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Most of us would rather not think about what we are going to do when we, our
parents and partners are too old and infirm to look after ourselves and care
at home becomes unaffordable. But with almost a quarter of the population
reaching pensionable age by 2032, and the numbers suffering dementia
doubling to 1.4 million by the same year, choosing a care home is something
most of us will have to do.
The biggest headache is where to find reliable information. One of the first
places should be FirstStop, an independent advice service that has been set
up by Counsel and Care, Elderly Accommodation Counsel, Help the Aged and
NHFA Limited.
Once you have decided that you or your relative can no longer safely live at
home, the next call should be to your council. Although your needs will
likely already have been evaluated, they will probably have to be
reassessed. The council will also have a list of care homes in the area, as
will the Government's watchdog, the Commission for Social Care Inspection,
on its website (www.csci.org.uk) with
star ratings.
Care homes that provide nursing cost on average £35,100 a year, according to
the latest report by Laing and Buisson, the health data specialists. For
that price, the residences should be caring and homely, but not all are.
Clare Kirkman, author of How to get Good Care Services, has worked in the
care home industry for 24 years. First, she advises, do not place too much
importance on how the home looks or its star rating, which is only a
snapshot. Managers and staff may have changed since the inspector called.
Ask if you can speak to other families and residents and if the home has a
system for dealing with complaints. If they claim never to have complaints,
they are not being realistic or honest.
Bigger, purpose-built homes may look better, and smaller cosier establishments
more dated, but the latter may spend money on other things, such as outings
or fresh flowers. Toilet odours or residents looking unkempt and slouched in
their chairs, with nursing staff too busy to attend to them, should raise
concerns.
Ideally, Kirkman suggests, you should ask to have lunch or dinner with the
residents. You should inquire about staff training, and if a resident's
physical or mental condition changes, will he or she be cared for
indefinitely there, and the visiting hours, meal times and whether snacks
can be provided, and what outings or activities are put on.
But finding a good home is only half the problem. How to pay for it can also
be a source of anxiety. Most 75-year-olds are reluctant to start saving
towards their nursing-home fees. But although councils will pay the fees of
residents who own less than £13,500 in assets, those with more than £22,250
in property, money and shares (which means most of us) are liable to meet
all the costs of care, less any state benefits to which they are entitled.
The NHS will typically also contribute £103 a week towards nursing costs.
The Government's Green Paper in the spring will put forward a range of
alternative funding models, such as a social insurance scheme. But given the
economic backdrop at the moment, it is unlikely that the Government is going
to offer generous subsidies to those with savings or property.
When it comes to funding, it is best to seek independent financial advice,
says Alex Edmans, care funding adviser at Saga. While a council cannot force
people to sell their homes, even if their assets (including their share of
the home) are worth more than £22,250, they will have to find ways of
raising that cash. However, a council must pay the full fees for the first
12 weeks that people are in care, if their assets, minus the value of their
home, are less than £22,250.
If the family or resident decides not to sell the home, it could be let, but
this is unlikely to meet the fees. Another option, Edmans suggests, is to
apply to the council for a deferred payment scheme, which is an
interest-free loan, whereby the authority pays for the care weekly. This
loan is set against the property and that debt has then to be repaid at a
later date. However, if the family or assets cannot meet that debt, the
property will have to be sold in the future.
One problem now is that many people find they cannot sell their properties
even if they want to and the values of properties are falling rapidly.
Further problems also arise when people have perhaps sold their home and
their assets begin to run out or dip below £22,250. Not only is there
nothing to pass on to the children, but if they are living in an expensive
home, the council may choose to pay the fees only up to a set level and ask
the family to pay the difference.
While the care home is under no obligation to keep a person there at a reduced
rate, many do. However, if no third party can make up the shortfall and the
council is not persuaded that it is crucial to the resident's wellbeing that
he or she remain, it may demand that the resident is moved to a cheaper
home.
So is it worth getting in nursing care at home? It depends how much you need,
says Edmans. If it's a couple of hours a day, then it would be cheaper. But
if it's 24-hour nursing care at an average cost of £13 an hour, it can add
up to as much as £113,000 a year. Going into a nursing home becomes much
cheaper. Agencies will cut a deal, she says, but care at home is usually
more expensive, as you have to feed the carer and pay the running costs of
your own home.
The ideal home?
The memory box outside 84-year-old George Evans's room suggests that he comes
from a large and happy family. There is an ageing black-and-white print of
his brother in sailor's uniform, a photo of a large birthday cake and one of
his family gathered for a recent anniversary.
Memory boxes are placed outside the rooms of all residents at Bupa's Thatcham
Court home, Berkshire - part of a £35 million development programme in
dementia care. They are designed to help orientate residents and personalise
the entrance to their rooms. They also remind staff that the elderly man or
woman behind the door is an individual.
Bupa claims that Thatcham is one of the first homes to be built from scratch
based on the latest thinking on dementia - a condition that affects almost
two thirds of care-home residents. Three other homes are set to open later
this year.What is apparent is the attention to detail. The dining room is
designed to look and feel like an old-fashioned tearoom. Billie Holliday
plays in the background as residents look at the lunch menu. A different
homemade soup is served each day. Poached salmon and pork casserole are
offered today. Lunch and dinner are served but snacks are available between
5.30 and 8.30pm, and a snack basket is available at night. “Some of our
residents wander for hours and can burn up a lot of calories. We encourage
them to pick up a cereal bar,” says Sue Smith, the home's manager.
All this comes at a price: fees at Thatcham are from £800 to £850 a week. This
is in line with other private specialist dementia care homes, but above what
most local councils will usually pay, says the Counsel and Care charity. For
that, residents get a home where everything has been designed to help them
retain as much independence and life quality as possible.
“A dementia home should cry out that it is different,” says Dr Graham Stokes,
head of mental health at Bupa. “Walls should cry out with information.
Handrails need to be in bold colours to attract attention.”
Each room has a flat-screen TV and a bed that can be lowered. That means that
there is no need for cotsides that make people feel hemmed in. Stokes is
most proud of what is absent from the home: the smell of urine. “People with
dementia are not incontinent until the final stages. It is about encouraging
them to use the toilet before they realise it. This captures what we are
trying to do here.”
Rosemary Bennett
Where to get advice
FirstStop advice for older people (firststopcareadvice.org.uk;
0800 3777070)
Counsel and Care (counselandcare.org.uk;
0845 300 7585)
Anchor Trust (www.anchor.org.uk;
020-7759 9100);
Saga (saga.co.uk/ltc;0800 0566101)
Help the Aged (www.helptheaged.org.uk/en-gb/AdviceSupport/;
0808 8006565)
NHFA Care Advice Line (www.nhfa.co.uk;
0800 998833)
Commission for Social Care Inspection (www.csci.org.uk;0845
015 0120)
Age Concern (ageconcern.org.uk;
0800 009966)
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