Archive for February, 2014

The Growing Cost of Health and Social Care

The aging population is having a considerable effect on public services. According to the government, the majority of public spending is spent on older people.

There are over 10.5 million older people in the UK. It’s estimated that there will be 5½ million more elderly people in 20 years’ time and the figure will almost double by 2050.

The fact of the matter is that we are living longer. Nowadays we have better healthcare, we have much more knowledge when it comes to healthy eating, exercise and habits like alcohol and smoking; and we take better care of ourselves.

However, this comes at a price. The number of older people needing care is growing at an alarming rate. There are three million people over the age of 80-years-old in the UK alone.

What does all this mean though?

  • Rise in State Pension age

The age at which British people receive the State Pension has recently changed. For years it was 65 for men and 60 for women but the pension age will rise to 66 for men and women by 2020. What’s more, it will start to increase again in 2026 to 67. The women’s state pension age will move to 65 by 2018 and then hike to 66 two years’ later.

  • Public spending

According to the Department for Work and Pensions, 65% of benefit expenditure goes to people over working age. This is equivalent to one seventh of public spending and an additional spending of £10 billion a year for every additional one million people over working age.

However, spending cuts mean that there will be less money for things like hospital beds and help towards care home fees.

  • Impact on the NHS

The Department of Health estimates that the average cost of providing hospital and community health services for a person aged over 85 years is three times greater than a person aged 65-74 years. The supply of state services has failed to keep up with the demand for care and support. Spending on the NHS has risen by £25 billion since 2004 but spending on social care has only risen by 0.1% per year in real terms.

Resources cannot be stretched even further. The result is that costs are rising and the eligibility criterion is getting tighter.

  • Care

By 2050, it is predicted that there will be three times more people of working age looking after two billion ageing family members. Caring for a family member can have a big impact on the economy with adults juggling work with care. The cost to individuals as well as the economy is huge as a 2011 survey revealed that 31% of working age carers gave up work or reduced their hours to care for a loved one.

So what does the future hold? Authorities have given their expectations as to what consequences our aging population will have but only time will tell.

What matters is that we have a solid framework to plan a fruitful future that cares for our elderly loved ones. Failures in social care will only lead to stifled economic productivity and we can turn the challenges it brings into a driver for economic growth.

How do we go about doing it? Perhaps we look to other countries to see how they look after their elderly; alternatively, a new system should be put in place that offers more financial support. Mr Dilnot, Head of an independent commission into social care, has previously recommended a cap on how much people should pay for their own care of £25,000-£50,000.

Only one thing matters- older people should always be viewed as a blessing, not a burden!

This article is provided by Cheselden, the UK’s leading independent authority on NHS Continuing Healthcare.

Person-Centred Funeral Care

I am well known for being passionate about care for older people being person centred and in my work often come across the subject of funerals. I was interested to know how they have changed over the years,  so I went to see a local funeral director, Max Webber the co-owner of H.D. Tribe in West Sussex. This company even has their own chapel, florist, function room and caterer, all in one place, which I think makes for a more convenient and intimate funeral.

I found the meeting fascinating and informative and would like to share what I learned with you. Max, like many independent funeral directors, finds carrying on the family tradition is a way of life and is deeply committed to upholding professional standards.DAD Funeral flower arrangement

Here is what I found out when I spoke to him:

In what ways have funerals changed over the last 10 years?

Expectations have shifted from religious church influenced funerals to more customer focused, person-centred funerals. Less than 70% of the funerals Max arranges, now have a religious funeral with 30% choosing a non or lightly religious celebrant. While there used to be only hymns and classical, respectful music at funerals, now the majority don’t have hymns. When you think about it, most schools no longer sing hymns and if someone doesn’t go to church, why would they choose to sing hymns at a funeral? Most people now choose popular classics and songs that reflect the individual which makes the funeral more personal.

What are the most common types of funerals?

Around 85% choose cremation and 15% a burial

What are the least common types of funeral people choose?

  • Burial at sea
  • Burial in own land (People can bury a person anywhere so long as they dispose of the body legally. The criteria for this is that they must not affect the water course, gas or electricity supply or cause a public nuisance)

How can People choose a funeral director?

Independent funeral firms can offer a more personalised service because they appreciate local customs and expectations and are not distracted or bound by corporate rules handed down from head office and shareholders , so can be more flexible and responsive to their customers’ needs.

To choose one ask the people you know if they can recommend a funeral director whose service they have been happy with or search on the internet. Here are a couple of useful websites.

