Archive for February, 2013

New Alzheimers Study Uncovers Shocking Statistics

Are you scared about going into a care home because you have dementia? I know I am and a recent survey undertaken by the Alzheimer’s Society found that 70% of us would be.

They also found that 80% of people living in care homes either have dementia or severe memory problems, which is significantly higher than had previously been estimated.

Worryingly the survey also found low expectations and a great deal of pessimism about life in care homes and highlighted a severe ‘image crisis’ in the care sector which they believe is leading to a failure to drive up standards of care.91 years of life

My own experience, both personal (my mother lives in a care home for people with dementia) and professional (over 30 years social and NHS experience, working with older people) supports these findings.

Low staff morale contributes to ‘low image’ of care homes

In this country we value working with money – high salaries and excessive bonuses – more highly than working in the care sector, where care staff earn little more than the minimum wage. Add to this the fact that Local Authorities have driven care fees so low there generally aren’t enough staff to do a good job and it isn’t surprising morale is at an all time low and people aren’t rushing to do this much needed work.

Caring for people with dementia is complex and demands greater skill than looking after older people who may be physically frail but remain mentally alert, yet this expertise is not acknowledged or reflected in higher pay.

My mother’s care home – a model of doing it right

When I visit my mother, I am always impressed by the endless patience, kindness and skill staff show residents. My mother’s home takes people at local authority rates (under £500 a week) yet it didn’t stop them taking residents out for an expensive meal at Christmas.  In addition, the manager had WiFi installed throughout the home when Mum got her iPad and recently allowed an elderly lady’s little dog to come in with her. However I know this care home is the exception rather than the rule and unrelated to the level of care fees paid. High care fees certainly do not guarantee quality and there are as many bad homes at the top of the care fees scale as there are good ones.

My rule of thumb

In my work as an independent specialist in care management for older people I regularly visit care homes for older people with dementia. Regrettably very few of them are as good as my mother’s and therefore fail the test I use for my clients:

‘Would this home be good enough for me or someone I love?’

With the number of people with dementia rising exponentially alongside increasing expectations, things will have to change. We demand the best for our children and ourselves throughout our lives so why should we settle for anything less for our own parents?

They will however be the last generation who put up with being treated badly. The Baby Boomers have now reached pensionable age and we will demand nothing less than being treated with respect, dignity and compassion. Until that time though, people with dementia will continue to be scared of going into a care home and expectations about care standards will remain low.

How to find a good care home for people with dementia

You will find my post Ten Questions to Ask When Choosing a Care Home  helpful.

Long Term Care Fees – The Truth Part Two

If you felt reassured by Monday’s announcement about the £75,000 cap on long term care fees, think again. The more detail is uncovered, the more concerned I am becoming. The following information is based on an article I read by James Lloyd, director of the Strategic Society Centre that I would like to share with you.

He made the point that  the ‘cap is not really a cap at all because of the ‘living cost’ contribution of  £12,500 that individuals will be expected to make. This is higher than previously considered and will force more people to draw on their capital.

Furthermore the vast majority of the 125,000 older people funding their own residential care in England pay more than the rates paid by their Local Authority. Self-funders will therefore pay more than the value of the ‘cap’ before they reach it, and carry on paying for care after it. This will mean many having to carry on drawing on their capital beyond the ‘cap’.

Once people realise that they are likely to die before reaching the ‘cap’ what happens to the ‘peace of mind’ they were promised? This will mostly affect southern areas in the country areas where the proportion of pure ‘self-funders’ in residential care are the highest.MC910217019

It is confusing as to why ministers keep going on about how the reforms will lead to a pre-funded care insurance market. This is absolute nonsense. The consensus view in the insurance industry is that the ‘capped cost’ model will not result in an insurance market.

I believe the reforms will never actually be implemented in the way they are described today and a great deal of thought and attention will need to be paid to the way it affects individuals, the means test and standardised ‘living cost’ contribution.

Finally, the reforms do nothing to address the serious shortfall in funding elderly care, leaving social care the only public service that we have to pay for ourselves. We are a modern society that can send satellites into space and explore Mars yet we can’t look after some of the the most vulnerable in our society, older people. So forget about  not worrying about funding care fees in your old age. One in three of us will need significant care as we grow older and most of us will get no support whatsoever from the state, so don’t put away your ”For Sale’ board yet.

