Daisy McAndrew and Annabel James explore what is good care – whether at home or in a care home – for elderly parents and relatives. Their guest is Stephen Burke, policy maker, campaigner and founder of the Good Care Guide.
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We’re all consumers of care, and people should comment in the same way they do about other things.
Starting the conversation about more care
It is crucial to talk with the individual to find out if they think life could be made easier by getting some initial support in, from help with cleaning and shopping and washing through to full home care, whether it’s help with personal hygiene, toileting, washing and showering, getting up in the morning, going to bed. One of the key things for a lot of people is to continue to eat well, so preparation of meals.
When is a carer home help?
There’s a stigma with the word carer and it means different things to different people. It can be a member of the family, or it can be someone who’s paid to do that. Calling that person a bit of help is a way of describing it, especially early on.
A Local Authority Care Assessment
Everyone, regardless of their income and assets, is entitled to have an assessment of their needs by the local authority Adult Social Services. If you’re looking after your mum or dad, then the local authority should assess your needs too and provide you with advice and information on services that are available.
Most local authorities have tight eligibility criteria as to who will be eligible for a service via the local authority, and whether the council will pay for it.
Most people will end up paying for their own care. If you have assets over £23,250 there is not going to be any help from the local council, apart from some advice and information and that free assessment. It is still worth having an assessment because it will help you understand what the needs are and how they can be met.
Where to live – critical for future care needs
One of the key things is about planning ahead and getting people to think about what’s life going to be like when I’m in my late 70s, 80s, 90s, and what can I do to ensure that I continue to be able to do the things I want to do as an older person? Housing is probably the first thing everyone needs to think about. Are you living in the right place? Does it provide any support?
How to help a parent or relative be discharged from hospital
No-one should be discharged from a hospital without a proper discharge plan. Every hospital will have someone responsible for managing discharge with the team and making sure a plan is put in place. Relatives have an important role to make sure that their relative doesn’t leave until services and support are put in place.
You should be able to get up to six weeks’ free rehabilitation and the equipment you need: a wheelchair, a walker, or you might need a stick or handrails. Some people have rehab in in the residential care or respite care setting, and others will be in their own home.
When and how to choose a care home
The best homes are places where people actually thrive.
The key is spending time at a home you’re thinking about. We spend more time choosing a car or a new house than we do finding a care home, because it’s difficult, we’re not quite sure what to ask. Have a meal at the home, see what the activities are, meet other residents, listen to what other people are saying about the care home, speak to family members of other residents, to the residents and the staff.
We’ve seen from the Care Quality Commission that even their chief inspector doesn’t think their reports are worth very much. They are the main thing that a lot of people go on in the same way that people rely on Ofsted reports about schools.
It’s about communication between the individual and the family, with those who are providing care, and the managers. And that’s normally where a problem arises. So keep talking with the staff.
Ultimately, the quality of care is dependent on the staff. You need to find out how long they’ve been working there, what their experience is, so ideally, you’ll find a care home where there is a very low turnover of staff, so there’s more consistency in care and quality. But unlike childcare there isn’t a legal ratio in a care home. So you need care homes that seem to have a good level of staffing, and that’s for you to assess.
A number of care homes suggest a couple of weeks doing respite care to see what it’s like to give your relative that experience of that particular home to put their toe in the water.
Some care homes allow residents to take cas and/or dogs into care homes but they’re relatively few and far between.
The cost of a care home
There are a lot of care homes that charge between £1000 and £2000, but quite a few top end care homes which charge well over £2000 a week. This is another reason for planning ahead.
You either pay for it out of your existing resources, whether it’s selling your home, or from savings and pension. There are some financial tools to enable you to buy what’s called an immediate needs annuity – for which you need a financial advisor.
If your own personal money’s run out and you’ve sold the house and you’ve got no assets the local authority will have to pay for your care. The question is, where will they pay for your care? They might expect you to move or you can stay but you’ll have to top up what they pay the care home, from the resident or from the family.
Tips to choosing home care
With home care you’re going to have people on different shifts so you are going to have different people coming into the home. This is why care services sometimes are best provided very locally. So it may be someone already living and working in the area who can visit regularly.
Home care agencies are using good technology to keep in touch with families. It provides some reassurance, one, that there has been a visit, but two, also that there may be particular issues to be followed up.
Ask other people, use the advice and information services that are available, either through the local authority or through organisations like Age UK, use websites like Age Space. But there’s nothing like speaking to other families that have gone through similar situations.
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