of their financial situation.

The duty is triggered under Section 9 of The Care Act 2014 for anyone who appears to be in need of support services.

The purpose of an assessment is to identify the person’s needs, how these impact on their well-being and the outcomes that the person wishes to achieve in their everyday life.

Even if the person doesn’t want the Council to support them it is helpful that they have a needs assessment to provide a foundation for care navigation and procurement.

There are two interdependent parts to the assessment and both must be met to qualify for social care funding. These are care and support and financial eligibility

Planning senior care on a whiteboard.

Using a Care Needs Assessment For Planning

  1. The criteria used to assess care and support needs

To be eligible for social care funding a person must be assessed to have a ‘substantial’ or ‘critical’ level of need. As a minimum, they are likely to need support with personal care and daily living on a daily basis.

  1. How financial eligibility is determined

The following rules apply to financial assessments for both residential care and care in the home:

  • People with over £23,250 pounds savings/capital will meet the full cost of their care.
  • People with between £14,250 and £23,250 will make a contribution from their savings/capital as a tariff income of £1 for every £250. A contribution from income will also be assessed.
  • People with savings and capital below £14,250 will not make a contribution from capital but contribution from income will be assessed.

The difference between the assessments is that for residential care, a person’s property is taken into account.

  1. The care assessment

A Care assessment is not always undertaken face-to-face. It is not unusual for an unplanned screening assessment to be carried out directly with an older person over the phone. This can come out of the blue to the older person, especially if they live alone. Older people are proud and often eager to minimise the help they need. Many are hard of hearing. Make sure you ask to be advised if and when a phone assessment will be taking place when making the referral, so you can prepare and support the person.

During the assessment the person should be advised to answer all questions as if it was their ‘worst day’ without any support.

  1. The person must have capacity to make decisions during the assessment

If an individual requiring assessment lacks capacity and there is no registered LPA in place, the Care Act imposes a responsibility to refer the matter to the Court of Protection who can appoint a professional Deputy.

  1. The person has to be offered support to participate if necessary

New rules under the Care Act 2014 allow the person to take the lead in explaining what support they need to make life easier for them.

There is also a duty to provide independent advocacy to represent and support the person, if needed, to facilitate their involvement in assessments.

  1. Unpaid carer’s needs and their need for support are entitled to be assessed

There is a duty for carers to receive an assessment regardless of their needs for support or their financial resources. Also to provide independent advocacy to represent and support them if necessary.

  1. Obtain a written copy of the assessment

The assessment and any other relevant information will be recorded and authorised. Make sure the person obtains a copy as they or their representative have the right to challenge or dispute anything they don’t agree with.

Here are some helpful links

The Care Act 2014 – Assessment and Eligibility

How to get help with social care for adults in West Sussex

Apply for adult care assessment in East Sussex

Apply for adult care assessment in Surrey

My next post will consider Health Assessments

How To Avoid Negligence Claims – Working With Elderly Clients

All legal professionals working with elderly clients want to avoid negligence claims when working with elderly clients. Unfortunately we live in an increasingly litigious society and attorneys and professional deputies are coming under increasing scrutiny. The number of elderly clients is also likely to increase as we have an ageing population in the UK. There are now 14.9 million people aged over 60 and this is expected to exceed 20 million by 2030.

Whether you are Attorney for health & welfare, or professional Deputy for an elderly client, it is important that you understand what needs to be done so you can be confident of best practice when working with older people and avoid potential for a negligence claim or disquiet from the OPG.

It is seen as good practice by the Office of the Public Guardian (OPG) to apply a high standard of care by involving and getting advice from other professionals, for example a qualified independent care professional and requires deputies to work with third parties to achieve the best possible outcomes for clients. These standards require solicitors to:

  • Ensure any level of care (including any supplementary therapies or treatments) is relevant to the client, good value for money and appropriate to the level of funds available.
  • Review or commission a care plan or occupational therapy report and commission any aids/adaptations necessary to ensure that the client’s needs are met.
  • Allocate a care professional when the client doesn’t have any family, carer or friend who could advocate on their behalf.
  •  Carry out a health review/assessment at least once a year to ensure the clients needs have not changed and are still being met.

My team of social work and occupational therapy consultants at Relative Matters support solicitors in Sussex and Surrey to meet these high practice standards. Occasionally we come into contact with someone whose needs and circumstances have been overlooked.

Example of the need to avoid negligence claims

Mr. Jones, an 88-year-old gentleman, had been placed in a high end residential home. His only relative was a nephew who showed no interest in him. His solicitor had a Lasting Power of Attorney for his property and finances.  Following a hospital admission his solicitor referred Mr. Jones to Relative Matters. The care home had refused to have Mr. Jones back when he was ready for discharge and we were asked to find a suitable placement for him. General-DSCF3361-GM291013-1100x1466

When I visited Mr. Jones in hospital he was apathetic and withdrawn. He was dressed in a hospital gown and had no personal toiletries. A glass of water was placed on his bedside cabinet but he was unable to reach it and appeared not to like water anyway.

