Archive for October, 2012

Paying for Care – De-mystifying Social Care Costs

There is a great deal of confusion around our complicated care system for older people. In my experience, most people don’t fully appreciate that adult social care is a means tested benefit and over 50% of people requiring care will need to part or fully fund it themselves. 

Adult social care funding has become a significant issue over recent years. An independent care commission was set up to consider the amount people pay towards their own care and have made proposals to the government. There is currently much political debate about this and how the extra money needed will be paid for.

In order to simplify things I have identified the key points that currently apply to make things easier to understand.

Community Care Funding for Residential care

  • If you need Residential or Nursing Home care and have savings (capital) of less than £23,000 it is likely that you will be eligible for financial help towards the cost of your care so long as you have been assessed to need it.
  • Anyone who has capital of their own above £23,000 will be assessed as being able to pay the full cost of their care home fees.
  • Those whose capital is between £14,000 and £23,000 will be expected to make some contribution from their capital as well as income (state pension, Attendance Allowance, fifty per-cent of any private pension or other income)
  • Your relative should not have to make any contribution from their capital below £14,000, but will still be expected to contribute from their income (state pension, Attendance Allowance and fifty per-cent of any private pension or other income)
  • Different financial rules apply for couples and single people.
  • Care in a residential home can be free for up to six weeks if it is arranged as part of “intermediate care” after hospital treatment.
  • All local authority Social Services have their own systems, allowances and procedures, although every person funded by Social Services is entitled to a personal allowance. You can check out current rates at www.turn2us.org.uk.
  • A personal allowance cannot be used to pay top-up for fees or for services that should be included by the home as part of the care service.
  • For the first twelve weeks after Social Services have made an assessment, the value of your relative’s property will be disregarded in their calculations. The purpose of the twelve-week disregard is to give your relative time to sell, let or raise money on their property to fund care costs.
  • If your relative claims Attendance Allowance and Social Services are making an increased contribution to their care fees, the allowance is withdrawn after the fourth week and reinstated at the end of the disregard period.

Community Care Funding for Home Care

  •  The situation for Community Care funding for home care  is even more complicated and varies between each local authority. This is the infamous postcode lottery that the government has pledged to reform. Until then eligibility is determined as much by what each Local Authority has a policy of  paying for, as by their need
  • If you have more than £23,250 in capital (not including the value of your home) you will be charged the full cost of your care.
  • If your capital is less than £23,250, your income will be assessed but you must be left with at least the basic amount of Pension Credit plus 25%.
  • Some councils are more generous and increase the capital threshold or set a maximum amount they expect anyone to pay for their care.

Paying for Care – The Two Best Kept Secrets

Your elderly relative may need care and support because of serious illness, physical disability, sensory impairment, mental health problems or loss of independence due to old age.

So how do you go about finding out if they are eligible for support from Social Services? (now often called Adult Services) First of all you need to contact Adult Services in their area who will undertake an initial assessment over the phone.

Everyone has the right to request an assessment, called a Section 47 assessment, to discuss their needs, including people who are not eligible for social care services. 

1. With increasing pressure on Social  Service departments, if your relative does not meet the Local Authority’s financial criteria, which is usually determined as part of the initial screening call, they will often have their needs assessed over the phone without having realised they have been assessed! Make sure you ask for a Section 47 Assessment during your initial call, and unless its considered urgent, be prepared to wait for it.

2.The Adult Services assessment process consists of two elements. Firstly they look at the issue of need and are obliged to undertake an assessment to determine how best the care needs of an individual can be met.There is a second element to the assessment, which is financial. If your relative’s level of need indicates that they may be eligible for social care funding, Social Services will carry out a means test.

 In order to be considered for social care funding your relative must satisfy both the level of needs AND financial criteria.

The Needs Assessment for social care will determine:

  • If a person is eligible for health and/or social care funding and services
  • What level of help and support the person needs
  • What kinds of services are needed, from aids and adaptations in the person’s home, to home care workers or residential care.

A needs assessment will form part of the basis on which to make decisions about your relative’s eligibility to receive support from Social Services. It also provides valuable information if your relative is to fund and arrange their own services at home or in a care or nursing home.

Most councils’ have now set their threshold at the substantial and critical levels. This means your elderly relative must have a high level of personal care needs and require support with personal care every day.

