Who Cares has been launched by the Financial section of the Mail on Sunday to offer advice, help and support to the millions of people in Britain today who are affected by the chronic difficulties of old age, whether they are elderly themselves or helping to care for older relatives and friends.

So many people now find themselves plunged into the confusing world of benefits, entitlements, dementia, care homes and home care. It can be a huge battle for younger relatives and a struggle for anyone since one of the worst aspects of this world is a sense of isolation.

It is hard to know which way to turn.

In a series of articles and blogs, Who Cares will be offering hard facts and straightforward advice to help you find your way through the maelstrom.

We want to create a community that includes you and offers genuine support. This will be a place where you can share your stories and where we will be campaigning to help push all these issues up the agenda..

>>Who Cares wants to hear your questions and concerns, your thoughts and your experiences. You can contact us by posting at the end of any of our articles or blogs, or you can email us direct on whocares@fmwf.com.

For Advice on:

Benefits and Entitlements click here

Home Care click here

Dementia click here

Living and residential care click here

Important Contacts click here

Sarah Whitebloom’s blog click here.

Benefits and Entitlements

Actually managing to get the benefits and other funding to which they are entitled is a major headache for older people and carers.

Very often, they only discover what they should have been getting completely by accident. A quick look at Britain’s complex system of entitlements and you will no longer wonder why there is £5 billion a year in unclaimed benefits for the elderly.

There is actually an extensive range of benefits and entitlements for elderly people and their carers and these come from various agencies – most from national and local government.

Both cash and benefits in kind can be available, if you know where to go.

Available Help

Some cash benefits are based on your physical ability to live independently and can help you get the assistance you want and need. Others are based on your financial resources and are awarded to those on low incomes. Some are a mixture of both.

There is a raft of other grants and benefits that can come from various sources, for everything from a walk-in shower to new glasses. These are often dependent on your financial resources. A host of living aids such as hand rails, raised lavatory seats and even hospital beds can also be provided.

Unfortunately, each and every benefit and entitlement seems to be assessed in a completely different way so you could end up having to jump through numerous hoops just to get what you ought to receive.

The forms, meanwhile, are anything but easy to complete. And, since the benefits are often dependent on how you express yourself on the form, it is advisable to complete such forms with great care. The way you say something really can make the difference between whether you get a benefit or not, regardless of need.

One 86-year old woman, who clearly needed help, completed a benefit application form on her own. She was refused the extra money by return of post. When a social worker helped her to complete the same form a couple of weeks later, she was awarded the benefit at the highest payable rate.

So do not make light of your difficulties when completing forms and, if possible, get a social worker or local volunteer organisation, such as Age UK, to help you fill them in. It is not a question of giving false information but of accurately describing your needs in a way that those awarding the benefit recognise.

Government Benefits

The main Government benefits, in addition to the state pension, come from the Department of Work and Pensions. Some, but not all, are means tested.  You can download forms from the DWP website. The Age UK website gives a thorough breakdown of all the benefits available. See contact details below

The main DWP benefits are:

Attendance Allowance, payable at £73.60 or £49.30 a week, depending on need, in addition to the state pension, to a person over the age of 65.  This is widely paid to the very elderly and others who have a condition such as dementia or who have difficulty doing the everyday things of life such as bathing. It is not means tested and is completely dependent on the way you fill in the form. It allows you to buy-in help you need but how you spend the money is up to you. If you have a social worker, they will be able to advise if you are likely to qualify or you can apply for it yourself either on-line or by calling the DWP. See contact details below.

• ·         Carers Allowance of up to £55.55 can be payable to someone who spends at least 35 hours a week looking after someone who receives Attendance Allowance. So, for instance, if a woman has dementia and her husband or other relative has to care for her, they could be entitled to receive Carers Allowance on top of the Attendance Allowance received by the woman. Carers Allowance could actually be claimed by both a husband and wife, if they are caring for each other and both receiving Attendance Allowance. It is not affected by any property or savings you may have. But you cannot claim it if you are earning more than £100 a week or in full time education. And, if you are in receipt of a state pension, you may not receive the allowance but be assessed as being entitled to it, which could be important when claiming other benefits.
• ·         Pension Credit and Savings Creditare means-tested additional pension from the DWP. Pension Credit is aimed at bringing an individual’s weekly income up to £137.35 or to £209.70 for a couple. So, even if you own your own home, if your income is less than the above thresholds each week and your savings are less than £10,000, you could qualify.You don’t count Attendance Allowance as part of your income for this. Pension Credit is a key benefit because entitlement to it automatically means that you qualify for a range of other benefits and allowances. So, even if the paperwork seems daunting, it really is worth filling in the forms – with help, if possible. If you don’t qualify for Pension Credit, you may qualify for Savings Credit which is payable to people who have a low income and modest savings of more than £10,000.