We were advised that no one had visited, despite the care home being paid in full for the duration of his six-week stay. Hospital staff had no personal information about Mr. Jones so conversation between him and hospital staff was limited and treatment restricted to his medical needs.

Mr. Jones was only receiving the lower rate of Attendance Allowance (he would have been entitled to the higher rate for some time) He had not been assessed for NHS Continuing Healthcare.

When I went to collect Mr. Jones’ clothes and toiletries from the care home I found photographs of him looking at me proudly in a naval uniform and another in a family group.

This proud man who had fought for his country had ended up a virtually anonymous patient without the dignity of even having his own clothes and toothbrush. His income was also less than it should have been.

Visiting someone in hospital is important for someone’s well-being. It is also an act of kindness and compassion. If your client is admitted to hospital it is not necessary to go yourself, but good practice to make sure someone visits.

Here are the questions you need to ask yourself to ensure your practice is sound and person centred.

  1. Have their needs been properly assessed?
  2. Is there a care plan in place?
  3. Are they receiving the public funding/welfare benefits they are entitled to?
  4. Has a specialist independent financial advisor been involved in planning future care fees?
  5. Is their care and medication reviewed regularly?
  6. How are safeguarding issues identified and addressed?
  7. How are Deprivation of Liberty Safeguards (DoLS) monitored?
  8. Does an independent care professional attend Best Interest (BI) meetings?
  9. Do they have LPAs in place?
  10. Are their end of life wishes known and recorded?

Over the coming months I will consider each question in depth and will be looking at Needs Assessment very soon. In the meantime please let me know if you have an issue relating to working with elderly clients I can help you with.

Finding a Care Home For Barbara

We are often asked which the ‘good care homes are?’ in a specific geographical area. We cannot answer this as everyone has unique needs, preferences and expectations. Finding the right care home for someone takes time, expertise and the ability to see things from the person’s perspective.

Relative Matters were asked to assist with a Bob who had become concerned about his Mother, Barbara who had returned home after a hospital stay and it had become evident very quickly that she was not coping. Bob had found a care home willing to take her at short notice, however, soon after she had moved in, Barbara was demanding to go home, her behaviour had become challenging and the home were not coping with her. During this time, Barbara was being assessed for a diagnosis of dementia and the Deprivation of Liberty (DOLs) team had been asked to be involved as the home were concerned that they were holding Barbara against her will.

We responded swiftly and assessed the situation from Barbara’s perspective and it was evident there were some memory and capacity issues. A full holistic assessment of her objective needs, her perceived needs, and her home environment were completed and through this process, it became apparent that she lacked capacity to make an informed decision to return home and was not actually concerned about going home. Barbara simply did not want to be in the home where she was.

Care home being enjoyed by two happy residents

Care home being enjoyed by two happy residents

After liaising with Bob, the DOLs team and the care home, it was agreed that it would be in Barbara’s best interests to move her to a care home that could meet her needs, and through meeting her needs, promote better behaviour patterns that could be managed in a more person centred way. A carefully drawn up profile was developed with Barbara of what she wanted from her next move. Once research had identified a specialist care home that could meet Barbara’s needs and preferences, she was escorted for a visit, so that she was fully involved in the process and then supported with the actual moving process.

The move was a complete success. We had ensured that the new care home was understanding of the behavioural aspects of Barbara’s dementia and were willing to work with her so that her needs could be met in a cohesive environment where she did not feel institutionalised, activities were interesting and she felt valued.

Finding a care home is easy if you use a ‘one size fits all approach’ but just like you and I will inevitably have different needs, preferences and expectations about where we live, older people are no different.

This post has drawn on work undertaken by Liz Tremlett. Liz works as one of Relative Matter’s Occupational Therapy (OT) Consultants. OT’s work with people to identify the difficulties they are experiencing in every day life and to work with the person to find ways to overcome these, in order to promote health and wellbeing.

Three Critical Things You Should Know About Paying For Care Home Fees

Paying for care home fees is often misunderstood and care and support services have never been free for the elderly. The misunderstanding is because people often think care home fees come under  healthcare from the NHS which is free. However care home costs are considered social care. Everyone has to contribute something towards care home fees and many have to pay the full cost.

The difference between Health and Social Care funding

Social care includes personal care such as washing, bathing, dressing, toileting and managing continence, assistance with daily living (shopping, administering medication, social stimulation etc.) and maintaining independence (assistance with mobility and equipment etc.) Social care does not require trained health professionals and care homes do not employ nursing staff.

Health care includes the treatment of disease, and illness, which needs to be administered or supervised by a trained health professional. Nursing homes have to employ a registered nurse 24 hours a day.

Local Authority social care funding criteria

Many people don’t realise there are two interdependent criteria for social care funding. You need to meet both to be eligible.

Care home costs being enjoyed by residents

Care home costs being enjoyed by residents

1. Needs criteria

The local authority will identify your care needs and check they meet a nationally agreed set of criteria. Basically you must have a significant or critical level of needs. This usually means that you need a high level of supervision and support for personal care and things like drug administration and/or food preparation every day, to qualify for social care funding. BUT even if you do have a significant or critical level of need, you must also meet the local authority’s financial criteria.

