Please note the following content was originally published on Caredirections.co.uk. We’ve saved it as reference guide. However, please note that the information may now be out-of-date and is no longer being updated.
Making the decision to give up your own home and go into a Care home is often very difficult and distressing. Nevertheless, trying to remain at home can become an awful struggle not only for yourself, but also for your carers and family.
A well run Care home where you will be respected and where your wishes and views are taken into consideration can be a very satisfactory alternative. Knowing that you will be looked after, that your meals will be regularly available, having people around you and that you will be warm and safe can be very reassuring when it is no longer easy to do everything for yourself.
In this section we will do our best to give you sufficient information so that you know what you might expect from a Care home and from a nursing home – and suggest how you should make a choice of accommodation. The longer you give yourself to plan this move the more likely you are to make a satisfactory choice from all the alternatives on offer.
Recognising your specific needs
Until recently care homes were categorised as either Nursing or Residential Homes. The distinctions have now been removed – although some homes will be better equipped and staffed to provide nursing care than others.
Where nursing is provided, the regulations state that a suitably qualified nurse is on duty at all times. Both types of home provide accommodation, all meals and personal care, such as assistance in bathing, getting dressed or going to bed.
At a home which does not specifically provide nursing care, residents may need special nursing provisions – such as treatment for a leg ulcer. This may be provided by a Community Nurse, or there may be a qualified nurse on the staff team.
Some homes specialise in caring for people who are confused. These are known as EMI (elderly mentally infirm) homes. Where possible, we have indicated in our regionalised listing those homes which provide this type of service.
If you are contemplating care in a home, it is probably sensible to ask your local authority Social Services Department for an assessment of your needs. Even if you are able to pay for the care yourself, an assessment may be helpful in deciding which home will suit you better. If you need funding from social services to pay for the care, an assessment is essential – see The Role of Social Services and Funding your Choice.
How to Choose a Care Home
All homes are required to be registered with and inspected by The Care Quality Commission (CQC). The CQC has the responsibility for ensuring that Care Homes are run according to the standards of care determined by government – and the homes have to be inspected at least twice a year.
You can contact The CQC by telephone. It will have details of all Care Homes in the area you are interested in, together with latest inspection reports. You are able to search a complete online directory at: www.cqc.org.uk
You have a right to choose which home you go into although, if it is to be paid for by the local authority, a maximum weekly cost will be laid down. The local authority should then supply you with a list of homes which provide care at the price which the authority is prepared to pay. There may also be some homes which are owned and run by the local authority.
Having determined the level of accommodation cost available to you, think very carefully about the priorities you are are seeking.
- To be close to friends or family
- To be in a small friendly home
- To be in a very well furnished and decorated home
- To have a single room
- To have a pleasant view from your bedroom
- To have a garden which is accessible
- To have en suite facilities
- To have a choice of communal rooms
- To be in a home where there is a choice of activities
- To be in a home which is near shops and a community
- To be in a home where you can stay in your own room as much as you want, including at meal times if you wish to do so.
When you have decided on your priorities you could start to get information about homes in your chosen area.
Use our lists to help you, or ask your Social Services Department for assistance. Telephone the homes and ask for a brochure. From these you will be able to identify those homes which most closely match your criteria. You should read any Terms of Business or Terms of Admission documents very carefully and make sure that you are entirely happy with all the conditions therein. The urgency with which you need to move and what vacancies are available may rule out some homes, or suggest that others are worth considering.
If at all possible, you should visit any home before making a decision. Ask a friend or relative to come with you, or perhaps to visit on your behalf if you cannot undertake a visit yourself.
For access to a comprehensive list of questions to ask and things you should look out for during an inspection visit, click here.
When you feel confident that you and your family/friends have selected the home which is right for you, ask if you can come in for a few days’ trial period before you make the final move. Most homes will be happy to agree to this.
If you were personally not able to inspect the home, the home supervisor would probably still want to meet you and reassure him/herself that the home will be able to meet your needs and that you will fit in happily.
Finally, if no Terms of Business or Contract of Residence was supplied with the brochure of the home you are considering, make sure you establish written terms – which are signed by you and the Home. Your solicitor or the Citizens Advice Bureau will be able to give you advice in this respect.
Inheritance Tax Planning
The legacy of imprudence?
Single people can leave £325,000 to their children without incurring Inheritance Tax. An estate and assets over that amount will be subject to a tax rate of 40%. It is possible for couples – maried or in civil partnership – to leave £650,000 when the second partner dies, before inheritance tax is applied.
When one considers a list of assets comprising a house, investments, savings, insurance, heirlooms, jewellery, cars and so on, an estate in excess of £500,000 is not uncommon nowadays. The 40% liability on an estate of this size would be £70,000 – and, moreover, this amount of tax might then have to be paid by your family to the Revenue before the value of your estate might be realised. Just imagine the cost and difficulties of having to such a level of tax liability for any period of time.
Keeping it in the family
By careful planning to conserve wealth now, you could reduce dramatically the burden of Inheritance Tax which might be placed upon your surviving family – and be certain that the full fruits of your lifetime endeavours will pass unencumbered to your loved ones, rather than be dissipated by the taxman!
Astute planning to reduce the burden of Inheritance Tax has to be a totally integrated financial approach, involving the correct structuring of will arrangements, a prudent distribution of assets to reduce the amount of tax that will have to be paid, and making provision to provide the funds necessary upon death to cover any remaining tax liability.
Avoiding the heartache
You may find the whole subject of wills and Inheritance Tax planning difficult to put your mind to. Children may also not find it at all easy to broach such subjects with their parents. Especially when dealing with sensitive topics such as funeral plans.
However, careful consideration now can avoid considerable heartache in future – not least for a grieving surviving spouse caught up in a distressing financial mess when a will has not been made.
Different people require different planning to help them prepare their wills and to mitigate the impact of Inheritance Tax. An experienced financial adviser will be able to examine the planning and structuring necessary to satisfy your desires and to suit your family’s particular circumstances.
For an overview article and Discussion Forum concerning the simple tricks that can save hundreds of thousands of pounds of Inheritance Tax, visit ‘The Money Saving Expert’ website. You can also sign up for its Free Money Tips’ latest news mails.
You might like to call the Government’s useful Inheritance Tax Helpline on 0115 974 2400, for recorded information and individual advice.
Equity Release Plans
Many elderly people, even before the need for long term care arises, have the bulk of their wealth tied up in their home, when what they really need is an income source. Today’s flexible Equity Release Plans are specially designed for people who find themselves increasingly ‘asset rich, but income poor’.
Equity Release schemes allow you to take advantage of the equity built up in your property – which can then be spent on anything you wish. You have the option of paying back the interest, or not, and the plan will run until the last person has died, or moved into long term care. At that point, the property is usually sold, with the proceeds of sale used to pay off the equity release scheme and the balance passes to any beneficiaries
If you are a homeowner age 55 or over with a property value over £60,000 you could be eligible to release cash from your property; in the form of a tax-free cash lump sum or an income for life. Equity Release schemes today are increasingly flexible and are designed to meet modern day lifestyles.
Staying At Home
All the surveys of older people, and of younger people with disabilities, clearly indicate that living independently in one’s own home is the preferred choice – if at all possible. This site will tell you about the range of services and support for people who choose to remain in their own homes.
Staying living at home requires a subtle blend of support services – ranging from personal care, to domestic chores and out-and-out nursing. You may need to use several sources of help, either temporarily or over a longer term. By using our menu and reading the relevant pages you will be able to decide which options are best suited to your needs. Comprehensive regional listings of services are then provided.
Your care needs may be short or long term: a temporary period of illness, or infirmity following, for example, a hospital admission; or longer term disablement or frailty. Whichever it is, you may find the solution in this section. You will also find a separate section on the issues relating to Hospital Discharge.
Moving to stay put
To stay living at home may actually entail moving from your current abode – perhaps to be closer to a relative, because your present home environment is unsuitable, or because you want a bit more support. Sheltered housing might be the answer – giving you your own flat, but within a purpose built scheme with some support. You can find a separate section relating to Sheltered Housing elsewhere in this site. It is also possible to find Sheltered housing that has care services provided.
Paying for the services
The ideal of staying at home may be preferable, but who will pay for the support services you will need? Firstly, you may be eligible for all or some services free. For other services there will be a charge, but you may well be entitled to financial help which you are not already receiving.
Our section on Funding your Choice gives extensive information on welfare benefits, grants and other sources of finance.
The Government has established the regulations which make Direct payments (where you obtain benefit money direct and can use it to purchase your own service), available to people over 65 years of age in England, Wales and Scotland. In England and Wales local authorities will be obliged to offer older people direct payments (instead of services) from April 2003. Guidelines for applying for this funding can be found in Funding Your Choice.
Home Care, Nursing & Companion Services
Home care is one of the most flexible support services on offer. It should provide assistance with personal care functions, such as dressing and bathing. It can help with the running of your home, coping with routine cleaning, cooking, shopping, laundry, and provide general assistance with paperwork.
Help to get out and about can also be provided, which might include personal transport if your care worker is a driver. Indeed, almost anything which will help you to lead a normal life, or which will allow you to recuperate and regain full independence after illness or hospital discharge, is likely to be available.
The terms used to describe someone who supports you at home – ‘care worker’, ‘housekeeper’, etc. merely relate to the basic range of tasks they will be asked to undertake and what is expected of them. There are no hard and fast rules, although services funded by local authorities will be more restricted on what can be done for you.
*It should be noted that the term ‘Care Worker’ is used to distinguish paid workers from those ‘Carers’ who are caring voluntarily for a friend or family member.
Nursing at home
Perhaps through a period of temporary illness, or because clinical nursing procedures are necessary, you may need assistance from a qualified nurse, rather than a home care worker. Most of what follows in this section applies to home nursing as well as to home care, but there are particular regulations which nursing agencies have to observe. One such regulation to be noted is that the organisation supplying your nurse has to be managed by someone who is also a qualified nurse.
The amount of home care you need can vary from an hour or two each week, right up to full time living-in help. You can also have night care with, either someone sleeping in your home with you (usually known as a ‘sleep-in’), or someone who stays awake, ready to assist with any needs you may have. All services may be available over weekends and Bank Holiday periods.
Homeshare arrangements, where someone provides an agreed amount of companionship or help in return for accommodation, may also be possible.
Some of these services are available from your local or health authority on the basis of a ‘needs assessment’. You can find out more about what might be provided and how to make contact with them by going directly to the The Role of Social Services.
The authorities may provide services, or they may contract with another organisation to provide them. Unless you have extremely limited capital and income, there is likely to be a charge for any service which is provided to you by the local authority, or paid for by them. Charges vary from authority to authority, or paid for by them – other than short term rehabilitation. Charges vary from authority to authority and there will be a financial means test of your ‘eligible’ capital and income
Some home nursing needs may be met by the Community Nursing Service which is part of the Primary Health Care team. There will be no charge for this service, but there will be assessment of your specific needs before the service is agreed.
There is now much more emphasis on helping people to regain their independence. Local Social Services and Primary Care Trusts (PCT’s) are required by government to work together, to deliver what is termed Intermediate Care. It will be free and it will be short term – typically 6-8 weeks at the most.
The independent option
You may have the independent means and preference to purchase the precise arrangement of care support and care workers you choose. Again, a full range of facilities and services may be available for you to consider. However, it is important to be aware that many agencies are finding it very difficult at present to recruit and keep good care staff.
Choosing to stay at home may mean an increased risk of loneliness and boredom – particularly if you have restricted mobility and have only limited visits from carers or family.
Even for those with mobility problems, getting out should remain a possibility. Getting out to clubs, to shop or to make social visits can make a very positive contribution to a more fulfilled life. It is something to look forward to, for the companionship and changes of scenery and routine it will bring.