The National Society of Allied and Independent Funeral Directors

The Association of Funeral Directors

Typical costs of a funeral

On average, the price of a typical funeral, including non-discretionary fees, is £3100 for a cremation and over £3,500 for a burial. This includes the following fees called disbursement costs:

Doctor’s fees for death certification £157  This fee only applies to a cremation, not for a burial. It also won’t apply if the deceased is in the hands of the coroner.

Cremation fees  Worthing Crematorium is currently £631.  Costs for crematoriums vary and it pays to shop around. If your funeral director has its own chapel like H. D. Tribe, you can have the service there and they will take your loved one to any crematorium afterwards,  and some charge considerably less. I think this is a much nicer idea as I hate the conveyor belt approach at most crematoriums and I always like to get value for money!

If you want to avoid a queue waiting for you to leave the crematorium and don’t want to feel rushed, for less than £100 you can book a double slot so people wont be ready to jump in your place the moment you leave.

Burial fees £1,500

Minister/Celebrant fees start at around £150

Your funeral director will be able to help you here as they all have a list. If people are uncertain, Max at H. D. Tribe asks his customers how religious they want the funeral to be on a scale of 1-10 and chooses the minister or celebrant accordingly. A nice idea I thought.

There are a number of additional services which you can add to a funeral, like Flowers, Catering, Notices in Newspapers and if a burial there is the headstone to consider as well. Remember, these aren’t essential costs. But if you do want to include them as part of the service, whether you arrange the funeral yourself or use a funeral director, it’s important to shop around as costs can vary significantly.

You can of course save money by arranging and managing the funeral service yourself and DIY funerals have become more popular recently. You can find out more about it here Good Funeral Guide Personally, I would find it hard to have the extra work and worry at a time when I was grieving for someone I loved but for some people, it offers a way forward.

What about pre-paid funeral plans?

The option to pre-pay for your funeral has for some time appeared to make good financial planning. Funeral costs continue to rise and a pre-paid plan can mean that everything is taken care of when the time comes. However in recent times, the big national companies have started to change the plans they offer. Some will not cover disbursements (i. e. cremation/burial costs, ministers/doctors fees) and others are now charging a supplementary administration fee. These changes are a direct response to the current financial climate. If you or your elderly loved one is thinking if taking out a pre paid funeral plan I would advise you to discuss this with your chosen Funeral Director as some of the funeral plans advertised in newspapers and magazines are linked to national funeral companies, that put them out to tender for the cheapest bidder, thus restricting client choice.

H. D. Tribes has been in business since 1929 and Max has been running the business for 32 years. They cover the coastal area of West Sussex. Check out their website at http://www.hdtribe.co.uk

Finally

There appears to have been a major shift in funerals over the past few years with people no longer being constrained by rules and regulations and opting for a more person-centred approach.

If you have any queries or need to arrange a funeral now or in the future, my advice would be to find a good local independent funeral director and talk over how you would like to personalise your funeral with them.

The Consequences of Reviewing Medication

In my previous post, The Cost of Failing to Review Medication I talked about the dangers and consequences of not reviewing medication for older people living with dementia. In this post I want to highlight the consequences of withdrawing long term medication for depression, Alzheimer’s and behavioural challenges without a proper plan in place to manage withdrawal. Medical Drugs for Pharmacy Health Shop of Medicine

The effects of withdrawing my mother’s medication

Following the review of Mum’s medication the drugs were withdrawn and have finally left her system. Before long her behavioural challenges returned with a vengeance and she has become distressed. Mum has suffered from depression and severe anxiety for most of her adult life and her dementia which began over 30 years ago became more complex a few years ago. She therefore been taking a cocktail of strong and powerful medication, some for many years. Since the withdrawal of medication that was making her feel sick, confused, disconnected, unable to speak and floppy, Mum has become very anxious and presenting angry outbursts, paranoia, hallucinations. This causes her immense frustration and sadness which is typical of older people living with dementia in residential care homes who have experienced so much loss and change.

Loss and lack of insight

Older people people living with dementia moving into care homes have lost their homes which have been condensed into one room, often their partners, local community connections, control over many aspects of their life, and to their families and close friends, their personalities. Mum also remains convinced that there is nothing wrong with her mentally, constantly reminding us that she is still an intelligent woman. Like most people living with dementia, she has no insight into her own abilities.