2. Financial criteria

You will have to fully fund your care home costs if you have more than £23,250 savings and capital. This includes property no longer occupied by you, unless it is occupied by the following as their main and only home, which they have occupied continuously prior to your move into a care home:

  • Your partner, spouse or civil partner (except where you were estranged)
  • A lone parent who is your estranged or divorced partner
  • A close relative or member of the family who is:
  • Aged 60 or over or
  • is a child under 18 or
  • Is incapacitated

If you have between £14,250 and £23,250 you will have to make a contribution from your savings/ capital as a tariff income of £1 for every £250. A contribution from income will also be required.

If your savings and capital are below £14,250 you will not need to make a contribution from capital. However, a contribution from your income will need to be made.

NHS funding criteria

The assessment process begins with a National screening tool called the Continuing Healthcare Checklist, and must be carried out by a trained health or social care professional. If you are assessed as eligible for funded nursing care, you will receive a standard rate of £110.89 a week from the NHS to pay towards your nursing care (amount correct at April 1st 2015)) This is paid directly to the care home and will be deducted from the local authority’s contribution. It will therefore not reduce the amount you have to pay yourself.

If you are paying for your own care home fees, the funded nursing care contribution is deducted directly from the cost of the care home fees before you pay and therefore reduces your care home costs.

The Continuing Healthcare Checklist will indicate whether a full assessment is indicated. If you disagree with a decision not to proceed to full assessment for NHS continuing healthcare following completion of the checklist, you can ask for the decision to be reconsidered.

To be eligible for NHS continuing healthcare, you must be assessed by a multi- disciplinary team of health and social care professionals as having a “primary health need”.

Whether or not you have a primary health need is assessed by looking at all of your care needs and relating them to:

  • what help is needed
  • how complex these needs are
  • how intense or severe these needs can be
  • how unpredictable they are, including any risks to the person’s health if the right care isn’t provided at the right time

Eligibility for NHS continuing healthcare depends on your assessed needs, and not on any particular diagnosis or condition.

You should be fully involved in the assessment process, kept informed, and have views about your needs and support taken into account. Your family should also be consulted where appropriate.

If you are considered eligible for full NHS continuing healthcare funding, it can be used to fund a package of care and support to meet all your assessed needs including personal care, mental health and physical needs. NHS continuing healthcare can be provided in a hospital, nursing home, residential care home or in your own home.

Paying for care home fees is a complex subject. Further information can be found below

Paying For Care

Age UK

Alzheimer’s Society

Dehydration and Our Need for Water

How do you feel when you’re dehydrated? Some people will immediately notice the tell-tale signs – headaches, dry lips, a dry mouth, tiredness – but others, for any number of reasons, will not. It could be that you’re so used to being dehydrated that you no longer pay attention to the signals, or it could be that you have so much else going on that you don’t have time to think about how thirsty you’re feeling.

Hydration as we age

As we get older, hydration is just as important as ever but is often harder to achieve. Our bodies aren’t always as adaptable as they once were, and we’re even less likely to notice the signals that they’re sending us.

On top of that, it’s often physically more difficult for older people to drink and stay hydrated. For some, getting to the kitchen to prepare a drink is a difficult and time-consuming task. For others, even lifting a cup can be a challenge.

We also have to remember that many older people don’t like water, which has become more popular in the last couple of decades. In this case cordial or sliced fruit can be added to make it more appealing.  water

How to stay hydrated

As a very rough guide, aim to drink approximately two litres of water per day. Each individual has different needs, so this figure might be a little high or a little low for you. What you’ll probably find, however, is that you’ll feel thirstier as you begin to drink more. This is because your previously dehydrated body is now getting used to being properly hydrated.

You can buy specialist equipment to help you or a loved one to stay hydrated, such as the Hydrant Drinking System which features a long and flexible straw, an easy to hold handle and clips for fixing the bottle to a bed or chair and the straw to your clothes.

Reminding yourself to drink

Being physically able to drink, whether you need specialist equipment or not, is only part of the battle. The other issue is that you need to actually remember to drink, which is often much harder than it sounds and made worse by the increasing number of people living with dementia.

Cues are important, whether they come in the form of regular alarms set on a mobile phone or in the form of post-it notes that are stuck around the house. You can remind yourself or a loved one to drink by putting a cup of fresh water/cordial in each room, if you have the energy to do so at the start of the day. Sometimes older people find a water bottle near where they sit a useful reminder. The important thing is finding a way that works for you, so that you or your elderly loved one can be reminded to drink as you go about your day.

The health benefits

Dehydration can lead to a wide range of issues from minor ones such as memory problems and concentration problems to more serious conditions such as kidney stones, joint pain, muscle damage and cholesterol problems.

By drinking enough to stay properly hydrated, you’re providing your body with the important water that it needs to stay healthy, active and as pain-free as possible throughout your retirement years.

If you or someone you know is struggling to drink enough for whatever reason then a visit to the GP might help you to find a solution. Before this, see if tools such as the Hydrant Drinking System or a simple pack of post-it notes could be all that you need to get your drinking habits back on track.

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