Care Select - The Handbook For Relatives May 2014

THE HANDBOOK FOR RELATIVES

WHAT IF MUM DOESN’T AGREE?




CAN WE AFFORD IT?

CAN WE AFFORD IT?

CAN WE AFFORD IT?

HOW WILL I KNOW WHICH TO CHOOSE?

WHAT ARE THE CARE OPTIONS?



WHAT IF I MAKE THE WRONG CHOICE?



CAN WE AFFORD IT?

CAN WE AFFORD IT?

CAN WE AFFORD IT?




WHAT ARE THE CARE OPTIONS? WHAT IF I MAKE THE WRONG CHOICE?


AGREE? WHAT IF MUM DOESN’T AGREE? WHAT


WE AFFORD IT? WHAT IF MUM DOESN’T AGREE? CHOOSE? HOW WILL I KNOW WHICH TO CHOOSE? HOW

CHOOSE? HOW WILL I KNOW WHICH TO CHOOSE? HOW WILL


OPTIONS? WHAT ARE THE CARE OPTIONS? WHAT ARE THE

OPTIONS? WHAT ARE THE CARE OPTIONS? WHAT ARE



CAN WE AFFORD IT? CAN WE AFFORD IT?

IT? CAN WE AFFORD IT? CAN WE





CAN WE AFFORD IT?

CAN WE AFFORD IT?

CAN WE AFFORD IT?








CAN WE AFFORD IT?

CAN WE AFFORD IT?

CAN WE AFFORD IT?




WHAT ARE THE CARE OPTIONS? WHAT IF I MAKE THE WRONG CHOICE?


AGREE? WHAT IF MUM DOESN’T AGREE? WHAT


WE AFFORD IT? WHAT IF MUM DOESN’T AGREE? CHOOSE? HOW WILL I KNOW WHICH TO CHOOSE? HOW

CHOOSE? HOW WILL I KNOW WHICH TO CHOOSE? HOW WILL


OPTIONS? WHAT ARE THE CARE OPTIONS? WHAT ARE THE

OPTIONS? WHAT ARE THE CARE OPTIONS? WHAT ARE



CAN WE AFFORD IT? CAN WE AFFORD IT?

IT? CAN WE AFFORD IT? CAN WE


YOUR COMPANION THROUGH THE EMOTIONAL AND PRACTICAL ASPECTSOF CHOOSING AND FUNDING CARE FOR AN AGEING RELATIVE.

WWW.CARESELECT.CO.UK £9.95

FOREWORD BY ESTHER RANTZEN CBE

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THE TUDORS CARE HOMENorth Street, Stanground, PeterboroughCambridgeshire PE2 8HRTel: 01733 892844 • Fax: 01733 554306Email: [email protected]

ABBEY ROAD53 Abbey Road, Ilford Essex IG2 7LZTel: 0208 518 6757 • Fax: 0208 554 7438Email: [email protected]

The Gold Standard of Care‘individuality, dignity and respect’

HILLSIDE NURSING HOMENorth Hill Drive, Harold Hill, RomfordEssex RM3 9AWTel: 01708 346077 • Fax: 01708 376513Email: [email protected]

WILLOWMEAD CARE HOMEWickham Bishops Road,Hat�eld Peverel, Essex CM3 2JLTel: 01245 381787 • Fax: 01245 382356Email: [email protected]

Choosing a care home can be a daunting experience.

Visit your nearest Gold Care Home, to see and sense for yourself the genuine care,compassion and respect our residents experience.

Find out more by visiting our website www.goldcarehomes.com or call us on our head o�ce number 01895 257 010

“We care for your care” www.goldcarehomes.com

Gold Care Homes was established in 1999 and has since grown to operate 24care homes:

• ABBEY ROAD• ALAN MORKILL HOUSE• AUTUMN VALE CARE CENTRE• BAUGH HOUSE • BLETCHLEY HOUSE• BRACKENBRIDGE HOUSE• BURROWS HOUSE• DRAYTON VILLAGE • HALCYON DAYS• HEATH LODGE CARE HOME• HILLSIDE NURSING HOME• KENT HOUSE• LUCTON HOUSE• MANOR HOUSE• MARTINS HOUSE• NEWSTEAD NURSING HOME• PEREGRINE HOUSE• QUEENSWAY HOUSE• SIR JULES THORN COURT• ST KATHARINE’S HOUSE• ST STEPHEN'S• THE TUDORS CARE HOME• WILLOWMEAD CARE HOME• WOOD HOUSE

GOLD CARE HOMES, HEAD OFFICE, GIDAR HOUSE, 13 THE CROSSWAY, UXBRIDGE, MIDDLESEX, UB10 0JH

Contents04 05 09 1216 18 26 34 40 42 54 556267 72 74758184 9699

103 115Publications

www.carechoices.co.uk

Alternative formats

This Handbook is available electronically at www.carechoices.co.uk. There is also a Browsealoud option for those requiring the information in the spoken word.

@careselectmag

Foreword by Esther Rantzen CBE

Starting your journey

Understanding their needs

Dealing with family pressures

Support to live independently at home

Making life easier in the home

Choosing care

Care and support at home

Choosing a home care agency checklist

Residential care options

Choosing a residential care home checklist

Specialist housing with care schemes

Was it the right decision?

Dementia and dementia care

Dementia – spotting the first signs

Residential dementia care checklist

Thinking of end of life care

Are you a family carer?

How is care funded?

Legal issues surrounding needing care

Essential contacts

Region-by-region care homes

Advertisers’ index

Contributors

Esther Rantzen CBE, Journalist and TV presenter

Di Bedford, Heritage Independent Living

Joe Levenson, Dying Matters

Ed James, QualitySolicitors Truemans

George McNamara, Alzheimer’s Society

Katie Bennett, Alzheimer’s Society

Les Bright, BCD Care Associates

Mark Thomas, St Monica Trust

Philip Spiers, EAC FirstStop Advice

Tracy Wharvell, Safe and Settled Limited

Trish Davies, Care4mum

THE TUDORS CARE HOMENorth Street, Stanground, PeterboroughCambridgeshire PE2 8HRTel: 01733 892844 • Fax: 01733 554306Email: [email protected]






Visit your nearest Gold Care Home, to see and sense for yourself the genuine care,compassion and respect our residents experience.

Find out more by visiting our website www.goldcarehomes.com or call us on our head o�ce number 01895 257 010

“We care for your care” www.goldcarehomes.com

Gold Care Homes was established in 1999 and has since grown to operate 24care homes:

• ABBEY ROAD• ALAN MORKILL HOUSE• AUTUMN VALE CARE CENTRE• BAUGH HOUSE • BLETCHLEY HOUSE• BRACKENBRIDGE HOUSE• BURROWS HOUSE• DRAYTON VILLAGE • HALCYON DAYS• HEATH LODGE CARE HOME• HILLSIDE NURSING HOME• KENT HOUSE• LUCTON HOUSE• MANOR HOUSE• MARTINS HOUSE• NEWSTEAD NURSING HOME• PEREGRINE HOUSE• QUEENSWAY HOUSE• SIR JULES THORN COURT• ST KATHARINE’S HOUSE• ST STEPHEN'S• THE TUDORS CARE HOME• WILLOWMEAD CARE HOME• WOOD HOUSE

GOLD CARE HOMES, HEAD OFFICE, GIDAR HOUSE, 13 THE CROSSWAY, UXBRIDGE, MIDDLESEX, UB10 0JH3Visit www.carechoices.co.uk for further assistance with your search for care

I had one of the briefest political careers

in history, when I stood as an Independent

candidate for Luton South. But although,

sadly, it didn’t lead to an exciting new life in

the House of Commons, it did mean that for

a few months I was able to immerse myself

in the community, including a memorable

visit to a care home for frail older people.

I was invited to tea, and having spoken to

the residents there, a care worker took me

to one side to ask if I could do something

to counteract the myth that all care homes

are bad, and that to ‘put Mum into a home’

is an act of sadistic callousness. ‘Look at

our residents,’ she said. ‘If they were trying

to survive in their own homes, they would

never have this standard of food and care,

and the company, and the activities. We

try to make sure they have a real quality of

life here, that they are happy. And we love

our work. And yet nobody ever talks about

the difference we make, you only ever hear

about the horror stories.’

Of course she was right. Well-run homes

can transform lives of older people who

may otherwise become so vulnerable and

isolated that they feel, as one lady wrote to

me ‘my life is pointless, and I’m a waste of

space.’ It’s part of the ageism of our society

that an older person should be made to

feel valueless, simply because of their age.

Equally, that same ageism means that the

people who work with older people all too

often also feel ignored and undervalued.

We need to spotlight the best practice, and

celebrate it. Some older people prefer to

live on their own. Others thrive in company.

Recently I visited a sheltered housing project

where a retired artist had decided to hold a

card-making class for other residents, it was

fun, it was creative and the artist herself

felt she was contributing the skills she had

honed over

a busy life-time.

Everyone enjoyed it, but it was only possible

because they were all living together as a

community.

That being said, we also receive calls at

The Silver Line helpline from the residents

of sheltered housing and care homes who

tell us they are still lonely. One memorable

call we received in the depth of winter, soon

after we opened our helpline, was from a

lady making the call from the bathroom,

on a borrowed mobile phone, reporting

that her care home had no heating on,

that the food was inadequate and she was

extremely fearful of asking for help. Other

callers ring us from sheltered housing to

tell us that even there it’s possible to be

extremely lonely. Not all the other residents

are friendly and the staff are often not on

site, or not around at weekends or holidays.

I remember a lady telling me on Christmas

day how empty and silent the place was and

how profoundly lonely she felt.

So it’s a crucial decision for older people

and their families, and the aim of this

handbook is to assist them, so that they can

find the right care and support including

well-run homes when they need them,

and projects with caring committed staff.

It is incumbent upon them that if things

go wrong, they ask for help. And we in the

media have a responsibility too, to spread

the message that ‘being put into a home’

may in fact not be a prison sentence, but

the reverse, a liberation, and a positive

transformation.

Esther Rantzen CBE

Journalist and TV presenter, Esther Rantzen

CBE, is founder of The Silver Line, a 24-hour

free helpline for lonely, elderly people.

0800 470 80 90 • www.thesilverline.org.uk

Foreword by Esther Rantzen CBE

04

Foreword




4 Visit www.carechoices.co.uk for further assistance with your search for care

04

Foreword





Choosing care





Specialist Housing with Care Schemes







How is care funded?


Essential contacts

Region-by-region care providers


There may be many reasons you find yourself looking for care and support for a relative and it’s not unusual if it feels like a difficult and emotional time. The care and support system is not always the easiest system to find your way around, especially if it’s at a time of crisis.

Emotions can be running high when you find yourself having to make difficult decisions that will affect you, your relative and members of your wider family. It is always good to be prepared and to have discussions beforehand in order to understand what really matters to your relative requiring care or support.

It is important to appreciate that for many older people, moving into a care home or receiving care at home, is not something they necessarily want or are looking forward to happening. It doesn’t help that the media is rarely kind about care homes or home care services, preferring to highlight the few cases where care needs have not

been met, rather than the many care homes and home care services providing excellent care.

Coming to terms

Making choices about care is rarely straightforward, and may be especially difficult when confronting the issue for a relative. All parties are likely to experience an ‘emotional rollercoaster’ at such critical times, and if you are one of a number of siblings or family members who are involved there can be competing opinions on what is necessary.

It’s not easy to keep everyone happy and feeling that their views are understood and respected. This may be particularly problematic for the person whose future will be most intimately affected. While your mother or father may have begun to recognise that the time is fast approaching when they will have to seek help, this will not make it easier for them to manage their own feelings or to readily accept and understand your worries. Decisions about care are often needed at times of personal crisis, after illness or hospitalisation as a result of falling. Everyone involved in the situation may be handling feelings of sadness, guilt or anxiety – perhaps all three. Tread carefully with all the sensitivity you can muster, even if you would prefer to be business-like and decisive. >>

Starting your journeyYou’ve reached the point where you think a parent, relative, or even a close friend needs support – where do you start and what really matters? For clarity, Care Select will refer to the person needing help as a relative or loved one throughout.

‘The care and support system is not always the easiest system to find your way around, especially if it’s at a time of crisis.’

5Visit www.carechoices.co.uk for further assistance with your search for care

>> When the time is right

Facing up to failing, because that’s what it may feel like to you or the person you love whose future is being discussed, is never easy at any time and so it is unsurprising that fear, resentment and stubbornness may get in the way of making timely decisions.

If you are only just beginning to discuss whether the time is right to consider care and support, whether in the home, specialist housing schemes or by moving into a care home, it is worth reflecting on how you would react if you felt that you were being ‘bounced’ into such a far-reaching and possibly irreversible decision. If it is a time of crisis, your loved one may realise that changes are necessary, although this may not mean that they are any more inclined to be co-operative than they had been while the situation deteriorated.

The onset of illness or disability, bringing with it reduced mobility; growing difficulties in managing aspects of daily life; or the loss of a lifetime partner, are each likely to have a devastating impact. You may read these events as signals to start organising changes, but the person most directly affected by these blows to their

independence and growing dependency on others may not share this view and will need sensitive handling to participate constructively.

When care is needed

You should be careful how you draw attention to any emerging difficulties, for example, problems climbing the stairs and getting to the toilet on time, should not focus on the indignity of being too late, but on what can be done to change the situation. Installing a stair lift or moving somewhere with level access and/or more toilets may be all that is needed - initially. Each of these options could restore confidence reaching far beyond the problem being addressed.

Risks associated with simple everyday activities like using cookers, kettles and other household equipment - often a serious concern due to physical frailty or memory lapses - could be eliminated

because hot drinks and nutritious meals will be provided whether

by in-home support or in a care setting.

In-home adaptations and equipment can also help in managing these and other risks.

Self-neglect - washing less frequently, or in the

case of elderly men putting off shaving and, therefore,

looking less well-groomed, or wearing the same clothes for longer than advisable, can be reduced or eliminated altogether by small amounts of help, which can increase in line with a growing willingness to accept assistance.

It may be possible to try out the benefits of a move to a care home through a trial stay (known as respite care) with such facilities in easily accessible public areas or an adapted

‘If it is possible you need to sit down and have a thorough discussion with your relative and other members of the family who would like to be involved in the decision.’


bedroom, providing all concerned with insights into the benefits of communal living. Although it may not be possible to organise a temporary stay in a housing scheme that provides care and support, visits by prospective tenants or purchasers are likely to be welcomed and provide opportunities to talk with others who have been through the process themselves.

Unless the situation is an emergency, you should try to move slowly and create the sense that you are setting out together on a journey whose destination will need to suit all parties. Above all, try to avoid focusing on difficulties, deficits or disabling factors – this will not only upset your loved one and possibly other family members too but is also likely to contribute to the sense of guilt which you, in common with many people, may be experiencing.

Be open

If it is possible you need to sit down and have a thorough discussion with your relative and other members of the family who would like to be involved in the decision. Choosing somewhere to live or inviting a care assistant into the home is a really individual thing, full of subjective decisions. What may be right for one person may not be right for another. What the family feel is right, your relative may not agree with or vice versa.

If you are looking for assistance, it is important to think about the type of support needed but just as importantly, consider personal preferences, likes and dislikes. You can also ask your local authority’s social services or adult social care department, as it can be called, to

complete a community care assessment of your relative’s needs to clarify exactly what is required. More information on assessments is available on pages 9 & 34.

Talking really helps

Make sure you know what is important to your loved one

by talking this through with them. Do they feel lonely? Would they like to meet new people? Are they struggling to

get up and down the stairs? Are they worried

about a stream of different care staff in the house? Are they

unable to make their meals? Do they need support to get out to the shops? Is the house getting too much for them and they want to move somewhere more manageable? All of these things and more may be playing on their mind and need to be considered.

You may feel guilty about your relative living in a care home or receiving care from a non-family member, or another member of your family may not agree with the decision, but it is important to remember that care homes and home care services provide specialist care and support. The right care service will add value to your loved one’s life and allow you to spend quality time together without the pressure of caring responsibilities or the worry of who will look after them when you leave.

Whatever position you find yourself in, Care Select will help you to make the best possible decisions in difficult times.

‘Choosing somewhere to live or inviting a care assistant into the home is a really individual thing.’


HC-One specialises in dementia, nursing, residential and specialist care, and provides a range of additional services including intermediate and respite care, alcohol related services, brain injury services, learning disability, mental health and end of life care.

The third largest provider of elderly care, over 14,000 HC-One employees provide care for more than 10,000 Residents at homes situated throughout the UK.

Each Resident and their relatives can trust that the care they will receive will be delivered with kindness, thoughtfulness and respect, in a safe, warm, comfortable and welcoming environment.

For more information:email: [email protected]: 0808 1000 212

www.hc-one.co.uk

HC-One has a clear vision to provide the kindest careHC-One specialises in dementia, nursing, residential and specialist care, and provides a range of additional services including intermediate and respite care, alcohol related services, brain injury services, learning disability, mental health and end of life care.

The third largest provider of elderly care, over 14,000 HC-One employees provide care for more than 10,000 Residents at homes situated throughout the UK.

Each Resident and their relatives can trust that the care they will receive will be delivered with kindness, thoughtfulness and respect, in a safe, warm, comfortable and welcoming environment.

For more information:email: [email protected]: 0808 1000 212

www.hc-one.co.uk

HC-One has a clear vision to provide the kindest care

04

Foreword





Choosing care












How is care funded?


Essential contacts



Understanding their needsLet’s assume you have overcome any initial resistance to considering looking for help and support for yourself or a relative. Then you need to address some fundamental questions, such as how much, or how little help your loved one needs, who can provide it, and who can help you to find the range of options.

Making decisions that could lead to giving up the home where the family was raised, loaded as it is with happy memories, can be a stressful time with anxiety being a feature for everyone involved. It is more likely that you will be able to make good decisions if you are in possession of sufficient information in a form that you can make sense of and act on.

Knowing what’s available is only part of the picture, you also need to have an objective assessment of the breadth and depth of your relative’s needs.

Getting an assessment

Regardless of whether your relative’s financial situation – accumulated resources, income or home ownership – means that they will not be eligible for any financial assistance from the public purse, they will nevertheless be entitled to an assessment of their care needs. This is one of the few rights under community care law – local authorities are required to carry out an assessment where it can reasonably be assumed that the person requesting the assessment is likely to have care needs.

It is generally accepted that older people, or those adult children acting on their behalf, will fit into this category. Sometimes your relative’s GP may be the obvious person to contact the local authority, adding extra professional weight to your request, but if that isn’t possible you can approach the local

council directly and ask for ‘adult social care’ or some local variant on that label; outline the situation and ask that they carry out an assessment.

It is increasingly likely that you will be told that the council is under financial pressure and consequently can only provide services to those considered in ‘critical’ or ‘substantial’ need. You should not allow this to be used as a reason for not meeting their legal obligation to carry out an assessment that is a necessary step to provide you with the information and enabling you to make timely appropriate arrangements for the future care of your parent.

What does the assessment consist of?

You may think your relative is slowing down, or becoming forgetful but a skilled assessor will move beyond such thinking and will be able to establish what the key issues are that are affecting the quality >>

‘It is increasingly likely that you will be told that the council is under financial pressure and consequently can only provide services to those considered in ‘critical’ or ‘substantial’ need.’


>> of life of your loved one. Visiting them at home will provide a wider picture, taking in any difficulties within the built environment, too many stairs or other potential hazards, for example in the kitchen or bathroom. Alongside this the assessor will also want to explore the current support from family and friends and the scope for stepping that up and the impact increased demands could have on those providing such help.

We all know our limits and sometimes if we go beyond that point the consequence is that we go under too – that’s why there is also an obligation to assess the situation of the principal carer, frequently the husband or wife of the person whose changing care needs may have set the process underway in the first place. Of course, it may be that you or one of your siblings play this key role but are physically and emotionally stretched to the extent that you can do no more without damaging your health and, therefore, putting your loved one at risk too. An objective review of your relative’s physical health, sight and hearing, mental capacity, relationships, support networks and personal resourcefulness will all come into play and will in turn lead to a fuller picture of what’s needed to compensate for temporary changes in their functioning or to map out a range of actions which can be taken to manage continuing decline.

For more information on the role of carers and their rights see page 81.

A care plan

When completed, the assessment belongs

to the person who has been assessed,

and will provide everyone involved with

the basis for seeking help – either to

remain in their current home or to make

the move to one of the other forms of

housing with care. Above all it will be

invaluable in ensuring that you enter into

the process of seeking help with a much

clearer understanding of the options.

If the local authority becomes involved

in providing services, making charges

based on a separate assessment of your

relative’s financial means, there will be

a care plan outlining the way in which

services will be provided. This should

be reviewed within three months of the

original assessment. The review will learn

from experience and modify times and

types of service in the light of what works

well and meets the needs of your relative

most effectively. If, for whatever reason,

the services are being provided by a third

party – a commercial service provider or

a charity – they too will devise a care plan

against which performance and impact

can be measured and, where necessary,

adjusted in line with changing needs and

the preferences of you and your parent.

Whatever the form of care you’re

choosing, you should ask the manager

about their approach to care planning,

considered by many to be the

cornerstone of a good personalised

service. A care plan should address all

aspects of your loved one’s life, not just

care needs or health status, and should

take account of spiritual well-being

as well as their physical and mental

health; likes and dislikes, and as much

information as you are prepared to share

with staff about your relative’s personal

‘You may think your relative is slowing down, or becoming forgetful but a skilled assessor will move beyond such thinking.’


history. This plan will form the basis for

future care but will be reviewed regularly, in consultation with you and your relative, and in the light of any changes arising from being well looked after and re-motivated to lead as full a life as possible.

Leaving hospital

If your loved one has been a hospital in-patient, either as a result of planned surgery or as an emergency admission, they should only be leaving hospital if a thorough assessment of their health, and the need for support at home to continue living safely, has been conducted by a multi-disciplinary team of health and social care staff.

In some cases this assessment may lead to a decision to move them out of hospital because their medical needs have been met, while recognising that a period of further care in a residential home is necessary prior to being fit enough to be discharged home again. The label attached to this service may vary from place to place, sometimes it is called reablement or enablement, but you should think of it as being a period of convalescence where strength is rebuilt, old skills are regained and new ones developed so that they can function as well as possible.

Most people leaving hospital have relatively simple healthcare needs but in some cases their continuing care may be complex and may qualify for NHS funding to pay for care in a home that employs qualified nursing staff. This can be a problematic issue with wide variations between the perceptions of professionals and ‘ordinary citizens’ concerned about the care of a relative, and the cost of paying for this in the marketplace. If there is a dispute it will be worth seeking specialist help to advise you in either pursuing a claim for NHS Continuing Care

funding, or to understand the agreed criteria for this, and why your relative does not qualify. More information on this is available on page 88.

Staying independent

We all want to remain as independent as possible for as long as possible, we want to stay in charge of the detail of our lives, giving up a bit of control as and when it becomes clear that we can no longer manage. This is generally understood by people involved in providing services. In such situations, advice and where necessary, assistance to adapt your relative’s home so that it is safe and hazards are minimised or eliminated altogether, is likely to be part of a comprehensive assessment.

Remember it’s likely that your loved one will carry on believing that they can manage without assistance and your task is to accept and work with this, rather than imposing your will on theirs.

Time to act

Making the decision to start searching for care can seem daunting but being prepared, taking the time to look into all the options and planning carefully can help. Start with a community care assessment and your journey should move forward from there. And if your decision is being made in an emergency, ask health and social care staff to help you in your search.

‘We all want to remain as independent as possible for as long as possible, we want to stay in charge of the detail of our lives, giving up a bit of control as and when it becomes clear that we can no longer manage.’


04

Foreword




Support to live independently

at home

Choosing care

Care and support at

home

Choosing a home care

agency checklist



Specialist Housing with

Care Schemes



Dementia – spotting the

first signs

Residential dementia care

checklist



How is care funded?

Legal issues surrounding

needing care

Essential contacts

Region-by-region care

providers


Declining health and mobility are difficult to come to terms with; they affect our sense of who we are, challenging our identity in a process that is progressive and irreversible.

If your loved one has always been an active gardener, it can be depressing and frustrating to see the garden looking unkempt and overgrown, as well as missing the fresh air, regular exercise and enjoyment of the seasons such activity brings. For someone who is an avid reader, there is nothing worse than failing sight. Thoughtless jokes are often made about deafness, but becoming hard of hearing increases social isolation and loneliness. These are life-changing conditions and have emotional as well as physical consequences.

After a lifetime of independence, older people are often understandably reluctant to admit to themselves as well as their family that they are not managing well. Fear of the future, embarrassment at a decline in controlling bodily functions, are all difficult subjects to talk about and symbolise a reversal of roles in family dynamics.

Your own life

People with relatives at this stage in their lives are usually under pressure of their own, juggling the needs of partners, children, even grandchildren, with demanding careers, often living their busy lives at some distance from their original home. They may be feeling guilty about not giving enough time to support their loved ones, and even more so about the thought of relying on

strangers to provide the daily care and support a parent

might need, and probably expects, from their son or daughter.

It’s natural to focus on physical impairment and practical support

but families come with histories, emotional

patterns of responding, and ways of behaving to each other

that are well-formed and difficult to

Deciding how to help an ageing relative is a daunting task. Their needs are first and foremost, but it is often difficult to make an honest assessment of how the ageing process is affecting their health and ability to maintain their independence safely.


‘After a lifetime of independence, older people are often understandably reluctant to admit to themselves as well as their family that they are not managing well.’


change. Not everyone will agree with what is needed or the course of action; your parent, sibling or a wider family member could have other ideas – you never quite know how people are going

to react. It’s hard to see things clearly when you are emotionally involved and attached to someone who needs care. However, such decisions are best approached with calm reason.

Examples of family pressures

I’ve been caring for Mum for the past five years. I can’t keep it up, it’s affecting my health. My brother lives at the other end of the country and only visits for Christmas and birthdays. He doesn’t want me to ‘put Mum in a home’, but I can’t cope anymore, I’m getting ill, I have no other choice.

Dad is fiercely independent and doesn’t want a stream of ‘strangers trooping through my house’ – but I know he needs someone to come in and help him out, otherwise I’m worried he’ll become isolated and deteriorate.

Our auntie has recently been admitted to a care home, I am in charge of her estate and need to arrange to sell the house to pay for her care. My cousins don’t agree as it was their family home, but they never come to visit and don’t support me or their Mum. The care home fees need to be paid and the house is the only way to do it.

These are just common examples

and each family has its own particular pressures. There are no right or wrong ways of dealing with these; however, asking for

independent advice, sitting down with someone

outside of the close family or even a mediator may help. Try to stay calm and look at things rationally, as certain

issues could cause life-long rifts in families and

that’s not something anyone wants, least of all your ageing

parent who is in the middle of it all.