 

Long Term Care Fees – The Truth

After months of number crunching the Government has set the cap for social care fees at £75,000 which is very misleading. It only applies to the personal care element and is subject to both eligibility criteria and the prevailing local authority rate. The cap will not cover accommodation, food and general living expenses, or above the rate paid for by the local authority. This can be as low as £276 a week with the average cost of a care home with nursing in the South East  being around £800 a week. So in reality the cap is nearer £200,000.MB900423551

Change in financial threshold

The current financial threshold of £23,250 will increase to £123,00. As the value of the average UK house is higher than this it will make little difference to many older people needing care and most homeowners will still have to sell their homes to pay for care fees. The plans will be paid for mainly by taxpayers in the South East by raising inheritance tax thresholds.

An underfunded care system

The stringent rules around care home fees are only one aspect of our grossly underfunded care system, and not the worst. The decision by most local authorities not to fund people who are in desperate need, but not technically ‘critical’ is an even worse problem.

Will insurance be the answer?

The insurance industry will be planning ways to cover that first £75,000 of costs. With the exorbitant mark-ups for which the industry is known, these products will be unaffordable for many. Experience has also shown that the market for insurance products to fund elderly care has hitherto been very small, largely because most people believe that social care, like the NHS, is free at the point of demand and therefore fail to plan for them.

Self funders

While I am pleased that at last a decision is made to place a cap on care fees for older people, which is particularly important for the 41 per cent of elderly people in the care system who are “self-funders” because they have over £23,250 in assets including property, many are not very wealthy, yet I believe they are among the most overlooked and underserved in the care system.

They are people like you and me who have worked hard all our life for a pension that will make us ineligible for most welfare benefits, yet have savings that will not last long when paying care fees at the rate of over £2,000 a month.

 

Paying For Care – New Policy But Don't hold Your Breath

An announcement today is expected to say that the cap for long term social care will mean that no one in England will have to pay more than £75,000 after 2017 for their care in old-age. Big deal! The amount was most likely decided by people who have no clue what life is like to have less than £75,000! The cap will be so high it will only help a few and many will still have to sell their homes to pay for care under £75,000.bigstock-House--2632885

Only actual care costs will be included

The cap will only cover personal care (help with washing and dressing) at the rate Social Services will pay, meaning the lowest rate possible and will not include the cost of accommodation or food. The figure is much higher than that recommended by the Dilnot report, which said that the cap should be set at £35,000.

The Current Situation

At present people with savings and capital of more than 23,250 have to pay for care costs. Those with assets of between £14,250 and £23,250 have these taken into account when their contribution is assessed. If they have less than £14,250 only a person’s Income is taken into account.

Means tested support will increase

It is likely that those with up to around £120,000 savings and capital costs, including property, will qualify for means tested support after 2017.

What will the cap actually mean?

According to financial expert, Paul Lewis, if the cap is set at £75,000 and doesn’t start until 2017, 214 weeks of care will have to be paid for. So if a person who has to fund their own care pays £500 a week for their care, they will have to spend £107,000 before the cap kicks in. They will also have been paying food and accommodation costs of £10,000 a year for more than four years, so around £150,000 will have been spent before the cap would apply. Most residents will have died before they benefit from the new arrangement!

A drop in the ocean

Although a step in the right direction a cap of £75,000 is nothing more than a drop in the ocean and most older people will still have to sell their home to pay for long term care fees. How long do we have to wait for a Government to seriously prioritise elderly care and realise that most older people have worked hard all their life and paid more into the system than the younger generation ever will?

Time to put our money where our mouth is

The cap of £75,000 for long-term care fees will do nothing to help the huge underfunding of the elderly care system which is a separate matter. Whichever political party is compassionate and brave enough to balance affordability in the current economic climate with a better way of adequately funding the care system for older people, will certainly get my vote. Will it get yours?

Relative Matters are independent specialists in care management for older people and we can often help people access funding (so long as they are eligible) save money and negotiate care fees with care providers on behalf of our clients. Why not give us a call and see if we can help you 0845 319 4870

Paying For Care – New Policy But Don't hold Your Breath

An announcement today is expected to say that the cap for long term social care will mean that no one in England will have to pay more than £75,000 after 2017 for their care in old-age. Big deal! The amount was most likely decided by people who have no clue what life is like to have less than £75,000! The cap will be so high it will only help a few and many will still have to sell their homes to pay for care under  £75,000.bigstock-House--2632885

Only actual care costs will be included

The cap will only cover personal care (help with washing and dressing) at the rate Social Services will pay, meaning the lowest rate possible and will not include the cost of accommodation or food. The figure is much higher than that recommended by the Dilnot report, which said that the cap should be set at £35,000.