Getting it right

Getting the medication right for a person with Dementia is a complex issue that requires trial and error and a lot of time. In the meantime staff at the residential home are having to manage my mother with all her behavioural difficulties and withdrawal symptoms from the years that she has been on, what are very powerful drugs. Unfortunately, whereas people addicted to heroine would have a structured programme of support and carefully monitored medication to manage their withdrawal, older people like Mum are often left to go ‘cold turkey’!

Time is needed

It becomes very difficult to watch someone you love needing urgent medical attention, as health professionals are vastly overstretched and arranging appointments for them to see Mum takes time. Advocacy, kindness and compassion

Unfortunately the situation will not be resolved immediately and there are likely to be many hurdles to overcome before the dose of Mum’s medication has been adjusted correctly. Unfortunately older people living with dementia just aren’t treated with the same priority as younger adults. We can only support our elderly loved ones, advocate on their behalf and support them with the kindness and compassion they deserve. I would love to hear from anyone who has experienced similar problems with medication for an older person living with dementia.

The Cost of Failing To Review Medication

My  mother has suffered with poor health all her life, having multiple and long term mental and physical health problems, including severe depression and vascular dementia.  When she was at home I managed her medications  The point I would like to make here is that I would always look up a new medication she was prescribed  to view the side effects and contra-indications if I was unaware of them.  I also regularly sat down with the pharmacist to review them.

Since Mum moved into a residential care home, 3 years ago, I have not only lost control of her medication, but also the knowledge of what she has been prescribed.  Soon after being admitted to a care home she was prescribed Aricept, it’s pharmaceutical name is Donepezil. My mother  also prescribed another drug for her dementia, although when I looked it up it’s primary use was for schizophrenia. Her medication for depression was also changed.   These drugs are very powerful.  Unfortunately I did not look up the side effects of these medications, as I would have done had my mother been at home.

Mum’s health deteriorated significantly

Several months ago Mum’s condition deteriorated, she began feeling and being physically sick, and more latterly became floppy, to the point she had to be fed and given her drinks.  Her speech became slurred and incoherent,  she was disengaged, unable to follow conversation and was sleepy all the time.  I kept asking for her GP to investigate Mum’s condition. She was seen by a variety of GPs but never her own, and had various blood tests and changes in medication, including another prescription for a drug to ease her sickness.

Preparing for Mum’s demise

At Christmas my son and I became so concerned about her rapidly deteriorating condition we decided  to let the family know we thought Mum was dying, to prepare them for how bad she looked when visiting her at Christmas.  It was a heartbreaking time for us.

Diagnostic intervention

After Christmas I asked for her own GP to attend and she contacted me to discuss Mum’s situation and possible courses of action.  As one of the considerations was that Mum may have had a stroke I asked that she could have a brain scan to confirm this.  I also requested a psychiatric assessment.

The brain scan identified that Mum had not had a stroke.

The psychiatric assessment identified a serious deterioration in her mental state and a detailed review of her medication was undertaken, with the result that the two powerful medications prescribed for her dementia, the one she took for depression and one for sleeping were discontinued. 91 years of life

Dramatic improvement

Following the withdrawal of these drugs, there was a dramatic improvement in Mum.  She became coherrent, more lucid, stopped being sick and regained control of her body again.  She was able to eat and drink independently, without the need for being fed.

Although my Mother obviously still suffers from dementia, with periods of confusion and forgetfulness, I could finally hold a conversation with my my Mum again, like I could before she was prescribed the drugs.

My family and I feel angry that despite seeing several doctors Mum had to experience sickness and other unpleasant side effects over a number of months before the matter was resolved.  Had her drugs been reviewed properly earlier on, the dramatic deterioration in her health could have been avoided.

I wonder how many other older people living with dementia are suffering unnecessarily.?

I want to make sure you are all aware of the danger of neglecting to ask for your elderly loved one’s medication to be reviewed regularly (not just given a once over at by a GP and hope you find the following tips helpful.

Top tips for reviewing medication

  • Make sure medication is reviewed regularly for your elderly loved ones. I believe GPs are too busy to review psychiatric medication thoroughly enough and pharmacists and community psychiatric nurses are better placed to carry out the review and make recommendations to the person’s GP.
  • Find out what each medication has been prescribed for
  • Are there any contra indications you/ the care home should be aware of?
  • What are the likely side-effects (if only we had known that a common side effect of Aricept (Donepezil) is sickness
  • Do the benefits outweigh the risks?
  • Does the dose need to be adjusted (people need less as they become older and often eat less and lose weight, as was the case with my mother

In addition to the human cost of failing to keep medication up to date for older people living with dementia, it also wastes valuable NHS money!