“With nearly a quarter of the UK’s population expected to be over 65 within 20 years, the dilemma of who should pay for the care of the elderly is a pressing issue for government. Dame Joan Bakewell has been exploring how we are facing up to old age.”

Click this link to go to the BBC to watch the video – Elderly Home Care Video from Panorama

With visiting care in many parts of England now costing £20 an hour during the week and £24 an hour at the weekend (and often up to £30 on Bank Holidays and at Christmas, New Year and Easter), then if a client is receiving an average of just 4.5 hours a day visiting care for 7 days a week, then the total weekly cost (£666 a week) is likely to be on a par with what they would typically be expected to pay for 24 hour live-in care.

If either you personally or a close relative is already receiving an average of 4 hours or more per day of visiting care, then you might like to consider the benefits of switching to 24 hour live-in care. The advantages of live-in care are many and varied and some of them are outlined below.

Support & Companionship

With a visiting care service, there is often a high turnover of care staff and a succession of regularly changing faces can be confusing for the person being looked after. By its very nature a live-in care service provides greater continuity of care and a good live-in carer will quickly gain an understanding of the person they are looking after and will be sensitive to their feelings and moods.

They will learn what to say and do to cheer them up if they are feeling low, but just as important, they will develop a sense of when they want company and when they want to be on their own for a time. A good carer will come to be valued as much for their companionship as for their care skills and many will find themselves treated almost like a member of the family.

Help with Personal Needs

Where an older person is suffering from painful arthritis or has other mobility problems, their carer will be able to help with their personal needs, such as dressing, washing and going to the toilet. A good carer will know how to offer their support in a sensitive and unobtrusive way, in order to preserve as far as possible the privacy and dignity of the person they are caring for.
Furthermore, in contrast to a visiting care service, where assistance is available at set times of the day, a live-in carer is 24 hours a day and can provide help and support as soon as it is needed.

Shopping & Cooking

As part of the care needs assessment which takes place before the start of a live-in care service, a person receiving care at home will be asked in detail about their likes and dislikes in terms of main meals, snacks and hot and cold drinks. Unless the family has made other arrangements, it will normally be the carer who does the shopping and buys in fresh food and then cooks it in the way the client likes it. If they are provided with meals they have chosen themselves and able to eat at a time which suits them, most older people will enjoy their food more and will tend to eat better than if presented with pre-prepared meals at set times by a visiting carer.

House-Keeping

A live-in carer will keep the house clean and tidy, clear up any accidents or spillages and make sure that food stored in the fridge or larder is not kept longer than it should be. A clean and tidy house is more pleasant for the person being cared for and more welcoming for family and friends who visit or come to stay.

Social Contact

When an older person still lives in their own home, it is much easier for family, friends and neighbours to drop in, even for a few minutes, than if they have moved into a care home, where visiting times are restricted and quiet facilities limited. Moreover, visiting someone in their own home is a much more pleasant experience for family and friends than visiting them in a care home, where there is little privacy and where they are just one patient among many.

Wherever practicable carers will encourage the person they are caring for to invite round and entertain family, friends and neighbours on a regular basis. The carer will help them plan and prepare morning coffee or afternoon tea and will then melt into the background, so that the client can enjoy their traditional role as host. In contrast, offering help with entertaining is not a service that visiting care agencies can reasonably offer their clients.

Health & Medication

Once an elderly person who has previously lived on their own starts receiving 24 hour live-in care, their health as well as their quality of life will generally start to improve. They will tend to feel happier and more secure, they will generally eat better and, with their carer’s assistance, they may take more exercise; even more significantly, they will start to take their medication more regularly, something which may fall by the wayside if calls are missed by a visiting care provider.

Protection from Accident or Harm

With the support of a 24 hour carer at their side to help them if need be with the more demanding physical tasks in life (getting dressed, bathing and/or showering, moving about the house, night-time visits to the toilet etc), people receiving care at home are less likely to suffer falls or other accidents and are also less vulnerable to burglars or intruders. They will feel safer, more relaxed, more confident and, in all likelihood, happier in themselves. Furthermore, the knowledge that an ageing parent, who was previously struggling to cope with living on their own, is at less risk of accident or harm can be a huge relief to their children, who may live too far away to be regularly on hand.