Try to be present with your elderly relative when they are being assessed. Sometimes older people find it difficult to express how difficult certain tasks have become and most older people underestimate the amount of care they need. If you are there with them you can provide moral support as well as offering gentle reminders about the problems they face.

If you are unhappy with the assessment of your relative’s needs for any reason, you can request a reassessment. If this is refused or you remain dissatisfied, you could consider making a complaint.

Once your relative’s eligibility has been established with regard to their level of need, they must also pass a means test in order for Social Services to provide funding and support.

Financial Assessment for Funding and Support

At the present time, anyone with more than £23,250 savings will not be eligible for funding and support from Social Services.

 If Adult Services might be funding part or all of your relative’s care, you will need to provide financial information, including:

  • Their pension details.
  • Bank and building society statements.
  • Details of any property they own and its current value.
  • Details of any stocks and shares they may hold or other financial products they own.

Paying for Care – Choice and Help with Care Home Fees

Social Services have a maximum fee they are willing to pay for a care home, including a person’s assessed contribution, based on their level of need and the type of home.

If you or your elderly relative want to go into a more expensive care home, this may be possible if you or another third party, such as a relative, friend or charity, pay the additional amount for as long as your relative is in the home. 

Third party payments

Under the arrangement the third party pays the difference between Social Services’ usual maximum rate and the amount the care home charges (often called a “top-up” or third party contribution). However, it is illegal for your relative to “top-up” his or her own fees.

Before you or any other third party agrees to make a contribution towards the cost of a care home, you need to be aware that the amount could increase at any time. You therefore need to be sure that you are able to maintain the payments for as long as required.

If someone is willing and able to fund the payments they will be asked to sign an agreement with Social Services who then collects the additional money to pay the home. If the additional payments are going to stop for any reason, advice should be sought from Social Services.

Financial help from social services

If your relative needs residential or nursing care and Social Services have agreed to give them financial help, they can still choose where they want to live. The home may be provided by Social Services or be run independently, but it must be a home that:

  • Has been approved by Social Services.
  • Is suitable for your relative’s assessed needs.
  • Will enter into a contract with Social Services.
  • Has a vacancy.
  • Is within their financial limit of support for your relative’s assessed level of need.

Paying for Care – Costs, Planning & Specialist Advice

The care system is confusing and people thinking that care is free and funded by the NHS get a shock when they realise that it isn’t. Even when someone has dementia, which is after all an illness, other than for severe and exceptional cases, when care is paid for by the NHS (Continuing Healthcare) most people will have to pay for some or all of their care fees. Hence the recent headlines about older people having to sell their home to pay for their care.

Funding long-term care is the second largest expenditure people have to make in their life, after buying a property and we are often in the position of being first-time buyers when it comes to choosing the right care home and long-term care services. I therefore find it surprising that while many older people make wills and ensure that their funerals are already paid for, they have rarely thought about whether they might need care and support and, if so, what they would want to happen and how it will be funded. 

Cost of care home fees

Alarmingly, people who fund care themselves; spend on average, around four years in a residential care home and one in eight stay eight years or more. With weekly care home fees costing between £500- £1200 (depending on where the older person lives and whether they need a care home with nursing) you can see how the cost soon mounts up.  Using an example of a weekly fee of £700, the cost over four years would be over £145,000, the cost of a small flat.

Unfortunately people who fund their own care make major decisions with consequences for large amounts of personal expenditure, on the basis of little or no independent financial advice. Few people are even aware that specialist financial advice exists in this field. Similarly, few are aware of the support available to carers. I always advise my family, friends and clients to seek specialist financial help when planning long-term care.

Paying for Long Term Care

Planning for long-term care is crucial to ensure that all options are explored, your relative’s financial assets and if relevant any proceeds from their property are invested wisely and any remaining inheritance protected. If your relative is considering long term care at home or in a residential or nursing home, it is in everyone’s best interest to seek accredited specialist financial advice before making important life-changing decisions.

To find a specialist financial advisor near you, contact the Society of Later Life Advisors (SOLLA) You will also find the ‘not for profit’ organisation PayingForCare  really helpful to find out more about paying for long term care fees.