There are some useful contacts on page 99, some of these organisations have helplines and may be able to advise you on ways to address some of the family issues you may be experiencing.

‘The care home fees need to be paid and the house is the only way to do it.’

‘Not everyone will agree with what is needed or the course of action; your parent, sibling or a wider family member could have other ideas.’



Mrs J, is 88, lives alone in a 30s semi with a steep, unruly garden in a Midlands town. Her two daughters, married with families, live away, one on the south coast and the other in Canada. Mrs J cared for her husband who suffered with dementia and as a result has become socially isolated herself over several years.

Her own health and ability to manage her personal care are deteriorating through macular degeneration, emphysema and diabetes. She has become forgetful, her diet is poor and she is very thin, but remains agile and still likes her favourite hobby, dancing.

Mrs J has a cleaner for one hour a week but strongly resists any suggestion of further help. Her fiery personality rather intimidates her eldest daughter, who visits every few weeks and organises delivery of shopping. The younger daughter has a more detached approach, but is conscious that she isn’t bearing the brunt of the situation. Both daughters are worried that, without regular support, their mother’s health and self-care will deteriorate so much that she will have an accident or become acutely ill.

A family meeting when both daughters are in the country is arranged with an independent adviser, where Mrs J’s optimistic perception of how she is coping is explored and contrasted gently but persistently with her family’s anxieties. Mrs J reluctantly acknowledges that some support

to take her to the doctor’s or out for coffee would be helpful, but she quite reasonably specifies that she must select the care worker herself, have continuity of care worker and only one visit a week.

This breakthrough is acted upon quickly - choosing an agency that provides well-trained staff, who are sensitive to the particular needs of Mrs J’s background and interests is crucial to success. Once she feels in control and has confidence in the service, it is possible to widen the range of support to focus on personal care, meals and mealtimes, and introduce a second carer so that she is familiar with a small team to cover holidays and sickness. Mrs J enjoys the companionship and activities the home care workers provide, her quality of life is improved and her daughters reassured. The agency manager undertakes that if sheltered housing or residential care becomes necessary in future, the care team will support Mrs J through the transition, alongside her family.

Mrs J’s resistance to change

‘Both daughters are worried that, without regular support, their mother’s health and self - care will deteriorate so much that she will have an accident or become acutely ill.’


Mr D’s supported to make some changes

Mr D is 96, widowed and lives alone in sheltered housing. He is very hard of hearing, registered blind, with severe macular degeneration, and suffers from arthritis which limits his dexterity and mobility.

His other health problems include bowel disease, irregular heartbeat, controlled by a pacemaker, and he has a catheter. Despite all these chronic conditions, he is resourceful in adapting his environment to his disabilities and fiercely independent.

Mr D has outlived almost all of his contemporaries and has few social activities beyond those organised by the housing association (which he frequently declines to attend) and the monthly Blind Club, which he enjoys.

He has one morning session a week from a local authority care worker, who takes him shopping and cooks lunch; the rest of the week he cooks frozen meals or has sandwiches. Mr D used to attend a day centre once a week where he had a bath, but decided that the journey was too long and the sudden increase in charges too high. He now pays someone to clean his flat while he bathes himself, so she is on hand in case he slips. He has recently had several falls, one of which was serious and required attention at the local A&E hospital.

It is clear to his son, James, who lives 200 miles away, that Mr D needs at least daily assistance with dressing, meals and bathing and probably requires 24 hour care, but he is frequently told ‘not to interfere’ on his regular visits.

James’ worries about his father are compounded by guilt and frustration

at being so far away, a fact for which he is often reproached.

James asked the local social services team to carry out a multi-disciplinary re-assessment and it was apparent to the housing manager and his care worker that Mr D’s safety was increasingly at risk. The GP and district nursing service are frequently called out, he is at the limit of support where he lives. There is a strong possibility that the next incident will mean an emergency admission to hospital or directly into a care home, for which Mr D is not prepared. He has limited savings and would very soon need local authority funding for residential care.

By having experts outside the family ask him what he is managing well and what he needs most help with allows him to be honest about his increasing disabilities. Although protesting that he is alright, he is prompted by those who see him regularly. He doesn’t like change and fears that a procession of carers will disrupt his life if he has daily home support. His minimal eyesight makes it essential that items in his flat always remain in their familiar places so he can find them. The care home alternative would also mean getting to know a new and larger set of carers, as well as a completely new physical environment. But it would also take care of his physical needs and offer more social life, relieving his loneliness. Mr D is firmly but kindly made aware that he cannot opt for no change. He asks for more information on care homes near his son and eventually decides to try respite care for a week.



16


at home

Making life easier in the

home

Choosing care


Choosing a home care agency

checklist




Care Schemes

A little encouragement

The first thing you should start doing is to encourage your relative to remain as independent as possible by having a balanced diet and taking regular exercise. It’s all too easy to think that the aches and pains and stiffness associated with getting older, make it more difficult to exercise but even the lightest activity is better than doing nothing. Even just encouraging someone to walk around the house rather than sit for long periods at a time will be beneficial. If they’re able, a short walk around the block or to the park can be enough to loosen up some aches and stiffness, a little light housework or gardening too.

It’s a fact that regular exercise can reduce risk of developing certain long-term health conditions such as high blood pressure, heart disease, stroke, osteoporosis and some cancers. It can also help to improve cognitive abilities, mobility and wellbeing.

If your relative has a health condition, contact their GP before starting any exercise. For more information on physical activity guidelines for older people and exercises to try, visit the NHS Choices website www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-older-adults.aspx

Staying safe at home

It’s no surprise that most people prefer to remain living in their own homes for as long as possible. It could be the family home, where they’ve perhaps lived for many years and feel the most comfortable but as your loved one starts needing support, even this safe haven can present fresh problems. Does your mum or dad struggle to get up the stairs? Is getting in and out of the bath becoming a problem? If your relative lives on their own, do you worry what happens if they fall and can’t get themselves up? These are just some of the everyday common worries that offspring face as their parents get older, recover from operations or get used to living on their own.

There are a lot of practical aids, technological innovations and levels of support that can help your relative live safely in their own home. These could be support aids and adaptations,

Has the time come where your relative is starting to need a little extra support around the home? Are you noticing that they’re struggling with things but won’t admit they need help? Do you worry that you don’t live close enough to help? These are common dilemmas but there are many products and services to help them remain living in their own home.

‘Even just encouraging someone to walk around the house rather than sit for long periods at a time will be beneficial.’


community alarms, home care and even live-in care.

Don’t be surprised though if suggesting even the simplest of aids like a kettle tipper or bath chair are met with initial resistance. Nobody likes admitting that they can’t look after themselves or cope in the same way that they always have. Gentle persuasion and persistence will usually win through, especially when they realise how simple changes can enhance their standard of living.

Aids and equipment

Local independent living centres have a wealth of aids, adaptations and information for you to explore. You can speak to occupational therapists and advisers who may be able to suggest items, aids, or adaptations to help support your parent or make moving around easier. Some independent living centres are open to the public to visit and look around, though you may need an appointment, others are run by the local authority so you may have to go through them in the first instance. Search the internet for independent living centres in the area your parent lives in and see how they work. The Living Made Easy website offers help and advice on daily living as well as details on equipment that could help you from small products right up to stair lifts, grab rails or external rails. It is run by the Disabled Living Foundation and works in conjunction with AskSARA. www.livingmadeeasy.org.uk AskSARA also helps you find useful advice and products that make daily living easier. Depending on your relative’s need there are a number of yes/no questions you can answer, it then generates a report of advice and products that could make a difference. www.asksara.org.uk

Time for tea

After Fred’s wife Catherine passed away he and his family knew it would take him a while to adjust to living alone. He was of the generation that went out to work whilst Catherine raised the family and tended to the house. Fred’s son James and his wife Lucy popped round most days to make sure he was okay and drop off meals. Although Fred was happy with this arrangement, he was fiercely independent and didn’t like having to rely on his son and daughter-in-law.

Fred had arthritis which affected the mobility in his hands. On one visit Lucy noticed that he hadn’t had a cup of tea – there were no cups to be washed and he hadn’t offered her a cuppa. Fred had been complaining about his arthritis but laughed it off as the wet weather. When Lucy got home and searched the internet, she found a simple kettle tipper online.

A few days later when it had been delivered she took it to Fred’s and offered to make him a cup of tea. He was initially dismissive of the ‘contraption’ but Lucy set it up, made a round of tea and left it in place. The next day when James visited Fred, Lucy asked him to see if Fred had made a cup of tea, and he had. James didn’t say anything.

When the family went to visit at the weekend, Fred proudly offered everyone a cup of tea and went off to the kitchen to make it. This simple aid had made a huge difference to his life and paved the way for James and Lucy to broach the subject of other aids including tap turners, a bath seat and large button telephone. Sometimes something as simple as the humble cuppa can make a huge difference.

BYRON


In the living room

Making life easier in the home

Chair raisers Plug with handle

Easi-reach

n To find out more about using technology in the home contact the local authority

WHAT THEY HAVE TO DO

WHAT IS DIFFICULT SIMPLE SOLUTIONS

MORE COMPLEX SOLUTIONS

COMPLEX SOLUTIONS

• Get in and out of chairs

• Standing up from sitting is difficult

• Block of foam in chair base• Buy a new chair – get

professional help to make sure the height is right

• Regular gentle exercise• Get up regularly, to keep mobile

• Ready made chair raisers if your chair is low

• Buy electric riser chair

• Open and close windows

• Can’t reach windows• Not secure to leave

windows open

• Move furniture out of the way • Gadget to open/close window

• Remove window opener

• Install extractor fan • Install new windows

• Environmental controls

• Control heating

• Can’t reach controls for fire or heating

• Change switches• Fit timer switch

• Move heating controls

• Install new or additional heating system

• Switch lights on and off

• Can’t reach switch• Switch is difficult

to use

• Light switch toggle• Socket extension • Handi-plugs

• Move light switches• Replace light

switches

• Environmental controls

• Keep warm • Affording the fuel• Carrying the fuel• Control heating

• Insulate your home• Ask for a winter fuel payment• Use a trolley – if you can safely

lift the fuel into the trolley

• Replace the fire • Get a grant• Change to a cheaper

heating system

• Watch TV • Hear the sound of the TV

• Use subtitles • See GP • Get a room loop• Request an assessment

for a hearing aid


In the living room


In the bedroom

M T W T F S S

Pillow raisers

Bed raisers

Pill dispenser

Easy grip scissors




COMPLEX SOLUTIONS

• Get in and out of bed

• Standing up from sitting on the bed

• Difficult to move from wheelchair to bed

• Bed is hard to reach• Bed is too soft

• Move bed/furniture• Leg lifter• Raise bed• Learn new techniques for

moving safely

• Fit grab rails • Buy a new bed

mattress• Transfer board

• Hospital bed• Buy an electric

adjustable bed• Mobile hoist • Ceiling track hoist

• Sit up in bed, turn or roll over

• Bed is too soft• Bedding is too heavy • Nothing to lean on

• Change bedding• Learn new techniques for

moving safely

• Buy a bed cradle• Buy a bed ladder• Bed lever• Pillow raiser• Change mattress

• Buy a specialised mattress

• Drop-down rail • Monkey pole

• Keeping warm in bed

• Checking the safety of their electric blanket

• Contact n (see key below) for further information

• Getting dressed

• Difficult to reach all of their body


• Learn new techniques for dressing

• Buy clothes with different fastenings

• Buy simple gadgets: long handled shoe horn; elastic shoe laces; dressing stick; button hook; stocking aids

• Consider care in their own home

• Cut your nails • Can’t reach feet• Hard to hold scissors

• Easy grip scissors • See a podiatrist

• Take your tablets

• Opening bottles • Remembering to

take tablets

• Ask pharmacist for an easy to open bottle

• Keep a note when they have taken a tablet

• Get a pill dispenser with days and times marked

• Ask someone to prompt them

• Read the time • See the clock to tell the time

• Buy a clock with larger numbers • Buy a clock that ‘speaks’



In the kitchen

Perching stool

Liquid level indicator

Teapot tipper

Pan handle holder

Chopping board with spikes

Large handled cutlery




COMPLEX SOLUTIONS

• Reach cupboards

• Cupboards are too high or low

• Cupboards are too deep • Cupboard doors are

too heavy

• Re-arrange things in cupboards/on surfaces

• Buy Easi-Reacher or Handi-Reacher

• Alter spring in door closers

• Lower or raise cupboards

• Use taps and switches

• Taps or switches are too awkward

• Can’t reach taps or switches

• Fit tap turners • Change switches• Raise or reposition taps• Fit lever taps or new taps

Alter kitchen

• Cutting, chopping, preparing and cooking food

• Work surface too high or low

• Hard to grip packets or jars• Hard to grip knife• Pans or kettles too

heavy to lift

• Sit at a table• Range of kitchen gadgets

available: knife with a thick handle; chopping board with spikes; pan handle holder; teapot tipper; lid gripper.

• Food processor• Perching/high stool• Buy a trolley

• Change height of work surface

• Make space under work surface for knees when sitting

• Moving around the kitchen

• Not enough space • Re-organise furniture • Review mobility equipment used

• Adaptation to kitchen

• Eating and drinking

• Cutlery is hard to grip• Food/plate keeps slipping • Can’t carry food to table• Can’t lift cup


• Large handled cutlery• Non-slip mat• Lightweight insulated cup• Use a cup with two handles

• Buy a trolley

• Laundry and ironing

• Washing machine is too high or too low

• Putting up ironing board

• Wall-fixed ironing board • Raise/lower washing machine

• Change washing machine or iron



In the bathroom

Grab rail

Long-handled sponges

Shower board

Raised toilet seat

Toilet seat and support frame

Tap turners




COMPLEX SOLUTIONS

• Wash hands, face and body

• Turning the taps• Standing at the basin• Basin is too low or too high • Can’t reach all parts of

the body

• Tap turners • Long-handled sponge • Flannel strap • Contact n (see key below)

for further information

• Lever taps or new taps

• Stool

• Raise or lower basin • Showers

• Have a bath • Turning the taps• Stepping into the bath• Risk of slipping in the bath • Getting up out of the bath • Difficulty washing their back

• Strip wash• Non-slip mat in bath• Tap turners• Buy a long-handled sponge• Half-step

• Grab rails• Bath board• Bath seat • Lever taps or new

taps

• Bath lift• Mobile hoist• Ceiling track hoist• Replace bath with

shower• Convert bathroom

to a wet room• Consider care in

their own home

• Dry yourself • Floor is slippery• Room is too cold• Difficulty in drying body

• Heat bathroom• Non-slip mat• Towelling gown

• Change floor covering

• Hot air body dryer

• Use the toilet • Toilet is too high or too low• Difficult to clean themselves• Flush lever is awkward• Toilet is hard to get to

• Raised toilet seat• Combined toilet seat and support frame • Flush lever extension• Contact n (see key below)

for further information

• Buy a commode• Buy a portable urinal• Grab rails

• Specialist toilet• Alter position of toilet • Request short-term

loan of commode

• Clean teeth • Gripping the toothbrush• Standing at the basin

• Toothbrush gripper • Electric toothbrush• Stool

• Have a shower • Difficult to stand for long shower

• Shower too high • Shower controls are awkward • Shower is slippery • Not enough room to move

• Strip wash• Non-slip mats• Half-step

• Shower board• Shower chair or stool • Replace shower

controls


Adaptations

Simple adaptations to the home can

sometimes make a huge difference to

someone beginning to struggle with

everyday tasks within the home. They

come in many forms from hand rails, to

kettle tippers, technology driven alert

systems or products to help someone

dress themselves or get in and out of

the bath.

Occupational therapists can help people

lead a more active and independent

life using a variety of methods and can

assess a home for hazards and point

out things that might contribute to falls.

They advise carers on techniques for

moving and handling the person they

care for. They can also help you apply for

funding for major adaptations if needed.

Home Improvement Agency services

may also be able to help assist on ways

of improving, repairing, maintaining or

adapting your home. They are also

known as HIAs, Care & Repair

or home improvement

services.

HIAs can advise and

guide homeowners

and private tenants as

well as undertaking a

financial benefits check

to see if the resident is

eligible for any help to live

independently. They can visit to

discuss requirements and work closely

with other agencies including the local

authority, to help to identify reputable

tradespeople and oversee the work. HIAs

help vulnerable people to ensure their

home is a comfortable and safe place to

live independently.

HIAs may recommend a handyperson

to help with small repairs or adaptations

around the home and advise you on

what may be best suited to help your

parent. HIAs may be contacted through

the local authority or via a quick internet

search.

Grants and financial support may

be available to help with the cost of adaptations. These include the Disabled Facilities Grant. To find out more contact the local authority who will arrange for an occupational therapist to visit your parent at home and assess their needs. They will then recommend which alterations, if any, may be necessary.

If the council agrees and approves the work there are some forms and a financial assessment to be completed. They will apply for the grant or advise of other financial support that may be available. It can take up to six months to hear about the grant and the financial assessment will determine how much may be expected to be contributed towards the costs.

Technically speaking

Apart from the more obvious aids such as grab rails and

stair lifts, alterations for the home can include new lighting, cooking equipment or even lower work surfaces.

Technological advances have also brought about

new telecare and assistive gadgets to help keep someone

safe in their own home. The community alarms are most

commonly used and come in the form of pendants, pull-cords or buzzers. In

‘Home Improvement Agency services may also be able to help assist on ways of improving, repairing, maintaining or adapting your home.’


the event of an emergency your relative activates the alarm and it either contacts you directly or goes through to a central call centre which makes the relevant calls to you or another relative, neighbour or friend. Some of these systems have a base unit where the controller can speak directly to the caller until help arrives. In some circumstances, sensors can give peace of mind to relatives as they can detect things like carbon monoxide or gas; or flooding from a running tap, while others detect movement and falls or the front door being opened. For anyone helping care for a relative with dementia, these sensors can help keep them safe and an enormous amount of peace of mind for their family.

You can even set a voice-recorded message alert in different areas of the home to prompt your parent if, for example, they have a tendency to try to leave the home. A message asking them not to leave the house, reassuring them can be all it takes to distract them from doing so. Telehealth remote patient monitoring, can help people with specific long-term conditions to monitor their health and transmit it directly back to their GP or consultant without the need for trips into the surgery or hospital. If this is an option for your parent, speak with their GP or consultant to find out more.

Wheelchair hire

If your relative is struggling with their mobility, some organisations offer wheelchairs for short and long-term hire either for a small charge or a donation. The British Red Cross, for example, offer a volunteer-led medical equipment service that provides wheelchair hire and short-term loans of equipment. You can search its website for your nearest service www.redcross.org.uk.

Getting around

Motability

If your loved one still drives but has a disability which received a higher level of mobility allowance, the Motability Scheme enables disabled people to use their government-funded mobility allowance to lease a new car, scooter or powered wheelchair. If your relative is in receipt of the Higher Rate Mobility Component of the Disability Living Allowance, Enhanced Rate of the Mobility Component of Personal Independence Payment or Armed Forces Independence Payment (currently £55.25 per week) or the War Pensioners’ Mobility Supplement (currently £61.75 per week), they may be eligible to join the Motability Scheme. To find out more visit www.motability.co.uk.

Figures may change during the life of this publication.

Blue Badge scheme

For those with severe mobility problems you may be able to apply for a Blue Badge to enable them to park closer to where they need to go. You can apply online via the GOV.UK website www.gov.uk.

Community transport

Community transport is a scheme to help your relative to get around if they can’t use existing transport. It is arranged by the local council and you will need to contact them, or search the internet to find out more in your parent’s local area.

>>


>> Free bus pass

Those living in England may be entitled to a bus pass giving free off-peak travel on local buses. Entitlement starts at ‘eligible age’. If your parent was born before 5th April 1950, they are eligible from their 60th birthday. If born after 5th April 1950, they become eligible when they reach the State Pension age for women. This is the same for both men and women. A bus pass can be applied for from the local council. This is a great way for people to keep in touch with friends, visit family and stay socially active – without the worry of driving or the cost of keeping a car.

Meals on wheels

If you’re worried your loved one isn’t eating properly, can’t get out to the shops regularly or is struggling to make meals; meals on wheels still exists. There are services that provide delivery of frozen meals or freshly cooked hot meals. Frozen meals can be delivered in bulk and kept in the freezer until required; the delivery of hot meals is for immediate consumption. Councils can arrange meals delivered to the door, or meals on wheels, though your relative would have to meet their eligibility criteria to qualify and it wouldn’t necessarily be free. National and local commercial organisations also provide such meals delivered at a charge. To find meals on wheels services in your area search the internet or the local council’s website.

Staying socially active

Day care services

Day care services are usually an opportunity for people to get out,

meet friends, try new activities and sometimes access specialist services like chiropody or hairdressing. Some even offer hot lunches and arrange transport. They should be located in the local area, but in recent years some services have struggled for funding from local authorities. However they are funded, services are likely to be chargeable but offer a regular opportunity to get out and meet people. Some local care homes offer day opportunities which are a great chance to become familiar with the home even if care is not needed at this time. The local council may have details of day centres, alternatively your local Age UK branch can advise.

Companionship

Getting on in life can mean that friends are no longer around making older people feel isolated or lonely, especially so after the loss of a partner. Befriending services can offer companionship and support if you’re worried your relative feels isolated or lonely. Companions could accompany them on appointments or outings or even just have a cuppa and a chat. Companions may be volunteers or employed by private companies such as home care agencies. They should be fully trained and have Disclosure and Barring Service checks.

Small changes

By starting with these smaller changes to home life you may be able to maintain your relative’s independence for longer whilst bringing peace of mind to you and them. There are many creative ideas and developments happening all the time. If they’re not open to big changes, start small, introduce one thing at a time until they feel comfortable. Sometimes little increments can lead to big changes over time.


Mr W is 96 and lives alone in his own bungalow. He had recently been diagnosed with macular degeneration of the eye which results in progressive sight loss. He felt he now needed to go into a care home and had selected two possibilities, one near where he presently lived, and another on the opposite side of the country near to his daughter.

Mr W discussed his care options and choices with an independent adviser who also reviewed a range of alternative solutions to residential care.

Following this:

• Mr W went for a short stay at the care home near his daughter but decided that he would prefer to stay at home for now. He discovered that all the people at the care home had much greater needs than he did; and that moving would not address his social isolation. He realised that he didn’t need a care home yet.

• His home care agency was visiting five times a week. They visited for an hour and he found it hard to know what to ask them to do once they had prepared his meal. The agency policy was not to do less than one hour visits. The

advisers suggested he ask for a review with the manager,

encouraging him to exercise control over the service he

was receiving.

• The visual impairment team provided him with a daylight light and he

purchased two more for himself.

• Mr W’s family bought him an iPad based on the

specification the advisers had sent them. Initially he found it too difficult to use but began finding it beneficial and enjoying the mental stimulation and social connection with the world and his family through electronic means.

Overall, Mr W’s quality of life improved as a result of the advisers’ intervention. The advice given, plus his experience of staying short-term in a care home enhanced his knowledge of support and care options. He now wants to find a flat within walking distance of his daughter’s home.

Mr W’s Story

‘Mr W went for a short stay at the care

home near his daughter but decided that he would prefer to stay at home

for now.’

Not an easy task

Regardless of when or how the decision is taken to choose more formal care, if more time is available to make the decision it will help with what can be a difficult stage of life. Good care is prevalent, however it is always the rare bad instances that will reach the media and taint your view. Thorough, considered research, good recommendations from others and personal instincts are the best tools for choosing good care. However, making sure a care home or home care agency can meet your parent’s specific social, personal, medical and lifestyle needs will help ease the transition.

Plenty of choice

By the time that you’ve arrived at an understanding that formal care and support is the best option to maintain or restore a good quality of life, it is likely that you will have gained insights into your relative’s care needs and the ways that they can be met. But don’t forget to also give due consideration to the personal issues and preferences that come into play, especially if selecting live-in care or a new place to live. For more information on live-in care, see page 36.

As mentioned on page 9, an assessment of care needs will provide information vital to finding an agency or home appropriately equipped and staffed to meet those needs, ensuring that you don’t look for a more expensive service, such as one providing nursing care, when it is not required.

However, there are some preliminaries that need personal rather than expert knowledge. In fact, matters of personal choice are just that – very personal. Giving thought to these ahead of time, especially if a decision is made in a time of crisis, such as an unexpected stay in hospital, will more than repay the time spent doing so.

Home care

If you are considering home care, there are many local and national agencies that should be able to support your relative. Home care enables people to remain living at home and receive the care and support they need. It means that they remain somewhere familiar, close to friends and existing networks. For those with relatively low level needs, who perhaps just require some support, home care can maximise independence and confidence as well as enhancing the quality of life.

Many feel this is the ideal option, enabling them to remain in familiar surroundings, possibly the family home that holds so many wonderful memories of a fuller and fulfilled life, and to carry on being a householder. However, if their mobility becomes limited and home care visits are only once or twice a day, to help with getting up and then back to bed, opportunities for social interaction can become limited. For some, this may

Choosing care


‘Thorough, considered research, good recommendations from others and personal instincts are the best tools for choosing good care.’


be fine, but for others they may come to miss the contact with others which had featured prominently in their previous, more active life.

The family home is likely to be filled with memories and emotions and so the thought of giving it up can be difficult to entertain for you, your siblings and above all your relative. However, if the

house begins to become a burden, costs of running and routine maintenance become unmanageable, alongside increased care and support needs, the time may be right to consider selling up and downsizing. This isn’t an easy decision, and needs careful consideration by all parties, with enough time to come to an agreement. >>

Some older people and their relatives may prefer to engage their own live-in carer rather than residential and home care. Good quality agencies can help clients to engage their own live-in carer by utilising extensive databases to carefully match carers and clients as closely as possible, ensuring they have similar interests and hobbies.

Hiring a carer with the help of an organisation means that the hassle of advertising, interviewing and vetting, are all taken care of. They will also organise respite care for when a carer or family member goes on holiday and can also arrange cover if a carer falls ill.

Good live-in carers work discreetly, not only acting as a personal carer but also as a housekeeper, helping with shopping, cooking, cleaning, washing and ironing. In many instances, they become close companions promoting both physical and mental wellbeing and facilitating outings and social activities.

A live-in carer will be expected to provide regular, freshly-prepared food and drink, making sure a meal is never missed. Similarly, carers/housekeepers can prompt dementia sufferers to take medication, as they may get confused and forgetful with key medication.

Engaging a carer/companion will also ensure your parent remains safe in their own home throughout the day and night.

If your loved one has dementia or confusion, they can benefit from staying in their own home rather than moving. Living in a familiar environment helps reduce confusion and anxiety and assists in keeping them in the ‘present moment’.