There are a number of options to think about:
A good way of obtaining a nutritious meal once or twice a week may be to attend a Luncheon Club, if there is one in your area. Unfortunately, these are not as common now as they used to be.
You might also find a club which has formed itself into a ‘cook and eat’ club – where the emphasis is on visitors regaining cooking skills. In addition to providing a substantial meal, the added benefit of such clubs is that they provide companionship and interest. Luncheon club staff may also provide access to other services through their contacts in the local community and they will also unobtrusively monitor the wellbeing of their regular visitors.
Luncheon clubs are likely to be provided by organisations such as Age Concern, local churches, a Community Centre etc. The Social Services Department or the local library may be able to tell you about clubs in your area. If transport is a problem, some clubs may be able to arrange transport. There will be a charge for the lunch.
Day Centres and Day Hospitals
Day centres not only provide lunches, but also several hours of care and companionship. Often other services such as bathing, hairdressing or chiropody are available.
Various recreational activities may be on offer or, alternatively, the emphasis may be on just shorter term rehabilitation. Again, there is no standard level of day care available in all areas. Each local authority will differ in its approach and you will need to telephone the Social Services Department in your area to find out what is available.
In some areas there may be day care available at weekends, as well as on weekdays. ‘Long’ days, to enable a family carer to go to, or stay later at work, may be possible. Also, specialist day care, such as for people with dementia, mental ill health or strokes, may be provided.
Such centres are likely to be referred to as Day Care Centres. Usually, day care is provided by voluntary organisations such as Age Concern.
There will be a charge for day care, but you may get some help towards the cost, depending on your local authority’s assessment of your need and your financial position. See The Role of Social Services.
Day care provided by the health service (often referred to as Day Hospital) is likely to be for a limited period, rather than over the long term – usually while someone is recovering from a stay in hospital. Day Care will be geared to rehabilitation rather than social activities. Usually, attendance would be organised when discharge from a stay in hospital is being planned, although you could also be referred by your GP. See Hospital Discharge. There will be no charge for attendance at a day hospital.
Being able to get out and about, if at all possible, is an important factor in maintaining quality of life. Driving your own car may still be a possibility. However, you must tell the DVLA if you develop a disability or health condition which might affect your ability to drive. Licences are not automatically renewed after the age of 70. Your GP will advise you if you are unsure about your ability and safety as a driver.
You may be able to find someone to drive you, either in your vehicle or theirs. If your car is used, make sure that you have insurance to cover another driver. Also make sure that anyone who is going to drive your car has a valid driving licence.
The Orange Badge
If you are regularly driven and find it difficult to get from the car to the buildings you are visiting, you can apply for an Orange Badge. This will enable your driver to park in defined disabled spaces, or places where there are normally parking restrictions. Your local authority Social Services department will decide if you qualify.
‘Helping Hand’ Schemes
In some communities there is a “Helping Hand” or similar scheme, in which volunteers will take you to hospital appointments, the shops, or even out socially in their own cars. The local Volunteer Bureau, WRVS, library or social services department is likely to know if there is such a scheme in your area. Local Churches may also provide the information. In rural areas, the Rural Community Council will know if there is such a service operating.
Dial-a-Ride is a similar service, except that transport is usually in minibuses – with tail lifts, or ramps for wheelchair users. There is normally a charge for this service and you will need to book in advance. Information on Dial-a-Ride can be obtained from your local council’s Transport Planning Department, the Rural Community Council in country areas, Citizens Advice Bureau, or the local library.
The Taxicard Scheme
If you live in London, you may be able to use a Taxicard scheme, to get a concessionary fare from defined taxi operating companies. This is designed for people who cannot use normal public transport because of a permanent disability. The scheme does not run in every borough, but DART (Dial-a-Ride and Taxicard Users) on 020 7482-2325, will be able to provide more detailed information on the availability of such schemes.
Concessionary Rail Fares
If you need to make a longer journey, you may need to use a train. There are concessionary fares for people over 60 who can get a Senior Railcard, or for people with disabilities who can get a Disabled Persons Railcard. Some trains are well adapted for people in wheelchairs, but not all. The cardinal rule is to make the arrangements beforehand, particularly if you need assistance at stations. The National Rail Enquiry Service on 0845 748 4950 will give information on train schedules, fares and which Rail Company operates your chosen route. The rail company will provide the more detailed information on the facilities available and will help to plan your journey. If possible travel with a companion.
Nutrition & Health
Staying healthy at home
Not withstanding the physical limitations of older age, basic guidelines can be followed which can help to maintain the healthiest existence – in every sense of the word. Fundamentally, we should all aim to close the gap between ageing’s inevitable changes to our bodies and those changes caused by disuse or poor diet.
For a variety of reasons many ageing people fall foul of a vicious circle of pain, lack of mobility, loneliness, depression and, often most critically, malnutrition. The effects of malnutrition, such as fatigue, weight loss, light-headedness and loss of appetite, are commonly incorrectly ‘diagnosed’ as illness, whereas many of the problems can be corrected simply by eating better.
In addition to looking after dietary needs, some form of exercise or movement encouragement can have a variety of benefits as you grow older. Exercise can make you feel better and enable you to perform tasks better. Oxygen flow to the brain is increased and mental alertness improved. Better general fitness and muscle strength will mean you are better prepared to cope with unexpected situations – and better prepared to avoid accidents and debilitating falls.
Eat better, age better
Elderly people need less energy because they tend to be less active and have less active muscle tissue. For this reason, they will tend to eat less food generally than in their earlier years. There are, however, other reasons why an older person will cut back to eating levels which do not maintain a nutritious diet.
There may be difficulty with chewing or swallowing. You may be unable to shop. You may be depressed, or suffering continual pain. You may experience a certain loss of taste and smell. Perhaps you cannot be bothered to cook for one. Men particularly may lack essential cooking skills.
Whatever the reason for eating less, elderly people must be careful to select highly nutritious foods to combat the lack of quantity consumed. Additionally, normal changes of ageing will necessitate higher requirements for some specific nutrients, such as Vitamin D – which is essential for proper calcium absorption and the maintenance of bone strength. For example, elderly housebound people often miss out on sunlight, the key source of Vitamin D. It should be noted that evidence shows that, even when older people are exposed to sunlight, their skin will absorb vitamin D less well than younger people. Dietary sources of vitamin D, such as oily fish (tuna, salmon, sardines, herring, pilchards), cod liver oil, eggs, liver and margarine should, therefore, be eaten regularly – albeit that the ability to absorb vitamins from foods also decreases with age. Dietary sources of Vitamin D, such as oily fish (tuna, salmon, sardines, herring, pilchards), cod liver oil, eggs, liver and margarine should therefore be eaten regularly.
To increase your defence against loss of bone mass and osteoporosis, additional vitamin D and calcium can be absorbed through high strength supplements. You would be well advised to consult your GP in this respect.
A little of what you fancy does you good
Older people, particularly those with arthritic conditions, should avoid too much fat, salt, sugar and red meat. This will help to keep their weight down and reduce the stress on their joints. Every lost pound can make a difference!
It is best to eat several small meals and healthy snacks a day, rather than one large, daunting daily meal. A cheese sandwich with a tomato and apple can be just as nutritious as a hot meal of meat and two veg. Plenty of wholegrain bread, cereals, fresh vegetables, fruit and fish form the basis of a healthy daily diet. Buying and cooking smaller food packages also reduces the temptation of relying on repetitious left-overs.
You should go easy on tea and coffee, because the caffeine content may lead to disturbed sleep. Some drugs interfere with the absorption of nutrients, so consult a doctor about your diet if you are taking medications.
Whatever you do, try to eat regularly. Why not make a habit of asking friends in to eat with you and vice versa.
The water of life
Gradual, steady loss of body water is a factor of ageing and older people do become dehydrated more easily. Dehydration can then be a major complicating factor of illness and can have a negative effect upon recovery prospects.
Fear of the likelihood of urinary incontinence and the need for visits to the toilet, will also mean that many older people will be reluctant to drink as much as they should. This frame of mind is, of course, made worse when diuretic medications (‘water tablets’) have been prescribed.
Whatever the reluctance to drink, the effort really must be made. Water intake is vital, as dehydration can result in illness, mental confusion, and can speed the ageing process generally. It is recommended that older people should drink at least 8 cups of fluids a day.
It is worth noting that tea, coffee, fizzy drinks or worse, alcohol, actually contain dehydrating agents. Indeed, for every alcoholic drink you consume, you will lose the same volume of water from your body!
Nutrition is very important for the maintenance of health and general wellbeing. Choosing to remain at home is more likely to be successful and sustained if regular nutritious hot meals are available.
However, shopping and cooking a proper meal may become difficult or impossible as a result of illness, frailty, or lack of mobility. Local authorities, therefore, provide ‘Meals-on-Wheels’ services – although in most cases, the meals are actually provided by another organisation, under contract to the local authority.
Hot meals may be delivered in a van with a heating unit. Alternatively, frozen meals may be delivered – usually a week’s supply at a time, previously selected from an illustrated menu. These meals can then be heated up at your convenience. A freezer may also be supplied in order that meals can be stored safely.
What is on offer will vary depending on your local authority. Some authorities will offer meals daily, but it is more usual that you will be offered meals on a few days each week. Nowadays local authorities are also concerned not to encourage people to become too dependent on supplied meals. You might, therefore, be offered this service for a short time only while you are recovering from an accident or illness. In all cases there will be an assessment of your need for the service and there will be a charge. For more information see The Role of the Social Services.
On the days you are not receiving ‘Meals-on-Wheels’ the choice of good quality chilled or frozen prepared meals now available in supermarkets can provide an acceptable alternative. If chosen carefully, it is possible to achieve a reasonably well balanced and varied diet from pre-prepared meals. Remember, however, that if chilled or frozen food is not to be consumed on the day it is bought, it is essential that it is stored in a fridge or freezer as appropriate.
Finally, it is important to note that anyone who is largely dependent on pre-prepared ‘Meals-on-Wheels’ or frozen meals, should supplement their diet with fruit, vegetables, bread etc. wherever possible.
Keeping your body moving
Increased physical activity in the elderly has been shown to improve brain functions and increase life expectancy, even into advanced old age. Exercise can protect against joint damage, keep joints and muscles working and helps to prevent disability. There is even new evidence that exercise helps prevent depression.
Unexercised joints lose muscle strength and can become unstable and painful. Even where joint inflammation and pain has to be treated with medication, it is possible to maintain the strength of those joints through gentle exercising movement.
Range of Movement (ROM) exercises gently take your joints through their full range of movement. This can be done just sitting in your chair. Your GP can be consulted regarding the specialist physiotherapy assistance you may need to start a programme.
The worst thing is to give in to the seeming inevitability of immobility and dependence. Recent research in the USA has shown that, with simple strength training, even 90 year olds could increase muscle strength by 160% and muscle mass by 10%! It appears that muscles are just as responsive to training in this age group as in younger people.
It should also be noted that exercises to improve balance, strength and co-ordination have been shown in trials to reduce the risk of falls’ injury that older people invariably face. It is shown that half of all fallers, fall again and, after a fracture, one in two older people can no longer live independently. More worryingly, it has been shown that a third of those who fracture a hip do not survive for more than a year. Such deaths should be preventable.
Bone strength and, therefore, improved balance and stability in older people can be maintained by regular, but not excessive, weight-bearing exercise. Walking and ROM activities as previously described are excellent.
Finally, whatever you decide you want to try, ask your doctor to give you a thorough check up. Remember, all doctors are required to offer an annual health check to all their patients aged 75 and over – and that you can ask for a home visit if it is difficult or impossible to get to the surgery.