In addition, the service we offer at Relative Matters includes helping people make their money go further. We also make sure our clients are getting the funding and benefits they may be entitled to and negotiate care fees on their behalf

Ten Questions to Ask When Choosing a Care Home

Once you have decided which type of  care home your elderly loved one needs and drawn up a list of criteria you will find there are a lot of other things to consider. Don’t worry about asking too many questions when you look round a home. It is sensible to do as much research as possible when you are making such a life changing decision. If you are able to, speak to some of the residents at the home or better still their relatives. They will be able to give you a realistic view about what it is like to live there. You can also have a look at the website of the Care Quality Commission who are the regulatory body for care homes and hospitals to find out more information.

When looking around a care or nursing home use your eyes and nose. First impressions really do count and if the home doesn’t smell pleasant then you are probably in the wrong place for your relative. Look at the décor. Is the home well maintained? Look at the people. Are the staff smiling and interacting with residents and more importantly, are the residents smiling and engaged in what is happening around them?

Questions to ask when considering a care home for your relative

  1. In what circumstances would your relative be asked to leave and what would happen if they run out of funds?
  2. How does the home handle complaints? Is there a residents” committee and a relative’s group?
  3. What would happen if your relative becomes ill and needs more care? Would they have to move?
  4. Will your relative be offered a choice of meals and can they choose when and where they eat?
  5. What is their policy for end of life care?
  6. Does the room have an en-suite bathroom? Is it suitable to meet your relative’s needs?
  7. Is there a TV and telephone point in the room?
  8. Does the home offer activities and an entertainment programme?
  9. Is there a garden?
  10. Can your relative keep their GP and manage their own medication if they want to?

When I was looking for a care home for my elderly mother, I didn’t just accept what I was told. I probed a bit further. For example I might say in response to something the home purported to do by asking ” Can you explain to me how you do this?”

It is important to check with the home whether they are able to meet your relative’s specific care needs such as dementia or incontinence and how they manage the progression of these and other conditions. If your relative has a condition that is likely to deteriorate, ask what their policy is when needs increase.

Finally, ask for a copy of the care home’s most recent inspection report and a copy of their Statement of Purpose. This sets out their aims and objectives and the services and facilities the home offers.

When you have finished you need to ask the most important question of all. Would I like to live in this home myself? Keep looking if the answer is no!

 

What are Your Best Tips for Choosing a Care Home?

Hardly a week goes by without someone asking me a question about choosing a care home for an elderly relative. There are so many care homes to choose from, all apparently promising excellent care, so where do you begin?

First of all you need to decide which type of care home they need. There are basically three to choose from

Care home (residential)

A residential care home provides the care and support your relative would receive at home from a carer. Staff can help with personal care such as washing, taking a bath or shower, getting up, dressing and assistance with eating and drinking.

Help is available twenty-four hours a day and meals are provided, usually with a choice of main meal. Activities and outings are usually available and visitors are always welcome.

Care Home (special needs)

Specialist care homes, which used to be called EMI (Elderly Mentally Infirm) homes, are care homes registered for people with dementia. The particular needs of people with dementia require more staff and that staff receive on-going training to help them manage the behaviour that is often associated with Alzheimer’s and other forms of dementia. Also to work in a person-centred way as everyone’s dementia journey will be different and personal to them.

Care homes (nursing)

Care homes with nursing generally care for more dependent people who have more complex and/or changing care needs and require the sort of care that can only be provided under the supervision of a qualified nurse. Accordingly they are required by law to have a qualified nurse on duty twenty-four hours a day.

Some care homes provide both residential and nursing care and are sometimes referred to as dual registered homes. You may decide to choose a home like this so your elderly relative doesn’t need to move again if their needs change.

Watch out for further tips to help you choose a care home for your elderly relative.

 

A Personal Story of Dementia Care at Home

Hardly a day goes by without hearing about the ‘dementia tsunami’ about to engulf one in three of us over the age of 65, and how the number of people suffering from dementia is projected to double over the next 40 years.

Well I don’t know about you, but I don’t want residential care to be the only option if I am one of these statistics. I, like most people, want to remain in my own home and I am passionate in my pursuit of good person centred dementia care for my clients.

As you may be aware, I managed my mother’s dementia care at home for several years until it became untenable for her to remain at home because of my father’s deteriorating health. One of my associates actually provided dementia care at home for her mother. She told me how she felt the care system let her mother down as her Alzheimer’s advanced and she became more difficult to manage. Eventually she ended up moving her mother in to live with her and her husband.