Staying at home means staying close to friends and relatives, which may include a spouse who is no longer able to act as the main carer and requires assistance. The support of a live-in carer/housekeeper will provide a spouse with the support they need if they want to continue to give some care.

When looking to employ a live-in carer, they should be thoroughly screened and reference checked to ensure they have the relevant skills and experience for each position, screening should include a DBS check (criminal records check) and a good agency will undertake all of this for you.

A good live-in carer can make a world of difference to someone’s life, empowering them to remain at home with the support and assistance they need to live their life.

Engaging a live-in carer


Achieve a superior quality of life in the familiar surrounds of your own home.

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The Royal AlfredSeafarers’ Society

www.royalalfredseafarers.com

Providing quality residential, nursing and dementia care primarily for seafarers and their dependants. Short periods of respite care are available. If you know of someone that needsour help please contact us.

acres of lovely Surrey countryside on the edge of Banstead. Donations and legacies are vital to us and help ensure that our residents continue to receive the best possible care.

For further information about the services we provide, or for

Chief Executive, Commander Brian Boxall-Hunt OBE,

Woodmansterne Lane, Banstead, Surrey SM7 3HB

Phone: 01737 353763 Fax: 01737 362678 Reg Charity No 209776. Est 1865

WHAT ARE THE CARE OPTIONS?HOW WILL I KNOW WHICH TO CHOOSE?

WHAT IF MUM DOESN’T AGREE?CAN WE AFFORD IT?

VISIT THE NEW CARE SELECT WEBSITEWWW.CARESELECT.CO.UK

CALL CARE SELECT FOR MORE INFORMATION:

0800 389 2077



>> When choosing a home care agency, it is important to shop around if the situation is not urgent. Speaking with the manager alone will not give a complete insight into how their care is delivered. Ask for testimonials or to speak to existing clients – a good agency will be forthcoming. Also, ask the manager about the feedback they receive and any challenges they face in providing a good service.

Where a decision needs to be made quickly speak to those involved in your relative’s care or discharge from hospital as they may have experience of services to help guide you in your choice.

For more information on home care see page 34.

Housing with care

Housing with care may feel like an acceptable middle ground to many people. It still involves leaving the family home but provides a feeling of independence that many worry could be lost in a care home setting. Housing with care comes in a variety of different models and offers the security of tenure, rented, part-owned or fully owned, with support available as required – you still have a key to your own front door.

If your loved one is in need of extra support, would like the more sociable opportunities of living near others of a

similar age and wants to retain as much independence as possible, housing with care could be the best solution.

For more information on housing with care see page 55.

Care homes

If your relative’s needs are such that a care home is the most suitable option, or they would prefer the companionship of living

alongside others, then you should make your

choice carefully. Choosing a care home is very individual and

subjective. Consider the location, size and style of home.

Would they prefer to stay close to the present neighbourhood to maintain links with friends, a place of worship or other community links? Would they prefer to relocate closer to key family members? Is the size of the care home important to your relative? A small home may have a more intimate and ‘homely’ feel, while a larger one may have a wider range of daily activities, suiting those who wish to remain as active as possible.

The building may also be important. Does your loved one prefer an older, converted property with ‘character’, or a purpose-built home which has been designed with the needs of older people to the fore. External appearances do not always correlate with quality of care though and although a home may look appealing, it is important to be completely certain that the quality of care provided is acceptable and matches their needs. Care homes come in all shapes and sizes, some are on the luxury end of the spectrum offering hotel-style living with à la carte menus and wine with dinner, whereas others >>

‘Housing with care may feel like an acceptable middle ground to many people.’


A Centre of Care & Excellence

Discover a haven that you will be happy to call home

Seeking a new home?In a serene and peaceful location set in the midst of trees and yet within minutes of the centre of Hitchin is this superlative hideaway. Whether your needs are for long term, respite, convalescent or palliative care we have staff trained in the provision of optimal assistance in all these areas. We have an experienced team of care staff who can assist those with a range of physical and sensory issues, as well as a specialised dementia facility. We have plenty to offer including:

An artistically designed, spacious home with vast amounts of sunlightLuxury rooms with sumptuously equipped en-suitesBeautiful vistas of the Hertfordshire countryside from your windowRestaurant with an outside dining experience serving an a la carte menuA ‘Sow, grow & eat’ experience with our very own vegetable gardenAn on-site shop selling everything from stamps to clothingSensory rooms to amplify your sensesExceptional gardens, grazing horses and an abundance of wildlifeA hairdressing salon and nail bar for therapyExercise roomsDedicated GP consulting room, working in partnership with local GPsA LibraryInternal CCTV for comfort and protectionPlus, an activity programme to tempt us all

••••••••••• •••

For more details or to set up an appointment please contact us on 01462 410 767 or email [email protected] can also visit us atwww.foxholescarehome.com.

Pirton Road, Hitchin, Hertfordshire SG5 2EN

“Working with extreme passion

to give the best care we

can!”

>> offer a more domestic style. They are as wide and diverse as the people who live in them.

Allow time to research

Care businesses are run by corporate organisations, charities, individuals or small businesses; it really is a very diverse sector. It may be that your relative would prefer to live in a home that is run by a charity, a benevolent society, a specific religious group, a small local business, or like the corporate style and facilities of the big national chains. For more information on care homes see page 42.

Unless it is impossible because of a sudden catastrophic change in health, you should always plan to compare and contrast a number of different providers that fit with your relative’s preferences and needs. Always aim to meet the manager as they are responsible for setting the tone and ensuring that staff measure up to the standards they and the registration body set. Wherever possible, aim to include your parent, and possibly someone else you both trust who is not caught up in

the emotional upheavals discussed here.If choosing a care home, arrange to

have a meal during the course of your visit, ideally alongside other residents; this will give you an opportunity to

chat with them to get their views on what’s good about the home.

They are likely to be free with their opinions on

food, favourite staff and the approachability of the manager – valuable information about how

the home feels to those living in it. If you like

what you see and hear, ask whether it’s possible for your

parent to have a short stay, without obligation – a sort of ‘try before you buy’ that is increasingly common with other goods and services.

Overcoming negative views

It might be that your loved one has stated quite clearly that ‘I’m not going to end up in a home’, and this is likely to make you all feel guilty as you explore how a care home could make a real and positive difference to their life.

However, many negative views of care homes may be based on limited and

generally highly partial information gleaned from media reports

of failed inspections, court appearances by care staff and ‘undercover’ investigations by television reporters. There may also be lots

of hazy memories of old institutions that no longer

exist.Many people have these

assumptions but don’t have direct personal experience of the kind of lives that residents of most homes actually >>

‘Wherever possible, aim to include your parent, and possibly someone else you both trust who is not caught up in the emotional upheavals discussed here.’

A Centre of Care & Excellence

Discover a haven that you will be happy to call home

Seeking a new home?In a serene and peaceful location set in the midst of trees and yet within minutes of the centre of Hitchin is this superlative hideaway. Whether your needs are for long term, respite, convalescent or palliative care we have staff trained in the provision of optimal assistance in all these areas. We have an experienced team of care staff who can assist those with a range of physical and sensory issues, as well as a specialised dementia facility. We have plenty to offer including:

An artistically designed, spacious home with vast amounts of sunlightLuxury rooms with sumptuously equipped en-suitesBeautiful vistas of the Hertfordshire countryside from your windowRestaurant with an outside dining experience serving an a la carte menuA ‘Sow, grow & eat’ experience with our very own vegetable gardenAn on-site shop selling everything from stamps to clothingSensory rooms to amplify your sensesExceptional gardens, grazing horses and an abundance of wildlifeA hairdressing salon and nail bar for therapyExercise roomsDedicated GP consulting room, working in partnership with local GPsA LibraryInternal CCTV for comfort and protectionPlus, an activity programme to tempt us all

••••••••••• •••

For more details or to set up an appointment please contact us on 01462 410 767 or email [email protected] can also visit us atwww.foxholescarehome.com.

Pirton Road, Hitchin, Hertfordshire SG5 2EN

“Working with extreme passion

to give the best care we

can!”


>> lead; how they’re kept safe, well cared for and in a happier state than if they had ‘soldiered on’ without help. But this doesn’t stop people from having opinions and predetermined ideas of life in a care home.

Of course, things do go wrong in care homes from time to time - there are thousands of them across the country and incidents do happen. However this sort of news travels fast and wide, while the realities of a better life – free of so many worries and with the scope for companionship, care and skilled help from trained staff - are so much slower to reach a wider audience.

Some people may initially prefer home care over care homes because they believe they will be giving up their freedom, control or choice by moving into a care home. Good care homes will challenge these assumptions and work hard to assist residents to retain as much control as they wish. They work with and empower residents, if they so wish, to take over the detail of their daily routines and the important things

that matter to them. Helping someone to remain independent is at the heart of good care home practice and families are frequently surprised that their relative

begins to regain skills they may have lost at home. This is

because staff are available to support them to find

new ways of doing the things that matter to them.

This is why it’s so important to

encourage your relative to share their wishes and

personal preferences when they are looking for a home. A

good manager will respond to these positively, giving feedback on how they can help your parent to achieve things they love.

When you or your loved one have made a choice about the care home or home care service, it is a good

idea to have a trial period to make sure the services

meet their needs and everyone is happy.

It is a difficult time and they will need lots of support to feel happy with their

new care service. For more informationon

evaluating whether a service is working see

page 62. Whatever your family’s path to searching for care and support, make sure that your relative’s wishes are at the heart of the decision and try to involve all parties, if possible.

Remember you’re not the first to have gone through this and there are specialists out there who can help you find the right support for your parent.

‘Some people may initially prefer home care over care homes because they believe they will be giving up their freedom, control or choice by moving into a care home.‘


At Porthaven we are proud to have been describedas running the best care homes in the country.

Our homes are beautifully designed, clean andspacious. We provide a range of interesting,enjoyable activities and an excellent menu of food.

At our homes we understand the business of caringwell, offering residential, nursing and dementia careas well as respite care for those who require a shorterstay.

There is, however, another element, and one whichmakes a difference to all our residents: a positiveattitude to caring and a genuine interest in others.

You will sense this from the moment you walk in thefront door; it’s unmistakable.

Call your nearest Porthaven Care Home and arrangeyour visit with one of our Home Managers today.

We look forward to hearing from you.

Homes you will love. Care you will appreciate.

www.porthaven.co.uk You’ll like us!

✓ Residential care

✓ Nursing care

✓ Dementia care

✓ Respite care

✓ Tailoredactivitiesand dedicatedactivities room

✓ Private ensuitebedrooms

✓ Expert care staff

✓ Excellent menu

✓ Restaurants andprivate diningroom

✓ Landscapedgardens

Avondale Care HomeGatehouse Road, Aylesbury HP19 8EH

Tel: 01296 438032

Chiltern Grange Care HomeIbstone Road, Stokenchurch HP14 3GG (Sat Navs: HP14 3XR)

Tel: 01494 480292

10998-14022 LRG:Care Select 24/2/14 10:57 Page 1

01932 857821www.whiteleyvillage.org.uk

Residents are able to enjoy the beautiful surroundings and be part of village life in a

friendly and caring community. The Village was described by HRH Prince Charles as a

“national treasure”. Family and friends are welcome to visit at any time.

The UK’s original

retirement village.

Nestled in 225

acres of beautiful

and tranquil

Surrey woodland.

Reg. Ch. 1103056

The best possible care...

In the best possible environment...

In Whiteley Village Care Centre, our highly trained, award-winning nurses and care

staff meet the individual needs and choices of our residents from residential care,

through to nursing, respite and end-of-life care, in a safe and peaceful environment.

04

Foreword





at home

Choosing care

Care and support at

home


agency checklist




Care Schemes




first signs


checklist



How is care funded?


needing care

Essential contacts


providers




Receiving care in their own home can be the first choice for many and can be what best suits their needs. It can also help you and any other relatives to feel reassured, knowing your loved one is in familiar surroundings.

Support in the home used to be for those only needing slight assistance with daily tasks or personal care a few times a day, but this is no longer the case and even those with later stage dementia are being supported to live at home in familiar surroundings.

Many people would prefer to remain in their own home before considering residential care alternatives, this could be because of the attachment to the family home or media impressions of care homes, but it doesn’t always suit everyone. Some may struggle with loneliness or isolation if they have difficulty getting out, and in these cases may feel their quality of life is much improved by moving into a more communal setting such as a housing with care community, a care home or care home with nursing.

Assessments and funding

Care in the home is provided by local and national organisations, large and small. Some companies operate franchised services. It is a chargeable service and there are many agencies that can support your relative. It’s also possible to employ someone directly to undertake this role. To understand the level of assistance your parent may need, a community care assessment by the local authority can help to identify specific needs and the type of support that might be best suited. Prices vary depending on the level of need, the location and the number of hours care needed per week.

If your loved one is funding their own care they can choose whoever they like to provide their care and support. If they’re eligible for local authority funding then there may be restrictions. Speak to your relative’s local authority about this if they are conducting a community care assessment. For more information on assessments and contacting the local authority see page 9.

Types of home support

Home help

A home help will come into the home and offer support with household jobs.

This might include: >>

If your relative needs more personal care or support to help them remain living at home, there is a spectrum of choice available, from home help support for the little jobs, to home care for help with getting someone up, or live-in care for those who need round the clock support.

‘Receiving care in their own home can be the first choice for many and can be what best suits their needs.’

CARE VISITS AT HOME & LIVE IN CARECaring for your lifestyle

What we offerWe offer everything from personal care to shopping, cleaning or social visits. In fact everything you need to stay in the comfort of your own home.

Care VisitsWith visit times ranging from 15 minutes right up to 24 hour-a-day live-in care, our customers benefit from as much or as little care as they require.

Please call to arrange your free visit from a supervisor to discuss your care needs

Visit us www.bluebirdcare.co.uk

Live in Care This provides a realistic alternative to residential care when full-time support is needed, and is completely flexible so that you, or your loved ones, can continue to enjoy an independent lifestyle in the comfort of your own home.

Epsom 01372 822875Guildford 01483 761000Reigate 01737 247111Runnymede 01932 567593Surrey Heath 01276 683577


• Help with housework, cooking, shopping and gardening.• Delivery of meals.

• Shopping.

• Companionship and social activities. Choosing the right home help can, in itself provide company as well as help at home.

• Transport to and from appointments, meetings or the shops.

• Helping to look after your pets.

• Small maintenance jobs or installing security equipment such as an emergency alarm, entry phone or key box.

Home help doesn’t include personal care. If your relative doesn’t have any specific care needs, home help can be great company and help them to keep on top of jobs around the house, making life a little easier.

Home care or domiciliary care

Home care or domiciliary care, as it is sometimes called, involves trained care staff assisting your loved one with personal care tasks.

These can include

• Getting up in the morning, washing and dressing.

• Helping them get to bed in the evening.

• Preparing meals and helping them to eat if they need assistance.

• Help with any medical and physical conditions.

• Continence care.

• Taking medication regularly.

Care staff can visit every day, sometimes more than once a day if needed. Visits should be agreed beforehand with the manager and according to your relative’s needs, laid out in a clear care

plan. Depending on the tasks, visits can be just 15 minutes, half

an hour or up to several hours. Generally, visits

are available from 7am until 10pm. Night-sitting services can also be arranged if needed.

The hourly rate varies depending on

the services required, the time of day and the location.

Rural areas may present particular difficulties and a travel charge will probably be made in addition to the normal hourly rate.

Home care staff have specific training covering moving and handling and the use of hoists if your relative isn’t very mobile.

Live-in care

If your relative needs round the clock care but is happy staying at home, 24 hour live-in care may be a solution. It can also be used as short-term support for any family carer who may need a break to recharge, or be used to help someone get back onto their feet after leaving hospital. Some people prefer live-in care to moving into a care or nursing home.

Costs vary and, as with home care, depend on the amount of care and the particular skills required. Live-in care is

‘The hourly rate varies depending on the services required, the time of day and the location.’

>>


also available to people with permanent physical or learning disabilities who require long-term on-going care. Staff are fully trained to support with any care needs agreed in your loved one’s care plan.As with home care, live-in care providers are regulated and inspected by the Care Quality Commission which publishes inspection reports on its website www.cqc.org.uk. When considering a service, always check its report and ask for feedback from other clients.

Be aware

Some would see it as a distinct advantage for their relative to remain living at home but it is worth bearing in mind that it doesn’t always suit everyone. Although continuity of care is something good agencies pride themselves on, you may be faced with a succession of different care workers at different times. Occasionally, because of staffing pressures during holiday times or sickness, the service might fail, if this happens you will need a back-up plan.

Choosing the right service

The Care Select website has much more information and gives you the opportunity to search for care provision in your given area via the publisher, Care Choices’, website (www.carechoices.co.uk). The interactive service, backed up with a friendly helpline enables you to look for providers based on your parent’s specific requirements. It will result in a tailor-made list of care services matching individual needs and preferences. Visit www.careselect.co.uk or call 0800 389 2077 to start your search for

care and support.Before making any decisions, be sure

to contact several different providers that may be able to meet your relative’s care or support needs. Ask for a ‘Service User’s Guide’, their charges and a draft contract between your loved one and the care provider. You should also receive a copy of their most recent inspection report from the regulator the Care Quality Commission which can also be viewed and downloaded from www.cqc.org.uk. The CQC inspects on Essential Standards of Quality and Safety. These cover all aspects of the operations from involving your relative in their care, keeping them safe, the number of staff employed, the range of skills staff have

and the procedures they must follow, and (as appropriate)

the upkeep of the premises. You may also find that some of the larger organisations have their own internal inspection processes that also

contribute to driving up and maintaining standards.

The Government is introducing a new comprehensive system of publicly rating care – this is likely to follow a similar style as Ofsted use for schools, however, details are not available at the time of print. Until then you cannot easily compare agencies, but the combination of inspection reports, conversations with staff, current clients and relatives will give you some strong indications.

Make sure that your relative is >>

‘Before making any decisions, be sure to contact several different providers that may be able to meet your relative’s care or support needs.’


>> properly assessed and has a detailed plan of their care needs. Also be aware that if the care is arranged by the local authority, some care agencies may be under pressure to reduce the time they spend with your loved one, in extreme cases this could be just 10 to 15 minutes. If this happens or you feel that the service your relative receives isn’t up to standard, raise it with the agency’s management or the local authority. Otherwise you or another family member may need to step in to fill any gaps in the care and support.

Careful consideration

Care or support to help someone to remain living at home can feel like a natural option and many begin to see improvements in their quality of life if they have a little help to remain independent. To many, home comforts and familiar surroundings are what they want. However, if your relative is remaining at home because of emotional attachment to the building and its memories or a fear of care homes, then consider whether home care is actually the best option for their situation. Isolation or loneliness can be a real issue for older people and other forms of care and support including communal living can help to tackle these.

• If time allows and your decision isn’t being made as an emergency, research a number of different care agencies in your relative’s area. The Care Select website www.careselect.co.uk links through to comprehensive details of all care providers in a given region and can help you narrow your search. Or call the helpline 0800 389 2077. If you or your loved one knows of someone else locally who receives support at home, ask them for a recommendation.

• Make sure you check the agencies’ inspection reports. All home care and live-in care providers are regulated and inspected by the Care Quality Commission which publishes inspection reports on its website www.cqc.org.uk. The agency should provide you with a copy of its most recent inspection report but they are available online

if they don’t. Home helps are not regulated as they don’t deliver personal care.

• When considering an agency, the manager should come and visit you and your relative to discuss care needs and support requirements.

• A clear care plan is essential to set out your loved one’s specific needs and ensure they are fully supported. If your relative doesn’t agree that they need support, this may prove difficult. It may be that you’ll need to have a couple of meetings to discuss needs or look to an external adviser to help with the process.

• If your relative has had a care needs assessment from their local authority, this will form a good starting point for conversations with any care agencies.

Top tips when looking for home care

‘To many, home comforts and familiar surroundings are what they want.’


Mrs T, the only daughter of Mr J,

was worried that her father was

unsettled at night. He had

suffered a mild heart attack

12 weeks earlier and she

wanted to know what

help could be provided

now and maybe for the

future. She also wanted

to do whatever she could

to support him to live at

home as long as possible.

After speaking to an independent

adviser, they looked for a night-

sitter to stay with Mr J for

two nights, preferably

Friday and Saturday

nights from 10pm until

8am. The night-sitting

service would reduce

his anxiety and ensure

that help is on hand to

defuse any panic attacks and

offer him comfort. This would also

ensure that Mrs T has two nights

respite where she and her family

should not be disturbed. Mr J was

adamant that he wanted consistency

in the service so it was someone

familiar with him.

The advisers explored availability

of night-sitting services in the area,

reviewed their CQC reports and

contacted 14 different companies to

discover no one could meet Mr J’s

needs.

They then contacted the local

authority commissioning

services and were offered

four service providers

who were contracted to

respond to night-sitting

needs, but none of these

services could meet Mr

J’s needs. He lived outside

of the area they operated in

and they lacked capacity to deliver

the service and the flexibility to meet

Mr J’s needs in terms of consistency

of night-sitting arrangements.

After further research, the

advisers found two services that

could provide a full ten hour service

and they brokered a reduced price

for the service. The team offered a

range of options to Mrs T, including

those that were unable to fully

meet Mr J’s needs, and

explained the CQC reports.

Mrs T really appreciated

the assessment and

reported to the advisers

that Mr J had not woken

during the night for a few

nights. Mrs T still took the

names and contact details of

the services available.

When the advisers next

contacted Mrs T, she explained

that they had not needed to

commence the night-sitting service

as Mr J had not called her or

the communications call system

since the visit from the advisers

discussing the options. She felt the

therapeutic intervention had helped

both of them.

Mr J and the benefit of therapeutic intervention

‘Mr J was adamant that he wanted consistency in the service so it was someone familiar with him.’


Agencies

• What experience does the agency have in your relative’s particular field of need?

• Can they supply references for you to check?

• Home care agencies providing personal care, must be registered and inspected by the Care Quality Commission. Ask to see a copy of their registration certificate and most recent inspection report.

• How long has the agency been operating?

• How many care workers would the agency assign to care for your relative and would they see the same one every day? If not, how does the staff rota operate?

• What happens if the care assistant goes on holiday or is sick, will your loved one be notified in advance that a different person will be attending?

• How can the agency be contacted in an emergency or outside office hours?

• If you need to, how can you make a complaint? How are things then put right?

• Ask for a copy of the agency’s contract terms and Service User Guide. Read these carefully. Ask any questions you may have before signing anything. The Citizens Advice Bureau or Age UK could help with this.

Care workers

• You should expect your relative’s personal preferences, dignity and privacy to be respected. Discuss this with the agency and ask how the most suitable care assistants for your parent’s particular care are chosen. Can you talk to them before deciding?

• Care assistants should be fully trained or be in on-going training. Ask the agency about their policies on this.

• Your relative will have a care plan drawn up by the agency which the care assistants will work to. Ask how often this plan will be reviewed by the agency.

• Care assistants must be checked with the Disclosure and Barring Service (DBS) and have a criminal records disclosure – make sure this is the case.

Paying

• If your loved one’s care has been arranged privately you should check carefully the fee rates charged and exactly what the payment covers.

• For care packages that have been arranged by the local authority, contracts and care plans will have been completed by the care manager and the agencies used will have been accredited to work for the local authority.


These questions may be useful when considering using the services of a home care provider to help you build up a picture of how your relative’s care needs will be met in their own home.

© Care Choices Ltd 2014

04

08000 [email protected]

• Highly personalised one-to-one home care – 24 hour live in, day care or respite

• Only the very best carers who are employed, experienced and expertly trained

• We care about our carers which means you get continuity of care

• Specialist care of conditions, including dementia, Parkinson’s and MS

• Unrivalled levels of support for you and your family• 24/7 support – peace of mind around the clock

Quality home care for a better quality of life

Together we can reach the people others cannot reach

We offer more than care and support.Whatever your needs, we can help.

• OutreachMentalHealthSupport-person centred and tailor made, allowing you to achieve your goals and aspirations

• OutreachSupport-for adults with learning difficulties, Aspergers Syndrome and Autism

• HomeCare-a holistic approach respecting people as unique individuals, delivering tailor made packages including but not limited to, personal care, managing finances, developing life skills, cooking, cleaning, laundry, accessing education and leaisure activities, maintaining and forging relationships

We also offer independent living flats, a mental health crisis support house, residential care and respite for adults with physical and learning disabilities as well as volunteering opportunities to gain new skills and meet new people.

Whynotmakeadifferencetosomeone’slifeandbecomeavaluedmemberofourShropshireteam?

Trident Reach the People Charity is an established provider of

support services in Shropshire. We have dedicated experienced staff

who work with you in a mobile and flexible way, meaning you are

always in control.For more information on the services we provide please call us on 01743 355715 or email [email protected]

Website: www.reachthecharity.org.ukFacebook: facebook.com/reachthecharityTwitter: @tridentreach

Trident Reach the People Charity, Canon Court North, Abbey Lawns, Shrewsbury, SY2 5DE

Regulated by the Care Quality CommissionCharity Number: 1129187


04

Foreword





at home

Choosing care

Care and support at

home


agency checklist




Care Schemes




first signs


checklist



How is care funded?


needing care

Essential contacts


providers




Negative media coverage of care homes has a lot to answer for, as the right choice can empower your loved one, allow them to meet new people and socialise, and do things they thought they’d never be able to again, all while receiving the support they need.

Care homes and care homes with nursing, can offer 24 hour care and support to your relative if they are no longer able to support themselves at home, or require more care than a home care agency is able to provide.

It may be that you, your relative and other family members feel a care home is a last resort, that you’ve failed them or given up. However good care homes are the norm, the bad ones are the exception.

Care homes explained

Care homes are first and foremost a home. They offer communal living, where your relative would have their own bedroom, in many cases with en-suite facilities. However, some older

homes may have shared bedrooms for couples or those who enjoy the company, and shared bathrooms. Dining and living facilities are also shared

though some homes may offer a

variety of dining and living

rooms. Care homes are

very varied and personal

preference plays a large

part in choosing a home.

Your loved one wants

to feel at home, safe,

secure and well cared for.

Care homes are divided

into two categories – those

offering just personal care and

those offering nursing care too. Some

may specialise in care for people with

different medical conditions but they

will either be able to care for personal

and social care needs or personal, social

care and medical needs.

If your relative is reasonably active,

but would like greater security, to be

among other people and also requires

personal care, a care home offering

only personal care may be the best

option. Personal care, as with home

care services, includes bathing, feeding,

dressing and help with moving around.

If your loved one has medical or

nursing needs, a care home with nursing

offers a higher degree of care. They

are best suited to people who require

24 hour support and have medical care

needs that must be supervised by a

registered nurse. Nursing homes usually

have higher staffing levels due to the

higher needs of the residents.