Your General Practitioner
GPs can be a very important source of support to people who are becoming dependent, but who choose to remain in their own homes. Apart from providing primary medical attention when necessary, your GP may also be the ‘gateway’ to other specialist services. Your needs may entail referrals to consultants such as neurologists, geriatricians, orthopaedic specialists etc. and to other services like community physiotherapists or occupational therapists, which may be needed to help maintain or improve the situation at home.
Whilst the majority of GPs will provide an excellent all-round service, you should not be afraid to ask questions about help you might need, the treatment you are receiving or the drugs you have been prescribed. Do not feel that you are a nuisance. You should always ask questions. If you wish to change your GP you can find out about other local GPs, by contacting your Primary Care Trust.
By telephoning 0845 4647 you can speak to a qualified nurse (counsellor) who will be able to offer advice concerning your current health problem.
Chiropody and Other Specialist Services
These services are known as Community Health Services and are provided by the Health Service in all areas. Your GP should be able to give you access to them, but it will be helpful if you are aware of what should be available. It is probably also fair to say that although the services should be available everywhere, there may in some cases be a wait before you can get an appointment.
The main services are:Community Nurses
Community Psychiatric Nurse
Most of these services will visit you at home, but you might be seen more quickly with, for example, chiropody if you can get to a clinic. Social workers may also be able to refer direct to some of these services.
In some areas there are also specialist nurses such as the Parkinsons’ Disease Specialist Nurses, Admiral Nurses who specialise in dementia care, and Macmillan Nurses or Marie Curie Nurses, who provide care for the termianally ill. Access to such specialist resources would be through the hospital consultant who deals with your condition, through your GP or through the District Nurse.
Another important source of health information, although not formally part of the Community Health Team, are pharmacists – the chemist’s shop. It is always helpful to stick with one pharmacist, who will get to know your needs and the regular medications you receive. They will be in a good position to advise you or to query medications prescribed. Many pharmacists will now undertake to deliver prescriptions if you are housebound. Some will also prepare a week’s supply of medication in carefully labelled daily doses.
Some pharmacists will also be able to supply aids and appliances, stoma care products and your incontinence needs. There is likely to be a specialised Incontinence laundry service in your area. If you or somebody you care for needs this service, enquire through the Community Nurse of Social Services.
All pharmacies should have a leaflet describing their range of services. Most of them will also be able to provide leaflets on specific diseases or conditions, plus a range of other health information.
Dental care can become a real problem if you are finding it difficult to get out and about. Problems with teeth or with ill fitting dentures can make eating very difficult and may well lead to poor diet and nutrition. Poor dentures can also detract from any pleasure in meals or in social occasions.
Firstly, be sure that you are keeping your registration with your regular NHS dentist up to date, every 15 months. You need to be registered for CONTINUING CARE.
If you are receiving treatment your dentist should provide a plan of the intended work and discuss it with you, so that you have an opportunity to refuse any specific item – or the whole plan if you wish.
If it is impossible for you to get to the dentist’s surgery he/she should visit you at home. There is a contractual requirement to do this, if you are registered with the practice for CONTINUING CARE and if you live within 5 miles of the practice.
If you need emergency dental treatment and you are not registered for CONTINUING CARE or your dentist is not available or willing to provide the treatment you need, telephone your Health Authority. It may be able to put you in touch with an emergency dental service.
There are charges for many categories of dental treatments and older age, in itself, is not sufficient to obtain exemption. After paying for your treatment you will need to complete and send a ‘Remission of Charges’ claims form to The Benefits Claims Office. Ask your dentist for the relevant forms.
Managing Your Own Home
Aids and Adaptations
There is a huge range of devices or aids which can assist you to live as independently as possible. Some of these items could be useful wherever you live, but they are particularly relevant if you are living alone in your own home. It is also possible to have adaptations carried out to your house or flat so that, even if you have limited mobility, you will be able to continue living there.
In addition to specialist manufacturers and retailers of Aids to Living equipment, there are also about 40 Disabled Living Centres across the UK – all of which display a wide range of equipment and have staff to offer advice. Getting proper advice is vital, to ensure that your purchases are suitable, safe and cost effective.
The range of aids covers simple pieces of equipment such as specially designed cutlery, crockery, tap handles, grip handles for reaching or picking up things, amplifiers for telephones and magnifiers for reading or watching television. For personal care, such things as commodes, raised lavatory seats, devices to lower you into and raise you from the bath are all available. Even more complex equipment such as powered hoists and powered beds can also be obtained.
For more information, call the Disabled Living Foundation Helpline on 0845 130 9177, or visit www.dlf.org.uk.
How the Occupational Therapist can help
Many of the above items can be provided by, or organised for you by Social Services. If you feel that you have need of these types of assistance you should first contact the social worker – and ask whether you meet the criteria for an assessment by an Occupational Therapist (OT). We give more information about this in the Section on The Role of Social Services. Unfortunately, OTs are in short supply and there may be a wait before you can obtain an appointment.
If you meet the criteria, the OT will undertake a comprehensive and expert appraisal of your physical ability and needs, and will advise you on what might be provided or is available. Many of the items will be provided free of charge but some authorities may ask you to make a contribution towards costs. Larger, more expensive items, such as motorised armchairs and beds, may need special disability funding grants. However, from April 2003, subject to legislative procedure, these charges will be eliminated. The government has, in fact, recently announced extra funding for equipment – and your local Primary Care Trust will also be sharing equipment resources. This should all mean that obtaining the equipment you need becomes easier and quicker.
Adaptations to your home will also need funding and the OT will be the best source of advice. Such things as additional handrails on the stairs, other wall gripper bars, ramps, replacement of baths by showers, lowered or raised working surfaces or stair lifts can all help immensely in making living at home a realistic choice instead of an impossibility. It may even be possible to have internal lifts fitted within your own premises. It is, of course, also possible to get adaptations of this sort done privately if you can afford to pay for it. If you have a Home Improvement Agency in your area, they may also help with adaptations.
The Health and Safety regulations now stipulate that employees should not endanger their own health, particularly their backs, when caring for people who are not able to move independently. Any care organisation moving you around, therefore, may supply or require additional equipment to assist staff in such tasks.
It should be noted that, as part of a care package, you will not be charged by your local authority for either loans of equipment or for making home adaptations, costing up to £1000 in each case.
Wheelchairs and mobility aids
Wheelchairs and mobility aids can be obtained privately, or may be made available by the NHS. These include powered and manual wheelchairs, walking sticks, crutches and walking frames. If these items are provided by the NHS, there will be no charge, but a returnable deposit may be required in some cases.
Your Occupational Therapist (OT) will be able to advise on your needs for mobility aids as part of your general assessment. However, if you need a wheelchair your GP will normally have to ‘refer’ you to the NHS wheelchair service. An OT or NHS physiotherapist should be available to advise choice and fit to your particular needs.
The NHS long term wheelchair service is free, but only standard models and limited choice will be available. If you decide to purchase a wheelchair independently, NHS vouchers may be available to put against the cost. It may also be possible to obtain charitable help in purchasing a wheelchair. For information concerning sources of funding for elderly people in need, contact: Charity Search. Tel: 0117 982 4060.
You can purchase a wide range of Mobility Aids budget furniture, commodes and many other items of medical supplies at unbeatable prices by clicking onto this link to Medisave. Secure on-line ordering.
Home Repairs and Maintenance
It is a well established fact that poorly maintained homes are more likely to belong to older people. Maintaining the living condition of your house or flat is crucial to your well being. Indeed, a key factor in older people having to give up their homes and to seek long term residential or nursing care is the unsuitability or poor condition of their own accommodation.
It should be noted that research shows that more than 60% of fatal domestic accidents occur to people of age 60 and over.
Whilst the sheer cost of building work is an over-riding consideration, there may well be anxiety about the integrity and competence of builders. Stories of builders claiming, falsely, that extensive work is necessary, or of them charging excessive sums for doing very little, are rife. Such practices do nothing to instil confidence in the public and older people especially often feel very vulnerable to being ‘ripped off’ in this way.
Home Improvement Agencies
In many parts of the country you can now find Home Improvement Agencies which will provide excellent support and assistance, to ensure that essential repairs are done competently by reputable builders.
The agencies will be able to offer technical expertise, to ensure that work you commission is identified and specified properly. They will also have case management skills to assist in obtaining essential grants or funding to pay for, or help pay for, the work. The agency should also be able to supply a list of reputable builders in your area and will even supervise the work, if you wish. There will be a charge for the use of the Home Improvement Agency, but it will be a very small proportion of the total cost of work, and invaluable for the technical expertise and reassurance provided. You can find your nearest Home Improvement Agencies using this online search facility.
If there is no Home Improvement Agency in your area your local authority planning department might be prepared to recommend a builder. It is wise in any case always to obtain two or three estimates and to ask each builder to specify exactly what they consider needs doing. You will then be able to determine a general agreement about the necessary work. It is wise also to ask a builder to provide one or two previous customer references. These customers may be willing to let you see the work the builder has done for them or, at the least, would be prepared to tell you whether or not they were satisfied.
Help with Technology
The most obvious and most common use of technology to support people at home is an Alarm Service. This will enable you to contact help rapidly in case of an emergency, such as a fall or the sudden onset of illness. Even though you may not feel the immediate need of an alarm, the fact that it is installed will be reassuring to friends and family. This should be an important consideration.
The main feature of all alarm systems is the connection to a call centre, with staff on duty at all times. These staff will be trained to respond appropriately to calls. This response might include alerting someone on your pre-advised list of people who can be contacted in an emergency.
There are many different kinds of personal alarm systems. Some involve wearing an unobtrusive pendant or bracelet, whilst others can be voice-activated.
In general, there are two methods of obtaining an alarm system:
purchasing the equipment and then paying a quarterly charge for the monitoring service. Likely costs would be £200 for the equipment and £75 per quarter for the service.
renting will involve an inclusive charge covering the equipment and the monitoring service. Typically, this would cost around £130 per annum in total.
This is another form of alarm system which is activated, not by your pressing a pad on a pendant or bracelet, but by a marked change in normal living patterns.
With this system in place, a pattern is built up over a period of several weeks, by a small computerised unit within your home. If this pattern then changes noticeably, the call centre will alert a source of help to visit you. Factors triggering the alert may be the fridge not being opened during the times of day you would normally make a meal, the lavatory not being flushed a longer than normal period, or your failing to answer an exploratory telephone call, etc.
The great advantage of this type of system is that it can be effective even if you are unconscious, or too ill to use a normal alarm.
More Local Authorities are now introducing Telecare monitoring systems – but widespread availability will be sometime coming.
Security is a major source of anxiety for older people and there are a variety of products which can help to make your home safer from intruders:
A keypad door entry system
A door entry system with closed circuit television so that you can see who is at the door
A safe for keys to enable essential visitors/staff to obtain entry to your home, even if you are unable to get to the door.
On a small but growing scale is the development of what are known as ‘Smart Homes’. This technology is usually best incorporated in new-build environments, because it is much more expensive to adapt existing homes. ‘Smart Home’ technology will: open and shut windows; open and shut curtains; run baths; turn heating on and off; switch lights, TV or radio, on and off; turn ovens on or off; raise or lower the heights of working surfaces or cupboards; and, generally, assist with almost any of the routine tasks of daily living!
The technological revolution has made it easier for large stores to provide shopping services for people who are housebound. Indeed, many people are now taking advantage of the convenience of telephone or internet ordering, for home delivery.
In addition to the services provided by the larger stores, there may also be specific local shopping services in your area. A call to your local Social Services Department will be the best way of finding more details.
Support For Carers
The term Carer is used to distinguish those who care voluntarily for a relative or friend, from paid Care Workers.
According to research, there are around six million carers in the UK, between them saving the public purse billions every year! If you are the person who is wholly or mainly responsible for providing or organising care for a relative or friend, you will be regarded as a carer. You do not have to be related to, or living with the person you care for. If you are looking after a severely disabled person for at least 35 hours a week, you could get Carers Allowance.