Sally was still working as a Social Worker at the time but the methods she used to recruit a carer for her mother flew in the face of conventional  practice. She started by advertising for someone to look after her mother in a local shop.

A woman knocked on the door one day. She was a single mum with a small child and had no experience of dementia care. However as they sat talking, her mother put out her hand to the woman who responded by holding it gently while carrying on talking. This seemingly small act was enough for Sally to be confident that her mother liked the woman and she gave Ann the job, without taking up a reference or CRB check.

Sally explained the things that were important to her mother and how she enjoyed having her hands massaged with her favourite scented oils and sitting quietly listening to music. She began working alongside Ann and quickly found she was a able to give her mother the compassionate person centred care she and her husband were providing.

Ann with her gentle, respectful manner soon became an important part of her mother’s world and when her child minder let her down, Sally said she could bring her daughter with her, so long as her mother showed no objection. On the contrary, her mother showed by her reaction and body language that she enjoyed the little girl’s company and the child would colour pictures, read stories to her and do things that made her mother smile.

My purpose for telling you this story is to highlight how a person with dementia can still make choices, however advanced their dementia is, if you keep an open mind and observe them carefully. Also how simple pleasures like having a hand massage and being read to by a child can warm their heart.

My mother would not have appreciated having a carer who sometimes brought her daughter with her, not because she doesn’t like children, she just feels more comfortable with animals and adult company. This highlights how everyone’s dementia journey will be individual and personal to them. In all my years of working with older people, I never met two people with dementia that affected them in the same way.

Dementia is one of the greatest challenges you and your loved one  will ever face and every person’s dementia journey will be individual and personal to them . However, I can honestly say from personal experience that with compassionate person centred care, their life can be enhanced with dementia care at home and we can learn simple, invaluable lessons along the way such as  watching for clues and doing things the person enjoys. Just make sure you look after yourself  and find  support for yourself too. The Alzheimer’s Society is a good place to start. Good luck and let me know how you are getting on.

 

 

The Best Kept Secret of Elderly Care

One of the best kept secrets in elderly care is that vulnerable elderly people are being admitted to hospital and even dying because they are not being given enough to drink and have become dehydrated.

As a specialist in care management for older people, I find that time and again, when I am supporting someone to leave hospital, their discharge is delayed because they have become dehydrated and have to be put on a drip. I believe there are several reasons for this. Firstly there are insufficient staff to ensure older people drink enough. A jug of water is placed on the person’s locker and either they are unable to see or reach it, or they forget it is there. However, I think the most common reason is that unlike younger generations, most older people simply do not like plain water.

Other factors include poor mobility, restricting opportunities for getting and making hot and cold drinks and the fact that most older people do not drink enough for fear that they may not get to the toilet in time.

Thirst, the body’s natural response to dehydration, has also been shown to be impaired in older people and those who have had a stroke or are suffering from Alzheimer’s disease, may be particularly insensitive to thirst. Older people also need to drink more if it is hot, or if they have a temperature because they are unwell.

As caring relatives, friends and neighbours we should be aware of the need for good hydration and the role we can play in ensuring older people drink enough fluids.

How to spot dehydration in an elderly person

  • Urine is a dark yellow rather than the straw colour it should be.
  • Urinating infrequently
  • Passing small amounts of urine
  • Confusion
  • Problems with walking or falling
  • Dizziness or headaches
  • Rapid heart rate
  • Constipation
  • Decrease in urine output.

You can easily check for dehydration by pinching the person’s skin gently on the back of their hand for a few seconds; if it does not return to normal within a few seconds, they are dehydrated.  If they live in in a care home, make sure that staff offer a variety of beverages (remember, taste buds change with age, so a beverage they used to enjoy may no longer taste right), and provide drinks not only at mealtimes but in between meals. If they are in hospital make sure you take in their favourite cordial or juice and that a mug or water bottle is placed within easy reach. Make sure you encourage them to drink while you are visiting and ask other visitors to do the same.

When I was managing the care of my own parents  at home, I used to keep one of those sports water bottles filled with pink grapefruit juice (their favourite) and placed one beside each of their chairs and another by their bed. I ensured their Personal Assistants refilled the bottles regularly and I did the same whenever I visited them. Of course I would also make and have a cuppa with them too.

As with most things, prevention is the key. Making sure older people stay hydrated now, is so much easier than treating them for dehydration later and it really doesn’t take much time.