In a care home with nursing, if your >>

The thought of moving a relative into a ‘home’ is sometimes the last thing anyone wants to contemplate. That’s probably because most of us know little of the benefits of the many great care homes that positively improve the quality of life for the people who live there.

‘Care homes and care homes with nursing, can offer 24 hour care and support to your relative if they are no longer able to support themselves at home.’

We are committed to providing a service that is �exible andrealistically tailored to your needs. Our staff are respectful,professional, �exible, resourceful, positive, problem solvingand have a realistic view of life’s complications.

We employ specialist learning disability nurses and so arethe ideal choice for people with learning disabilities.

We also employ experienced personal assistants whoprovide support to the elderly, frail, physically disabled,in�rm or those with sensory disabilities.

Our services include but are not limited to• Personal care• Keeping safe at home and out in the community• Developing independent living skills • Activities of daily living (shopping, laundry, cleaning, gardening, �ling and general organisation) • Accessing social, religious or cultural activities including holidays• Accessing employment, education or training• Managing �nances • Social Companionship

K I M A R A SUPPORTTel: 0203 291 3436 • Fax: 0203 727 0836Email: [email protected]

KIMARASUPPORT

www.facebook.com/wealdcare@wealdcare

CARE & REHAB IN YOUR OWN HOMETHROUGHOUT SURREY INCLUDING

SUSSEX & HAMPSHIRE BORDER

Our Services Include:

• Personal Care

• Specialist / Complex Care

• Live-In Care

• Physiotherapy

Supporting Independence,with Innovative DomiciliaryCare & Rehabilitation.

For further information or to arrange a no obligationassessment of needs, please contact us on:

Tel: 01483 801810 (24 Hours / 365 days a year)E-mail: [email protected] • www.wealdcare.co.uk



VISIT THE NEW CARE SELECT WEBSITE WWW.CARESELECT.CO.UK


0800 389 2077


>> parent is eligible, the cost of the

nursing care part of the fees is called the

Registered Nursing Care Contribution

(RNCC) and is paid by the NHS to the

home directly: the current amount is

£110.89 per week. To find out if your

relative is eligible they will need

to have a community care assessment at their local authority or be assessed by the hospital if being discharged. Ask about their eligibility for the RNCC at the same time. Figures may change during the life of this publication.

Is it what my relative needs?

To understand your loved one’s specific needs they will require a community care assessment by their local authority. This will help to determine whether a care home or care home with nursing will best suit their needs and ensure you don’t end up looking for a service that can’t support their needs or is more than they require.

If your relative has been in hospital, the discharge team should assess your parent’s needs before they are discharged; alternatively you can contact the local authority directly for one.

What to expect?

Care homes and care homes with nursing comes in all shapes and sizes. There are big, hotel-style homes or

smaller, more intimate ones. The one that suits your loved one will be the one that can meet their needs and in which they’ll feel the happiest. Choosing a care home is like choosing any home, your relative needs to feel comfortable,

settled, able to enjoy their personal preferences and

have a good quality of life whilst meeting their care and support needs.

Staff should be friendly and caring in

nature, taking time to get to know your loved

one, sit with them and assist them, not just doing

tasks for them. The home, staff and management should take into consideration your relative’s personal, cultural and religious wishes, discussing these before they move in and ensuring they are incorporated into daily life. A care home is a home and your loved one should be encouraged to join in as much or as little as they want.

It is important to make a shortlist of care homes to visit. Think about the types of locations that might be best, close to where your relative currently lives to enable them to keep social ties, closer to you or another family member, closer to local amenities or good transport links.

For more information on what to look for when choosing care, see page 26.

Can care homes be a short term solution?

There are a number of ways that a care home can meet someone’s needs in the short term.

Short break or respite

Short stays can be available in care homes, sometimes called respite. They >>

‘To understand your loved one’s specific needs they will require a community care assessment by their local authority.’


The Red House

CARE HOME WITH NURSING

The Red House is an excellent, independently run home of character and distinction offering both Residential and 24 hour Nursing Care of the highest quality. The Red House is home for up to 25 residents in single rooms, some with en-suite facilities, tastefully decorated and comfortably furnished yet retaining much of the character you would expect from a late Victorian house.

The owners and staff of The Red House are committed to providing the highest levels of quality care in a warm, homely environment that respects the individual’s right to privacy, dignity and personal choice.

Tel: 01372 27455243 Skinners Lane, Ashtead, Surrey KT21 2NN

Email: [email protected] • www.redhouseashtead.co.uk

The Red house

Brockfield House, established in 1984, is a delightful home registered for 45

residents and situated in the village of Stanwick, close to amenities and local

transport.

The Home specialises in the care of people living with the effects of long-term mental health problems

and those living with dementia. Nurses and care staff are respectful

and sensitive to the individual needs and choices of residents and provide

care in a comfortable and safe environment.

Brockfield House

Villa Lane, Stanwick, Wellingborough NN9 6QQ

01933 625555

01933 625555

A care home where your loved ones come � rst www.peterhousecare.com

YOU CAN FIND US IN THE OLD TOWN OF BEXHILL-ON-SEA. Contact Eddie Kasprowicz on 01424 730809 or email [email protected]

John’s comfort isn’t our only priority. Taking the time to listen to his stories is just as important.

Of course, the quality of care John receives is paramount. But having nurses who treat him like an individual is what really makes the di� erence.

At Peterhouse Care Home we treat our residents like mums, dads, brothers and sisters. Because that’s what they are to you and we understand how important family is. • Full CQC compliance• Compassionate, stable team• 3 acres of beautiful grounds


>> give the person needing care and support the opportunity to visit and stay in a care home for a period, receiving support and care as needed. It also enables anyone at home who may be caring for them informally to have a break. These short stays are useful to enable your relative to become familiar with the home or see if they like care home life.

It is possible to have a number of short stays in a care home throughout a year which are chargeable and each care home will have its own fees.

Intermediate residential care

If your family member is being discharged from hospital but isn’t yet able to return home they may be discharged into a care home. This can be a short stay while their future options are considered but where staying in hospital is unnecessary because they no longer have acute medical needs. If it is decided by the hospital that intermediate care is the best solution for their current needs, your relative will not be charged for the first six weeks of intermediate residential care. Typically a placement lasts for a maximum of six weeks, after which a decision is usually made. This could be returning home with home care or a permanent move into residential care.

Temporary residential care

This can last up to 52 weeks with the aim of your loved one returning to live independently. It is a chargeable service, though it won’t take any property into account when assessing any contribution to the cost of care (as long as the temporary stay does not exceed 52 weeks without good reason and subject to the conditions outlined in the Department of Health’s Charging for Residential Accommodation Guide). An example might be if your relative needs to leave home whilst major repairs are carried out but they want to return once these have been completed. For more information on paying for care, see page 84.

Finding the right care home

If you are looking for a care home, a great starting point is to look at the services within this issue of Care Select. The book is accompanied by a website www.careselect.co.uk which also links through to a searchable database of care services. You can search by

postcode, region or county and find out more detail about the

homes in that area. At a glance you can see how

they perform against essential standards of inspection and also link through to the Care

Quality Commission’s (CQC) website

www.cqc.org.uk to read a full inspection report. There

is even an option to request a brochure to be sent directly to you from the home.

As with home care services, all care providers in England must be registered with the CQC. All services are inspected >>

‘There are a number of ways that a care home can meet someone’s needs in the short term.’

MY GRANDMA IS A V. I.P

www.bridgehouseabingdon.co.ukThames View, Abingdon, Oxfordshire, OX14 3UJ

residential, nursing and dementia care for very important people

please call us on 01235 856 002 to arrange a visit


>> by the CQC, who report on their findings. The CQC has a responsibility to inspect care homes and home care agencies and to produce a report that shows whether or not the service is meeting statutory requirements. You can even click through to the CQC’s website www.cqc.org.uk to read the reports and make a shortlist based on the criteria that you and your relatives have identified. The CQC inspects on Essential Standards of Quality and Safety. These cover all aspects of the operations from involving your relative in their care, keeping them safe, the number of staff employed, the range of skills staff have and the procedures they must follow, and (as appropriate) the upkeep of the premises. You may also find that some of the larger organisations which run a large number of homes, have their own internal inspection processes that also contribute to driving up and maintaining standards.

The Government is introducing a new comprehensive system of publicly rating care – this is likely to follow a similar style as Ofsted use for schools however details are not available at

the time of print. Until then you cannot easily compare homes or agencies, but the combination of inspection reports, conversations with staff and current residents will help your decision.

When contacting the home, ask to speak to the manager and, if

you haven’t received one, ask for a company

brochure and copy of the most recent inspection report.

The right to choose a care home

Your relative has the right to choose any care home that they

would like to live in and that meets their needs. If they are funding their own place they are free to visit and decide upon any care home, anywhere in the country.

If the local authority is funding the care place, your loved one still has the right to choose a home to meet their assessed needs. However, if the cost of the accommodation is higher than the local authority would usually expect to pay, you may be expected to find a third party top up to cover the difference in cost. If supported by the local authority and your relative chooses a care home in another area, the local authority in the area your loved one currently lives is responsible for the care fees. The home chosen must meet their assessed needs and comply with the terms and conditions set by the funding authority. The fees that the local authority will pay may vary. They may offer to cover the fees they would expect to pay for comparable care within their county, or they may offer the fees that the local authority would pay in the chosen region. Seek further advice before making these decisions. >>

‘The CQC has a responsibility to inspect care homes and home care agencies and to produce a report that shows whether or not the service is meeting statutory requirements.‘


>> For more information on paying for care, please see page 84.

Rights in a care home

Moving into a care home doesn’t mean that your relative gives up their rights as a citizen. It is their home and they must be given the opportunity to live as normal a life as possible.

They have the right to:

• be treated with dignity, respect, care and sensitivity,

• privacy and their own private space,

• be as independent as they want to be,

• decide for themselves what they want - or don’t want – to do,

• go where they want as long as it is safe to do so,

• be involved in all decisions about their care at all times,

• expect the home to keep them fit and alert and help them maintain as much independence as possible,

• keep in touch regularly with friends and family and expect the home to help facilitate this,

• expect that the routines of the home, such as meal times, will suit their needs,

• be offered the opportunity to be involved in activities taking place outside the home,

• have any complaint they make dealt with quickly, fairly and efficiently.

Care home contracts

If your relative is funding their own care, they will have to sign a contract with the care provider. It is important to speak to solicitors with experience in this field. Any contract should explain the cost of care, what services are included in the price and how often this is reviewed; how any medication will be administered, your relative’s rights and the obligations of the care provider under the contract; the company’s complaints procedure and how the contract can be cancelled, if needed.

If the place is funded by the local authority, it will contract directly with the care provider, however your relative should receive a written copy of the terms and conditions.

Changing perceptions

Despite the image portrayed of care homes in the media, care homes are, in the main, homely, welcoming and enjoyable places to live. Many people are surprised to find out that a good care home can do wonders for someone and many people who move into care homes go on to live full lives and even have a better quality of life than if they’d stayed at home.

Use your instincts when visiting care homes. Consider what sort of life your relative likes to lead. If it feels homely, welcoming, clean, relaxed and the staff seem caring, engaged and supportive, chances are you’ve found a good home. For more information on choosing a care home see page 29.

You are likely to worry about your loved one and they may take a while to settle in. Don’t be afraid to raise any concerns with the manager or your relative’s key worker - the person taking the lead on their care and support. They will be open to your concerns and >>

A beautiful, small, family-run home

Situated in Purley, south east London, Heatherwood Nursing Home provides high quality nursing, residential and palliative care to 22 residents. We are a family-run Home that focuses on individual care and attention.

As a small home we have the time and resources to ensure each resident receives the very best in care and facilities. Our individual programmes, bespoke menus and wide range of activities confi rm time and again how happy residents and their families are to have chosen our beautifully appointed home. Heatherwood is indeed a home everyone would be proud to call their own.

The Home’s 22 rooms include two doubles (for couples or shared) and we encourage residents to personalise bedrooms with furniture and photographs. Flat-screen TV and DVD are included in each room along with Freeview, internet access, individual digital heating, therapeutic mood lighting which can be left on all night (very good for people with dementia) turn-lock valuables provision and new en-suite facilities furnished to the highest specifi cation.

For further information please visit our website or contact us.

Tel: 020 8660 664647 Foxley Lane, Purley CR8 3EH

www.heatherwood.org





each resident receives the very best in care and facilities. Our individual programmes, bespoke menus and wide range of activities confi rm time and again how happy residents and their families are to have chosen our beautifully appointed home. Heatherwood is indeed a home everyone would be proud to call

The Home’s 22 rooms include two doubles (for couples or shared) and we encourage residents to personalise bedrooms with furniture and photographs. Flat-screen TV and DVD are included in each room along with Freeview, internet access, individual digital heating, therapeutic mood lighting which can be left on all night (very good for people with dementia) turn-lock valuables provision and new en-suite facilities furnished to the highest


As a small home we have the time and resources to ensure each resident receives the very best in care and facilities. Our individual programmes, bespoke menus and wide range of activities confi rm time and again how happy residents and their families are to have chosen our beautifully appointed home. Heatherwood is indeed a home everyone would be proud to call

The Home’s 22 rooms include two doubles (for couples or shared) and we encourage residents to personalise bedrooms with furniture and photographs. Flat-screen TV and DVD are included in each room along with Freeview, internet access, individual digital heating, therapeutic mood lighting which can be left on all night (very good for people with dementia) turn-lock valuables provision and new en-suite facilities furnished to the highest

For further information please visit our website or contact us. 47 Foxley Lane, Purley CR8 3EH 020 8660 6646

47 Foxley Lane, Purley CR8 3EH Tel: 47 Foxley Lane, Purley CR8 3EH Tel: 47 Foxley Lane, Purley CR8 3EH

Heatherwood_FP.indd 1 14/03/2014 09:38

>> experienced at telling whether there are any settling in issues, teething problems or real concerns. A good care home manager will listen to you and work with you to make sure your parent settles well. For more information on evaluating the decision see page 62.

It can be tough

Beginning to think about a care home for your relative can be emotional. It is a big decision, everyone has their own ideas of what to expect and it is likely to raise a number of emotions. However, if it is the right option to support your parent effectively, with careful planning, an accurate care needs assessment and some time to find and visit suitable care homes, you should be able to find the right home.

Who’s who in a care home?

There are lots of different people in a care home, the main people you’ll come into contact with are:

Registered manager The registered manager is in charge of the day to day regulated services in a care home and is responsible for ensuring the home meets the national standards. They must be qualified to NVQ Level

4 in Leadership and Management for Care Services (formerly the Registered Managers Award), registered with the Care Quality Commission, and fully DBS checked. They may be the first person you come into contact with when

starting to look for a suitable care home, or they may pass

you to an administrator depending on the size of the home. The manager may also be supported by a deputy manager.

Care assistant Care assistants deliver

the day to day care and support in care homes. A good care

assistant should be caring, personable, compassionate and friendly. They should be patient and supportive. They should be DBS checked and although qualifications aren’t essential, they will have had a 12-week induction training which covers national minimum standards of care and they can work towards further qualifications. Senior care assistants will have more qualifications and may take on more of a management function whilst also having a caring role.

Activities co-ordinator A good care home should

offer your relative an opportunity to enjoy their life and participate in daily activities. Some homes will have a dedicated activities co-

ordinator who interacts with residents to provide

a wide range of activities to interest and stimulate residents.

They will encourage everyone in the home to participate including staff but will also respect that sometimes people


‘It is a big decision, everyone has their own ideas of what to expect and it is likely to raise a number of emotions.’

FAR FILLIMORE CARE HOME

Wood Lane, Hanbury, Burton-on-Trent DE13 8TGTelephone: 01283 812 180 • Email: [email protected] • Web: www.farfillimore.co.uk

“Home away from home”• Accommodation for 26 residents • For elderly people and people with Dementia• 2 double rooms for couple sharing • Group activities • Long and short term respite care • Palliative care• Large landscaped gardens • Local GP visits

NIGHTINGALE COURT CARE HOME “Offers a sense of togetherness”• Accommodation for 43 residents • For elderly people and people with Dementia• Long and short term respite care • Palliative care• Regular group activities • Sensory gardens• Sensory room • Local GP visits

LITTLEOVER NURSING HOME “Premier nursing home”• Accommodation for 40 residents • Specialise in palliative care with unrestricted visits• Regular group activities and entertainment • Within walking distance of shops and post office• Local GP visits • On-site nurse

“Warm, friendly and professional residential homes”

11/14 Comberton Road, Kidderminster DY10 1UATelephone: 01562 824 980 • Email: [email protected] • Web: www.nightingalecourtcarehome.co.uk

149 Stenson Road, Littleover, Derby DE23 1JJTelephone: 01332 760 140 • Email: [email protected] • Web: www.littleovernursinghome.co.uk


don’t want to join in or would like to do something else. Activities encompass pretty much anything and could include traditional activities like bingo or card games, or helping with the gardening, supporting them to cook or make a cup of tea, lay the table, fold washing, read or continue with or take up any activities they wish. They may also arrange events such as garden parties, Christmas parties, day trips, coffee mornings etc.

Ancillary staff Most care homes will also have ancillary staff depending on the size including administrators, cooks, housekeepers, laundry assistants and gardeners.

Everyone in the care home should work together to support your parent to lead their life.



0800 389 2077

HOW WILL I KNOW WHICH TO CHOOSE?WHAT ARE THE CARE OPTIONS?


54

Home 1

Home 2

Home 3

£ p/w

£ p/w

£ p/w

First impressions

• Are staff warm, friendly, polite, clean and

respectful?

• Do the residents seem happy, active and

sociable?

• Does the home feel homely and welcoming?

• Is the home fresh, clean and comfortably

furnished?

Accommodation

• Are bedrooms single or shared? Is there

a choice?

• Can you decorate and arrange your own

room?

• Can you bring your own furniture and TV?

• Is there a call system for emergencies?

• Can you control the heating in your room?

• Can you lock your room/secure place for

valuables?

• Is there a separate dining room? Bar?

• Are there both adapted showers and baths?

• Does the home have the right adaptations

and equipment to meet your needs?

• Are all areas safe and accessible

(e.g. for wheelchair users)?

• Is there adequate provision for sight

or hearing difficulties?

• Are the grounds/gardens attractive

and/or quiet?

Life within the home

• Are there any rules and restrictions

(e.g. going out, returning)?

• Can you choose when to get up and

retire every day?

• Are residents involved in decisions on

life in the home?

• Can you make and take calls in privacy

and comfort?

• Is alcohol served or permitted?

• Are there smoking and non-smoking

areas?

• What arrangements are there for

religious observance? (e.g. are places of

worship nearby/Is there a prayer room)?

• Can you handle your own money?

• Does a hairdresser/chiropodist visit?

• Does the home provide its own

transport?

• Do staff have appropriate language

skills/knowledge?

• Are the staff formally trained?

• Is there an adequate number of staff

on day and night?

• Are visitors welcome at all times? Can

they stay overnight?

• May your visitors join you at meals?

• How much choice do you get about meals?

• Is the food varied and interesting?

• Can the home cater for your dietary

needs e.g. Black and Minority Ethnic

diets?

• Can you have snacks or drinks any time?

In your room?

• Can you continue to pursue your

hobbies?

• What activities and entertainment are

organised?

• Are outings and holidays arranged?

At what cost?

£ ........................................................................

Fees and contract terms

• How much are the fees? Do they cover

all services available?

£ ........................................................................

• Under what circumstances will the fees

alter?

• Can you retain your own room if away?

• Can you have a short-stay or trial

period?

• Will you be given a statement of terms

on admission?

• Are all procedures clearly spelt-out?


Visit www.carechoices.co.uk for further assistance with your search for care

1 2 3 1 2 3


04

Foreword





Choosing care












How is care funded?


Essential contacts



Specialist housing with care schemesBeyond home care and care homes, there is another option for older people who need some support. Housing with care is a concept which combines independent living, a home with security of tenure, along with care services.


They are varied and diverse but most people are familiar with the traditional model of sheltered housing. Housing with care incorporates sheltered housing along with modern developments to cater to the needs and individual wishes of older people.

Due to its nature there are no real definitions of housing with care schemes however terms you may come across include sheltered housing, very sheltered housing, retirement housing, assisted living, extra care or close care.

Housing with care explored

Housing with care is designed around the needs of older people and may have levels of care and support on site or arranged by external companies. Your relative would have the security of their own home with a link to an on- or off-site manager, warden or care company. Housing with care schemes can offer services arranged by the organisation

that manages the site or a contracted company including:

• Help to arrange or receive care services.

• Care staff visiting at arranged times delivering agreed care services.

• On-site care staff.

• On-site care home.

• A restaurant or dining room offering meals.

Housing with care is particularly suited to older people who would like to live independently but may prefer to be near to other people with whom they can share interests; people whose home is no longer suitable for them but they don’t require a care home; couples where one partner needs support; and people who want the peace of mind of care and support close by should they need them.

If enough time and planning is given to care and support, housing with care can be a great solution. It is a mid-ground for many people and can allay some people’s fears of residential care or prove to be a happy compromise if other members of the family don’t agree with the need for formal support. The level of support can be increased as needs increase and those sites with on-site care homes can enable families to become familiar with the services long before they need to become a resident. >>

‘Housing with care incorporates sheltered housing along with modern developments to cater to the needs and individual wishes of older people.’

>> However, it is worth bearing in mind that it does involve moving from the family home which needs to be carefully broached if one party has particular ties to it.

Finding a scheme

The best place to start is the Care Select website www.careselect.co.uk, it accompanies this book and can offer you more than we have here, plus it links through to the publisher, Care Choices website (www.carechoices.co.uk) which enables you to search for care or support. You can search by postcode, town or region, for housing with care and review details of services. Make a shortlist of services in the selected area which meet the criteria you have identified and make arrangements to visit the service and meet with the manager. The Care Select helpline 0800 389 2077 can also help and offers a friendly voice at the end of the phone to help talk through the options and who can perform a search of schemes in your given area, that may be able to meet your criteria.

Different forms of housing with care

As mentioned above, there is no real definition of housing with care but here is an overview of some of the more common terms.

Sheltered housing

This type of housing, sometimes also called retirement housing is designed for people who want to remain living independently but with the reassurance

of knowing that assistance is on hand in an emergency. These schemes are available both to rent and to buy and usually consist of between 15 and 40 dwellings.

Some housing schemes are designed to meet the needs of older people and linked to a community alarm. Many schemes have a scheme manager or warden either visiting or based on site as well as the community alarm service and there are often communal facilities such as a lounge, laundry, guest flat and garden. Meals are not normally provided but a few schemes include a restaurant and some can arrange hot meals.

Extra care housing

When a retirement housing scheme offers on-site personal care - the kind of services available in a residential care home (care home without nursing), such a scheme is more likely to be called extra care housing, a model promoted by the Department of Health.

Extra care housing describes developments of self-contained homes with design features and support services enabling self-care and independent living. This type of care is popular with people whose disabilities, or those who are frail or whose health needs make ordinary housing unsuitable for them but who don’t need or want to move into long-term care. They may provide a high level of services and facilities, such as on-site domestic support, meals and recreational facilities, as well as one or two bedroom, self-contained accommodation. Wheelchair accessibility and level access showers are often at the heart of their designs and this type of housing can be owned, rented, part-owned and part-rented and leasehold. Some developments mix types of tenures. >>

‘If enough time and planning is given to care and support, housing with care can be a great solution.’


Independent living, with award-winning care and support

Retirement Villages• The Fairways, Chippenham• Mickle Hill, Pickering• Wadswick Green, Corsham• Herne Court, Herne Bay

Retirement Living with Care• Welland Place, Market Harborough, Leics• Hatherlow House, Southport

Enabling couples to stay together where one person has dementia.

Assisted Living• Fitzwarren Court, Swindon• The Maples, Peterborough• Woodbank, Woking• Fulwood Court, Liverpool• Alexandra Court, Dovercourt, Harwich

Auchlochan Garden Village Offering Retirement Living with care, Assisted Living and Care Homes. South Lanarkshire, Scotland.

Learn more about lifestyle choices at MHA

www.mha.org.uk

phone 01332 425 207 or email us on [email protected]

Head Office: Epworth House, Stuart Street, Derby, DE1 2EQ Registered as a charity - No. 1083995. Company Limited by Guarantee - No. 4043124.

MHA can offer you the best of both worlds. As one of the UK’s leading charitable providers of housing, care and support for older people, our aim at MHA is to help you stay independent for longer, in your own comfortable apartment, with flexible care and support available if and when you need it.

You can enjoy:• The privacy and pleasure of your own home • Superb range of social and leisure facilities• 24 hour emergency response• Award winning care


>> Very sheltered housing

Very sheltered housing is a form of extra care housing. It is usually provided by the private sector and if you are becoming increasingly frail or need more assistance, it enables you to retain your independence in a home of your own for as long as possible by providing meals, domestic assistance and 24/7 housekeeping staff cover. Social sector providers also use the term for housing that is somewhere between traditional sheltered and modern extra care.

Assisted living

Assisted living describes privately-provided, short-term rental properties with care services for older people who can no longer live on their own at home but don’t need round the clock, complex medical supervision. Should additional assistance be required, it is easy to arrange though the management team, available 24 hours a day. It is similar to very sheltered housing and extra care housing.

Retirement/care villages

Retirement or care villages offer a variety of accommodation specifically for older people. They are usually in a rural setting and have many community facilities. A typical retirement village may have one, two or three-bedroom flats and bungalows, to buy or rent, and

a restaurant, clubroom, shop, laundry, cleaning services, leisure facilities and perhaps a medical centre, care staff and a minibus. The size of these developments often means that they are located at the edge of towns, not close

to public amenities but they are extremely popular with their

residents and regularly win top awards.

Close care

Close care schemes are usually small - often six

to 25 flats or bungalows on the same site as a care home.

Residents can purchase additional services such as meals, personal care and cleaning directly from the care home.

Making your choice

If you feel that a form of housing with care is the right solution for your parent, there are many things to consider.

Location

• Is it near to family or close friends?

• Is it close to amenities?

• Is it easy to get to, is there public transport, adequate parking?

• Is it in a town or the countryside? Which would your parent prefer?

Facilities

• What communal facilities are on site?

• Would my parent use the facilities or prefer other things?

• Are there private gardens/places to sit outside?

• What are the views like?

• Are there social events? >>

‘Assisted living describes privately-provided, short-term rental properties with care services for older people who can no longer live on their own at home.‘

Delivering well-beingRegistered Charity 202151

Since we were founded over 85 years ago, the St Monica Trust has expanded its services in and around Bristol. Our approach combines the continuous development of responsive, customer-focused services, with a history of stable, sustained growth. Today we are proud to be regarded as a leading provider of retirement living and continuing care for older people in the south west.