Trips and Outings

Where appropriate carers can be provided who drive and this will enable the person receiving care to go on trips and outings. They may want to attend church or be driven to see family and friends or visit a local beauty spot. Such outings can be important in helping maintain contact with the outside world and keep their spirits up. In contrast, time does not normally permit a visiting care service to take their clients on trips and outings.

Switching from Visiting Care to Live-In Care

Very few visiting care agencies offer live-in care, so if you are thinking of switching to live-in care, make sure you talk to a specialist provider of live-in care.

Care At Home are specialist providers of 24 hour care and operate across London, the South East and the Midlands. If you would like to explore the possibility of switching to live-in care, then please give us a call and ask us to arrange a free Care Needs Assessment Visit. You will then receive a visit from Diane Bowyer, our Nurse Risk Assessor or Sarah Vincent, our Care Manager, who will be able to advise you on the level of care required and the likely cost.

There are 27 standards which care providers must adhere to in designing, implementing and monitoring the care services they offer. The regulations go into great detail about all aspects of both the provision and management of care services and they leave any would-be provider in no doubt as to the level of professionalism, commitment and dedication required to meet the standards.

However, one glaring anomaly is that, although all organisations providing care services to the elderly are officially bound by the regulations, agencies which supply self-employed carers are exempt from a large number of these same regulations!

If the exemptions related to minor and peripheral aspects of care, this would perhaps be understandable, but the alarming fact is that agencies supplying self-employed carers are allowed to ignore a large number of core regulations which have been specifically designed to ensure the safety and welfare of the very people they are supposed to be looking after.

Historically a lot of care services for the elderly have been provided by local authorities and, even though a lot of their work has now been delegated to private care companies, local authorities still insist that all outsourced care services have to be provided by agencies which employ their carers directly, rather than by those which supply self-employed carers. There is a good reason for local authorities to insist on this and that is, quite simply, that, they do not believe they can trust agencies supplying self-employed carers to provide a professional and reliable care service.

The list of regulations which care agencies supplying self-employed carers can ignore includes a number of key standards which are fundamental to the welfare and safety of vulnerable older people. In particular they are NOT REQUIRED to:-

? Provide clients with a written contract.
? Draw up a personalised care plan for each client.
? Provide a consistent, continuous and reliable care service.
? Draw up and implement policies & procedures in relation to health and safety and medication.
? Carry out any risk assessments.
? Draw up and implement policies and procedures in relation to clients’ money and possessions and in relation to safety and security in clients’ homes.
? Provide a comprehensive daily record of care provided or even of any significant incidents.
? Provide carers with detailed job descriptions.
? Provide carers with any formal training.

Conclusion

Many agencies advertising 24 hour live-in services merely act as introducers of self employed carers, over whose work they have very little control. The agency may make an effort to find suitable carers, but it has no responsibility to train or supervise them or monitor their work. Indeed, in most cases the client will pay the carer directly and pay a separate agency fee on top. These agency fees can be quite substantial and many clients and their families may be left wondering exactly what the agency really does to justify its fees.

If you want to be sure of receiving a professional care service from properly trained carers, then you should engage a care provider which employs its carers directly. Before the service starts, you will receive a visit from an experienced nurse/care assessor who will assess your care needs, consider any risks involved and draw up a detailed care plan. The care will then be delivered in accordance with the plan by a small and settled team of qualified and experienced carers, whose work will be regularly monitored and appraised.

It may cost slightly more to use an agency which employs its carers directly, but it is the only sure way of guaranteeing a professional and reliable service. Not only will this enhance the quality of life of the person being cared for, it will also provide their family and friends with far greater peace of mind.

NHS continuing healthcare means a package of care that is arranged and funded by the NHS and is free of charge to the person receiving the care, be it in a care home or in their own home and is usually referred to as “fully funded NHS care”.