What does all this mean for you as a carer?
Carers are entitled to a local authority assessment of their needs and local authorities have been given funding to provide support specifically for carers. This does not apply to Wales and Scotland, where any funding will be determined by the governments of those countries. Unfortunately, there are no hard and fast rules regarding the available funding. It almost certainly depends on where you live.
As a carer, you may need some or all of the following:
- Some time to yourself
- Some time when you can go out, see friends, pursue other activities etc.
- At least two or three undisturbed nights’ sleep each week
- The possibility of lying in in the morning occasionally
- A holiday or weekend break once or twice a year, or more often
- A failsafe system in case of emergency – in particular, an agreed plan for how your dependent relative/friend would be cared for in the event of your illness or accident
- Assistance with tasks which you cannot easily do by yourself
- Training in caring eg how to lift and move your relative/friend safely
- Information about what support is available
- Enough support to enable you to go on working
No one should feel guilty about having to seek support for needs such as these and any others not listed here. It is recognised how important the needs of carers are.
Your local authority is required to consult with service users and carers. There may be some sort of forum or meeting you can attend to make your views known. You should also discuss your needs with the social worker who undertakes your assessment. You may even feel like consulting your local Councillor or writing to the Director of Social Services. The evidence shows that, where carers feel properly supported and are supported from early in their caring career, they are much more likely to be able to continue caring over a longer period. This is likely to be better for the cared-for person and also much more cost effective for the local authority.
Carers have their own organisation – the Carers National Association tel: 0808 808 7777. This has done much to raise the profile of carers nationally and to lobby for improvements in the situation they face. It also has local support groups in many areas and is an excellent source of information. There are other organisations, such as The Princess Royal Trust for Carers (tel: 020 7480 7788) which also provides valued support services in some areas.
This is a non-contributory benefit for people aged 16 or over who are spending at least 35 hours a week looking after a severely disabled person. The disabled person, however, must be receiving Attendance Allowance or the equivalent rate of Disability Living Allowance.
You cannot receive Carer’s Allowance if you earn more than £100 per week. Your basic State Pension and other benefits may affect whether Carer’s Benefit can be paid. Carer’s Allowance is taxable and counts as income for means-tested benefits – but being entitled to Carer’s Allowance can increase entitlement to other income-related benefits.
It should be noted that the 35 hours of care given can include preparing, cleaning or just being in attendance as a precaution. Further information and the current weekly rate of payment can be obtained at https://www.gov.uk/
The Voluntary Sector
There are many voluntary organisations which can provide ‘specific condition’ care information and/or services, not readily available elsewhere – such as The Alzheimer’s Society and the Parkinson’s Disease Society. In some cases, special Helpline Call Services are also available.
There are societies or associations in existence for many of the conditions which cause frailty and dependence in later life. You can click at the end of this section to find out what is listed. We will also provide a direct link into the website of these organisations, where possible.
Some of the organisations have a network of local branches. Branches may provide specific services, such as day care or sitting services. They may also provide informal support and companionship. A call to the head office of the organisation concerned will be the best way to establish whether there is a branch in your area.
Crossroads is an organisation which has a large number of branches throughout the UK and provides free sitting services to support carers. Some of the branches are no longer affiliated to the parent body, so you are more likely to be able to find out whether there is a branch in your area from your Social Services Department than by ringing Crossroads head office.
In addition to the specific organisations, there are more general ones, such as Age UK, which provide publications, fact sheets and information call centres relating to a vast range of subjects. Counsel and Care for the Elderly is also an extremely helpful source of information
You may want to stay in a home of your own but feel that your present accommodation is no longer appropriate for your needs, or is unsuitable for your state of mobility. You might, for example, live in an isolated area or have a lot of stairs. Your home might simply be larger than you now need. If any of these situations apply to you, it would be sensible to consider whether one of the housing options specifically for older people might be the answer.
Retirement housing with the possible inclusion of an integral alarm service is one such type of development specifically for older people. Sheltered housing, on the other hand, will normally have warden support, an alarm system and some communal facilities and services There are also sheltered housing schemes for younger people with disabilities.
Rent or Purchase Options
Both purchased or rented homes are available and there are also a variety of different arrangements for part purchase/part rent. The majority of sheltered housing to rent is provided by voluntary sector housing associations or by local authorities and the majority of owner occupied retirement housing is provided by private organisations.
Rented sheltered housing provided by housing associations is likely to be cheaper than renting from private organisations, because housing associations are subsidised and should not be aiming to make a profit. Tenants are likely to have to pay a service charge in addition to the rent, in order to cover the costs of the alarm system, warden and the upkeep of communal areas and garden. For further information on different schemes, costs and how to pay them, see our section Funding your Choice.
Generally, retirement or sheltered housing will consist of a number of self-contained units, either flats or bungalows. Purpose built, or more rarely adapted, they will be specifically for use by older people or by another defined client group such as younger physically disabled people. There is huge variation in the size and quality of accommodation, ranging from single bed-sitting rooms with cooking facilities and bathroom, right up to luxurious 4 or 5-roomed apartments with access to amenities such as swimming pools, tennis courts and so on. Many of the schemes will also have some communal facilities such as sitting rooms or a restaurant and some will have a guest’s room for residents’ visitors to stay overnight if necessary.
There is usually a warden either resident, or on site for a certain period each day. However, in many schemes there is less warden cover than was originally planned and it may be wise to ask whether any changes in this respect are anticipated. Wardens are not there to provide personal care or to help with cleaning, nor do they normally undertake shopping for tenants. They will, however, keep an eye on you, calling regularly and can alert emergency services if necessary. They may arrange social events and are often a good source of advice, companionship and support.
If you are thinking about purchasing a retirement home in a scheme which advertises itself as providing care as well as accommodation, ask for detailed information about what type of care is provided, how much is offered and what determines its availability. You may want to know, for example, whether there is anyone on duty or on call during the night.
Finding a Sheltered Home vacancy is not always easy and you may find that you need to go onto a waiting list if you are to have any chance of entering the scheme of your choice. It is good advice, therefore, to think sooner, rather than later, about future needs. The more time you have to plan for your future life, the more likely you are to make an appropriate decision.
Extracare and Close Care
Another option in some areas is ‘Housing with Care’ – sometimes known as ‘Extracare’ In such schemes there is normally a 24-hour care service on site, although the amount of care which any individual receives will be broadly based on an assessment of need carried out by your local social services department. This type of home support facility will be a personal care service, to assist you with washing, dressing, etc. You would need to check whether it would also be possible to have domestic help included and how this is arranged.
The care service will be funded by social services although you may well have to make a contribution to the cost. Extracare schemes are gaining in popularity and are an excellent answer to the problem of how to keep your independence and your own front door, yet be assured that the help you may need is always at hand. Admission to such schemes will be on the basis of an assessment of need (see Role of Social Services).
Close Care is another option, if you think you may need access to just some regular personal care. Close care apartments are normally built close to a care home and tenants can use the services provided within the home if they need them. These services might include meals, cleaning and personal care, or short term nursing care.
In summary, the main advantage of sheltered or retirement housing is that there will be other people of your own age (the normal minimum age for taking on a tenancy is 60) for companionship. Additionally, there may also be activities or social events of various kinds organised either by other tenants or by a warden.
How to choose a retirement/sheltered home
Choice in these types of living accommodation will largely be determined by means and by availability. Fortunately, there is a great deal of sheltered housing available and it is widely dispersed, see our listing. However, all types may not be available in your area and you may need to consider moving to a different location in order to find the home which best suits your needs.
If you want to investigate whether sheltered housing might be right for you, you will first need to decide whether you intend to buy or rent, or whether you are interested in one of the part buy/part rent schemes. You might use the following list to decide what your priorities are. Once you have done that, it will be easier to make a shortlist:
- Location in your current area
- Near shops and a ‘community’, with post office, library etc. You can now order fresh Waitrose products for home delivery from Ocado.
- Frequent and convenient public transport
- Accommodation – size, number of rooms etc.
- Social events
- Availability of warden
- Being able to keep a pet
- Cost including services
- Mobility access within the scheme
We suggest you then contact schemes in your area which fit your criteria and ask if you can make visits. In that way, you will get a better feel for what is on offer and whether you would be happy in the environment. You might also enquire whether there is a waiting list of people wanting to buy or rent and, therefore, a history of satisfied residents. In rural areas there may be little choice.
When you make a visit it will be important to find out in detail what it might be like to live there. It will be important to obtain answers to the points raised above, but you might also find the following check list helpful:
- Ask to see a flat or apartment and look for such things as accessibility of switches, ease of opening or closing windows, suitability of design for walking frames or wheelchairs; suitability of bathroom equipment etc.
- Is there a lift (if apartments are on floors above ground level)?
- Can tenants or owners control their own heating system?
- Is there satisfactory security for individual units and for the whole scheme?
- Is there 24-hour emergency help/cover via an alarm system, and how are emergencies dealt with?
- How much storage space is there in the individual units?
- Is there a warden and what is her/his availability?
- Are there any plans to alter the warden service in any way?
- Do tenants make decisions about social events etc., or not?
- Would you be allowed to employ a live in companion, or nurse (over a period of temporary illness).
- Would you have to pay a levy to the freeholder if you re-sell the property.
Codes of Practice
There are various Codes of Practice to protect the rights of renters or purchasers of retirement housing.
The National House Building Council (NHBC) Code of Practice for Sheltered Housing applies to all retirement housing built after 1st April 1990. This code requires all potential buyers to be given a Purchaser’s Information Pack containing detailed information, as soon as they have paid a reservation fee. (The code is available from the NHBC, Buildmark House, Chiltern Avenue, Amersham, Bucks HP6 5AP. The Association of Retirement Housing Managers (ARHM) has a Code of Practice which covers all its members. (Available from ARHM, 46A Chiswick High Road, London W4 1SZ).
Security of Tenure
Before you make a final decision make sure you have seen a copy of your chosen organisation’s Tenancy Agreement or Lease. You will need to be cautious about possible rises in service charges. Ask the management company for details about past annual rises and, possibly, written guarantees concerning the levels of future rises. Check also whether there is an audited and professionally-administered ‘sinking fund’ established – to pay for unexpected and expensive common parts repairs or renewals. We suggest that you ask someone such as the Citizens Advice Bureau to check all such details for you.
A critically important factor of accommodation will be the applicable terms of your Security of Tenure should you become more frail and dependent. In theory, a sheltered housing tenant should be regarded in the same way as a tenant in any other rented accommodation.
The Role Of Social Services
Local authorities’ social services departments are often key to finding successful solutions to dilemmas about care. They play a lead role in assessing the need for services and will both provide and fund care services under some circumstances especially when you may not be able to make your own arrangements or when you cannot pay in full for the services you need.
Assessment for Community Care
Since 1993, local authorities and, through them, their social services departments, have been charged with; assessing people’s needs for community care services; and, where they have agreed that there is a need, with providing an appropriate service. Health authorities and, where appropriate, other professionals such as physiotherapists, are also required to take part in assessments.
‘Assessing needs’ simply means finding out what help or support you may need. The remit is to provide services which support people in their own homes, or to provide a placement in a care home. In either case, subject to a financial means test, there is likely to be a charge for services.
The only exception to this is where there is an assessed need for continuing health care, hospital or care from the district nurse, or when there is a short term need for rehabilitation. In such cases, the service will be provided free of charge.
People living in care homes receive free nursing care, but only when the nursing is carried out by a qualified nurse. There is a complicated ‘banding’ system which then determines just what discount you will receive. The accommodation and non-nursing costs will still have to be paid for.
Anyone who believes that they need assistance, either to continue to live at home or because they can no longer manage at home, is entitled to ask for an assessment of need. You can also request an assessment if you are registered disabled, or if you are a carer (see below).