• A variety of well-appointed properties to buy or rent

• 24-hour home care and personal care

• Specialist nursing and dementia care

• Short term respite care

• Physiotherapy

The very best in retirement livingOur retirement villages are the perfect place for living in retirement. There’s a choice of facilities, including restaurants, pool and leisure activities, as well as regular social events. Whether you’re looking for independent accommodation, or have a higher level of need for support, we have something for everyone.

Call 0117 949 4004 to find out more.www.stmonicatrust.org.uk | [email protected]

>> Services

• What care services are available?

• How are they organised?

• How are they paid for?

• Will they be able to accommodate your relative if their needs increase?

Visit prospective schemes, meet the staff and, if possible, talk to the residents. There will generally be a guest room. If possible, ask if your parent can spend a whole day and a night to get a feel for the community.

Housing with care is not regulated by the Care Quality Commission but any care services provided will be. It is important to check the inspection reports of the care and support providers before making a decision. Inspection reports can be downloaded from www.cqc.org.uk or through Care Select’s publisher’s website www.carechoices.co.uk when you search for suitable housing with care in a specific area.

The detail

The managing organisation may have eligibility criteria which applicants have to meet – generally to give priority to those needing care. There are different

ways the schemes may be purchased or rented, then there will be any services or care costs on top.

• Purchase – most buyers finance their purchase through the sale of their

house.

• Shared ownership – the purchaser buys a share in a property which the developer or managing company owns the

remainder of and is let to the owner. Most buyers

finance this through the sale of their house.

• Market rent - the resident rents from the owner at a fixed price. Sources of finance include annuities, pensions, investments or proceeds of the sale of a house.

• Social rent – this rent is subsidised by the state. This form of tenure is generally reserved for ex-local authority and housing association tenants and for those unable to raise sufficient capital for the sale of their property or from other sources. In these situations your parent may be eligible for Housing Benefit.

• Care costs - The cost of care will naturally depend on your relative’s individual care needs. As in residential care homes, self-funders will have to pay for personal care services, whilst social services will pay for those who have been means-tested as eligible. If eligible, Attendance Allowance can be used to pay for care. Individual budgets and direct payments for those receiving state support can also help residents to buy care services.


‘Housing with care is not regulated by the Care Quality Commission but any care services provided will be. It is important to check the inspection reports of the care and support providers before making a decision.‘

St Monica Trust Retirement Villages

St Monica Trust operates four retirement communities that provide a unique combination of care, support and accommodation in an active and lively environment for older people.

Sandford Station is a semi-rural retirement village community in North Somerset. It has 108 retirement homes in a choice of designs, with one, two or three bedroom flats and cottages for independent living and with care and support on-site. The facilities include a private and communal gardens and allotments, pool, gym, licensed restaurant, hairdressers, 24 hour emergency assistance and a regular programme of activities and events.

The Trust encourages residents to maintain their independence and remain in their retirement homes as long as possible. As needs change, residents are offered a continuity of care for residents including regular periods of increased care at home, or a more permanent arrangement within their nursing care home or dementia care home facilities.

The future

Housing with care offers people the opportunity to live independently but within a community of older people. It can reduce social isolation as there are

many other people and activities on-site. Care can be arranged

as and when it’s needed and this can increase with any change in needs.

There are many different options in many different locations so it is important for your parent to consider what they’re looking for from their home and finding something that best suits their wishes and needs.

‘Care can be arranged as and when it’s needed and

this can increase with any change in needs.‘


‘The Trust encourages residents to maintain their independence and remain in their retirement homes as long as possible.‘





0800 389 2077






0800 389 2077


62


Did we get it right?

It is important to recognise that any change in routine or living environment will take a while for your loved one to settle into. You need to be aware that there may need to be a significant period of readjustment for the whole family and your relative will need reassurance and support to feel settled with their new care service.

If your relative has agreed to receive care at home it’s important they understand how this will work for them. It is a good idea to write what is happening and who is visiting on the calendar so when you are not there, they know when to expect a visitor and what they will do when they arrive.

Many people are at first resistant to new people coming into the house and can refuse entry to care workers or become obstructive. This is completely natural and may partly be due to them feeling out of control with their situation.

Speak to the manager of the service and the specific care staff too. They will have experienced this before and

may be able to help you. Ensuring your relative has continuity of care staff coming to visit them will help as over time they should begin to build a bond

and grow familiar with the people coming

in to help them. If they don’t and

there appears to be a clash

of personalities, don’t be

hesitant to speak to the

agency as they will be able

to look at rotas to allocate a

different care worker to your

relative.

If your loved one still doesn’t

settle into the new routine, consider

speaking to an external adviser, another

agency or professional who may be able

to help you resolve any underlying issues.

Sometimes all it takes is for a few friendly

chats with somebody outside of the close

family to get to the crux of the issue.

If your relative has moved into a care

home they may need additional support;

they have had a complete change in

routine and in their living environment.

When you are helping them to settle

in, you need to make sure that they

are fully involved, wherever possible,

planning their own care and deciding

how they will spend their time. It is also

important that you and other family

members visit as often as possible. Your

loved one will really value seeing familiar

faces while they are getting to know the

other people living and working in the

care home.

It can be daunting entering a new

environment for the first time and your

Was it the right decision?Evaluating any form of care provision can be tricky. However there are ways to distinguish between teething problems and real issues.

‘It is important to recognise that any change in routine or living environment will take a while for your loved one to settle into. ‘


loved one needs to feel supported to

retain links outside of the care home.

If they are used to going to particular

activities, groups or meetings they need

to be encouraged and helped to continue

to do this.

Monitor the situation

Whether your relative is receiving care at home or if they have moved into a care home, you need to monitor the situation. It wouldn’t be uncommon for them to be extremely unsettled or anxious to start with; and it’s difficult to gauge how long this may continue. We are all individuals and therefore we all adapt to new things differently. However, you know your loved one well and you would hope to see small signs of them settling into their new care service fairly quickly and if they remain agitated, unsettled or anxious, clearly something isn’t working.

If something isn’t working

If you find yourself in a situation where you don’t think the new care service is working; the most important thing to do is to talk to your loved one. This may take time and patience as often older people don’t want to be seen as a ‘burden’. When you discover what the problem is, you need to work with your loved one to try to resolve it in a way they feel

comfortable. It is important that you don’t

rush in to try to problem solve if this isn’t

what they really want you to do.

Sometimes it may not be possible for

your relative to explain what the problem

is, so you will need to monitor the

situation and establish what you think is

the issue based upon your knowledge of

them, what they like and how they feel in

particular situations.

You need to remember that if your

loved one has dementia it may be more

difficult to understand what is not

working and sometimes you may need to

think about their early life to help them

feel more settled. For example, if they

lived through the war, they may

become agitated if there are

lights on in the evening.

Make sure you speak

to the manager or your

relative’s key worker to see

if they can help your loved

one to settle, or if it is normal

settling or adjusting behaviour.

They are very experienced at this

and a good care provider will work with

you and your relative in a sympathetic

way to help them to settle into the new

routine or environment and to allay any

fears you have.

A good care home wants everyone to

enjoy life, live together happily and feel

supported to live the life they lead, and a

good care agency is focused on delivering

top quality care to its clients. If staff or

management aren’t forthcoming with

support or assistance, consider whether

it is the right place for your relative to

be living. When you need advice and

guidance from the manager or staff,

sometimes you’ll get a gut feeling as to

whether they’re doing all they can and

are working with you and your family to resolve any teething problems. If you’re not certain, again consider whether it is the right service for your loved one. >>

‘Make sure you speak to the manager or your relative’s key worker to see if they can help your loved one to settle, or if it is normal settling or adjusting behaviour.‘


>> Serious concerns

If you have any serious concerns at all

that your relative is not being treated

well by the people delivering a care

service, or you are worried that your

loved one is being abused in any way,

you need to act on this immediately.

Ideally, the first thing you should do

is talk to the manager, explain your

concerns, agree actions and let them

know that you will be monitoring the

situation closely.

You should also ask for a copy of

the complaints procedure if you do

not already have this. The complaints

procedure will have the contact details

of the Care Quality Commission (CQC)

(www.cqc.org.uk) which is responsible

for care service regulation and will take

any complaint you make very seriously.

The safeguarding board at the local

authority will also be a useful port of

call if you have serious concerns.

If you need additional support during

this process you may want to seek

advice from Safe and Settled or the

Residents and Relatives Association,

both organisations support people and

their families moving into care homes.

You may also find Action on Elder

Abuse helpful if you are worried that

your loved one may be being abused

in any way. All of these organisations

have helplines. Contact details can be

found starting on page 99.

Don’t be afraid to raise issues and

don’t fear any retribution to your

realtive if you do complain. Good care

providers work hard to support people,

but if after a prolonged period of time

your relative isn’t settling it may be

worth considering another care agency

or moving them to another home.

Although this can be distressing it

may prove to be the best solution to

ensuring your parent is happy.

Receiving care and support services

can be a positive experience. However,

it can take a while to settle into and

sometimes, often due to unclear

expectations, things go wrong. In order

to try to avoid this, it is important that

care needs and desires are discussed

with the care services so everyone is

clear.

If your loved one is not happy with a care service the most important thing you can do is listen, empower them to resolve the issue and/or take action if you ever consider them at risk.


‘If you have any serious concerns at all that your relative is not being treated well by the people delivering a care service, or you are worried that your loved one is being abused in any way, you need to act on this immediately.’




0800 389 2077






0800 389 2077




Hannah’s Mum, Daphne, 76, lives in a care home in Swansea. Here, Hannah talks about how they found a care home to suit her Mum’s medical, personal and social needs.

‘When my Mum, Daphne, first started to develop dementia she was living at home with my Dad who used a wheelchair. Because of my Dad’s disability we had already moved their bed downstairs to make their lives easier. At the time, I was living in London and commuting to Swansea every weekend to be with my parents. Fortunately, my sister lives close by so was able to pop in to check on them regularly.

‘As my Mum’s dementia progressed the local authority carried out a needs assessment and agreed to provide home care, however having people they didn’t know coming into their home just didn’t work for my parents – particularly as it was quite often a different face every day. It caused arguments, and after three weeks we had to call a halt to it.

‘Fortunately, we were in a position to hire a private care agency who came in to help at meal times. This worked better as it was usually the same carers so my parents grew to know them. We also had to sell it to my parents as a cleaner and a private chef coming in as it made them more amenable to outside help!

‘Everything changed when my Mum had a seizure. She started wandering off and one week she went missing four times. We were given 48 hours by social services to find my Mum a care home as my Dad wasn’t able to stop her leaving the house and she wasn’t safe.

‘It was essential that we found a

care home close by as my parents had been married for 54 years and we wanted Dad to be able to visit her on a daily basis. However the first care home we put Mum in, the one closest to us, wasn’t right. The staff just didn’t want to deal with dementia and we would get calls at 11pm to say that Mum was being difficult and we needed to come and calm her down.

‘Six weeks later, we transferred Mum to another home a little bit further away where the staff were trained in person-centred dementia care. It has made a world of difference. Since being there, Mum has never asked to ‘go home.’ The environment is relaxed and homely, Mum has lots of her possessions around and there are regular activities – from carol concerts to summer garden parties. Mum is a lot calmer – she’s known as the lady who always has a smile on her face. My advice to someone in a similar position would be:

• Visit a lot of different care homes at different times of day so you see how staff interact with the residents.

• Trust your instincts. I’m not a care professional but I am an expert on my own mum and so I know the types of environment in which she would be comfortable.

• Keep on top of your relative’s care plan. Make sure you refer back to it, check what is written down and revise it when appropriate.

• Try not to panic. It can be an emotionally distressing time for the whole family, but keeping calm will benefit all involved.’

Daphne and the importance of trained staff

Princess Christian Care CentreStafford Lake, Knaphill, Woking, GU21 2SJ

Call 01483 488917 or [email protected]

ContaCt US today for more information

Princess Christian Care Centre is accredited by Investors in People, and committed to the Gold Standards Framework, the UK’s leading and most respected best practice and quality improvement programme for care homes.

Princess Christian Care CentreLocated close to Woking, in the heart of the Surrey countryside, Princess Christian is a purpose-built centre providing specialist Residential or Nursing care for elderly people who have been diagnosed with Dementia. The Home offers varied and modern en-suite accommodation, outstanding amenities, and is staffed by a dedicated and highly skilled team of Nurses and carers.

Our philosophy:“The wellbeing of our residents is central to all that we do. The focus always is on the individual, and we are committed to enabling each person within our care to lead an active and fulfilled life, based on dignity and choice.”

Excellent facilitiesSet off a quiet rural lane in attractively landscaped gardens, the centre comprises individual en-suite accommodation for up to 96 residents. Rooms are spacious, airy and equipped with all modern amenities.Other amenities include a sensory room to aid relaxation, physiotherapy services, an onsite hair salon and purpose-built cinema, showing a varied programme of popular films.

InformationWe welcome new residents from social services and the private sector.

We maintain an open-hours visiting policy, which means relatives and friends are welcome to drop by and see their loved ones at any time of the day, seven days a week.

Please also call for information on respite, holidays and day care services.

NEL_020_PC_Full-page-AD_210x297_FINAL.indd 1 14/02/2014 12:33

Princess Christian Care CentreStafford Lake, Knaphill, Woking, GU21 2SJ



Princess Christian Care Centre is accredited by Investors in People, and committed to the Gold Standards Framework, the UK’s leading and most respected best practice and quality improvement programme for care homes.

Princess Christian Care CentreLocated close to Woking, in the heart of the Surrey countryside, Princess Christian is a purpose-built centre providing specialist Residential or Nursing care for elderly people who have been diagnosed with Dementia. The Home offers varied and modern en-suite accommodation, outstanding amenities, and is staffed by a dedicated and highly skilled team of Nurses and carers.


Excellent facilitiesSet off a quiet rural lane in attractively landscaped gardens, the centre comprises individual en-suite accommodation for up to 96 residents. Rooms are spacious, airy and equipped with all modern amenities.Other amenities include a sensory room to aid relaxation, physiotherapy services, an onsite hair salon and purpose-built cinema, showing a varied programme of popular films.




NEL_020_PC_Full-page-AD_210x297_FINAL.indd 1 14/02/2014 12:33

04Foreword





Choosing care












How is care funded?


Essential contacts



The Alzheimer’s Society is the leading provider of dementia advice and care, they see the difference that tailored support can bring, in respect of enabling people with dementia and their loved ones to live well with the condition.

What is dementia?

Dementia describes a set of symptoms that may include memory loss, mood changes and problems with communicating and reasoning. These symptoms occur when the brain is damaged by certain diseases. Alzheimer’s disease is the most common form of dementia, but there are over 100 other varieties including vascular dementia and Pick’s disease.

Dementia affects people in different ways and the onset of the condition will vary depending on the disease. Dementia is predominantly a condition that affects older people but it is indiscriminate of social class, gender or ethnicity. Of the 800,000 people in UK with dementia, there are around 17,000

people who are under 65. While there has been a big emphasis

on developing better drug treatments and finding a cure for dementia through investment in scientific research, one of our top priorities must be ensuring that people living with the condition in the here and now are supported to live well in the place they want to be.

How can dementia be supported at home?

As many as two-thirds of people with dementia live in the community. Understandably, if your relative has dementia, the familiarity of the home can be a comfort if they find that their mental abilities are beginning to decline. In the early stages of the condition, simple additions like memory aids can be used around the house. However, as the condition develops, people often need increasing amounts of support.

They may need help getting up in the morning, getting washed, having meals or going to the toilet. Providing this level of care can become too much for often elderly partners or busy sons and daughters - and this can be all the more difficult if your loved one lives alone with no family close by.

However, extra support should be available from the local authority or privately. As with other conditions, a >>

Dementia and dementia careDementia and getting a diagnosis can cause a range of emotions. For some, it brings relief, understanding and an explanation for the changes people have experienced or loved ones witnessed, but for others it can bring anguish and even upset. But what we do know is that dementia affects each person in different ways.

‘If your relative has agreed to receive care at home it’s important they understand how this will work for them.’

67





>> local authority assessment will establish whether the local authority has the responsibility of providing support. This could be someone coming into the home to help in the morning and at mealtimes. If you, other family members or friends spend a lot of time caring for your relative they should also be assessed, enabling them to access invaluable respite care.

Innovation and technology in the home

Having dementia makes day-to-day life more difficult and increases the likelihood of accidents at home. Mistakes like leaving the tap on or the gas unlit can make the home potentially hazardous. However, there is a range of equipment available that can make life easier and safer your parent if they have dementia.

Assistive technology, if used in the right way, has the potential to facilitate memory and recall and increase independence and autonomy both for your parent and those around them. At one end of the spectrum there are ‘smart’ homes complete with customised electronically linked up appliances, personal voice prompts and movement sensors. At the other end of the spectrum simple touches like automatic calendar clocks can be helpful for forgetful moments and labelling cupboards or rooms can prevent disorientation.

However, it is really important to note that people react differently to different

products. Where possible, decisions about alterations in the home should be made by your parent. If not, those responsible, you, siblings, other family members must have the person’s best interests at heart and be mindful that unfamiliar additions to the home can cause distress rather than comfort.

Implications of living at home with dementia

While there are many benefits to living

at home, some people with dementia

can struggle to access the support they

need. In this time of austerity, councils

are forced to make extensive budget

cuts. As a result, up and down the

country the criteria for who qualifies for

care has been raised while the numbers

of people with dementia needing access

to services continues to increase. This

imbalance between supply and demand

has serious consequences and without

appropriate support, people with

dementia can end up reaching crisis

point. For example, without help getting

dressed, a person with dementia may

suffer a fall and be admitted to hospital

as an emergency case.

For those who are not entitled to local

authority financial support, the costs

of paying for care can be exorbitant.

Presently, the Care and Support Bill

going through Parliament marks a step

forward as it proposes a limit on the

costs an individual has to pay for their

care. This should come into force in

2016, however, with the limit being set

high at £72,000 on the lifetime costs

an individual has to pay. Alzheimer’s

Society is concerned that many people

will still have to pay significant amounts

for their care.

We are, however, hopeful that the

Care and Support Bill will address

deficiencies in local authority services,

‘Mistakes like leaving the tap on or the gas unlit can make the home potentially hazardous.’


including the commissioning of 15

minute visits for people requiring care

at home. In October 2013 a report by

the charity Leonard Cheshire, supported

by Alzheimer’s Society, found that as

many as two-thirds of local councils

commission 15 minute home visits

which are insufficient and fail to treat

vulnerable older people with the dignity they deserve. Alzheimer’s Society campaigns strongly on the need for adequate social care provision for people with dementia.

When the time comes for a care home

As your relative’s dementia progresses

they will need more support and care,

and there may come a time where

full-time residential or nursing care

is needed. If they cannot make this

decision for themselves, it often comes

down to you as their carer or close

family member. Being prepared for

this eventuality early on, and having

discussions as early as possible, can

help to make this decision slightly easier

when the time comes.

Prior to making this decision, you

may wish to consider whether sheltered

accommodation or assisted living would

be appropriate for your relative. Respite

care is another option. It offers a chance

to experience residential care on a short-

term basis and gives your relative’s main

carer a break. It may also help to discuss

the decision with a social or health care

professional, such as a social worker or

your parent’s GP or consultant. Often

they can give you their professional

opinion on the type of care your loved

one may need. A social worker can

review their needs assessment, which

can help with deciding the level of care

your relative may need and the right

care setting.

Although a move to a care home can be

an emotionally difficult time, for some,

the consistency and quality of care

provided is higher than can be provided

at home by family members or paid

care staff. There are also social benefits

of living in a care home such as the

interaction and friendships that are built

between residents and the activities that care homes can provide.

Talking about your continuing involvement in the care of your relative with the staff of the care home may help you decide whether it is the right decision.

How can dementia be supported in care homes?

It is thought that more than 80 per cent of care home residents have dementia or severe memory problems. As a result, there are many care homes which have a full appreciation of the complexities and difficulties of dementia, while at the same time understanding the individual needs of each resident. However, not all care homes are suitable for people with dementia and so choosing the right home is very important. A good care home will focus on the individual rather than their dementia. This approach is known as person-centred care – it takes into account your relative’s unique qualities, interests and needs. Often this can be achieved through small but significant actions, for example, finding out how they like to be addressed or what their preferred daily routine is. Equally your loved >>

‘It is thought that more than 80 per cent of care home residents have dementia or severe memory problems.’


>> one’s beliefs can shape many aspects

of their lives, so if someone refuses

to eat a plate of sausage and mash or

shepherd’s pie at dinner time they may

not be displaying ‘difficult behaviour’

but instead could have been a life-long

vegetarian.

Alzheimer’s Society has developed a

useful leaflet called ‘This is me’. Where

possible you, your parent or

another close family member

fills in the leaflet by listing

likes, dislikes, hobbies and

habits - it can then be

shared with care workers

so they can understand

more about your parent.

When choosing a care

home, it is important that you ask

managers quite specific questions in

relation to their philosophy on person-

centred care. A good way of exploring a

manager’s understanding of dementia

might be to ask what approach they

would take if your relative continually

asked to go home or wanted their

mother. A ‘good’ answer would be one

that recognises the emotional needs of

insecurity and loss and an attempt to

respond to these needs.

A good care home should also provide

a range of activities that are meaningful

to its residents. Research has shown

that availability of activities and

opportunity for occupation is a major

determinant of quality of life. Whatever

stage of dementia they are at, by having

interesting activities to occupy them

throughout the day it can transform the

environment – this could include daily

tasks such as laying the table or folding

laundry to music and art therapy.

It is important to take your time to

assess a care home properly. Consider

everything from first impressions, to

exploring what activities take place

and even the security and safety of the

home. The care home checklist on page

54 and the dementia checklist on page

74 serve as great pointers of what to

consider when looking for a care home.

Negative perceptions of care homes

Certainly it seems that not a

month goes by without reports

of neglect and ill-treatment

in care homes. While it is

true that the care sector

must do considerably more

to prevent such incidents

occurring, it is important to

stress that most people in care

homes receive good quality care

from dedicated staff. However, stories of

unacceptable care and a wider pessimism

about life in care homes are leading to

many people settling for less. A 2013

report by Alzheimer’s Society found that

while three quarters of relatives (74 per

cent) would recommend their loved one’s

care home, less than half (41 per cent)

reported their relative as having a good

quality of life.

It is vital that we get out of the mind-

set that people cannot live well in a care

home as this perception is leading to a

failure to drive up standards. Alzheimer’s

Society is calling on the Government

and care homes to work together to lift

expectations so people know they can

demand the best.

We all know people with dementia can

live well if they have timely access to the

necessary support and care that they

need throughout their dementia journey.

If someone is worried about their

memory, or the memory of a loved one, it

is best to seek advice from your GP. The earlier you seek help, the sooner you can get information, advice and support.


04

Foreword





at home

Choosing care

Care and support at

home


agency checklist




Care Schemes




first signs


checklist



How is care funded?


needing care

Essential contacts


providers




Memory problems can be due to a number of reasons and dementia affects everyone in different ways but if you notice these key symptoms in a loved one, it’s best to seek medical advice as early as possible.

The key symptoms of dementia

• Struggling to remember recent happenings but being able to recall things from the past,

• Finding it hard to follow conversations or programmes on television,

• Forgetting the names of friends or common everyday objects,

• Inability to recall things your relative has heard, seen or read,

• Repeating themselves or losing the thread mid conversation,

• Having problems reasoning,

• Feeling anxious, depressed or angry,

• Feeling confused even in familiar surroundings.

What to do next

If you’re worried that a relative could be showing signs of dementia, encourage them to visit a GP. They might well be resistant to the idea so offer to go along with them as well. There

are many reasons for memory loss apart from dementia – these include depression, infections and vitamin and thyroid deficiencies. A GP will be able to test for treatable conditions and rule out other reasons for confusion such as poor sight or hearing, emotional upsets from perhaps a bereavement or a move, or the side effects brought on from certain drugs.

If however, the visit does lead to a diagnosis of dementia, it means you can get access to information and details of the support available, so it’s worth getting it checked out as soon as you can.

What does the assessment consist

of?

The GP will first look at the person’s medical history for other conditions which might

affect memory and cognition. You can expect

the GP to spend some time talking to you and the person

Are you guilty of joking about a relative’s forgetfulness, brushing it off as just a sign of them getting older? Or are you worried they might be showing the first symptoms of dementia and wonder what to do about it?

‘If you’re worried that a relative could be showing signs of dementia, encourage them to visit a GP.’

73

you’re accompanying, to ascertain some of the symptoms. Normally a GP will carry out a physical examination and a number of tests such as blood and urine to identify other conditions that may be causing the confusion. They may also ask a series of questions to test thinking and memory.

The GP may want to send the patient to a memory clinic for further specialist assessments. A diagnosis of dementia is made in memory clinics and can take from 4 to 12 weeks to diagnose if scans and other investigations are required. If tests do not indicate dementia, patients may be invited back every 6-12 months to monitor symptoms.

What treatments are available if dementia is diagnosed?

While there is no known cure for dementia, there are drugs and other therapies that can help with some of the symptoms. With a combination of these, lots of people can live well with dementia for many years.

There are different types of dementia and most of the drugs available are for the treatment of Alzheimer’s disease, but are ineffective on other forms. It’s well worth finding out which type of dementia a loved one has so treatments and support can be tailored to their specific needs.

Drugs aren’t the only way to treat or manage the symptoms of dementia. There are many other things that can help people to live well such as talking therapies, reminiscence therapy and cognitive stimulation therapy.

You could be put in touch with local services offering support or your loved one might be offered the chance to

attend groups or take part in activities that may help you and any carer to cope better.

Simple tips for helping people cope with memory problems.

If your relative is having difficult remembering things,

you may like to suggest some of these ways of helping them cope.

For everyday life

• Use ‘to do’ lists,

• Break up tasks into small chunks to make them seem

less of an issue,

• Do one thing at a time,

• Try to have a routine to give a structure to each day,

• There’s no rush. Tell them to take their time.

Memory aids

• Wear a watch, use clocks and put up a calendar to help keep track of time and dates,

• Keep a diary to help you remember appointments and ‘to do’ lists,

• Use sticky reminder notes,

• Keep important things like keys, money, glasses in the same place,

• Keep a list of important phone numbers by the phone,

• Arrange to pay important bills by direct debit or standing order.

‘There are different types of dementia and most of the drugs available are for the treatment of Alzheimer’s disease, but are ineffective on other forms.’


Residents

The best indication of a good home is that the residents appear happy and responsive.

• Are there rummage boxes around the home to stimulate residents?

Access

If the person with dementia needs or is likely to need equipment or adaptations you may want to check:

• There is adequate signage and cues for different parts of the home such as dining room and bathroom.

• The home’s policy about locking external doors.

Bedrooms

You may want to find out whether the person with dementia can have a single room and whether:

• Residents are encouraged to bring in some of their own furniture and possessions to increase familiarity.