As one in three women in Britain, and one in five men, will eventually need long term care, the funding of such care is an issue that is likely to touch most people’s lives in one way or another. So over the last few years, the Government has attempted to make clear in law the type of healthcare needs that qualify for NHS continuing healthcare.

A national framework has been developed to provide guidance to the NHS about this and to try to ensure that consistent decisions are made across the country.

NHS continuing healthcare assessments

Primary care trusts (who manage local health services) are required to carry out an assessment for NHS continuing healthcare where health services might be needed for elderly home care.

The assessment should be carried out for Continuing Care when a patient is discharged from hospital before referring the person to social services for help with social care needs. Also, an assessment should be requested if the physical or mental health of the person you are looking after deteriorates significantly. Some people who need an urgent decision, such as those who are terminally ill, should be fast-tracked to receive NHS continuing healthcare immediately.

Where is NHS continuing healthcare offered?

NHS continuing healthcare can be provided by the NHS in any setting, which includes a care home, hospice, hospital or the home of the person being looked after. Where NHS continuing care is provided in the home of the person being looked after, it will cover personal care and healthcare costs.

Responsibilities of social services

If NHS continuing healthcare is provided for care in the home, then the local social services may still have responsibilities to provide some services in addition to the home care. It is possible to receive ‘mixed’ packages of care, where some services come from the NHS and some from social services. Where local social services provides the care services, it will usually do a financial assessment to decide whether the person you look after must make any financial contribution.

The NHS team will consider each of the healthcare needs of the person looking for continuing care funding, which are:

- behaviour,
- cognition (understanding),
- communication,
- psychological/emotional needs,
- mobility,
- nutrition (food and drink),
- continence,
- skin (including wounds and ulcers),
- breathing,
- symptom control through drug therapies and medication, and
- altered states of consciousness.

An example of the type of care that might warrant continuing care funding is “Fred has been diagnosed with Alzheimer’s disease. His Alzheimer’s has reached an advanced stage and because he lives at home he needs assistance with all of his personal care tasks. In particular Fred needs help with his washing and eating and he also has both bowel and urinary incontinence, and needs constant supervision to ensure his safety.”

The value of Continuing Care may exceed £1,000 per week, but You do not receive the cash directly yourself, but instead the NHS spends it on your behalf in accordance with the needs and aims stated within a Care Needs Assessment. The health authority (Primary Care Trusts in England, Health Boards in Scotland and Wales) are obliged to take the wishes of the client into account though. So if you want, for example, to have a live-in carer provide you with the care you need at home you should make this clear to the NHS, as early as possible during the care needs review.

If you want to continue this discussion you will find the sam esubjuect on our forum here – NHS Continuing care funding for the elderly.

The preconception is that dementia only affects the elderly but research shows this not to be the case. According to the Alzheimer’s Society website there are over 11,500 under 65 year olds in the UK who also suffer from this.

Dementia is a disease of the brain. When someone has dementia their brain cells die faster than they normally would.

Dementia is not curable and memory loss and confusion are often the first symptoms. It may be useful to keep a diary with keys dates in for the sufferer to refer to if necessary. Gradually over time sufferers may also lose the ability to do tasks they would normally carry out without hesitation. Tasks such as washing, eating and toileting can be become increasingly difficult as the symptoms progress.

Caring for someone with dementia can be very difficult as sufferers may feel vulnerable and require a great deal of reassurance and support. It is essential that sufferers remain as fit and healthy as is possible. A nutritional diet will help the sufferer to feel happier.

There are many different types of dementia with Alzheimers being the most common. Symptoms vary depending on the type of dementia.

This is the question we at Care at Home recently asked ourselves and, as a result decided to launch a new 5-day week live in care service. So effectively providing part-time live in care for only 5 days a week.

We receive many calls from people looking for visiting care, where really and truely in a number of cases they may need full-time live in care. However, the cost of full-time live in care is sometimes cost prohibitive when the weekly start cost is £650 per week. However, our new 5-day week part-time service starts at £500 per week, which represents a 23% saving.