The assessment should focus on the following key aspects:
- The wishes and feelings you have about the way you would prefer to live.
- Your state of health – both physical and mental.
- Any risks your illness or disability may subject you to.
- Your home environment and its location in relation to your condition.
- Whether you have anybody who looks after you.
- A close relative, carer or friend can be present during the assessment and would be able to contribute views to the Care Manager.
Although the social services department will take the lead, it is also required to involve the GP and other professionals from a Primary Care Team or Primary Care Trust – such as Practice Nurses, District Nurses, Health Visitors, Community Mental Health Nurses, Macmillan Nurses, Podiatrists, Community Dietitians, Counsellors and Psychologists.
Some authorities have set criteria to determine whether or not they will undertake assessments and will only assess your needs if you meet these criteria. You may, for example, be asked about your financial circumstances. If it seems likely that you would have to pay for the service you may be referred direct to the service provider, rather than being formally assessed.
Local authorities are required to provide information about how their assessment procedure works. This information should be available through the social services department, local library or your GP’s surgery. The information should also be available in Braille or on tape – in languages appropriate for all the local community.
If you are refused an assessment you can challenge the decision. You should write in the first instance setting out all the reasons why you think you should be entitled to the assessment.
The person who comes to assess your needs may be a care manager, or a social worker, or may be a community nurse or other professional. The way in which the assessment is carried out will also vary. There is no ‘right’ way to do it. However, the one thing which is important is that the person being assessed should be consulted about what they feel their needs are and about what kind of help they would like to have.
Age UK suggest that it might be useful to make a list of things you find difficulty in doing, or to keep a diary in which you make a note of things which are always difficult and things which you can sometimes, but not always, manage. You can then refer to this during an assessment.
The community care guidelines from the government state clearly that care services should be devised which meet people’s real needs, rather than trying to fit people into existing services. However, local authorities are entitled to take cost into account when they provide or arrange services – and you may not be offered what you want.
Local authorities are also now required to offer people the money to purchase their own services, as an alternative to providing the service.
Once the local authority has undertaken an assessment and decided that you are in need of community care they will consider your eligibility to receive a service. There are no nationally agreed eligibility criteria, so there is huge variation in what is available from area to area. This is sometimes referred to as the ‘postal code lottery’!
If your local authority decides that your needs do not meet its criteria for providing or arranging a service and they are not able to offer you any help, ask them to write to you stating their decision and the reasons for it. You could also lodge a formal complaint against the Authority. Local authorities are not, however, the only source of help and we suggest refer to our section on Staying at Home and perhaps also read Funding your Choice.
The Care Plan
If Social Services do agree to provide or arrange services, they should produce a care plan. The care plan will set out what services will be provided, when they will be received, what tasks will be undertaken and when these arrangements will be reviewed. You should be given a copy of your care plan, together with a written copy of the assessment. You should not sign any record of the assessment, unless you are entirely happy that it records your views accurately.
There is more about carers and services for carers elsewhere on this website – see Support for Carers. Local authorities now have a duty to offer a carer’s assessment, and to provide assessments of carers’ needs if they are requested to do so. This is applicable whether or not the authority is also undertaking an assessment of the needs of the person being cared for.
The community care services which your local authority can provide are set out elsewhere in this website. Look under Staying at Home, Sheltered Housing, or Care Homes, to find out in more detail what might be available.
Social Services may provide the service(s) themselves or they may contract with an independent voluntary or private organisation to provide the service. In theory, you should have some choice about the service provider assigned. In practice, there may be established contracts with organisations to provide services, especially where home care is concerned – so, there will be less opportunity for choice. However, in entering into a contract, the local authority will have ensured that the servicing organisation is reputable, with stipulated clear standards and that it is registered with the Commission for Social Care Inspection (CSCI) Tel: 0845 0150120..
The care manager
If you are receiving service at home, particularly if it is more than one type of service, you are likely to be assigned a care manager from the social services department. This may or may not be the same person who carried out your original assessment. The role of the care manager is to keep an overall eye on the services you are receiving (sometimes referred to as the ‘package’ of care services) and to ensure that they are operating smoothly and are still right for you. From time to time, the care manager will also arrange a formal review of the service arrangements.
The service plan
Very few local authorities will now provide assistance purely with domestic tasks, if that is all you need. Local authorities’ resources have to be concentrated on the most frail. Assisting people with personal care needs, such as getting dressed, having a bath or shower, getting to the toilet, or making a meal will be more likely to be the type of help provided – if the local authority agrees to provide a service.
The care plan will specify the tasks to be done and your service provider will have to stick to the plan. You should note that the care provider is then not allowed to change the specification, to include extra tasks you might want done. Of course, if you are paying for a service privately, you can decide just exactly what the staff do while they are with you.
If your need is for a care home, social services may help you to choose a home and assist with your move. They will certainly do this if your capital is below £23,250 and you are not able to pay the full cost of care or if, for reasons of mental or physical frailty, you are unable to arrange things for yourself.
There is also now much emphasis upon rehabilitation – to help you to become more independent again. If this is the intention, you will be offered the service for a clearly defined period only: 6-8 weeks is typical and the help will be focused on getting you to do things for yourself, rather than everything being done for you. There will be the clear expectation that the service level will be reduced when you are able to manage better and the service manager may visit you frequently to assess your progress. A short term service such as this may be free
Local authorities are entitled to make charges towards the cost of community services and most of them now do so. There is no standard national level of charging for non-residential services and they do all vary. Recent Government guidance on charging suggests that considerable variation will continue.
One aspect of your initial assessment by Social Services will be some questions about your financial circumstances. It may even be that the financial assessment is done separately to the needs appraisal.
Fundamentally, Social Services’ charges are required to be ‘reasonable’. However, in some instances you might actually be able to purchase your own service more cheaply directly from the same organisation supplying the services – than by getting it through the local authority! (Obviously, you would then have much more control over the times and type of service you receive and, indeed, the staff delivering the service).
It should be noted that, as part of a care package, you will not be charged by your local authority for either loans of equipment or for making home adaptations, costing up to £1000 in each case.
To summarise, Social Services should tell you about the costs involved when you are offered care services and given the care plan. If you feel that costs are too high or that you simply cannot afford them, you should say so straight away. You can also find out more about costs and Direct Payments – where you receive money from social services to pay the service provider directly for the services you need in Funding your Choice.
There are intended to be basic principles applying to discharge from hospital. Unfortunately they are frequently disregarded. Discharge is only meant to happen when:
i) key decisions have been made about the provision of any care needed and the source of that care agreed.
ii) funding of all required resources or accommodation after discharge has been established.
Discharge from hospital should be planned and arranged by a team which will include, or have links with, Social Services and Health (the PCT). There may be a specific member of Hospital staff acting as a Discharge Facilitator (or co-ordinator).
‘The Patients Charter’ provides for you and your carer(s) to be consulted at all stages regarding any arrangements made for you. However, there is intense pressure on hospital beds and hospital discharge may not always be properly organised. If you are funding and arranging your own post-hospital care, the pressure may be particularly acute!
Hospital discharge Procedure
Intermediate care may be available to bridge possible gaps between the services provided by health and social Services. It is designed to help those people leaving hospital, but not able to manage independently in their own homes. It would include physiotherapy and/or occupational therapy, where needed. This type of care may be provided in a nursing home, or in a person’s own home. It would normally last for six weeks, but local variations will apply (see below).
There are guidelines and check lists for all aspects of discharge procedure. Here is an outline of what you might expect:
Date of discharge
Patients and carers should be given adequate warning of the precise date and time of leaving hospital. There should be contingency planning for Friday afternoon or weekend discharges.
Appropriate transport should be organised, including an escort if necessary.
The home of a patient living alone should be properly prepared for their return. Unfortunately, this is often neglected.
You should be provided with a hospital contact telephone number in case of medical difficulties following discharge.
You and/or your carer should be provided with precise information concerning rest, diet, medications and follow-up appointments. This information should be provided in a form appropriate for people from ethnic communities, those with learning disabilities, or those with sensory impairment.
Support services such as domiciliary care, district nurse or meals on wheels should be initiated or re-established, to start on the required date. Any necessary home aids and adaptations should be supplied with full use instructions for you and your carer(s).
Written discharge information should be sent to your GP within 24 hours of your leaving hospital. Advice of all follow-up hospital appointments will also be forwarded.
On-going Care Plans should be provided for all patients transferring to care homes.
Intensive Support/Palliative Care
When necessary, this might entail further NHS inpatient care, placement in a care home, or an intensive support package at home. Palliative care, where people with a life threatening condition no longer respond to medical treatment, also comes into this category.
The diagnosis of life-threatening illness brings with it a transformation of life – where emotional, physical and specific medical needs will need to be met. For those suffering such conditions and their families, it is comforting to know that a wide range of specialist support is available to accommodate changing circumstances and preferences.
From first diagnosis of conditions such as cancer your specialist hospital team, in conjunction with your GP, will be the fulcrum which activates all available aspects and sources of hospital and home care. The objective will be that all your wishes as regards treatment options will be taken into full account at all times – within an appropriate programme for every stage of your condition.
There comes a time, however, when you may be told that further treatment or surgery will not help. It does not mean that nothing else can, or will be done for you. There will certainly be treatment available that will be able to control the symptoms caused by your deteriorating condition. This type of treatment is termed Palliative Care. It focuses on controlling pain and symptoms – and meeting the social, emotional and spiritual needs of you and your family.
Targeted at the point of requirement
Palliative care may be provided by Macmillan nurses employed by NHS Community Trusts; home care nurses, doctors or other health professionals from voluntary or NHS hospices or specialist Palliative Care Units; Marie Curie nurses; and a wide range of other voluntary and statutory services.
These professionals are highly skilled, widely experienced and sympathetic in managing patients’ needs and changing circumstances. Palliative care can be provided in your own home, a care home, in an NHS hospital or, indeed, in a hospice.
Eventually, someone whose illness is becoming progressively worse may need 24 hour attention and care, may be offered a place in a Hospice – where the objective will be to provide the most appropriate care, all necessary medications and, with that, the very best quality of life. Hospice staff are specially trained to advise on pain and symptom control and to give emotional support to patients, their families and loved ones – during illness and after bereavement.
It should be understood also, that some Hospices offer their services to patients who are not terminally ill, but would benefit from sessions of palliative care – or to those whose families might need respite.
The Hospice service is completely free of charge and often provides a wide range of on-site facilities, which might include specialist physiotherapy, aromatherapy, reflexology and a day visit centre.
For more information on UK hospices/palliative care services, contact the Hospice Information Service. Tel: 020 8778 9252.
Intermediate care is targeted at people who would otherwise face unnecessarily long hospitals stays, or inappropriate admission to acute hospital care or long term residential care.
When Intermediate Care is part of the overall care plan you should not be charged for the services. Intermediate Care is varied to suit your needs and could involve active therapy, medical treatment or the support of your recovery time. Many of us might understand the whole concept better by thinking of a traditional ‘convalescence’ provision.
Intermediate Care will be provided with an objective in mind – such as enabling you to resume living independently at home. The plan will be reviewed within a six week period and then decisions made concerning possible longer term rehabilitation needs, or specific home care.
For more information about local Intermediate Care and how you might qualify, contact your local NHS body, your GP or NHS Direct on 0845 4647
Discharge to a Care home
If your post-hospitalisation needs are such that it is no longer viable for you to live at home, the local authority may arrange for you to move to a care home on a more permanent basis. Even if you are assessed as having to meet the whole costs of this yourself, the authority may still help you to find a suitable home. In either case, it is important to note that you have a choice.
Do not feel obliged to make a quick decision. When beds are scarce hospitals may try to hurry you along. If this happens, exercise your right to choose which home you are to move to. Read our sections on Care Homes and Funding Your Choice.