The Current Situation

At present people with savings and capital of more than 23,250 have to pay for care costs. Those with assets of between £14,250 and £23,250 have these taken into account when their contribution is assessed. If they have less than £14,250 only a person’s Income is taken into account.

Means tested support will increase

It is likely that those with up to around £120,000 savings and capital costs, including property, will qualify for means tested support after 2017.

What will the cap actually mean?

According to financial expert, Paul Lewis, if the cap is set at £75,000 and doesn’t start until 2017, 214 weeks of care will have to be paid for. So if a person who has to fund their own care pays £500 a week for their care, they will have to spend £107,000 before the cap kicks in. They will also have been paying food and accommodation costs of £10,000 a year for more than four years, so around £150,000 will have been spent before the cap would apply. Most residents will have died before they benefit from the new arrangement!

A drop in the ocean

Although a step in the right direction a cap of £75,000 is nothing more than a drop in the ocean and most older people will still have to sell their home to pay for long term care fees. How long do we have to wait for a Government to seriously prioritise elderly care and realise that most older people have worked hard all their life and paid more into the system than the younger generation ever will?

Time to put our money where our mouth is

The cap of £75,000 for long-term care fees will do nothing to help the huge underfunding of the elderly care system which is a separate matter. Whichever political party is compassionate and brave enough to balance affordability in the current economic climate with a better way of adequately funding the care system for older people, will certainly get my vote. Will it get yours?

Relative Matters are independent specialists in care management for older people and we can often help people access funding (so long as they are eligible) save money and  negotiate care fees with care providers on behalf of our clients. Why not give us a call and see if we can help you 0845 319 4870

Top Tips For Putting Care of Older People in Hospital On The Road to Recovery Post the Francis Report

In my previous post I started to look at the scandalous situation surrounding elderly care in hospital and the report published by Howard Francis following a lengthy investigation.

The Francis report makes 290 recommendations and while I don’t disagree with any of them, I am horrified that no-one has been held to account for the premature death of hundreds of older  people and that Francis makes no direct allegations. Here is what I would like to happen to turn the situation around. bigstock-Closeup-Of-An-Old-Woman-s-Hand-6224883

  • Identify the people responsible for the deaths (I believe this has already been done) investigate them thoroughly and take appropriate, decisive and public action.
  • Identify and fund minimum staffing levels for hospital wards to include at least one staff member and volunteers recruited with sole responsible for supporting patients well-being. This must include making sure elderly patients are eating and drinking. This will need to be monitored by the Quality Commission (CQC) in the same way they monitor staffing levels in care and nursing homes.
  • Introduce basic care standards elderly patients can expect and ensure the CQC monitor them rigorously.
  • Make corporate neglect a criminal offence.
  • Involve patients and relatives in the design and production of basic care standards, policies and procedures.
  • Identify a person centred patient care champion for each hospital rather than a Chief Inspector of Hospitals.
  • Provide training for Trust and Board Members so they can provide strong person centred leadership. We are entitled to see the people who are ultimately responsible for the service held to account.
  • Introduce lay assessors (ordinary people who have used a hospital) to inspect hospitals on a regular basis and report to the Care Quality Commission (CQC)
  • Increase duration of the annual budget cycle to three years in order to introduce longer term improvement strategies.
  • Identify hospitals that provide person centred care to older patients (use patient and relative surveys to find them) and use them as pathfinders for excellence in elder patient care.
  • Introduce an independent ‘hospital neglect line’ on the lines of Child Line for three years to allow time for the above changes to take place.

Making the much needed changes will take concentrated effort over many years and I believe the NHS will feature highly in the next election. However we have no time to lose if we want to regain our pride and confidence in the NHS for older people and we all have a vested interest in making that happen!

The Francis Report and Older People in Hospital

My initial reaction to the Francis report into the failure of Mid Staffordshire hospital to provide safe, dignified and compassionate care leading to the deaths of hundreds of vulnerable older people is one of great sadness. I am also astonished that the people responsible are not being investigated for consideration of corporate manslaughter. bigstock-Sad-Elderly-Man-Sitting-With-A-6067493-1

Whenever front line staff are accused of a transgression affecting patient care they are quite rightly subjected to disciplinary investigation. Why on earth should this be any different for the people ultimately responsible for patient care at that hospital?

Poor practice in hospitals

The Francis report is the most recent in a long line of reports highlighting failures in patient care and I suspect it won’t be the last. 11 other hospitals are already being investigated for unexpectedly high death rates. I fear poor standards of care for older people on hospital wards is endemic, although I acknowledge there are pockets of good practice too.