Activities

Residents should be stimulated without feeling stressed.

• Are reminiscence activities available?

• Are residents able to compile memory boxes?

• Do staff compile life story books including photographs and

mementoes?

Staff

It is important to note whether staff seem friendly and caring towards residents and

whether they treat residents with respect.

• Do they have any training and experience in dementia care?

• Will the person with dementia have a member of staff particularly responsible for their care?

• Is there a member of staff you can talk to about your own worries about the person with dementia?

Manager/head of home

A manager who is caring as well as efficient can make all the difference to a home.

• Does the manager have knowledge of dementia and can they deal with difficulties that may arise in an understanding way?

• Is there a full assessment at home before a resident is admitted?


Things to look for in care homes specialising in dementia. Please use in conjunction with the care homes checklist on page 54.



04

Foreword





Choosing care












How is care funded?


Essential contacts



People deal with the prospect of losing a parent in different ways, and there’s no right or wrong approach. The signs may be there warning you that end of life is drawing near for your Mum, but you, your Dad and other siblings might have conflicting views on how you want to acknowledge the fact.

It might be your loved one who finds comfort in talking about, for example, where they’d prefer to die, thus making it easier for their family to try to make sure this is able to happen when the time comes.

You only die once and it has been said that what we fear most about dying is the associated loss of control. By giving people the power to express their wishes the control can be restored.

Key facts

• 81 per cent of people have not written down any preferences about their own death. Only a quarter of men and just over one in three women across England have told someone about the

funeral arrangements they would like to have after they die.

• Nearly two thirds of us would prefer to die at home, yet of the 500,000 who die in England each year, 53 per

cent die in hospital.

• Nearly two-thirds of people have not written a will. This includes a quarter of people over 65.

Sooner rather than later

Talking about death doesn’t bring death any closer. It’s about

planning for life. Without communication and understanding, death and terminal illness can be a lonely and stressful experience both for the person dying and for their friends and family. By addressing the subject of eventual death with a relative, whether the likelihood is still years off, it can help the whole family plan and hopefully see through as many of their wishes as possible. This can make the whole experience a better one for everyone.

Nobody wants to be the first to bring up and start such a depressing and emotional conversation but many have reported that bringing it out into the open can be a relief and allow others the chance to talk about their own death too. >>

Thinking of end of life careIt’s the one thing we all know is going to happen but dread - the passing of our loved ones. But while many of us prefer to avoid the subject until the sad inevitable happens, others find it helps to pluck up courage and talk openly about their close relative’s dying wishes.

‘Talking about death doesn’t bring death any closer. It’s about planning for life.’

75



>> Try to choose the right place and the right time to start the conversation. Avoid stressful situations and gauge how happy your loved one is to talk about their future. Maybe at the point of talking about retirement or care requirements is a good time to bring up their final wishes too. There’s no right or wrong way to address the topic of dying but here are a few sensitive suggestions:

Starting the conversation

• Broach the conversation with a question rather than a statement, ‘Have you ever wondered what would happen…?’; ‘Do you think we should talk about…?’

• Sometimes it helps to start with something direct but reassuring, like, ‘I know that talking about these things is never easy…’ or ‘We’ve never talked about this before but…’

• Encourage everyone to be totally honest about how they feel from the start. If you’re all open, there may be either laughter or tears – don’t be afraid of either.

Consider

• Though others may initially want to change the subject when you talk about dying, talking about it will ultimately make everyone’s lives easier.

• If your relative is worried about talking about death with those they love, suggest they perhaps talk to someone else they respect and trust like a nurse or friend.

Why plan ahead?

• For those with a terminal illness, or approaching the end of their life, it makes sense to make plans for your care in advance. It involves thinking and talking about your wishes for how you are cared for in final few months of life. It can make things easier for your loved one or relatives. It could include where you would like to die, if you wish to be resuscitated or if you want to refuse any kinds of treatment.

• By discussing these questions with your family, you are at least saving them from having to make the difficult decisions on their own later on.





0800 389 2077


WHAT IF MUM DOESN’T AGREE?HOW WILL I KNOW WHICH TO CHOOSE?



0800 389 2077



In the checklist below are some of the areas people often leave too late to discuss. Although it may not be easy to talk about, you could leave this with your relative for their consideration.

It is important to think about all the things you want well in advance, talk to your family, write it down and keep it safe.

1. Consider legal and financial matters

• Make a will, get legal advice if necessary.

• Think about the costs, consider insurance, a funeral plan.

• If you need financial help to support you and your family with care costs, transport.

• Plan for the care of dependents.

2. Save other lives - through organ donation

• If you want to donate any organs to save other lives or leave your brain or body to medical research, e.g. to help with dementia, write it down and tell your family.

3. Make a plan for what you want when you die

• The type of care you would like towards the end of your life,

• Where you would like to die,

• Whether you have any particular worries you would like to discuss about being ill and dying,

• Whether you want to be resuscitated or not?

4. Consider how you would like to be remembered

• What would you like people to know before you die?

• Messages, memory boxes, videos for loved ones.

5. Plan your funeral arrangements

• What do you want, burial, cremation, green funeral, other?

• Any service, memorial service, wake, celebration of your life?

• What songs, messages, themes?

• Who do you want to attend?

6. Prepare for bereavement

• If you need help or advice, find out where to go for support.

• Find out what to do about legal and financial matters after death.

Planning dying well

As the end approaches

Wherever your relative is being cared for, in their own home or a care home, you should be confident that the people charged with caring for them will have the necessary training to help make their end of life as comfortable as possible. A good understanding of someone’s wishes can help to avoid unnecessary admission to

hospital. Most people would prefer not to die in a hospital and with good planning the care staff should help to ensure this happens.

Care staff should assess your loved one and be familiar with their specific wishes. Each organisation should have its own end of life care policy, ask your relative’s care provider for their policy and >>



>> training on the subject. End of life should be a sympathetic time and care staff, whilst being professional, will also be sympathetic and understanding of the situation and the emotions surrounding it.

The Gold Standards Framework

Living with, or caring for someone, who is nearing the end of their life or who is living with a life-limiting condition can be demanding, stressful and emotional. Feeling confident that the person you are living with, or caring for, is receiving the right care, in the right place at the right time, all the time, undoubtedly helps ease those concerns. The Gold Standards Framework (GSF) helps doctors, nurses and care assistants provide the highest possible standard of care for all patients who may be in the last years of life.

It is clear training the professionals need to provide coordinated, joined up care, so that no matter what stage of their illness your relative or loved one is at, or where they are being cared for, everyone involved in their care knows about their wishes and is best prepared to ensure they are fulfilled. GSF helps link together all of the people who provide this care, preventing people from being overlooked.

Two thousand care homes have completed GSF training and 400 have received GSF accreditation so they have demonstrated that they are properly identifying the people who

need special care at this time of their life, assessing what they

need and planning their care in close conjunction

with them and their families and carers. GSF accredited care homes are twice as likely as

other care homes to care for people in the

home up until the end. That means very few inappropriate

admissions to hospitals that can be distressing for all concerned. GSF encourages doctors, nurses and care assistants to talk to their patients at the earliest and most appropriate time, about how and where they want to be cared for. GSF accredited GP surgeries are in a better position to provide the specific care that people want. Patients nearing the end of their life deserve the best care - the ‘gold standard’ of care. That means high quality, reliable and consistent support. GSF encourages doctors, nurses and care home staff to help families and carers too, so they can work together to avoid ‘crises’. Better planning of patients’ care means a last minute prescription panic or something more major can be averted. Speak to your relative’s care provider about GSF and how they approach end of life care.

Palliative care

Palliative care (from the Latin ‘palliare’: to cloak) focuses on the relief of pain and other symptoms and problems

‘The Gold Standards Framework (GSF) helps doctors, nurses and care assistants provide the highest possible standard of care for all patients who may be in the last years of life.’


experienced in serious illness. The goal of palliative care is to improve quality of life, by increasing comfort, promoting dignity and providing a support system to the person who is ill and those close to them. Palliative care is appropriate for anyone of any age who is facing serious illness. It can be delivered alongside active treatments designed to try to prolong life at an early point in the disease process. It is also applicable at the end of life and into bereavement.

Palliative care neither hastens nor prolongs death. It celebrates life, even when time is limited. It regards dying as a normal process. Palliative care can be delivered in any care setting, including home, care homes, hospitals and hospices. Hospices provide palliative care services at home, in day care centres or hospice inpatient units. Most people who have inpatient hospice care return home once their problems or needs for care support are addressed.

Team delivery

In palliative care, decisions about treatment and care are made with the help of the members of a multidisciplinary team and in line with your relative’s personal goals and preferences. Team members usually include doctors, nurses and social workers. Occupational or physiotherapists, chaplains, pharmacists, nutritionists and others might also form part of the team.

Myths about dying

The preconceptions of dying stem from our childhood and images we see on

television and in films. Some are wrong but as many of us don’t talk about dying a lot, these misconceptions grow. Don’t let the myths get in the way of planning properly for how you’d like yourself or your loved one to live at the end of their lives.

The most common myths

Myth 1: There’s no point in thinking about dying

Thinking about death does not bring it any closer. If we think about it a little in advance, we can plan for the kind of death we’d actually wish for. Encouraging your relative to make a will, decide what kind of care they’d like, or just practical things to help those left behind, can make the last days easier and help reduce feelings of regret.

People who have gone through this process report being able to get on

with life more happily and the same goes for those caring

or supporting them.

Myth 2: Most of us will die in hospital – it’s inevitable

Currently in the UK, it’s true that more people die

in hospital than elsewhere, but that doesn’t make it inevitable

as increasing numbers of people are getting the support they need to be able to die in their own homes. Some will die in hospices, care homes or supported housing. >>

‘If we think about it a little in advance, we can plan for the kind of death we’d actually wish for.’

‘If people are given good care, there is no need for them to be in pain. ‘

>> Planning ahead and talking to the health or social care team and encouraging your relative to write down their wishes may make it more likely that they will die where they want to.

Myth 3: It’s better to keep family in the dark to protect their feelings

Although it’s hard to talk openly and honestly about illness or dying with those you love, facing illness together can bring people closer, take away unanswered questions and make the situation easier for all to cope with.

Myth 4: Death is generally very quick or very painful

The media of TV and films often portray deaths that happen in a romantic, violent or very quick way but everyone’s death is different and often the dying process is gradual. If people are given good care, there is no need for them to be in pain. There are many different medications available to doctors and nurses to control pain and although morphine is one of them, it does not mean someone is going to die if they are being prescribed it as a controller of severe pain.

Myth 5: Everyone is vulnerable and powerless at the end of their life

Many people remain in control because they’ve prepared for a time when

decision-making won’t be as easy. Leaving instructions

for where and how they’d like to be cared for, when they would like treatment to stop and who they would like to make decisions for

them.

Practical help

There is a range of organisations that can help you and your relative to plan the support and care they need towards the end of life, advice on writing wills and advance care plans, and provide advice on the emotional issues surrounding dying.

Dying Matters www.dyingmatters.org and the NHS Choices websites are useful starting points http://www.nhs.uk/Planners/end-of-life-care.





0800 389 2077






0800 389 2077



Are you a family carer? 81


Sometimes a caring role can be thrust upon you in a time of crisis, or begin with just checking in on your way home from work. However it begins, it is common for regular carers to reach a point of needing support to enable them to continue caring.

What is caring?

There are 6.5 million people caring, unpaid for their loved ones in the UK today. They help with personal things like helping your relative to get up and dressed, helping them to the toilet, or administering medication. They may also help with the practical things like cooking, cleaning and shopping. Does this sound familiar to you?

Getting support

Caring responsibilities can have an overwhelming impact on your life. It can be tiring, frustrating and often raises a mix of emotions. Caring for a parent can change the dynamics of a relationship and takes some adjustment.

Whatever your situation, if you or a relative are caring for someone, receiving support can make a real difference and it can come in many ways.

Support could be:

• Aids and adaptations to the home, such as grab rails, hoists to help with moving the person if they’re immobile, devices to detect gas with the ability to shut it off, devices that detect if someone gets out of bed or a chair, fall detectors, alarms if a parent exits the property. These electronic devices are called telecare and more information can be found on page 24.

• Someone to give you a little respite by coming to sit with your relative or take them out a few hours occasionally, or on a regular basis, so you have some time to yourself.

• A short or respite stay in a residential care home to enable you to take a longer break.

• Support is also available at short notice in cases of

emergencies.

Look after you yourself

It’s so important to look after your own

health and wellbeing to be able to continue caring

for your loved one. If your caring responsibilities are affecting your health, tell your GP. >>

You may not identify yourself as a carer but if you support an ageing relative with daily living tasks that may be you. Caring for a relative can feel like the most natural thing in the world to take on, or something that has just evolved as your loved one has needed more support. While no two people’s caring roles are the same, it is often an emotional, stressful and exhausting experience.

Visit www.carechoices.co.uk for further assistance with your search for care 81


>> There may be local support networks they could tell you about or offer you regular health checks. Caring can involve emotional strain, stress and even physical pain from helping to move a loved one around so make sure you take any support that is offered.

Asking for help can be difficult but there are a number of organisations who can offer support. The Carers UK website www.carersuk.org has a wealth of information to help and support you in your caring role. It also has links to carers’ organisations in specific areas under its ‘Help & Advice’ tab, ‘Finding help where you live’.

Get a carer’s assessment

You are entitled to a carer’s assessment from the local authority whether the person you look after received any services or not. It will assess what kind of an impact your role is having on your health and wellbeing and how much caring you do combined with perhaps other work. This assessment will not have any bearing on any benefits either you or your relative receives. To obtain one, contact your local social services department. You may be able to fill out a form online or have it sent by post. You can talk to an assessor over the phone or face to face. It’s important to remember that you are honest about your caring role. There’s no point in playing it down as social services can advise you of what help and support you may be able to receive.

Benefits for carers

As a carer you are entitled to claim

benefits; the main benefit being the Carer’s Allowance. The current rate is £61.35 a week. It isn’t means-tested but any earnings may affect whether you are entitled to it. It is also taxable. To receive Carer’s Allowance you must:

• Be 16 or over,

• Not be in full-time education,

• Earn £100 a week or less,

• Be a UK resident,

• Look after someone who gets a qualifying disability

benefit,

• Look after that person for at least 35 hours a week.

To claim, you can fill out an online form via the GOV.UK website www.gov.uk or by contacting:

Carer’s Allowance UnitTel: 0845 608 4321Textphone: 0845 604 5312Email: [email protected]

Caring for someone after a hospital stay

If you are a carer and expecting your loved one to come out of hospital soon, this can be a particularly worrying time. This might mean getting used to a brand new situation. Hospital staff should have informed you, as their carer, during their progress in hospital and particularly planning for their discharge from hospital and how their care needs may now differ. Before the patient leaves hospital, the following should happen:


• You and your relative should be given verbal and written information, contact details and information about future treatment and care.

• If the patient lacks mental capacity you may be able to make certain decisions about health and welfare matters if you have a Lasting Power of Attorney (LPA) dealing with health and welfare matters. If there is no LPA, the law requires professionals to act in the patient’s best interests and you should be involved in the decision making process.

Working and caring

If you also work, the Work and Families Act 2006 gives eligible carers the right to ask their employer for flexible working. Your employer has to consider the request seriously but can refuse if they have a good reason. There is a right to appeal. You also have the right to unpaid time off work in an emergency situation relating to the person you care for.

What if I can’t carry on caring?

If the caring role all begins to feel too much for you to carry on, it’s worth doing something about it as soon as possible. Don’t labour on thoughts that you’re letting your parent down; if you’re struggling, you need to start looking for alternative options before you really don’t have a choice. It might have reached the time to consider formal care in the home or in a care home for your loved one, so you’ll need to discuss the possibilities with anyone else involved in your situation including your relative, your partner and any siblings you may

have. This can often provoke an emotional response but whatever the outcome, you should not feel pressured into carrying on or feel guilty about your decision.

Contact the local authority to ask for an assessment of your relative’s needs even if they have been assessed before. They may have deteriorated or their needs changed, and a new assessment will help you with your decisions going forward.

This is a time when you may need to give your loved one, and other family members, a lot of reassurance that your decision is based on what is best for the both of you and discuss alternative options together.

Your relative may not want to speak about it but you could still look for temporary solutions until they come round, or seek advice from professionals or other people about the situation, including other carers or carer support groups. They may be able to give you some ideas for broaching the subject or someone else may be better placed to

raise it with your parent. Informal carers save the UK £119 billion a year. You are

doing a significant service for your loved one and whatever your situation now and in the future you should be proud of

the caring role you have undertaken. There is support

available to you and a carer’s assessment should help to identify any

needs you may have. Figures may change during the life of

this publication.

‘If the caring role all begins to feel too much for you to carry on, it’s worth doing something about it as soon as possible.’

83

04

Foreword





at home

Choosing care

Care and support at

home


agency checklist




Care Schemes




first signs


checklist



How is care funded?


needing care

Essential contacts


providers


How is care funded?

Funding care in a care home

When it comes to funding care it can feel very confusing, finding out whether your relative is eligible for any local authority support can be a starting point. But anything the local authority may contribute towards their care will depend on their financial situation and level of need. The rough rule of thumb is whether they have more than £23,250 in capital and savings.

Are they eligible for financial support?

Do they have more than £23,250 in capital and savings?

The value of their home (or former home) is included in the assessment of capital unless it is still occupied by:

• A spouse or partner or civil partner,

or

• A relative who is 60 or over or incapacitated, or

• A child under 18 who is theirs or their responsibility, or

• A lone parent who is their estranged or divorced partner.

If the answer is NO

The local authority may contribute financially towards care costs after they have carried out an assessment of care

needs.

How much?

To work out how much they may pay, your relative will need a care needs assessment from their local authority to

define their care needs and how they will be best met. The local authority will also

undertake a financial assessment of your parent to determine how much your loved one may have to pay and how much the local authority may have to pay. Any choice of care provider will be limited to those that accept the local authority’s funding level. More expensive care homes will expect you to arrange a third party payment to ‘top-up’ the difference. Your relative is not permitted to pay this themselves if their capital is below £23,250.

If your loved one’s capital is less than £14,250 and the provider you choose charges fees that are within the local authority’s funding rate, your relative’s contribution will be assessed only on their income. Normally all their >>

For those who are not entitled to local authority financial support, the costs of paying for care can be high. Presently, the Care and Support Bill going through Parliament marks a step forward as it proposes a limit on the costs an individual has to pay for their care. This should come into force in 2016 however, with the limit being set high at £72,000 on the lifetime costs an individual has to pay. There is concern that many people will still have to pay significant amounts for their care. For more information on changes to funding, see page 95.

84

How is care funded?


needing care


‘The onset of illness or disability, bringing with it reduced mobility; growing difficulties in managing aspects of daily life.’

Phone: 0845 602 2059 For more info visit: www.ashmere.co.uk

Ashmere has been caring in Derbyshire and Nottinghamshire for 30 years. Family owned and managed for three generations, Ashmere has striven to deliver the very best care to our residents, and our experience shows. For those who value their independence our residential care offers all the assistance needed, whilst offering the freedom of choice of which activities and hobbies to pursue from those on offer, along with many trips and outings to allow you to enjoy being a part of the community. Our nursing homes provide all the equipment and expertise required to provide the best care possible. Whilst our extra care units provide specialist care for residents with dementia. In some of our homes all three levels of care are catered for, taking away any stress of having to move again.

The Ashmere Lifestyle

Smalley Hall: Main Road, Smalley DE7 6DS King William: Lowes Hill, Ripley DE5 3DWValley Lodge: Bakewell Rd, Matlock DE4 3BN Sutton Court, Lodge & Manor: Sutton-in-Ashfield NG17 2AH

Codnor Park: 88 Glass House Hill, Codnor DE5 9QTThe Firs: 90 Glass House Hill, Codnor DE5 9QT Kidsley Grange: 160 Heanor Road, Smalley DE7 6DXWest Hallam: Newdigate St, West Hallam, Ilkeston DE7 6GZ

care homes for loved ones

Ashmere has been caring in Derbyshire and Nottinghamshire for 30 years. Family owned and managed for three generations, Ashmere has striven to deliver the very best care to our residents, and our experience shows. For those who value their independence our

Nursing Care

Residential Care

Dementia Extra Care Units

Day, Respite and Long Term Care

125 North Road, Carnforth, Lancashire LA5 9LU Telephone: 01524 734176 • Email: [email protected]

Why not arrange a visit and see for yourself. Tel: 01524 734 176

Meresbeck Care Home

Meresbeck is situated in Carnforth fairly close to the town centre and is registered to provide personal care for up to 20 older people.

We think you’ll find we’re ideally suited to meet your needs now and in the future.

Facilities Summary: • 24 hour care

• 12 single rooms and & 4 double rooms

• 2 en-suite bathrooms

• Nurse call in every room

• Own furniture welcome

• Excellent cuisine

• Diets catered for

• Two lounges & two dining rooms• Landscaped gardens with seating

• Patio area

• Wheelchair access

• Lift to first floor

• In house activities and outings

• Religious services

• Hairdressing salon

• Visiting chiropodist and optician

85Visit www.carechoices.co.uk for further assistance with your search for care 85

>> income would be taken towards the fees except £23.50 they are allowed to keep back as a personal expenses allowance. The income of their spouse or partner is ignored as is the value of any savings held in their name.

With capital between £14,250 and £23,250 your loved one’s will also be expected to contribute £1 per week for every £250 they have above £14,250. Local authorities now offer cash payments in the form of Personal Budgets to pay for any care and support needs in your own home if someone is eligible. For more information on this see page 93.

If the answer is YES

If your relative’s capital and savings is more than £23,250, they will be responsible for paying for their own care. A social care assessment will still define their care needs and how they will be best met. This will help when considering care providers and whether they are able to meet these needs. Your loved one is then able to choose the care that meets their needs from the provider that they wish.

My relative will be paying for their own care – what next?

Moving a close relative into a care home can be a very difficult and emotional time for all involved. As though that’s not enough, if they are funding their

care (self-funding), then there is the added worry of it being affordable over the long-term and their money running out.

Around 45% of care home residents are self-funding but despite this,

little is on offer in the way of information and

advice. In fact, a report commissioned by the Association of Directors of Adult Social Services cited that those who

approached their local council for help, because

of their financial status as funding their own care,

received little information or advice and were often simply given a list of care homes and left to find their own way.

The decision to move into a care home is often taken at a time of crisis and most people aren’t prepared for what to expect or aware of what help and support is available particularly if they are self-funding their care. Consequently, some older people can find themselves in very precarious situations as well as missing out on help and financial support that could be available to them.

Below are a number of useful pointers that can help you navigate this journey although it is always worth picking up the phone to seek advice about your relative’s own personal circumstances.

Care home fees explained

The cost of care homes vary depending on the type of care required, the location of the care home or, as with hotels, the degree of luxury chosen. Regardless of the care home you should be given a contract which both the care home and you or your relative

‘What is important is that the fees of the home your relative is choosing are going to be affordable over the long-term.‘


signs. This contract and the care home’s ‘terms and conditions’ should clearly set out what is included in the fees, what might cost extra and when the fees are due for payment. It should also explain situations like what happens if your loved one’s care needs change, or they need to go into hospital, what notice periods are required and how long fees remain payable after a resident has passed away.

What is important is that the fees of the home your relative is choosing are going to be affordable over the long-term. If there is any chance of their money running out and they had to fall back on local authority funding, you should discuss this with the care home operator and the local social services department to see what the consequences are likely to be.

Most care homes charge more than the local authorities normally pay for care home places. It may be that if your relative were to find themselves in this position, the care home would continue to accommodate them at the lower local authority rate or, more likely, they would require a third party to top-up the fees. Your loved one would not be allowed to do this from their remaining capital; it has to be a third party. Failing this, it could end up

with your relative having to move to cheaper accommodation which could be detrimental to their health and wellbeing. This is why it is so important to plan your loved one’s finances at the outset.

What you can expect from the local council

An assessment of needs

Even if your relative is self-funding their care it’s important they have an assessment of their care needs from their local authority. All people self-funding their care are entitled to an assessment of their care needs which should always precede any financial assessment. Why is this important? Because, without being assessed as needing a place in a care home they could miss out on some financial support from the council or the opportunity to be considered for fully-funded NHS Continuing Care. Also, if they were to choose a care home that doesn’t match their assessed needs the local authority may insist on them

moving care homes if, in the future, their money ran out

and they had to rely on state funding.

Twelve weeks property disregard funding

If your loved one is assessed as needing to

move into a care home permanently and their capital,

apart from their property, is less than £23,250 (as stated above) the council may assist with the funding for the first 12 weeks if they don’t have enough income to meet the cost. Speak directly with the local authority regarding this. >>

‘Even if your relative is self-funding their care it’s important they have an assessment of their care needs from their local authority.’


>> Deferred payments agreement

After 12 weeks, the council may continue to provide funding for the care fees with an interest free loan whilst your relative’s property remains unsold. A charge is placed against the property and the loan is repaid when it eventually sells. This is highly dependent on the local authority so it is important to speak with them directly about whether it is an available option.

Council Tax exemption

If the property is left empty when your loved one moves into a care home it should receive full exemption from Council Tax until such time as it is sold.

What you can expect from the NHS

NHS Nursing Care Contribution

If the care home provides nursing care your relative should be entitled to a NHS Nursing Care Contribution towards the fees. This is currently £110.89 per week paid by the PCT direct to the care home.

Fully-funded NHS Continuing Care

When assessed, your loved one will be screened to ascertain if they are entitled

to NHS Continuing Care funding which could meet the full cost of their care. To be eligible, their care needs would have to be primarily health care needs. It is important to be aware that if not

initially eligible for NHS Continuing Care funding, if their condition

deteriorates, a review and

re-assessment can be

requested at any time in

the future.

Section 117 Aftercare

If your relative has a

mental health condition

and was admitted to hospital

under Section 3 of the Mental

Health Act 1983 for assessment and

treatment, their care home fees could

be fully-funded under what is called

Section 117 aftercare. This is provided by

or jointly with the local authority.

What can I expect from the Benefits Agency?

Attendance Allowance - A non-taxable,

non-means tested benefit payable to

those aged 65 and over who need care

whether at home or in a care home. It

is paid at a lower rate of £54.45 if care

is needed by day or night or at a higher

rate of £81.30 per week if needed by

day and night. Contact the Attendance

Allowance Helpline for more information

on eligibility and how to claim.

Telephone: 0345 605 6055,

Textphone: 0845 604 5312,

Monday to Friday, 8am to 6pm.

Pension Credit - Pension Credit is an

income-related benefit. It has two parts

- Guarantee Credit and Savings Credit.

Guarantee Credit tops up weekly income

whereas Savings Credit is an extra

‘After 12 weeks, the council may continue to provide funding for the care fees with an interest free loan whilst your relative’s property remains unsold.’