Having come to a decision you will then be ‘means tested’ on your ability to cover all or some of the costs from the capital and income you have. Full details of Funding your Choice of home care and supported accommodation are included elsewhere in this site.
In summary, the fundamental objective of a hospital discharge service is that you should receive all the information you will need to make key decisions – about the continuing care needed and the likely cost, if any, to you of any option you might consider. Sadly we are well aware that hospital discharge is frequently much more haphazard than the planned process we have described.
If you are dissatisfied with the way you have been treated by Social Services, the Health Service or by a service provider it is your right to make a formal complaint. However, it is always advisable initially to discuss your problems with someone from the organisation or body concerned – in an attempt to resolve things informally. If, however, you do decide to make a formal complaint, every service-providing organisation must have a defined procedure for handling such matters.
They will have a printed Complaints Procedure, which should set out things like:
- How to make your complaint.
- How it will be dealt with.
- Who will deal with it.
- The timescales for dealing with the complaint.
- The reviewing process, if you are not happy with the outcome.
Where large organisations such as Social Services, a hospital, or health authority are concerned there should be a designated person to deal with complaints. Smaller organisations such as a nursing home or care agency should identify a senior manager to take responsibility for dealing with and resolving complaints.Your local authority should also be able to suggest someone (usually called an ‘advocate’) who will be able to help you to make a complaint and to present your point of view.
It should also be noted that, in the event of an unsatisfactory resolution of matters with a health authority, you can contact the Health Service Ombudsman. Telephone the Helpline on 0845 015 4033. Or visit www.ombudsman.org.uk
Although the various service providers will have their own complaints procedures some of the national providers’ organisations such as the United Kingdom Home Care Association (UKHCA) set standards for their membership and will have a complaints system you can make use of.
If your complaint relates to a care home, The Relatives and Residents Association is also a useful contact point: write to 24 The Ivories, 6-18 Northampton Street, London N1 2HY. Telephone advice line 020 7359 8136 or view the website www.relres.org. Almost all health and social care services – whether they are provided by the authorities or by independent private or voluntary organisations – are now required to be properly registered and regulated.
Funding Your Choice
This section provides an overview of the range of options for funding your choice of services, or the funding of those services which you are advised as being appropriate for your needs. Check in the menu items above for details relating to your accommodation situation.
Some of the services we discuss may be available free, or will be supplied to you at a subsidised rate – depending on your own financial circumstances. On the other hand, some people may have the independent means to pay for their own care – identifying and purchasing the service directly from the relevant organisation. This could be from a home care agency, a care home, or any other source which meets a particular need and choice.
Whatever your requirement or capability, Caredirections will help you to explore the potential of different approaches, guide you in making the best choice and help you to identify the most appropriate point of service.
In addition to examining eligibility criteria for free or subsidised services the comprehensive ‘Funding Your Choice’ section will also help you to obtain all the income to which you are entitled to help you meet the cost of any services you need.
In all matters of funding care or accommodation needs, there is an obvious first question for most people. What help can be expected from the State? Caredirections will help you to find out more about the current state of play and future expectations in this respect.
Whilst the government has recently announced some helpful concessions for the future funding of long term nursing care, state funded support generally is not generous. It is vitally important, therefore, to ensure that you are aware of and are claiming all the help to which you are entitled.
Lasting power of attorney
Both elderly people who are becoming increasingly frail and their carers should consider the on-going ability of the elderly person to deal with their own financial and legal affairs. It may make good sense to formally pass over this responsibility to a child or close relative, in an ‘lasting power of attorney’ arrangement.
Living in Sheltered or Retirement Housing
Housing intended specifically for older people is available to rent, to purchase or to part-purchase.
Paying for rentable sheltered housing is the same as renting any other property. You would fund it either from your own income, if that is adequate, or with the help of Housing Benefit.
You may plan to buy a home in a retirement housing development. This would normally be financed through the sale of your present property. However it is also possible for older people to obtain interest only mortgages, where the capital is not repaid until the eventual resale of the home. See Financial Planning.
Retirement housing for sale may be built either by private developers, or by non-profit-making housing associations. Buying such a property is different from buying any other home because of the service contract. The property is likely to be leasehold rather than freehold, and there may be some restrictions over the resale. We strongly suggest that you should assure yourself on the terms of any service agreement and take advice from a solicitor before entering into any agreement to purchase.
If you prefer the security of owning your own home, but cannot afford outright purchase, a shared ownership scheme may suit you. Such schemes provide for you to part buy the property from a council or housing association, usually 25%, 50% or 75%. Most schemes then require you to pay a reduced rent on the remainder of the value.
Some housing associations also offer leasehold schemes in which you purchase a 70% share of the lease (and get back 70% of the market value when the property is resold). Private developers also offer part purchase deals, for example some will offer to part-exchange with your current home.
Living In a Care Home
Where an individual’s care needs are primarily health care needs, it may be possible that their whole care home costs will be fully funded by the NHS under its free continuing care criteria. Such people should request careful assessment of their needs comparing the results and decisions given with their health authority’s published criteria. Professional guidance in case pursual from a specialising law practice might well need to be considered.
If, however, you move into a nursing home and do not qualify for fully funded NHS continuing care, the ‘nursing’ part of your support is covered by Government funding. The NHS would normally contribute £108.70 per week. People who qualify usually need ongoing specialist medical treatment on a regular basis. Some people will be assessed as not requiring any nursing and will, therefore, get no subsidy. The above applies to England only.
It is important to understand the definition of ‘nursing’
– as being those care needs carried out by a registered NHS nurse, as opposed to those tasks undertaken by a care assistant. There are many anomalies of practice across local authorities – particularly where budget restrictions are in place. Sadly also, many care homes have suffered badly from the very low rates paid by local authorities and they may have seen the nursing subsidy as an opportunity to raise their own income – rather than pass on the whole amount to the resident.
Care home residents will still have to pay for accommodation and personal care, such as help with washing, bathing, dressing and eating. See below for details of possible ‘means tested’ State Support relating to accommodation and personal care.
Support From The State
You will only be eligible for accommodation and personal care help from the state (other than for NHS services) if:
you have been assessed as needing care by the Social Services department and they have agreed to provide or arrange a service
your capital is less than £23,250, including the value of your property, savings and investments. The local authority will disregard the value of your home if it is occupied by your spouse or partner, or by a relative who is incapacitated or over 60. The local authority may also disregard the value of your home if it is occupied by someone who gave up their own home in order to become your carer.
If you have capital over £23,250 you will be expected to pay for all of the cost of accommodation and personal care. You will be expected to make some contribution to the cost if your capital is between £14,250 – £23,250. You should not have to make any contribution from your capital below £14,250, but you will be expected to contribute from your income (less £22.50 retained for personal expenses).
The local authority will assess your financial situation and will calculate your total income, including any Benefits to which you are entitled. It is important to note that local authorities cannot assess the joint recources of couples – they have to look at the income and capital of the person going into the home. You are advised to obtain the excellent Age Concern Factsheet 10, which contains comprehensive guidance as to how split capital/property assets are considered. Tel: 0870 500 99 66.
Additional State help towards the cost of care home care may be available in the form of Attendance Allowance. A full description of this benefit is included in this section under ‘Remaining at Home’ .
Benevolent funds may be available from organisations set up to look after the welfare of individuals who have worked in particular trades or professions, or who have served in the forces. Further information is provided in this section under ‘Staying in Your Own Home’. You could also look in our Benevolent Fund section.
Using your home to fund accommodation
The normal expectation is that homes will be sold in order to pay for any care in a care home. Being forced into selling your home in order to meet care costs is often a source of great distress to people who are already suffering the loss of independence and control over their own lives. They may also feel that they have nothing of value to hand on to their children after a lifetime of hard work.
The government’s future change of the level of capital before which you are required to pay for your own care is intended to help people retain their homes. The government is also planning a scheme whereby local authorities can ‘lend’ the money for care, taking it back from the sale value of your home – only after your death. In many cases though this might mean that much of the value of the home would eventually be taken by the local authority.
There are, however, ways in which the full value of your home can be preserved, whilst at the same time helping to finance your care – especially if your family can participate or contribute in order to preserve their inheritance.
Your ability to rent your home instead of selling it will depend on several factors:
Its suitability – perhaps it needs redecorating or modernising?
Its location – is it in an area of high demand for rented housing? Is it close to public transport?
What level of rent will it command?
You would be well advised to implement the renting of your property through a reputable, local estate agent having an established ‘lettings’ arm to its business. Take care in agreeing the precise introductory and renewals commission terms with the agent. The agent may be able to provide a ‘standard’ tenancy agreement – or you could construct your own through a solicitor.
Help With Home Maintenance
There are several different types of grants available for improving or maintaining your home. Grants are obtained from the Housing or Environmental Health department of your local authority and are likely to be means tested. However, even if you are above the means test limit, you may be successful in getting a grant for part of the cost.
If you are applying for a grant, you should never start the work before the Council has given its final approval, because the grant could be refused. If you move within 5 years of getting a grant,you may be required to repay part or all of the grant. This would not apply if you move permanently into hospital, a care home or sheltered housing.
If there is a Home Improvement Agency in your area they may be able to assist you in applying for a grant. In particular, the means test for Renovation grants is complex and the agency’s advice will be very useful. The publication ‘In Good Repair’ by Care & Repair England and Scope will also be helpful in guiding you to possible funding sources (for a copy call 0115 982 1527).
These are for major work, such as structural repair, dealing with damp, unsafe wiring, inadequate water supply or improving washing and toilet facilities. Renovation grants are also available for conversion, such as turning a house into flats. Your home will not be eligible for a grant if it is less than 10 years old and you must have lived in the property for at least 3 years.
Renovation grants are discretionary, which means it is the local authority’s decision to whom they give grants. However, they should have a policy which determines how they will make their decisions. Your local authority may provide a leaflet about this, or council staff should explain the policy to you.
Applying may be a two-stage process. The first stage will require you to provide some basic information, so that the council can tell you whether it is worth making a formal application. If you then go ahead, the council must inform you within 6 months whether or not they are willing to make a grant. If you are unsuccessful and feel that the council has not responded in line with their own policy, you might discuss it with your local councillor, or make a complaint through the council’s formal complaints procedure.
Home Repair Assistance
These are smaller grants, given for essential repairs or alterations, to older or disabled homeowners, or private tenants who are on low incomes.
The sort of work which might be covered would be repairs to windows or doors, home insulation, a downstairs lavatory – essential works to render a home safe, weathertight, and suitable.
Although not means tested, Home Repair Assistance is still discretionary and local authorities may impose their own criteria.
Disabled Facilities Grant
Unlike the other grants already mentioned, the disabled facilities grant is mandatory – that is, the local authority must give it if you fulfil certain conditions.
You must be disabled, meaning:
You are registered disabled OR
Your sight, hearing or speech is substantially impaired
You have a mental disorder or impairment of any kind
You are physically substantially disabled by illness, injury, impairment present since birth, or otherwise
You also have to establish that, without the intended work being done, you do not have ‘access’ to your home, or the basic amenities within it. You also have to satisfy the means test, which is similar to the one in force for renovation grants.
The disabled facilities grant could cover: making access to your home, or within your home, easier; providing appropriate kitchen or bathroom facilities to enable you to be more independent; improving the heating system; or a variety of other work which would make your home more suitable for your needs.
The grant is normally available from local authority’s housing department. You might, however, first approach social services, because they will be required to recommend the nature of adaptations to the housing department. An occupational therapist (OT), trained to assess the needs of people with disabilities, will visit you to assess your needs. Unfortunately OTs are in short supply and there may be quite lengthy delays for an appointment. You should not wait for the assessment, but make a formal application to the housing department as soon as possible, because the council is only required by law not to keep you waiting for more than six months for a decision. The sum available for disabled facilities grants will also be budgeted each year and you may have to wait if all the year’s allocations have been made.