Only the other week one of my elderly clients was discharged from our local hospital to a care home in a thin hospital gown with nothing on her feet on a freezing cold day. I alerted the Safeguarding Team which worryingly the manager had not done before I arrived. She told me bad discharges were the norm and despite raising it with hospital staff nothing seemed to change.Frequently I also find discharges delayed because my elderly clients are dehydrated (something which costs the NHS dearly as time in hospital is increased)

Recommendations made by Francis

I believe that if the recommendations made by Francis are to stand any chance of success there needs to be a robust action plan WHICH IS IMPLEMENTED AND MONITORED. So often good ideas and recommendations made after expensive enquiries and by so called Tsars who have been brought in to change things are unheeded by the Government and never translated into practice.

I believe the success of turning things around will ultimately involve breaking with tradition and involving patients, relatives and front line staff in finding successful solutions.

The Heart of The Matter by Amanda Waring

This great book about person centred care for older people is inspired by the lack of compassion and dignified care afforded to the author’s mother at the end of her life and a resultant burning desire to make a difference and improve the care of older people.

The book is aimed at staff who care for older people but is equally valuable for anyone who has an elderly loved one.

Amanda’s authenticity and passion for her subject shines throughout the book, which is full of inspirational quotes, and useful tips to help carers understand, communicate with and provide, personal care and social stimulation for people with dementia.balladofbobdylan_HB

The book is packed full of powerful, experiential learning exercises to help readers understand the older person’s perspective and gain insight into the kind of care environment they are and should be providing and the world of someone living with dementia.

I particularly enjoyed the meditation on compassion, seeing the importance of life histories for person centred quality of life plans highlighted and the section on supporting older people on their end of life journey.

This is a ‘must have’ book for staff, managers and owner’s of services supporting older people in care homes or in their own home. It also provides valuable reading for anyone who has an elderly relative or interest in the care of older people.

I love that this book is also available in Kindle for £9.12. All this good advice for under a tenner!

You can buy it from Amazon here

Responsibilities and the NHS – The A&E Abuse that's Killing our Ageing Population

Along with rights come responsibilities, right? The NHS is at breaking point for a number of reasons including an ageing population. There can be no doubt that the current healthcare system is unsustainable and we need to do something about it.

I feel passionate about involving people in every aspect of their care because I believe we know ourselves better than anyone else possibly could. I am also motivated to protect the rights of older people and take this responsibility very seriously.

Now as I mentioned earlier, rights come with responsibilities and I am on a mission to help people become more aware of what those responsibilities are.

The NHS is at breaking point for a number of reasons including an ageing population. There can be no doubt that the current healthcare system is unsustainable and we need to do something about it.

The following information provided by Age UK demonstrates the extent of the problem and helps us understand why we must start to take responsibility for our own health without delay.

Facts and figures about the ageing population

  • Nearly one in five people will currently live to see their 100th birthday
  • There are 10.3 million people aged 65 or over in the UK
  • By 2083, about one in three people will be over 60.
  • There are more pensioners than there are children under 16
  • The number of people over 85 is predicted to double in the next 20 years and nearly treble in the next 30.

With the growing number of older people many of whom have, or will have, long term, complex and multiple conditions, it is not surprising that we are experiencing longer waiting times to see our GP, have an operation and be treated at A & E departments.

Increase in use of A & E departments

Ambulance parked outside hospitalA survey undertaken last year by the Care Quality Commission found one in three patients claim they have spent more than four hours in hospital accident and emergency departments in England. And only the other week I read in our local paper about the massive increase in hospital A & E admissions in our hospitals.

This means A&E departments across the country are slowing down and people who need urgent medical care are not getting prompt treatment.

Reason for the increase in use of A & E departments

The reason for this is that many people are using accident and emergency departments for non emergencies, minor ailments and as an extension of their doctor’s surgery. A &E staff have to balance the need to deal with genuine medical emergencies and serious injuries, with the needs of people who are less seriously ill, which results in long waiting times.

It is understandable that if we are worried about our health, we want to get treatment and reassurance. However unless we are seriously ill or have had an accident, there are alternatives which are more appropriate, more convenient and quicker than heading for our nearest A & E department such as seeking advice from NHS Direct, a pharmacist, or making an appointment to see our GP.

Playing our part in reducing demand on A & E departments

It is our NHS and if we want our hospital A & E departments to deliver prompt professional medical treatment when we need it, we must play our part and only seek their help when absolutely necessary and having considered other alternatives.