Visiting care could cost around £420 per week for three 1-hour visits per day, where this is for 7-days a week at a charge of around £20 an hour. The total charge would obviously be less if the visits were less than 1-hour each time, but could equally be more if say 4 daily visits were required.

The types of care where visiting care is perhaps more questionable is where the person has either Alzheimers or Dementia. A person might receive a visit at say 8:30am and not be re-visited until around mid-day. This means that the person is left on their own for long periods of time and being that they are forgetful and have a tendency to wonder there is a problem. In some cases the person is locked in their own home, which effectively becomes a prison. Being locked in their own home could become a real hazard, if a fire were to break out, for example. In these circumstances we believe that live-in care would be the preferred and safer choice.

Visiting care is fine, so long as the person being cared for is “Safe” to be left alone for long periods of time. However, it is important to note that the elderly are prone to falling and it only takes one fall at a time when they are alone to be a problem. This is not to say that visiting care is not good, it has it’s place, but when any relative is looking for care for an elderly loved one, it needs to be thought through very carefully.

The part-time live in care service would mean that the family will have to look after their elderly relative over the weekends, but it does mean that during the week they can still go to work in the knowledge that their loved one is being looked after and at a price which is more affordable.

We are hoping that with a reduced price for a 5-day week instead of the full 7-day week package, combined with the possibility of obtaining government help towards the payments by way of direct payment, our new service will be well received.

For more details visit our main site and contacts us for a free no obligation care plan and quote

A questionnaire of staff from the Commission for Social Care Inspection (CSCI) also raised worries that residents are at greater risk.

The questionnaire was organised by BBC Radio 4’s Today programme.

A CSCI spokesman said that the organisation was taking more action against poor providers than before.

The spokesman added that the watchdog, which oversees 18,500 care homes in England, believed that services were improving.

“To be honest, I would not leave my dog in 90% of our care homes” Anonymous respondent

An anonymous questionnaire was distributed to more than half of CSCI’s employees via unions Unison, the Royal College of Nursing and Prospect.

In all, 30% were returned and more than 200 inspectors took part.

Some replies did not pull any punches.

“To be honest, I would not leave my dog in 90% of our care homes,” one inspector wrote.

Another respondent said: “I do feel CSCI is trying to get it right in terms of making the best use of available resources but given the reduced budgets and political agenda, it seems inevitable the system of inspections will become more arbitrary and less responsive to the needs of those who live in care homes.”

‘Less protected’

The BBC sent out the questionnaire after receiving concerns from a small number of inspectors. One contact told reporter Jon Manel:

“Homes aren’t inspected as frequently as they were before. We rely a lot on information given to us by the providers of a service to say how good that service is. When we actually go out to visit the homes they are completely different to what the proprietors have actually told us in their feedback to us.”

The contact added that at one time, all homes would be inspected a minimum of twice a year.

“That’s now changed and we’ll be inspecting homes anything from what could be a weekly or monthly process for very poor homes right up to a maximum of one inspection in three years.

“Services can change – even excellent services have been seen to go down to poor in the last year.”

Care homes now also carry out self-assessments.

Complaints raised by families about homes are no longer looked into by the watchdog. Instead, the complaint is passed to the care home owner or the local authority which funds the individual.

The CSCI says the new system helps the organisation focus on improving the performance of below-standard homes.

The questionnaire suggested inspectors were not doing enough inspecting

‘Huge pressure’

The BBC was also told that an inspector had been forced by a CSCI manager to change the outcome of an inspection.

The contact said: “For me the issue was the care is poor and if it is poor, we need to say it is.

“However the pressure I was under was huge and so against my own judgement, I made the rating adequate.”

The contact said that a poor-performing home required a lot of extra work. The contact said:

“As soon as a poor home comes on the radar, then an inspector’s time and a manager’s time is focused on that home.

“Managers don’t want that but inspectors do because that’s what we’re there for.”