Remaining At Home
Support from the state
Unfortunately, help with the cost of services you might need at home is not standardised. Almost all local authorities now impose charges for such services, but there is no standard level of charging and no agreed system for assessing people’s means. Charges are highly variable.
They are heavily subsidised in some areas, whilst in other areas charges are so high that individuals could possibly purchase the same, or similar, services more economically privately.
Councils have discretion to make charges for a very wide range of services, including home care, day care, lunches, transport, incontinence laundry and alarms.
Most councils use some form of means test in order to assess an individual’s ability to make a contribution towards the cost of such services, however there is, as yet, no national standardised test. In some areas, even if you are receiving Income Support you may have to pay towards services such as home care.
However, you should be aware that Councils are subject to a test of ‘reasonableness’. An advice note to local authorities from the Social Services Inspectorate demonstrates this:
- Charges must be waived or reduced for those unable to meet them
- Users must be left with adequate disposable income
- No account should be taken of the resources of carers or other family members
- Service users have the right to appeal against their ability to pay
- Services cannot be withdrawn for those unable or unwilling to pay, but debts may be pursued through civil procedures
- Your Social Services department should give you the information you might need to make a complaint, or to appeal against a level of charges which you will have difficulty in meeting. To find out whether it would be possible to get some help towards the cost of support services , you should ask social services for an assessment of your need – see The Role of Social Services.
This is money paid to you by Social Services, to enable you to pay directly for your own care – rather than accepting care arranged by Social Services. You can employ your own care worker(s) or you may prefer to buy services from a voluntary or private agency.
Unless you live in Scotland, you cannot use Direct Payments to buy services from your local authority – but it may be possible to combine Direct Payments with other services provided by your local authority.
If you think you might want to switch from an existing care service, to organising your own care with the help of a Direct Payment, you will need to talk to your social worker or care manager. If your need for services is being assessed for the first time, you should raise the question about managing your own services at the time of the assessment. You should not be left without help whilst you arrange your own services so may need to asksocial services to provide temporary assistance.
All local authorities now have a duty to offer the option of Direct Payments – to disabled people; and anyone aged 65 or over, who has been assessed as needing community care services. The criteria local authorities adopt in making a decision regarding Direct Payments are:
You have been assessed as needing a service.
You (possibly with help) are able to manage your Direct Payment. The key point is that the local authority must be satisfied that you will have control over the services.
Your needs will be met by using Direct Payments.
Direct Payments also have to be offered to carers (except in Scotland, where this duty only extends to carers of disabled children).
Using direct payments
You should be able to use the payment as you wish, so long as this results in your needs being met. The whole idea of Direct Payments is to give people more choice and control over their own lives. Nevertheless, the legislation states that you cannot use the money to pay:
Your spouse or partner, or a relative living in the same household.Users must be left with adequate disposable income
Anyone else living in the same household (other than a paid live-in carer).
The guidance in Wales differs from that in England and Scotland. In certain circumstances in Wales, direct payments are given to individuals receiving support from someone in their household. Each case is looked at individually.
A close relative living elsewhere.
For a service provided by Social Services (except Scotland).
For a service which should be provided by the NHS.
For a service which should be provided by the housing department.
For permanent care in a care home, although you can use it to pay for short stays of under 4 weeks at a time.
You may choose to use your Direct Payment for services such as Home Care. Look in the section on Staying in Your Home which will tell you about agency services and live-in services. If you intend to employ your own help you will find the section Employing Your Own Staff useful. Direct payments can also be used for purchasing equipment and we suggest you look at Aids and Adaptations.
Arranging your own staff
In most areas there are likely to be organisations which will help you in setting up your own service. They will offer help in understanding your responsibilities as an employer and may be willing to take on the actual paying of your staff and deductions of tax and national insurance. They may be able to help you to find suitable staff and will suggest possible wording for contracts and appropriate terms and conditions.
Your local authority will be able to tell you about these types of services. If there is not a specific organisation to support you in this way, a local home care agency may be willing to help and will also provide a back-up service if your own care staff is temporarily unavailable for any reason.
Maximising your income
We have already looked at both subsidies from Social Services towards the cost of care to support you at home and direct payments. There are also entitlements to some benefits which may assist you either to pay for local authority-provided care, or to purchase your own care. Very many people, particularly the elderly, are not aware of additional income to which they may well be entitled.
This is a government benefit for people aged 60 and over, paid by the Pension Service. Pension Credit is designed primarily to provide a basic minimum income for pensioners on very low incomes – but also includes possible top-up payments for some people who have income from private pensions and savings.
For all couples aged 60 and over, the Pension Credit guarantee is £209.70 per week and £137.35 per week for a single person. For people over 65 with savings or private pensions the possible topped-up amounts are £27.09 a week for a couple and £20.52 for single people. These top-ups are means tested, depending on assessments of current income from savings and investments.
How to find out more
You can find out everything about Pension Credit through The Pension Service website. Go to https://www.gov.uk/government/organisations/pension-service. It gives full details concerning payments qualification, income assessment examples and application procedure. Alternatively, you can call the free Pension Credit line on 0800 99 1234.
Council Tax Benefit
You can get help with Council Tax as follows:
If you are on a low income you may be able to get help to pay your council tax bills.
You can apply for a discount if you are the sole resident of your home or if the only other resident is someone who is a carer. There are some other more complex rules about who can be considered a carer for this purpose, including their level of earnings.
You can get a disability discount if you or anyone in your home is considered to be ‘substantially or permanently disabled’ and if there are specific facilities or space in order to cater for your (or their) needs.
‘Granny flats’ occupied by elderly or disabled relatives are exempt from Council Tax.
Any dwelling occupied only by someone with severe mental impairment is exempt.
Council Tax Benefit can be claimed from the Housing Department of your local authority, who should provide you with the necessary forms. You will also find a Council Tax claim form (NHB1) in the Income Support claim pack referred to above.
There will be a test of your means, which establishes your ‘applicable amount‘ – your income and your ‘eligible rent’. ‘Eligible rent’ will be the rent you pay less deductions for any heating, water charges, or other service items. There is an exception at present for general counselling and support services, such as might be available from a warden in sheltered housing schemes, but the government has reviewed this ‘Supporting People’ money and there is currently an interim funding arrangement in place. Care Directions will keep you updated with further changes as they are
You cannot get housing benefit if you go permanently into a care home. You should certainly note, however, that Housing Benefit is still an important option if you are moving into sheltered or retirement housing. One grey area at present is the applicability of housing benefit to help pay for your accommodation in some assisted living schemes where, although you live in your own flat or bungalow, care and meals are provided. There are also some other exclusions – which will be explained to you by Social Services.
Housing Benefit can be claimed from the Housing Department of your local authority, who should provide you with a claim form.
Deprivation of Assets
Note: If you are found to be ‘depriving’ yourself of capital by, for example, giving away assets in order to obtain benefit or increase benefit, you will be treated as still having the capital in question.
This is a key non means-tested benefit for older people who are infirm and need help with personal care. Your eligibility for the allowance is not dependent on your financial circumstances but on your ability to care for yourself and the extent to which you need assistance. It is a particularly important benefit because, once you receive it, you may well be entitled to other help, such as with the cost of Council Tax. The allowance is paid at two levels:
£49.30 per week is paid if you need care during the day or night
£73.60 per week if you need care during both day and night
You have to be 65 or over to be eligible (although those under 65 can claim Disability Living Allowance). You have to be resident in the UK (and not an immigrant subject to any limitation or condition). You will also have to be so severely physically or mentally disabled for at least the last six months, that you require either:
Frequent attention throughout the day in connection with your bodily functions, or continual supervision throughout the day to avoid substantial danger to yourself or others.OR
Prolonged or repeated attention at night in connection with your bodily functions, or another person to be awake at night for a prolonged period or at frequent intervals to watch over you.
If either one of these conditions apply to you, you will be able to claim the lower level of allowance. If both the above are applicable, you would be eligible for the higher rate of allowance. If you are terminally ill you should automatically qualify for the higher rate of Attendance Allowance, without having to wait for the six-months lead-in period.
The term ‘bodily functions’ is perhaps misleading and off putting. In this context it is taken to mean breathing, hearing, seeing, eating, drinking, walking, sitting, sleeping, getting in and out of bed, dressing, undressing, using the toilet and moving around.
Attendance Allowance should be claimed from the local Disability Benefits Centre by telephoning 0800 882200. They will send you a pack with a claim form. It has to be said that the form is long and complex and you may well be advised to seek some help in completing it. Your GP will need to verify certain sections of the form and will generally be very useful to consult concerning your application. Remember to state clearly those aspects of caring for yourself with which you need help, not just those with which you already receive help. It is probably a good idea to think through a normal day and to identify those tasks you have difficulty with, or need support to accomplish.
If your initial application is rejected, do not be deterred. If you think the decision is wrong, or your situation has worsened, write to the Benefits Agency restating your case. The decision will be reviewed in most cases. Be persistent, Attendance Allowance can often make all the difference if you are determined to continue living relatively independently.
It should also be noted that Attendance Allowance is not affected if you have to move into a nursing or care home and can, indeed, be a crucial element of the funding you may need to live in the accommodation you prefer.
Disability Living Allowance
This applies only to disabled people making a claim, before the age of 65. Disability Living Allowance is in two parts the mobility component and the care component. You may be able to get just one component, or both, depending on the severity of your disability.
You cannot make a first claim for DLA once you reach the age of 65 (Attendance Allowance would then apply). If,however, you made the DLA claim before that age and are receiving the benefits, they will continue after the age of 65. This is particularly important with regard to Mobility Allowance, since that is not available unless you claim DLA.
You can claim Disability Living Allowance from the Benefits Agency on form SDA1. DLA is non-taxable and does not count as income for means-tested benefits. DLA application can also entitle a claimant to premiums of means-tested benefits.
If you are terminally ill, you automatically qualify for the higher rate of Attendance Allowance or Disability Living Allowance and do not have to satisfy any waiting time qualifications. Your doctor will have to support your claim by completing a form DS1500.
Winter Fuel Payments
Winter Fuel payment varies betweem £100 tp £300 depending upon age and circumstances.
Almost all trades or professional associations have welfare funds. If you (or your wife or husband in some cases) have worked in these fields you may be able to get either specific one-off grants or regular small payments. The Forces too have welfare funds and, even though you may only have served for a short time, you may well be eligible for some help. There are also some more general voluntary organisations which are able to offer financial help to older people in need – such as the Royal United Kingdom Beneficent Association (RUKBA) and the Universal Beneficent Society, which offers survival income for the elderly at home. They can both be contacted on the same telephone number: 020 7605 4200.
Counsel and Care for the Elderly offers good advice on possible sources of voluntary funding and may also be able to help you with planning how to pay for care. Their telephone number is 0845 300 7585 and their line is open on weekdays between 10.30am and 4pm.
Using your home to pay for care
If your choice is to stay in your own home you will not, of course, be in a position to sell your home outright to pay for the services you need. However your home may still be a very useful source of additional income:
Our section on Financial Planning makes suggestions for various options for releasing equity, or part of the capital value, from your home. Known as Equity Release Plans or Home Income Plans, these include Remortgage Annuities and Reversion Sales.
NHFA is an extremely knowledgeable specialist in all forms of funding, both for care homes and, despite the name, for the support you may need in your own home. The NHFA has a nationwide team of specialist financial advisers who will visit and provide personal advice. This might include advice on welfare benefits or on specific fees’ plans to cover the costs of care. The service is particularly useful if you are unhappy with your local authority’s assessment of your needs. The NHFA adviser will be able to review the assessment and might be willing to intercede with the local authority on your behalf.