‘The rental income would be taxable. You must be

prepared for gaps in rental periods if the tenant fails to pay up or leaves. ‘

payment for people who have saved

some money towards their retirement.

You don’t pay tax on Pension Credit. If

your relative receives Pension Credit

and qualifies for Attendance Allowance

they will also be entitled to the Severe

Disability Addition currently £61.10 per

week. Their property, if on the market,

is disregarded capital for Pension Credit

purposes.

Will I need to sell the family home?

Not necessarily. If the family home is not disregarded as capital in the means test for care there are options if your relative doesn’t wish to sell it. You could let it for them whilst at the same time taking advantage of the local authority’s deferred payments scheme (see page 88) if it is available. Depending on how much financial support you will be able to obtain from them and the level of rent you can expect to achieve this may enable you to meet the care costs whilst also deferring the sale of the property. There are, however, some things you should bear in mind.

A loan from the local authority will have to be repaid at some stage and, although whilst your parent is alive it is currently interest free, interest will begin

to be applied 56 days after they die and it could be at quite a high rate set by the local authority. You would need to consider whether the property is suitable for letting and whether you could manage it or if your loved one can’t afford to employ a letting agency. The rental income would be taxable. You must be prepared for gaps in rental periods if the tenant fails to pay up or leaves. Would you be able to meet the shortfall in income needed in this situation? Letting the property could also adversely affect any entitlement to Pension Credit because it would then be treated as capital by the Benefits Agency.

Will I still get an inheritance?

This brings into play two conflicting emotions, from feeling on the one hand that you want the best possible care money can buy for your loved one and on the other you see the inheritance you were expecting diminishing very quickly. How much you might inherit is impossible to answer; it depends entirely on how much capital your relative has, the level of care fees they are paying and for how long. The very least you could expect might be the remaining capital if your loved one’s money were to deplete to the capital threshold at which the local authority might begin assisting with the funding, this is currently >>

‘If the family home is not disregarded as capital in the means test for care there are options if your relative doesn’t wish to sell it.’


>> £23,250. If your relative is nearing that figure then you should contact the local authority to seek their assistance.

Seeking financial advice on paying for care

Should you choose to sell the property to meet your relative’s care costs you will have the capital available but not knowing how long care might be needed can still be extremely worrying. Despite this many people fail to seek financial advice to understand how best to meet the costs. As interest rates remain low, money held on deposit and used for care fees

can be depleted very quickly. It would

be sensible, therefore, to consider

other forms of investments that could

potentially deliver higher returns.

There is only one financial product

specifically designed to meet long-term

care costs, these are called ‘Immediate

Need Care Fee Payment Plans’. Offered

by some insurance companies they

are purchased from capital to deliver

the required income. Depending on

your loved one’s age, life expectancy

and circumstances, a mixture of low

risk investments may also be worth

considering, particularly if they

have underlying capital

guarantees on death.

Care fee payment

plans, if appropriate,

can deliver the

certainty of a regular

increasing income over

the possible long-term

and might only require

part of your relative’s

capital. The income, if paid

direct to the care home, is tax-free.

The price of these plans is based

on the insurance company’s actuarial

interpretation of life expectancy from a

medical report, provided by your loved

one’s GP or the care home, their age

and the amount of income required.

The more impaired the life, the cheaper

the cost.

Capital protection can be purchased

for extra cost, failing this, you must

consider the possible short-term loss

of capital against the peace-of-mind

factor and longer-term benefits in the

event of a lengthy stay in the care

home.

There is no charge for the medical

report so there is usually no cost in

considering this route as an option.

‘As interest rates remain low, money held on deposit and used for care fees can be depleted very quickly.‘





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Catherine is 85 and has been assessed as needing care in a nursing home following a stroke, she has £20,000 savings and a property worth £275,000. She has pensions of £625 per month. The nursing home she and her family chose cost £3,250 per month. A care fees adviser helped Catherine claim Attendance Allowance and told her about the NHS Nursing Care Contribution. Together these contributed just over £800 a month but even so, allowing £150 spending money, she needed another £1,975 each month to cover the fees.

It was decided to sell her house rather than let it out. This could take a little while but, because she was assessed as needing permanent care and her other capital was below £23,250, the council assisted with funding for the first 12 weeks. After 12 weeks Catherine could continue to receive funding but as an interest free loan through a ‘Deferred Payments Agreement’ with the council.

Her adviser showed Catherine and her son three options for meeting her care costs from her property proceeds.

Option 1: Leaving the money on deposit, but with low interest rates, it showed it would quickly deplete.

Option 2: Retaining some of the capital to meet the care home fees in the short-

term and investing the balance of the proceeds into low risk

investments which could be drawn upon monthly over the longer-term. Although offering the potential of higher returns than might be

achieved on deposit, it carried the risk that the

investments can also go down.

Option 3: Using some of her capital for a ‘Care Fees Payment Plan’ and investing the remainder. This provided the certainty of a regular increasing income for the rest of her life and potentially left some money for her family. The downside was, without a capital

guarantee, once purchased the money used would be lost to

her Estate.The house sold and

they chose option 3 for peace of mind. Catherine enjoyed her new home for several

years and she and her son had the reassurance

that she would always be financially secure.

This is a fictional case study. Catherine chose the Care Plan and benefitted from the income for several years however, although people can live for many years whilst receiving good quality care, longevity is an unknown factor that must be considered.

Catherine’s care funding


Paying for care and support at home

The cost of home care will vary, depending on where your relative lives and the level of care they need and the times they need it. Care at night and at the weekend is likely to cost more. Your loved one’s council will set the amount it charges for services it provides to people who are eligible and this may depend on the amount it has negotiated and contracted to pay home care agencies. The council would need to undertake an assessment of your relative’s needs and financial circumstances before deciding whether they are eligible.

Paying for home care privately

If your loved one doesn’t qualify for local council support it may be necessary to purchase the care they need privately through home care agencies, all of which have to be registered with the relevant social care registration authority who also inspect them to ensure the care they are delivering is up to the prescribed minimum standards.

The cost of employing a home care agency will depend on where your relative lives and the amount of care they need. Details of local home care agencies and the services they can provide can be obtained through your local social services department, from the Care Quality Commission www.cqc.org.uk or from the United Kingdom Home Care Association (UKHCA) www.ukhca.co.uk.

Many councils produce directories of care services in their area. Care Choices Limited, the publisher of Care Select, is the largest publisher of care directories in England and Wales. Visit the website at www.carechoices.co.uk to search for care in the region in which you are looking. They also have a helpline, where a friendly operative can help you to narrow down your search for an agency according to your loved one’s needs and preferences. Both the website and helpline can arrange for you to receive information from matched agencies. You can also view e-versions of regional directories or request a hard copy.

Care and support at home from the local authority

A national framework called ‘Fairer Charging Policies for Home Care and Other Non-Residential Social Services’ provides guidance to local authorities on how to work out charges for home care provided or arranged by them. Applying this, each local authority should publish and make available clear information about charges and how they are assessed. This should be at the time your parent’s needs assessment is carried out and, after the means test, written information should be provided detailing how any charges are worked out and payable.

In principle, the fairer charging policy instructs councils to allow people to retain a minimum amount of money for their own personal use, rather than all of it being used up paying for care. This amount should be set as a 25% buffer

above the basic levels of the guaranteed

credit of Pension Credit. For example,

if Pension Credit was £145 per week,

125% of that would be £181.25 and be

the amount ignored in calculating the

income assessable when charging for

‘The cost of home care will vary, depending on where your relative lives and the level of care they need and the times they need it.’


care. However, in most areas if you have

capital or savings in excess of the means

test limit which in the 2014/2015 period

is £23,250, you can be charged the full

cost of your care. These are the minimum

capital limits provided in the fairer

charging guidance although a

few councils exercise their

discretion by increasing

the capital limits or might

set a maximum level of

charges people should be

asked to pay.

The value of your

relative’s home is not taken

into account in the means

test for home care and, if only one

member of a couple requires care, the

means test should only take into account

the resources of that person. Any joint

accounts are treated as divided equally

between the partners.

Local councils may charge differently

depending on the services being used.

For example, meals at home or in day

care may be charged at a flat rate to

all users, without applying a means

test because they are regarded as a

substitute for ordinary living costs that

you might be expected to incur anyway.

There is no set national guidance for

how services should be charged for, but

normally it would be based on the hours

of service provided. Whatever method is

used it must be deemed to be reasonable.

If the local authority is contributing

towards or arranging your loved one’s

care then they will most certainly use a

system called self-directed support. Self-directed support puts people in control of the support they need to live the life they choose.

Personal Budgets

If your relative is eligible for social care support, self-directed support gives

them a Personal Budget based on an assessment of their eligible social care needs. They may need support or help to manage day-to-day activities and everyday tasks such as washing and dressing, help with eating and drinking or

getting out into the community. They can then choose what

social care and support services this money is spent on. They can be as creative as they want, as long as the money is spent to meet their needs.

A Personal Budget can be received in various ways:

• A Direct Payment (DP) – the local authority pays your loved one an amount of money. The money can then be spent on solutions and services of your relative’s choice to meet their eligible social care needs, and they are in control of this money;

• An Indirect Payment (IP) – this is made available if your loved one is not able to consent to a Direct Payment, but where a Direct Payment is deemed to be in their best interest. It can be paid to a person who is ‘suitable’ on your relative’s behalf. There are rules and guidance to help the council decide who is a ‘suitable person’;

• Individual Service Funds – your Personal Budget, or some of it, can be lodged with a service provider for >>

‘If the local authority is contributing towards or

arranging your loved one’s care then they will most certainly use a system called self-directed support.’


>> your relative to draw from to get support as and when needed; or

• The local authority arranges and pays for the support.

Direct Payments

Direct Payments are financial payments made to people who have been assessed as eligible to receive support from the council. They can make a Direct Payment to most people who need support including:

• People who have been assessed as needing community care services (including those with Mental Health needs) aged 16 and over, incorporating short as well as longer term needs;

• carers over 16 for carer’s services; and

• parents of disabled children, for children’s services.

Instead of the council arranging or providing services directly, your relative can use these payments, either by themselves or with assistance, to purchase support that they consider most appropriate to meet their assessed social care needs, however Direct Payments cannot be used to pay for residential care. Also, carers may be able to receive Direct Payments to help in their caring role or to have some time for themselves.

Why have a Direct Payment?

Direct Payments allow more control over the decisions that affect your parent’s life. They provide more flexibility

and choice, as your parent can buy appropriate support tailored to their individual needs. Another option is for the council to source a portion of the care/support needs through services commissioned directly by them and also provide a Direct Payment to arrange those remaining services that your parent wishes to have more control over.

What can Direct Payments be used for?

If your relative receives a Direct Payment, the money is used to arrange support to meet eligible needs. They may choose to employ someone directly, to buy services from an independent or voluntary sector provider or purchase equipment to help live more independently. With Direct Payments, people or agencies employed are accountable to your parent and not to the local authority. Therefore, Direct Payments enable more control, choice and flexibility over how your parent plans their support to fit with their life. It is important that their plans meet their assessed needs. Therefore, provided the money is used lawfully, and eligible needs are met, the flexibility that these payments allow means it is impracticable to outline what the money can be spent on. However, there are certain items on which these payments cannot be spent, for instance:

• services that should be provided by health

• routine living expenditures, utility and household bills etc.

Most Direct Payments are made to meet regular on-going support needs; however they can also be made as a single payment, for example, to purchase equipment or a short respite break.

‘Direct Payments allow more control over the decisions that affect your parent’s life.’


As part of the proposed Care Bill the Government is considering making significant changes to how much people will have to pay for their care.

From April 2016 there will be a cap on how much people will be expected to pay towards their eligible care needs. This is currently set at £72,000 and once you have spent that amount on your care the local authority will take over the funding. However, you will have to be assessed as being eligible for support and the amount is calculated based on what your local authority would usually pay for the care you need and not on what you might actually spend if you have chosen more expensive care. It only relates to care costs and not what are deemed to be living costs which at the moment the Government has said to be about £240 a week of a care home’s fees. The £72,000 cap applies to older people above retirement age, younger adults will

pay less and people with eligible needs before they are 18 will get free care. Anything the local authority pays towards your care will count

towards the cap.If you have been assessed as needing

care in a care home it is proposed to increase the upper capital limit to £118,000 from April

2016. This means that if your savings and capital,

including the value of your home, is less than this figure

the local authority may assist with the costs. You will however still have to make a contribution of £1 for every £250 between the lower capital limit and £118,000.

From April 2015, the deferred payments agreements mentioned above will become more readily available from local authorities instead of being at their discretion as they are now. They will be known as universal deferred payment agreements. However, the loans will no longer be interest free.

Proposed changes to care funding

Seek Advice

Paying for care is a complex subject and in association with Care Select, EAC FirstStop Advice can explain what you might be entitled to from all the agencies involved. Before deciding on what may be the most appropriate solution for meeting care costs it would be sensible to talk to a specialist care fees adviser who has CF8, the relevant qualification financial advisers must have for advising on funding long-term care. The EAC FirstStop Advice helpline

can also refer you to a member of The Society of Later Life Advisers (SOLLA) near to you or your parent. SOLLA accredited advisers specialise in the financial needs of older people. You can contact the EAC FirstStop Advice Line by calling 0800 377 70 70, emailing [email protected] with your name, address and contact details or completing the online form at www.firststopcareadvice.org.uk.

Figures may change during the life of this publication.



Have you thought about who will make decisions for your relative if they are finding it tricky or impossible to decide themselves? Who will act in their best interests if they are faced with competing plans for their welfare? When moving towards long-term care it is more important than ever that families have certainty and control over their relative’s situation. Many people are surprised to learn that in the eyes of the law family doesn’t automatically take over on a relative’s behalf.

Lasting Power of Attorney

A Lasting Power of Attorney (LPA) is a vital tool to make certain that people are protected, and decisions are made, with the minimum of fuss and in their best interests, by those they trust. LPAs are legal authorities which allow one person to choose another person or people from among family and friends, or indeed anyone over 18, to act on their behalf if they cannot do so. There are two types:

• Property and Affairs LPA for decisions about finances, for example, in relation to bank accounts, investments and property.

• Personal Welfare LPA for decisions, such as where the person lives and what care and medical treatment they might receive. This LPA also allows a person to make an advance decision about whether they would refuse life-sustaining treatment should they be seriously ill and unable to make such a decision themselves.

LPAs allow people to give detailed instructions to attorneys:

• to direct how decisions will be made on their behalf;

• to decide whether attorneys should act together in taking some decisions, but individually in others; and

• to choose who should be told when the LPA is registered.

An LPA must be registered before it can be used. If attorneys are acting for someone under an LPA they must follow the principles of the Mental Capacity Act which provides sound protection and comfort that they will still remain in control for as long as possible. The attorney must

• assume that the person is able to make their own decisions unless it’s established that they cannot;

• make every effort to help the person make as many of their decisions as they can;

• not treat them as being unable to make the decision simply because they want to make an unwise decision;

Legal issues surrounding needing careWhen the time comes to consider formal care and support, it’s important to explore any legal issues and make sure your relative’s affairs are in order.

‘When moving towards long-term care it is more important than ever that families have certainty and control over their relative’s situation.’


• always act in the person’s best interests; and

• always take into account the person’s rights and freedom when making a decision.

Why should my parent make an LPA?

The risk of mental and physical incapacity is increasing with greater longevity and related conditions such as dementia. Even if your relative has not lost the capacity to make decisions it is helpful to have someone they trust who can legally deal with their affairs and wellbeing under their instructions.

If your relative loses capacity to make their own decisions, they will want someone to help with their financial affairs if they are no longer able to manage them, or they are going abroad or into hospital. Banks, building societies and all financial institutions will not deal with anybody but the account holder or an attorney. This will make dealing with your loved one’s money and finances almost impossible when faced with unhelpful bank staff who will protect themselves by parroting the data protection provisions if your relative is unable to deal with them directly, causing serious problems and delays. A properly drawn up and registered Property and

Affairs LPA will avoid these problems.A Health and Welfare LPA lets your

loved one make it crystal clear how they wish to live and be looked after if they become ill or unable to look after themselves. An attorney has the legal authority to fight your relative’s corner and make sure that their instructions are followed. When combined with a Property and Affairs LPA you can make sure that the right care package is commissioned for your loved one. This could save money and property as well as giving you certainty about your relative’s future care. If your loved one has strong feelings about life-sustaining treatment, a Health and Welfare LPA allows them to give an attorney authority to refuse such treatment on their behalf if they are only being kept alive by medical intervention. If your relative doesn’t make a LPA and they lose capacity you may have to make a lengthy and expensive Court application for a deputyship to obtain permission to look after their financial affairs. The Court is very unlikely to grant a

deputyship concerning their welfare and these decisions will be

made by social workers and doctors.

Wills

Your loved one’s situation and possibly

their assets are changing when they receive long-

term care. You should, therefore, encourage them to

review their Will so that it is up to date and reflects their current wishes and circumstances. This should be done every three years in any case and certainly whenever there is any major change in life. >>

‘The risk of mental and physical incapacity is increasing with greater longevity and related conditions such as dementia.’

>> A properly drawn up Will can:

• ensure a person’s assets pass to the people they want when they die;

• protect assets against care fees by ring-fencing assets for the next generation;

• avoid disputes;

• minimise Inheritance Tax;

• appoint Guardians for any children under 18; and

• provide for a partner if they are not married.

If someone dies without making a Will this can lead to anxiety and confusion for those left behind. The law ensures that spouses and children are provided for, where possible, from whatever money, property and possessions a person leaves when they die, once any debts have been settled. This can take time to sort out, during which family members may not be sure where they

stand. If someone is not married then the law views a partner as a friend and they may not receive any provision, leaving them in financial difficulties.

Your parent’s home

If your relative has been living in their own home

before entering long-term care they or you as their attorney will need to decide what is to happen to the property

by assessing the options carefully and making sure

that all legal protection is in place.

Funding of residential care is a source of great anxiety for some people and a major concern is whether or not your relative will have to sell their home to pay for care and whether it is possible to avoid this. For more information on this see the paying for care chapter on page 84.

Get advice

There are a number of advisers who can guide you through the legal process, your family solicitor, if you have one, or a local law firm, may be a great starting point.

With thanks to Ed James, QualitySolicitors Truemans


‘If someone dies without making a Will this can lead to anxiety and confusion for those left behind.‘




0800 389 2077






0800 389 2077



99Essential contactsAction on Elder Abuse (AEA) Helpline: 0808 808 8141 Web: www.elderabuse.org.uk Works to protect, and prevent the abuse of, vulnerable older adults.

Age UK Advice line: 0800 169 6565 Web: www.ageuk.org.uk Information on issues affecting older people and their carers.

Alzheimer’s Society - National Dementia Helpline Helpline: 0300 222 11 22 Web: www.alzheimers.org.uk Promotes its unique knowledge and understanding of dementia, develops quality in its care services, to support people with dementia, their families and their carers. Its confidential advice, information and support helpline is open seven days a week, with trained advisers who understand the needs of people affected by dementia. You can also email enquiries to [email protected].

Ask SARA Web: www.asksara.org.uk Guided advice about daily living.

Association of Charitable Organisations Tel: 0207 255 4480 Web: www.aco.uk.net A national umbrella body for ‘benevolent charities’.

Association of Independent Care Advisers (AICA) Tel: 01483 203066 Web: www.aica.org.uk Represents member organisations around the country that help people decide on the best choice of care.

BCD Care Associates Web: www.bcdcareassociates.org A consultancy offering support to the social care sector – particularly focusing on care homes, their residents, managers and staff.

Care 4 mum Tel: 01223 511 487 Web: www.care4mum.com An experienced and professional service to help you choose the best care for yourself or your elderly parents.

Care Choices Tel: 0800 389 2077 Web: www.carechoices.co.uk A leading social care publisher whose publications include Care Select and regional directories of care services. Operates a friendly helpline for those searching for care and has a comprehensive, fully-searchable website of care provision in England and Wales.

Care Quality Commission Tel: 03000 616 161 Web: www.cqc.org.uk National organisation responsible for inspecting and regulating care services.

Care Select Tel: 0800 389 2077 Web: www.careselect.co.uk The online version of this handbook with many more features, plus a link to online care search and helpline via the publisher Care Choices (see above).

Carers Trust Tel: 0844 800 4361 Web: www.carers.org The largest provider of comprehensive carers’ support services in the UK. >>

Essential contacts



>> Carers UK Advice line: 0808 808 7777 Web: www.carersuk.org Provides support to anyone who is a carer.

DLF Tel: 0845 130 9177 Web: www.dlf.org.uk A national charity that provides impartial advice, information and training on daily living aids. Also runs database of daily living equipment - DLF Data www.dlf-data.org.uk.

Dying Matters Tel: 08000 21 44 66 Web: www.dyingmatters.org Aims to change public knowledge, attitudes and behaviours towards dying, death and bereavement.

Elderly Accommodation Counsel Tel: 0207 820 1343 Web: www.housingcare.org Helps people make decisions about where to live and any support or care they need.

FirstStop Advice Advice line: 0800 377 7070 Web: www.firststopadvice.org.uk Advice and information on finance and rights for older people.

Friends of the Elderly Tel: 0207 730 8263 Web: www.fote.org.uk Committed to enhancing the quality of life for older people by providing a range of high standard services.

Gov.uk Web: www.gov.uk Information portal for Government services and information.

Housing Options for Older People Online Web: hoop.eac.org.uk Online questionnaire to help consider the most suitable housing for your parent’s needs.

Independent Age Tel: 0845 262 1863 Web: www.independentage.org.uk Helps older people on very low incomes to live independently in their own homes and when this is no longer possible, they can help with care home fees.

NAPA - National Association for Providers of Activities for Older People Tel: 01634 716 615 Web: www.napa-activities.co.uk Works to create new opportunities for community involvement and activity in care settings.

NCF - National Care Forum Tel: 024 7624 3619 Web: www.nationalcareforum.org.uk Represents the interests of the not-for-profit care sector.

National Council for Palliative Care (NCPC) Tel: 020 7697 1520 Web: www.ncpc.org.uk Umbrella organisation for all those who are involved in providing, commissioning and using hospice and palliative care services in the UK.

Pension Service, The Web: www.thepensionservice.gov.uk Information on pensions, benefits and retirement.

Relatives and Residents’ Association, The Advice Line: 0207 359 8136 Web: www.relres.org Offers support and information to


families, friends and relatives about issues affecting care homes.

Safe and Settled Limited Tel: 07768 126548 Web: www.safeandsettled.co.uk An independent Social Enterprise comprised of experienced professionals. Its aim is to support people, their families and friends to find solutions and make the best decisions possible when they are considering care support.

Society of Later Life Advisers Tel: 0845 303 2909 Web: www.societyoflaterlifeadvisers.co.uk A not-for-profit organisation aiming to ensure that consumers are better informed about the financial issues of later life and can help you find an Accredited Adviser.

Solicitors for the Elderly Tel: 0844 567 6173 Web: www.solicitorsfortheelderly.com A national association of solicitors,

barristers and legal executives providing and promoting a range of legal services for older people.

The Silver Line Helpline: 0800 470 8090 Web: www.thesilverline.org.uk Free 24 hour helpline providing information, friendship and advice for older people.

United Kingdom Homecare Association Tel: 0208 661 8188 Web: www.ukhca.co.uk Promotes high standards of homecare and takes an active role in liaising with local and central government on all homecare and related issues.




0800 389 2077



Hengist Field Care CentrePond Farm Lane, Sittingbourne, Kent ME9 8LS



Hengist Field Care Centre is working towards completion of the Gold Standards Framework – the UK’s leading and most respected best practice and quality improvement programme for care homes.

Hengist Field Care CentreLocated near Sittingbourne, in the heart of the Kent countryside, Hengist Field is a new centre providing specialist 24-hour care for elderly people with General Nursing needs or who have also been diagnosed with Dementia and related illnesses. Purpose-built in 2012, this state-of-the-art accommodation offers outstanding amenities, and is staffed by a dedicated and highly skilled team of nurses and carers.


Excellent facilitiesSet in beautiful landscaped gardens, Hengist Field provides an exceptional setting for care. The Home comprises individual en-suite accommodation for up to 75 residents. Other amenities include specially adapted bathrooms, a sensory room and garden to aid relaxation, an onsite hair salon, activity centre, internet café and purpose-built cinema.




NEL_020_HF_Full-page-AD_210x297_FINAL.indd 1 14/02/2014 12:33

> East Midlands 104Derbyshire, Leicestershire, Lincolnshire, Northamptonshire and Nottinghamshire.

> East of England 105 Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk, Peterborough and Suffolk.

> North West 107Cheshire, Cumbria, Greater Manchester, Lancashire and Merseyside.

> South East 107Berkshire, Buckinghamshire, East Sussex, Hampshire (including the Isle of Wight), Kent, Oxfordshire, Surrey and West Sussex.

> South West 113Bristol, Cornwall, Devon, Dorset, Gloucestershire, Somerset and Wiltshire.

> London 114 All boroughs of London.

> Yorkshire and the Humber 114East Riding of Yorkshire, North Yorkshire, South Yorkshire and West Yorkshire.


Yorkshire and the Humber

North EastNorth West

East Midlands

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West Midlands

London

East of England

South West

103




East MidlandsDerbyshire

Codnor Park Care Home is a purpose built residential home with 40 fully furnished en-suite rooms. Facilities include a library, a craft room and 3 lounges including a garden lounge with French doors overlooking our well-maintained gardens. Our kitchen is well equipped and serves good home cooked meals with special diets catered for. The home is always busy organising various activities, trips out and fundraising events for everyone to enjoy. Recently there’s been a Swinging 60s day, plenty of art & craft sessions and a trip out to Ashmere’s very own heated swimming pool and spa with full facilities. Whether its day care, respite care or long term care you need, Codnor Park can meet your needs! www.ashmere.co.uk

Codnor Park

Tel: 01773 741111

88 Glass House Hill, Codnor, DE5 9QT


Smalley Hall Care Home is located on the outskirts of the attractive Smalley village. The building is full of character having once been the coach house to Smalley Hall, which stands separate to the home.With only 27 residents when full you can be sure that attention to detail at the home is second to none. There’s plenty to keep you busy in our brand new activity room, which was decorated by our residents, relatives and staff. Our lovely manager also brings her dog to work to keep everyone entertained. Whether its day care, respite care or long term care, Smalley Hall can meet your needs. Why not come and see for yourself? Come and join the family! www.ashmere.co.uk

Smalley Hall

Tel: 01332 882848

Main Road, Smalley, DE7 6DS



Sutton Court Care Home is situated only a few minutes walk from Sutton in Ashfield town centre and has well maintained gardens with a beautiful enclosed inner courtyard.Our purpose built home is furnished to a high standard, with several communal lounges. There is a residents’ kitchen where tea or coffee is provided at any time and meals are catered for by qualified cooks.We have a 12 bedded extra-care unit with specially trained staff which is registered to care for residents with various types of dementia. The home also offers a hydro-therapy pool and our manager and deputy manager both hold NVQ level 4 registered Managers Awards. www.ashmere.co.uk

Sutton Court Care Home

Tel: 01623 443003

Priestsic Road, Sutton in Ashfield NG17 2AH

Valley Lodge Nursing Home is set within the stunning countryside, a mile away from Matlock town centre, with panoramic views of the River Derwent and the High Peak Railway with its historic steam engines.Our purpose built home offers residential, nursing and dementia care within an environment that offers quality care for all our residents. We have three lounges, a craft room, an onsite hairdressing salon, as well as an Extra Care Unit, designed with dementia in mind and offering round the clock care.With all three levels of care catered for, there may be no need to move again, easing any worries for the future. This means you can really settle in and feel at home, safe and cared for. www.ashmere.co.uk

Valley Lodge

Tel: 01629 583447

Bakewell Road, Matlock, DE4 3BN



East Midlands continued

Cambridgeshire

Caring for the elderlywith nursing needs

Soham Lodge Care Centre, specialising in care for the elderly with nursing needs. We aim to provide residents with a safe and secure, relaxed and homely environment in which care, well-being and comfort are of prime importance.