Another questionnaire respondent said care homes were now effectively policing themselves.

“All people using care services regulated by CSCI are in effect less protected than previously because we are inspecting them less on the basis care services will police themselves.”

“The home was poor throughout and needed enforcement action to be taken but the regulation manager did not want this to happen – too many poor homes this year” Anonymous inspector

‘Improving services’

A CSCI spokesperson said that the organisation had consulted widely and received widespread support for the way it was carrying out inspections.

“Our new way of inspecting allows us to be much tougher with poorer providers than before.

“The evidence is clear. Services are improving. And we are taking more action against the poorest providers than ever before.

“Our new quality ratings for all providers will also give them a further incentive to improve. With better information people are likely to choose the best services, which will thrive.

“The poorest services will face closure by us unless they improve.”

News reported by BBC

Dementia is a term commonly used to describe various different brain disorders that have one thing in common – a loss of brain function which is usually progressive and eventually severe, leaving the person severely disabled and in most situations extremely frustrated.

The term ‘dementia’ is used to describe the symptoms that occur when the brain is affected by conditions, including Alzheimer’s disease, stroke and many other rare conditions.

Symptoms of dementia include problems with speech and understanding, a loss of memory, confusion and can lead to aggressive behaviour. Carers looking after people with Dementia need to have special training in this field and experience is vital.

A link to causes of dimentia (opens in a new window)

It is however, important to note that people with dementia can still be cared for in their own home, as compared to having to be placed in a care home.

The advantage of care at home with respect to dementia and in particular with Alzheimers, is that anyone with this desease very much benefits from having a set routine and familiar surroundings. It is therefore easier to acheive this in their own home.

For more help and advice on this subject and dementia care at home you can email Care at Home or visit Care at Home’s contact page.

A person must be able to give their consent to receiving direct payments and be able to manage them even if they need help to do this on a day-to-day basis.

Who is eligible?

If you already receive social services
Your local council is obliged to offer you the option of direct payments in place of the services you currently receive. There are some limited circumstances where you are not given this choice and your council will be able to tell you about these.

If you’re not receiving social services
To get direct payments you’ll need to contact your local council to ask them to assess your needs. Social services – and therefore direct payments – are normally available if you are:

– disabled and aged 16 or over
– a carer aged 16 or over, including people with parental responsibility for a disabled child
– an older person

If you’ve been refused social services
If your local council has decided that you do not need social care services, it will not offer you direct payments. If you think your needs or circumstances have now changed, ask your local council for a new assessment.

How much do you get?
The amount you receive will depend on the assessment your local council makes of your needs.

How it’s paid
Direct payments are made directly into your bank, building society, Post Office or National Savings account.

If you need someone who cares for you to collect your money, or you are registered blind, payment can be made by sending a cheque which can be cashed at the Post Office.
How to apply for direct payments locally

If you already get services, ask your local authority about direct payments.

If you are applying for services for the first time, your social worker should discuss the direct payments option with you when they assess your care needs.

The following link will let you enter details of where you live and then take you to your local authority website where you can find out more and/or apply online.

Find out more and/or apply for direct payments locally (opens new window)

What you can use direct payments for
The money is for you to use to pay for the services and/or equipment which will meet the needs the local council has assessed you as having.

As a general principle, councils should aim to leave you to choose how best to meet your assessed needs as long as they are satisfied that agreed support arrangements made, are being met.

What you can’t use direct payments for

You cannot use direct payments to:

– pay for permanent residential accommodation – but you may be able to use direct payments to secure occasional short periods in residential accommodation, if your local council agrees that is what is needed
– secure a service from your spouse or civil partner, close relatives or anyone who lives in the same household as you, unless that person is someone who you have specifically recruited to be a live-in employee (other than in exceptional circumstances, which your council may agree with you)

Record keeping
If you receive direct payments, you’ll need to account for the money you spend. Your local council will tell you what records you need to keep and what information you’ll be expected to provide: such as timesheets signed by personal assistants, or receipts for services from agencies.