There are also more direct ways of ensuring that your home itself contributes to the care funding you may need. For example, using a Live-in care service scheme may provide you with the type of help you need at a cost which reflects your providing accommodation as part of the arrangement. A Homeshare arrangement can realise some free care, support and companionship in exchange for accommodation.
Do you, like many older people, live in a house which is now far larger than you really need? An option may be to turn the house into two self-contained flats. The rental income on one flat will provide, or contribute to, the funding for any assistance you need. If there is a Home Improvement Agency in your area they might well be able to help you identify reputable builders and be prepared to oversee the work for you in return for a small fee. A trusted friend or relative might also be asked to help and advise.
If you decide to establish a rentable property you must ensure that you get advice from a solicitor, to draw up a suitable shorthold tenancy agreement. You should also seek help and advice on advertising for and selecting tenants. A reputable estate agent with a lettings department would be able to assist with this.
The Funding Your Choice section of this site covers all the aspects of State support entitlements in respect of care and home accommodation for those having limited capital assets.
If, however, you have savings or investments over £23,250 (excluding a property) you will be expected to pay for all of your care needs at home – or all of the costs of residence in a care home. There are some circumstances where the value of a former home must be ignored for the purposes of a capital ‘means test’ – such as a spouse or partner continuing to live in the property. Whatever the case, the local authority must disregard the property for 12 weeks from the start of care home admission.
The bitter pill to swallow
This may come as a bitter pill to swallow for those who have paid national insurance contributions throughout their working lives and have sensibly built financial assets for themselves and, subsequently, their families to enjoy.
Unfortunately, with today’s cost of private care services and care home accommodation, the notion of wealth cascading down the generations can be but a pipe dream! Indeed, many children may find themselves funding their ageing parents, rather than inheriting anything from them!
It’s a sobering thought that with care home costs amounting to as much as £33,000 a year, the value of a £100,000 property could be wiped out as a cherished family asset in little more than three years. Even if cheaper home accommodation is found, it should not be forgotten that, with today’s advances in medical science, our ageing population is living longer and longer. Many years of care may have to be funded.
It is some solace that ‘nursing care’ is now provided free but there are still serious concerns about the definition of ‘nursing care’ and about how this works out in practice. If, for example, a qualified nurse undertakes a task it is free. If a care assistant provides that same help, it is charged!
Tens of thousands of people are still forced to sell their homes each year to meet the costs of accommodation and personal care – unless other ways can be found to fund the services needed.
The government’s provision for local authorities to ‘lend’ the care costs to individuals may be one solution to the funding of preferred care services. However, the net result of such a ‘mortgage’ arrangement will still be the loss of the major part of an inheritance, when the lent amount is recouped from the eventual Estate proceeds.
Whichever way you look at it leaving a legacy may indeed be a thing of the past for many people.
Prudent forward planning
However, the financial impact of long term care can be softened by prudent financial planning before the need arises. Firstly, there are ways for your family to ‘ring-fence’ cherished assets completely. Alternatively, you could create an income flow which will allow you to afford the choice of care and home accommodation that you prefer, for as long as it’s needed.
Unless you are fortunate enough to have sufficient independent wealth to generate substantial investment income, it will pay you to look at the options of Long Term Care Insurance and Home Equity Release Plans, as described in this site.
We would suggest that, whichever option you consider, objective, professional advice is obtained. Age Concern, for example, can provide excellent information on these topics.
Lasting power of attorney
An important financial issue which may affect many elderly people and their families is the matter of lasting power of attorney.
Power of attorney itself is the formal legal instrument of appointment necessary for somebody to look after the financial affairs of another – when, for example, that person may be living abroad. Lasting power of attorney (LPA) is special, in that it remains valid after somebody has become mentally incapable of managing their own affairs. A LPA legal document can be produced only when an elderly person (the donor) is in sound mind and still capable of making decisions about the future. A prescribed form of document can be obtained from legal stationers – or a tailored document can be drawn up by a solicitor or other professional advisor.
The donor then appoints one or more people (attorneys) to manage their financial affairs and property, either now or at a future date. It is worth noting that a LPA can normally be used as soon as the document is completed. If it is intended that the power should not be used until after the donor becomes mentally incapable of managing their affairs, an appropriate restriction should be included in the document.
You should also be aware that an Attorney can have wide, unrestricted powers to run somebody’s affairs – so, as a precaution against possible misuse of Power, consideration should be given to appointing more than one attorney.
When there is reason to believe that the donor is becoming mentally incapable of managing his or her own financial affairs, the attorney(s) must apply to register the LPA with the Public Guardianship Office.
For further details about the Public Guardianship Office telephone 0845 3302963, or visit www.guardianship.gov.uk
Many children and relatives are mistaken in thinking that they will automatically be given LPA power of attorney when the parent in question is considered incapable of making decisions. In fact, if a LPA instrument is not in place those relatives would become a ‘receiver’ – overseen by the Court of Protection and its agency, the Public Trust Office.
The Court’s strict function and duty is to protect and manage the property and financial affairs of persons who are unable themselves to assume such responsibility. The process of being accepted as a receiver can be long, complicated and upsetting – even for children of an affected parent. Dealing with the Court can prove time consuming and endlessly bureaucratic.
The lesson is, that the process of a lasting power of attorney application should be started with a solicitor well before there is an apparent need for it.
Long Term Care Insurance
Long Term Care Insurance (LTC) is specifically designed to protect you against the substantial open-ended costs of long term nursing home accommodation, or health and disability-related services you may need to stay living at home. With nursing home fees usually around £400 a week and care at home costs variable, but £300 per week or more is not unusual for a high level of care – the potential burden is considerable. It is, of course, extremely unlikely that any private health insurance policy held would cover such requirements.
Like private medical insurance, the cost of LTC cover will be determined by the area in which you live and the cost of care locally. Policies can be arranged to suit different cover requirements e.g. to a fixed number of years, or to set payment amounts.
The most popular plans are of the regular monthly contribution kind, where payment will only kick in when you come to need nursing care.
Premiums vary depending upon personal circumstances, together with the level of benefits to be provided. Average premiums to cover a £13,000 a year benefit would be approximately £70 per month for a male at age 60 and £130 per month at age 75. With their greater life expectancy and longer need for care, female premiums will be higher than those quoted.
Alternatively, you could opt for an immediate care plan – where a one-off payment in the range of £60,000 to £90,000 might be made, to buy an annual income of £20,000. You will, of course, be ‘gambling’ your life longevity against the amount paid out – and may not live to see a full ‘return’ on your capital.
Whatever LTC plan you choose, policy payment will typically be made when the insured person can no longer perform two or three of the following daily living tasks, without the aid of a third party:
- washing and bathing
- food preparation
- use of toilet
- movement from bed to chair or wheelchair
- mobility from room to room
The drawback of Long Term Care Insurance for many people can be the cost of monthly premiums – especially if the policy is taken out well before it might be needed. It is with these circumstances in mind that family members often ‘club together’ to afford the premiums – in the knowledge that they are guarding cherished assets for family generations.
If Long Term Care Insurance is not for you, an alternative, preferable care funding method may well be an Equity Release Plan. It’s important to read all the conditions of Long Term Care Insurance very carefully before proceeding.
Another method of protecting the value of a property from being wiped out by care home fees is to set up a trust arrangement.
People cannot be ejected from their home to pay for the care fees of their partner. However, if one partner dies and the surviving partner needs to go into care, all their assets and property could be used for payment – until only £10,000 remains!
To avoid this situation, you can draw up a will which incorporates a property trust. Within this will, each partner leaves their half of the house in trust for the children or other nominated beneficiary. That half cannot be claimed, however, until the surviving partner dies.
Although the surviving partner would have full use of the trust half of the property, he or she would not own it and the local authority could not claim it for care cost fees.
Find An IFA
Whichever funding options may appeal to you, we would strongly recommend your taking legal and financial advice, before making any decision or commitment. A financial adviser will be able to present all the options and considerations pertinent to your complete financial circumstances – now and into the future. As well as income needs, this advice should cover attendant topics such as taxation and inheritance tax planning.
Only an Independent Financial Adviser (IFA) will be able to give you totally unbiased, expert advice – as he or she will not be ‘tied’ to any particular product or service. It will mean that you will have access to the widest range of financial products applicable to your circumstances and the fullest appraisal of those products’ performances.
Indeed, IFAs are bound by law to recommend the product most suited to their clients’ personal requirements – based on factors such as past performance, charges, flexibility, service and financial security.
IFAs will work on either a fee or commission basis. Make sure you understand exactly how your adviser is to be remunerated for the work done for you – by charging you an agreed fee, or by taking a commission from any insurance-based product sold to you.
Although there are thousands of IFAs in the UK, relatively few will specialise in such areas as long term care, Inheritance Tax planning, home equity release plans and retirement/pension income.
About Care Directions
Care options: knowing your rights, exercising your choice.
The majority of the population, both older and younger people, are able to lead healthy, active lives. However, for many people there comes a time when, either for themselves or for someone close to them, there is a critical need to know what is available in the way of care or living support and how it can be accessed – for short or long term needs.
In this situation people are often faced with very little choice. Often, they are told that a care home is the only option. A home may be an excellent choice for some people but, as this site will show, there are lots of other possibilities and options to think about.
A unique information resource
Finding appropriate care can be a complex and demanding task. You will need to know what rights you have, what range of services is available, how to choose and, not least, how to fund your choice. Many people find themselves overwhelmed at the enormity of the task – at what can be a very difficult time in their lives.
This unique site is designed to give you access to a whole range of essential information, facilities and services which will make your task and your choices easier and, we hope, the outcome more successful.
Expectations of health and care services
If you have had little direct past experience with either Social Services or the Health Service you may well be confused about who provides what, to those in need. Indeed, many people do find it surprising (and irritating) that they cannot find a single point of contact or source for all the services they need.
In England, Wales and Scotland there is a clear division between health services provision (the responsibility of the NHS) and social care services provision (the responsibility of local authorities’ social services departments). In many areas health authorities (Primary Care Trusts) and local authority Social Services departments are beginning to work more closely together – but this is not happening everywhere yet.
In Northern Ireland there are already Health and Social Care Boards, although you may still find that you have to deal with two departments.
A very general rule relating to services provided by the State is that health services are likely to be free, whereas there is likely to be a charge for other services which are regarded as ‘social care’.
Another source of confusion is the unequal distribution of services nationally. Because there is a large degree of local autonomy, services which are available in some areas will not be available in others. This applies to both health care and social care and, because boundaries have got to be drawn somewhere, the side of the street you live can sometimes determine whether or not you have access to a particular service! (This is sometimes called ‘the postcode lottery’.)
NB. We should also point out that, whilst most of the guidance information contained in this site is applicable to all parts of the United Kingdom, there will be regional variations in the legislature of Northern Ireland, Scotland and Wales. Scottish readers will find the Alzheimers Scotland web site to be extremely useful reference to that country’s particular welfare, benefits and legal technicalities. Go to alzscot.org.
Caredirections.co.uk has been created by people coming from different ends of the Care spectrum: a team of leading professionals highly experienced in the provision of services; together with people who have had to find their way through the maze of facilities available. Caredirections is an entirely independent entity, with no affiliation or association with any service provider.
Whilst this site will provide general ‘best explanation, advice and guidance’ Caredirections cannot be responsible for particular circumstances and conditions. We may help by pointing you in the direction of people or organisations which may be able to provide individual advice – but we would also strongly advise consultation with the relevant medical practitioners, social workers, financial advisors or legal representatives, as may be appropriate.
Although we can assist by providing you with advice on how to choose and what to look for, we have not inspected any facilities ourselves. We are not, therefore, in a position to recommend any particular service amongst those listed.