T: 01353 720775 E: [email protected] Fen Common, Soham, Ely, Cambridgeshire CB7 5DFwww.sohamlodge.co.uk

All rooms are ground fl oor, large bedrooms with en-suite wet rooms, communal areas for meals, socialising and activities and enclosed garden areas.

Please telephone todiscuss individual

requirements

“Warm, friendly and professional nursing homes”

BURTON LODGE NURSING HOME410 Burton Road , Derby, Derbyshire DE23 6AJEmail: [email protected] • Telephone: 01332 365 240

• Accommodation for 31 residents• Regular group and individual activity sessions• For elderly nursing and dementia care• Palliative care with unrestricted visiting• 24 hour on-site Nurse• Local GP visits• Local to town centre & amenities

www.burtonlodgenursinghome.co.uk

Derbyshire continued

East of England

Leicestershire

Brockfield House, established in 1984, is a delightful home registered for 45 residents and situated in the village of Stanwick, close to amenities and local transport.

The Home specialises in the care of people living with the effects of long-term mental health problems and those living with dementia. Nurses and care staff are respectful and sensitive to the individual needs and choices of residents and provide care in a comfortable and safe environment.

Brockfield House

Villa Lane, Stanwick, Wellingborough NN9 6QQ

01933 625555





0800 389 2077






0800 389 2077





0800 389 2077



East of England continued




For more information call us on 01708 346 077

































Seeking anew home?Pirton Road, Hitchin, Hertfordshire SG5 2EN

For more details or to set up an appointment please contact uson 01462 410 767 or email us [email protected].

You can also visit us at www.foxholescarehome.com.

Come and join us for a tour of Foxholes.

Hertfordshire

You’re unique. So are we.At Honey Lane Care Home we believe that it’s through taking time to understand each individual, their likes and dislikes and their life stories that we can provide personal care with a real difference.For more information or to arrange a visit please call: 01992 800 138 or email: [email protected]

Specialist Dementia Care Honey Lane, Waltham AbbeyEssex, EN9 3BA

Essex





0800 389 2077






0800 389 2077



North WestCheshire

Lauren CourtResidential careRespite andlong term care01244 373 761

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Morningside Rest Home is a carefully adapted Victorian Mansion House. Our team of highly qualified and attentive staff provide first class 24 hour residential care that really focus on the individual needs of our residents’ with a tailored care plan for each person. Dedication can be seen across the board in our cooking, hospitality, housekeeping and in organising activities for our residents.We think you’ll find we’re ideally suited to meet your needs now and in the future.

52 Swanlow Lane, Winsford, Cheshire CW7 1JE Telephone: 01606 592181 • Email: [email protected]

www.morningside-rest.co.uk

Why not arrange a visit and see for yourself

South EastBerkshire

Buckinghamshire

A home you will love. Care you will appreciate.

Avondale Care HomeGatehouse Road, Aylesbury HP19 8EHTel: 01296 438032

✓ Unsurpassed levels of care✓ High-quality, homely surroundings✓ A refreshing, positive approach✓ Dedicated Alzheimer’s and dementia

care available

www.porthaven.co.uk/aylesbury You’ll like us!

10998-14022 SML:Care Select 24/2/14 10:58 Page 1

The home is situated in the prestigious village of Loughton (recently refurbished).• Long and short stay • Respite and convalescence• Local GP service • Varied menus and special diets• Personal laundry service • Regular activities and outings • Visiting clergy • No restrictions on visiting • Visiting hairdresser & chiropodist.

BECKET HOUSE Nursing Home

Tel: 01908 231981 Email: [email protected] Web: www.beckethouse-carehome.co.ukPitcher Lane, Loughton, Milton Keynes, Buckinghamshire MK5 8AU





0800 389 2077





0800 389 2077



South East continued

Buckinghamshire continued

A home you will love. Care you will appreciate.

Chiltern Grange Care HomeIbstone Road, Stokenchurch HP14 3GG(Sat Navs: HP14 3XR)Tel: 01494 480292

✓ Unsurpassed levels of care✓ High-quality, homely surroundings✓ A refreshing, positive approach✓ Dedicated Alzheimer’s and dementia

care available

www.porthaven.co.uk/stokenchurch You’ll like us!

10998-14022 SML:Care Select 24/2/14 10:58 Page 2

East Sussex

Tel: 01323 501026 Email: [email protected] Web: www.roseberry-carehome.co.uk 2 Rosebery Avenue, Eastbourne, East Sussex BN22 9QA

• Long and short stay • Respite and convalescence• Local GP service • Varied menus and special diets• Personal laundry service • Regular activities and outings• Next to the park • No restrictions on visiting • Visiting hairdresser & chiropodist

The home specilaises in providing care for people suffering from dementia and alzheimers.

ROSEBERRYHOUSE Residential Home

John’s comfort isn’t our only priority. Taking the time to listen to his stories is just as important.

www.peterhousecare.com

01424 730809 YOU CAN FIND US IN THE OLD TOWN OF BEXHILL-ON-SEA. Contact Eddie Kasprowicz on or email [email protected]

At Peterhouse Care Home we treat our residents like mums, dads, brothers andsisters. dads, brothers and sisters. Because that’s what they are to

• Full CQC compliance• Compassionate, stable team• 3 acres of beautiful grounds

Of course, the quality of care John receives is

Woodside Hall Nursing Home

Polegate Road, Hailsham, East Sussex, BN27 3PQ • Telephone: 01323 841670 Web: www.woodsidehall-nh.co.uk • Email: [email protected] Making our home your home

• 24 Hour Trained Nursing Staff• Nurse Call system• Tastefully decorated en suite rooms with colour TV & telephone• Care Plans on computerised system• Catering for special diets• Visting hairdresser, chiropodist, opticians & other specialists• Wheelchair access throughout

• Unrestricted visiting with ample parking facilities• Respite, convalescence and continuing care welcome• On site activities and entertainment coordinator• Events and outings organised• Extensive gardens and seating areas• Newspapers and flowers delivered on request• Competitive prices

This well equipped, purpose built nursing home is set in the Countryside, half way between Hailsham and Polegate.

Telephone: 01494 773606 • Email: [email protected] Weedon Hill, Hyde Heath, Amersham HP6 5UH WWW.CAREATRAYNERS.CO.UK

Rayners, the first purpose built Residential Home for the elderly in South Buckinghamshire was opened in June 1990, designed specifically to provide the elderly with a level of care and comfort that is unsurpassed. In addition to the high level of care provided we are able to offer ‘extra care’, in the event of a resident becoming more dependant.

This degree of care is not usually available in residential homes and gives the resident and their relatives alike confidence and peace of mind. Rayners also has the ability to accommodate respite or short stay residents, subject to suite availability. Rayners who is still family owned and managed is also proud to offer luxurious ‘Assisted Living Apartments’ at Maple Tree House, situated on the same site as Rayners Residential Home.


Hampshire

www.wenhamholtnursinghome.co.uk

London Road, Hillbrow, Liss, Hampshire, GU33 7PDTelephone: 01730 895125/892711 • Email: [email protected]

Established since 1977, an independentand family run nursing home providing

24 hour nursing care with excellentfacilities and services.

Rotherbank Farm Lane, Liss Forest, Hampshire, GU33 7BJ

Rotherbank is a small, friendly, family owned and operated residential care home. We are registered for dementia care and the frail elderly. We provide a homely environment affording security, independence with supportive care.

Our care assistants are your personal carers, friends and companions. Your needs are constantly met and reviewed following an individual plan of care. All staff are trained to NVQ 2, 3 & 4. All staff are happy and settled which promotes an excellent friendly atmosphere for residents. Staff turnover is extremely low resulting in agency staff never having to be used.

If you would like further information, please call us on the telephone number above or feel free to visit us any time.

Rotherbank Tel: 01730 892081

Telephone: 02392 510254 • Office: 02392 529908 • Fax: 02392 503054

Alverstoke HouseCare Home with Nursing

Alverstoke HouseCare Home with Nursing

R EG IS TE R E D

IAT ION

AS SOC

NUR S ING HOME

Alverstoke House is a purpose built, family run nursing homespecialising in Caring for the Elderly who have complex nursing careneeds. We also specialise in terminal care and provide care for thoseneeding nursing after leaving hospital before returning home.

“An ideally situated Care Home with Nursingoffering a high standard of care by our specialist team"

• Excellent reputation in the Alverstoke Area• 30 beds, some en-suite, two sitting rooms, dining room and two conservatories.• We operate an open door policy for visits of family and friends.

84-86 Shorncliffe Road, Folkestone, Kent CT20 2PG

Cumbria House provides quality services and individual care to make our residents feel as much at home as possible. Come and visit us or telephone for a brochure.

Tel: 01303 254019 www.ashwoodhealthcare.co.uk

Kent

www.nellsar.com

AbbotsleighCare Centre

George Street, Staplehurst, Kent TN12 0RB

Abbotsleigh is a modern, purpose-built facility specialising in both Residential and Nursing

care for those with Dementia or related illnesses. The home is set in a

beautiful semi-rural setting just15 minutes from Maidstone.

Call us on 01580 891 314

NEL_020_AB_90Wx53H_AD_FINAL.indd 1 14/02/2014 12:42Birchwood House Rest Home• Set in 6 acres of beautiful Kent countryside • Ideal for long/short stay, convalescence and respite care • 24 hour supervision• En-suite facilities in all rooms • Lift to all floors• Home cooking - special diets catered for • Hairdresser, chiropodist and library available• Shopping trolley providing everyday requisites • In house communion service• Visits to speldhurst and other local churches can be arranged • Links with village activities

Tel: 01892 863559 Stockland Green Road, Speldhurst, Kent TN3 0TU

Birchwood Care ServicesHelping people to live independently as long as possible in their homes in the local areas of Speldhurst, Penshurst Tunbridge Wells, Pembury Tonbridge, Leigh, Edenbridge

Member of the Kent Care Homes Association

Tel: 01892 863710


www.nellsar.com

Loose ValleyNursing Home

15 Linton Road, Loose, Maidstone, Kent ME15 0AG

Loose Valley is a Nursing home that provides specialist 24-hour care for the elderly. Set

amidst three acres of landscapedgrounds, it offers panoramic views

of the countryside – the perfectenvironment for relaxing and

watching the world go by.

Call us on 01622 745 959

NEL_020_LV_90Wx53H_AD_FINAL.indd 1 14/02/2014 12:42

Kent continued

The perfect little care homeLocated in the leafy setting of Shortlands, this 12 bedroom Residential Care Home with Dementia Care, has a homely feel, promoting dignity and independence at all times whilst providing exceptional care and support, just perfect for a respite stay or making it your permanent home from home.

• Beautiful victorian house with mature gardens• Family run for over 25 years• Full activity programme

• Lift to all fl oors• En-suite rooms• Excellent home cooking

To book a visit or a trial stay, please call us on 020 8460 6555

33-35 Farnaby Road, Shortlands, Bromley BR1 4BL [email protected] - www.theheathers.co.uk

www.nellsar.com

St Winifreds Dementia

Care Home236 London Road, Deal, Kent CT14 9PP

Located in the picturesque seaside town of Deal, St Winifred’s is a Residential

home providing specialist 24-hourcare for elderly people who havebeen diagnosed with Dementia.

Call us on 01304 375 758

NEL_020_SW_90Wx53H_AD_FINAL.indd 1 14/02/2014 12:42

www.nellsar.com

Lulworth House Residential and

Dementia HomeQueens Avenue, Maidstone, Kent ME16 0EN

A very attractive 1920s property on a leafy avenue in a highly desirable area of

Maidstone. The Home comprises twospacious lounges, 38 bedrooms

with a newly refurbishedconservatory & patio area.

Call us on 01622 683 231

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22 Cornwallis Avenue, Folkestone, Kent CT19 5JB

The Grange provides quality services and individual care to make our residents feel as much at home as possible. Come and visit us or telephone for a brochure.

Tel: 01303 252394 www.ashwoodhealthcare.co.uk 01732 353070 www.highhilden.co.uk High Hilden Close, Tonbridge, Kent, TN10 3DB

High HildenIndependence | Dignity | Quality of Care

Residential care & respite care

If life at home is becoming difficult with more hurdles to overcome every day . . .

Visit us at High Hilden and consider the alternatives . . .



Glebe House CARE HOME WITH NURSING

• 24 hour nursing care • Long term and respite stay • Full programme of activities • Day care

Registered with Care Quality Commission - Excellent Report

For further details please contact 01883 344 434

Email: [email protected] • Website: www.glebe-house.comChurch Lane, Chaldon, Nr Caterham, Surrey CR3 5AL

Abbey Chase Nursing HomeBridge Road, Chertsey, Surrey, KT16 8JW

Abbey Chase Residential and Nursing Home is Located close to Chertsey town centre and has ground of approximately 10 acres including orchards and moorings on the Abbey River. Abbey Chase offers

first class accommodation with every modern convenience. We aim to create a friendly family atmosphere between staff and residents to ensure that our residents are happy, comfortable and content in their

retirement. We encourage our residents to pursue their leisure interests whether outdoor or in, the range available is extensive to suit all tastes and examples are fishing; riverside walks and gardening.

For more information or advice telephone 01932 568090 email: [email protected] or visit www.abbeychase.co.uk Holders of a CQC 3 STAR rating (Excellent) and Investors In People (Gold) award.

Surrey

Belvedere House

www.royalalfredseafarers.com Tel: 01737 360106

Weston Acres, Woodmansterne Lane, Banstead SM7 3HB

Belvedere House is a modern two-storey building set in the Royal Alfred’s extensive and pleasant landscaped grounds, providing 68 single rooms.

Oxfordshire

Thames View, Abingdon, Oxfordshire OX14 3UJ

01235 856 [email protected] • Nursing care • Residential care

• Specialist dementia care

At Bridge House Care Home we understand that our residents have unique care needs, and we are passionate about delivering the highest standard of care with warmth, love

and compassion. All care homes should be this way.

Kent continued

www.nellsar.com

WoodstockCare Centre

80 Woodstock Road, Sittingbourne, Kent ME10 4HN

A specialist centre providing 24 hourResidential care for the elderly or people

with Dementia or related illnesses.Well situated in Sittingbourne, the

Home has an outstanding localreputation for superb care.

Call us on 01795 420 202

NEL_020_WO_90Wx53H_AD_FINAL.indd 1 14/02/2014 12:42


We employ specialist learning disability nurses and other quali�ed staff so arethe ideal choice for people with learning disabilities.

We also employ experienced personal assistants to provide support to theelderly, frail, physically disabled, in�rm or those with sensory disabilities.

K I M A R A SUPPORTTel: 0203 291 3436 • Fax: 0203 727 0836 • Email: [email protected]

Our services include but are not limited to• Personal care • Keeping safe at home and out in the community• Managing �nances • Developing independent living skills • Activities of daily living • Accessing employment, education or training

We are committed to providing a service thatis �exible and realistically tailored to yourneeds. Our staff are respectful, professional,�exible, resourceful, positive, problem solvingand have a realistic view of life’s complications.

KIMARASUPPORT

Red House CARE HOME WITH NURSING

• 24 hour nursing care • Long term and respite stay • Full programme of activities • Day care

Registered with Care Quality Commission - Excellent Report

For further details please contact 01372 274 552

Email: [email protected] • Website: www.redhouseashtead.co.uk43 Skinners Lane, Ashtead, Surrey KT21 2NN

01932 857821www.whiteleyvillage.org.uk

Whiteley VillageCare CentreThe UK’s original

retirement village.

Nestled in 225 acres ofbeautiful and tranquil

Surrey woodland.

Reg. Ch. 1103056

Whiteley HouseMeeting the needs of individuals requiring nursing, palliative, respite or end of life care in a safe and peaceful environment.

Ingram House Residential care in well appointed rooms with en-suite facilities. Our friendly and caring community guarantees security and peace of mind.

Wolfe House• Excellent 24 hour care • Respite care • All good size single rooms• Small caring home registered for 13 residents• Visiting physiotherapist, Chiropodist and Hairdresser

Set on the edge of beautiful woodlands, Wolfe House offers personal care and attention to its residents. Recently refurbished it provides a “home from home” environment and a relaxing and peaceful atmosphere, and has a high reputation locally.

RESIDENTIAL REST hOME

Tel: 01883 716627 or 01883 334626

Wolf ’s Row, Limpsfield, Oxted, Surrey RH8 0EB

Close to Bromley & Biggin Hill

You’re unique. So are we.At Claremont Court Care Home we believe that it’s through taking time to understand each individual, their likes and dislikes and their life stories that we can provide personal care with a real difference.For more information or to arrange a visit please call: 01483 324 088 or email: [email protected]

Specialist Dementia CareResidential & Nursing Harts Gardens, GuildfordSurrey, GU2 9QA

Surrey continued



www.wenhamholtnursinghome.co.uk

London Road, Hillbrow, Liss, Hampshire, GU33 7PDTelephone: 01730 895125/892711 • Email: [email protected]

Established since 1977, an independentand family run nursing home providing

24 hour nursing care with excellentfacilities and services.

West Sussex

South WestBristol

Avon Lee Lodge has been designed to provide our residents with maximumindependence, encompassing a community feel in a pleasant, safe, andhomely environment. Call for a brochure or visit our website for more details.

Preston Lane, Burton, Christchurch. BH23 7JU.t 01202 476 736 e [email protected]

AVON LEE AD CARE SELECT final 16/9/11 08:28 Page 1

A positive approach to care of people living with dementia in a supportive and reassuring environment.

High quality 24-hour personalised nursing care.

Both care homes are part of Sandford Station, the award-winning retirement village in North Somerset.

Call 0117 949 4735 to find out more.

The Russets

Sherwood

www.stmonicatrust.org.uk

Dorset Somerset

Located at the heart of our retirement village communities, our nursing care homes support older people to maintain independence, dignity and personal fulfilment in Westbury-on-Trym, Bristol.

Call 0117 949 4735

The Garden HouseJohn Wills House

www.stmonicatrust.org.uk

Surrey continued





0800 389 2077





0800 389 2077




LondonNorth South

Yorkshire and the Humber

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North Yorkshire

Tel: 01756 701220 Email: [email protected]: www.carletoncourtskipton.co.uk Carleton Road, Skipton, North Yorkshire BD23 2BE

Genuine care, professional staff, a warm and welcoming environment and a place to call ‘home’

• Managed by a qualified team • Single en-suite rooms• Elegant, comfortable surroundings • Close to local amenities • Special diets catered for • Nurse Call systems in all public rooms as well as bedrooms.

CARLETON COURT Residential Home

A beautiful, small, family-run home

Tel: 020 8660 664647 Foxley Lane, Purley CR8 3EH

Situated in Purley, south east London, Heatherwood Nursing Home provides high quality nursing, residential and palliative care to 22 residents. We are a family-run Home that focuses on individual care and attention.

As a small home we have the time and resources to ensure each resident receives the very best in care and facilities.

www.heatherwood.org

South Yorkshire

A Home away from Home

Tel: 020 8688 702284 Coombe Road CR0 5RA

Lloyd Park is a modern and highly-skilled care facility, that can show a proven record in functioning as satisfying elderly care accommodation for a wide range of individual health requirements.

This facility’s dedicated team are not idle or unimaginative in the care solutions they bring to their residents.

www.lloydparknursing.org • [email protected]




0800 389 2077





0800 389 2077




A Abbey Chase Nursing Home 111Abbey Road 2, & 106Abbotsleigh Care Centre 109AGE Nursing Homes Ltd 46 & 105Alverstoke House 109Ashmere Care Group 85 & 104Ashwood Healthcare 1, 109 & 110Avon Lee Lodge 113Avondale 33 & 107

B Bayford New Horizons Ltd 43Becket House 107Beeches, The 70 & 106Belvedere House 111Bentley House 70 & 106Birchwood House 109Bluebird Care 35Brico Ltd 35Bridge House 48 & 111Brockfield House 46 & 105Burton Lodge 105

C Carebase Inside back cover, 106 & 112Care Select Website 28, 43, 53, 61, 64 76, 80, 90, 98, 101, 105, 107 113 & 114Carleton Court 114Chiltern Grange 33 & 108Claremont Court Care Home 112Cliveden Manor 70 & 108Codnor Park 85 & 104Coombe Hill Manor 70 & 111Cumbria House Care Home 1 & 109

D Denby Dale Care Centre, The Inside front cover

F Far Fillimore Care Homes Ltd 53 & 105Firs, The 85

Four Star Holdings Ltd 85 & 107Foxholes Care Home 31 & 106

G Garden House John Wills House, The 113Glebe House Outside back cover & 111Gold Care Homes 2, 106 & 114Good Care Group The 41Grange Care Home , The 1 & 110

H HC One Ltd 8Heathers, The 110Heatherwood Nursing Home 51 & 114Hengist Field Care Centre 102Heritage Independent Living 28High Hilden 110Hillside Nursing Home 2 & 106Honey Lane Care Home 106

I Ingram House 112

K Kidsley Grange 85Kimara Support 43 & 112King William 85

L Lauren Court Inside front cover & 107Littleover Nursing Home 53 Lloyd Park Nursing Home 114Lulworth House 110Loose Valley Nursing Home 110Loxley Park 70 & 114

M Malvirt Ltd 109Meresbeck Care Home 85Meridian Healthcare Inside front cover, 107 & 114MHA Group 57



Millbrook, The Inside front coverMiramar Care & Nursing Home 70, & 110Moorlands Lodge 70 & 113 Morningside Rest Home 107

N Nellsar Ltd 66, 102, 109, 110 &111Newstead Nursing Home 114Nightingale Court Care Home 53

OOakes, The Inside front cover & 114

P Peterhouse 46 & 108Porthaven Care Homes 33, 107 & 108Princes Christian Care Centre 66

R Rayners Extra Care Home 108Red House, The 45 & 112Roseberry House 108Rosebery Manor Care & Nursing Home 70 & 113Rotherbank Residential Care Home 109Royal Alfred Seafarers Society 28 & 111Russets, The 113

S Scoona Ltd 35Sherwood 113

Signature Senior Lifestyle 70, 105, 106, 107, 108, 110, 111, 113 & 114SKR Ltd 85 & 107Smalley Hall 85 & 104Soham Lodge 105South Lodge 70 & 105Spemple Ltd 107, 108 & 114St Monica Trust 59 & 113St Winifreds Dementia Care 110 Sunninghill Care Home 70 & 107Surrey Care Services Ltd 35Sutton Court Care Home 85 & 104

T Tudors Care Home, The 2Trident Reach The People Charity 41

V V+J Billington Ltd 35Valley lodge 85 & 104

W Weald Care Ltd 43Wenham Holt Nursing Home 109 & 113West Hallam 85White Rose House Inside front coverWhiteley House 112Whiteley Village 33 Willowmead Care Home 2 & 106Wolf House 112Woodside Hall Nursing Home 108Woodstock Care Centre 111

Advertisers’ index continued

Care Choices Limited has taken

every care to ensure that the

information contained in Care Select is accurate. The

company cannot accept responsibility for any errors or

omissions or if a home varies from the facilities listed either

in an advertisement or the listings. Care Choices Limited does

not endorse or support any particular institution included in

the publication.

ISBN 978-1-909048-95-9

Ref. No: 4001/CareSelect05/14. Reproduction of any part of

this publication in any form without the written permission

of Care Choices Ltd is prohibited.

Published by: Care Choices Ltd, Valley Court, Lower Road,

Croydon, Nr Royston, Hertfordshire SG8 0HF. Tel: 01223 207770.

Publisher: Robert Chamberlain.

Director of Sales: David Werthmann.

Head of Editorial: Emma Morriss.

Editor: Alistair Robertson. Deputy Editor: Heather Day

Regional Team Manager: Russell Marsh.

National Sales Manager: Paul Leahy.

Senior Sales Executives: Debbie Feetham, Elaine Green.

Sales Executives: Rebecca Edmonds, Rachel Joseph, Vanessa Ryder.

Director of Creative Operations: Lisa Werthmann.

Assistant Production Manager: Jamie Harvey.

Production Designer: Nick Cade.

Creative Artworker: Holly Cornell.

We believe that it’s through taking time to understand each individual, their likes and dislikes and their life stories that we can provide personal care with a real difference.

We not only offer the highest standards of nursing, residential and dementia care, but a vibrant community where our residents can connect and enjoy their time together. It’s just one of the ways we help your loved one lead a better life.

Carebase has a range of care homes across the South of England and East Anglia. To find out more information about any of our homes or to arrange a visit please call 0208 879 6567 or email [email protected]

You’re unique. So are we.

YoYY u’re unique. So are we.

Nursing, Residential & Dementia Carewww.carebase.org.uk

Corporate_CareSelect Directory_FP_303x216.indd 1 17/04/2012 12:18

CARE HOME WITH NURSING

Glebe House is an excellent, independently run home of character and distinction offering both Residential and 24 hour Nursing Care of the highest quality.

Glebe House is home for up to 41 residents mainly in single rooms, tastefully decorated and comfortably furnished yet retaining much of the character you would expect from a late Georgian and Victorian house.

The owners and staff of Glebe House are committed to providing the highest levels of quality care in a warm, homely environment that respects the individual’s right to privacy, dignity and personal choice.

Tel: 01883 344 434Church Lane, Chaldon Nr Caterham, Surrey CR3 5AL

Email: [email protected] • www.glebe-house.com

GlEbE HOUSE

Care Select - The Handbook For Relatives May 2014

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