The council will have to satisfy itself that the needs for which it is giving you direct payments are being met. They should tell you how they will go about this. This may involve a visit to your home.

Carers and direct payments
If you are a carer aged 16 or over, including people with parental responsibility for a disabled child, you may be eligible for direct payments.

However, you cannot use direct payments to buy services for the person you care for. They can only be spent on getting the support you, as a carer, have been assessed as needing.

Direct payments for carers – arranging care and services (caring for someone section)

Effect on other benefits
Direct payments are not a replacement of income and therefore do not affect any other benefits you may be receiving.

What to do if your circumstances change

If your social services needs change
If your needs change, contact your local council as soon as possible so that they can reassess the level of payments you require. It doesn’t matter whether the changes are long- or short-term.

For example, if you don’t need to spend the full amount because your condition improves temporarily, or you go into hospital, they may need to adjust your payments.

If you don’t want to continue with direct payments
If you decide you don’t want to continue, the local council will arrange services instead. If the council decides you cannot manage with direct payments, it might decide to stop making direct payments and provide services instead.

Exctract from Government website click here.

Care at Home – The Home Care Live-in specialists

Care at Home were established in 1990 and have their head office based just outside Saffron Walden in Essex.

Live-in Care works because more and more people are looking to retain their independence and want to maintain a quality of life as well as retain the freedom of their own home. Care at Home employ their carers who are all trained to the highest standard and who have been fully checked with the Criminal Records Bureau (CRB).

Live in care also works well because you are in your own home where things are familiar and you have complete say in what happens – there are no visiting times and if you want to keep your pet, then you can.

In summary Care at Home is key in providing the following:

One-on-One care

The key benefit of live in care in your own home is that you receive one-on-one care, which is unlike the service provided in a care home where one carer might serve several residents at the same time. The service can therefore be absolutely tailored to suit your needs. You are in complete control of your care and it will be your decision as to the time you get up in the morning to the time you go to bed.

Client specific care plan

We prepare a bespoke care plan for you which is tailored to your specific needs and is then used by the carers to carry out your care on a day to day basis. The care plan covers the following areas:

– Details of your family and who visits you regularly and what involvement they will have in your care.
– Details about your home and the access arrangements for visitors including both your family and friends. Also, whether you have any pets living with you.
– Your communication ability and whether or not you have problems with either of your speech or of your hearing. Do you wear a hearing aid and will you need help with fitting it, for example and whether you wear glasses to read.
– Information relating to your existing medical conditions and allergies that you may have and are you on any medication so that we can assist you in making sure that you take any tablets you have been prescribed. Included within in this we make sure we know about your continence so that the carer can cater to your specific needs.
– What personal care do you specifically require, for example how mobile are you and what assistance will you need in getting around your home. Will you need any help with washing and with the cleaning of your teeth and of course at what time do you like to get up in the morning and then go to bed at night.
– You can let us know what are your favourite foods and drinks and of the things you dislike together with any special health needs you might have. We ask things like where do you like to eat you meals and whether or not you require help in cutting your food up.
– We specifically like to know about your mobility so that we can help you, where necessary, to go out of the house on walks around your neighbourhood or if you have a wheel chair our carers can assist you in moving about. You can tells us what you have difficulty with, for example, stairs or uneven floors etc.
– We like to find out specifically what you like to do, for example do you like going for walks, or do you enjoy watching the TV, or perhaps seeing your family and friends.
– Your care plan will also include vital information about your local GP, your district nurse and any other important contacts in case of an emergency or changes to your situation.
Security and comfort

If you decide to use the services of Care at Home you will obviously continue to live in the comfort of your own home. You will continue to be in a familiar and safe environment with the added security of having a carer on hand 24 hours a day seven days a week. You will avoid any unnecessary stress involved with moving and you will continue to live in your known neighbourhood where all your friends that know you live too.

If you would like to chat with a friendly member of our team please either:

Call on 01799 541400
Email: To email click Care at Home
Or visit our website at Care at Home.

We look forward to hearing from you.