Other Benefits 

• ·         Council Tax rebates. If you get Pension Credit, you will probably get a Council Tax rebate as well. But you could be entitled to some money off Council Tax even if you do not get Pension Credit. If your partner has dementia or a disability, regardless of your income, you can claim to pay the single person’s council tax rate. Your social worker or the local authority will advise. But be prepared, if you apply for Council Tax Benefit it will result in more means testing and unbelievably huge forms and demands for proofs of identity and financial resources. But councils will provide help with the forms, if required.
• ·         Other Pension Credit consequential benefits. In addition to Council Tax Benefit, if you are receiving Pension Credit, then you could also be entitled to numerous other benefits. Housing benefit is likely to be payable to help with rent. You are likely also to qualify for cold weather payments, if the temperature falls below a set level for a certain period of time. This is in addition to the winter fuel allowance, which is paid to all pensioners.

You may also get a grant to help insulate your home. And people on Pension Credit can get help with funeral costs and various other free services in their local area.  For instance, you can have a free Digital Switchover visit, if you’re on Pension Credit. You could also get free NHS dental treatment, free eye tests, money towards spectacles and financial help with travel to NHS appointments.

This funding comes from the NHS and you can find out more from their website. See contact details below.

Living Aids. On top of all this, you may also be able to get help adapting your home, such as putting in a walk-in shower if you have trouble bathing. Your local occupational therapists can advise and provide you with any living aids such as commodes that you may need. You can get in touch with them either through your doctor or social worker. People report that Occupational Therapists are very helpful and, for most things, there will be no forms to fill in. You will only need to complete paperwork if they agree to major work on your house – not just for a handrail or wheelchair but for a new bathroom – which would be means-tested.

Contacts

Department of Work and Pensions – All the Department of Work and Pensions’ benefits are set out on the direct.gov.uk website. For advice on Attendance Allowance you can call 08457 123 456

Age UK – Age UK is Britain’s leading charity for the elderly and it offers help on a local level. Their website is ageuk.org.uk. Or you can phone them on 0800 169 6565

The NHS – The website nhs.uk/carersdirect also provides excellent advice and guidance on available help. To call Carers Direct ring 0808 802 0202

Care at Home

Few elderly people want to admit that they need carers coming in to help them at home. And most will only allow this to happen when they have no choice.

But it can make a real difference to an older person’s life and once carers have been appointed, they will often wonder how they managed without them.

The trick is to make sure you get the care you want, need and pay for – and there is the rub.

Finding decent home care is a real challenge.

Most people come into contact with the care industry after a crisis – perhaps a hospital stay or a collapse in health. At this point they will be vulnerable and can find themselves getting involved with a poor quality care provider or putting up with slap dash care. And this is what is so annoying because, home care can be such a lifeline for an elderly person – if it is done properly.

Care Agencies

Care at home is now big business with professional agencies dominating the field. It is a far cry from the days of the council-employed home helps who looked after a couple of people, did their shopping, laid their fires, cooked meals and generally befriended them.

Now, private agencies employ dozens of  ‘carers’ who may visit 20 homes in a day and do not have time, or often inclination, to give a decent service. Much depends on the individual carers, of course. Some can be really helpful and can transform an elderly person’s life. Others, do not even do the minimum and only add to the client’s woes. As for the firms, they get paid literally by the minute and so time is money – their money that is. Agencies can charge £15 for half an hour – more at weekends and public holidays.

Depending on the agency, an elderly person may see a different carer every morning and evening and yet never speak to anyone. And their half hour visit may actually be seven minutes long. A carer may dash in, rush them off to bed and dash out again.  In this largely unsupervised business, abuses are all too common.

Finding a Care Agency

It is well worth thoroughly researching your local area, if you are thinking about getting carers in to help an elderly relative. Social services are not supposed to tell you which are the better agencies, even if they know. But you can ask at your local carers’ group or day centre. If you don’t have any local contacts, then you need to interview the local agencies individually. You cannot tell which is good from their websites. It is time consuming and awkward but if you set it up well to begin with then it can save an awful lot of time later, checking and complaining about standards of service.

Services Provided by Carers

Carers can provide help with washing, dressing, meal preparation, shopping and even housework. If an elderly person is struggling with these basics of everyday life, then it is time to get help. If this is the case, you will probably be in touch with social services who will recommend that home care is needed. Social services can become involved following a doctor’s recommendation or you can request that they attend.

Local Authority Advice and Funding

A social worker will come to the house and talk over what care is needed. They will carry out a complete assessment of a person’s needs and it is desirable for a younger relative to attend such a meeting, because real decisions can be taken at this time.

Whether an elderly person qualifies for local authority funding for care at home will depend on their financial resources. Property is not taken into account in this, unlike with residential care. But social services will want to know all about savings and income.

If the individual is assessed as having substantial or critical needs, social services will decide how much care they need and a notional sum to cover the care will be arrived at. This can vary from authority to authority.

At this point, in England, the individual will be means tested. Anyone with personal savings of more than £23,250 will be required to pay for all their own care while someone with savings of more than £14,250 could have to pay for some of their care. Again, it varies from one authority to another.

Funding Holding

If the council has agreed to pay for care, you can ask for the awarded funds to be paid to you or a family member so that you can buy-in your own care. If you become a so-called  ‘fund holder’ you will be required to open a separate bank account for the money and will be obliged to account for every penny.

You will have to produce receipts and bank statements, on request, proving that all the money was spent on care and that it was not paid cash-in-hand. It is something of a hassle but the advantage of being a fund holder is that you are effectively a private client of a care agency, putting you in a stronger position when dealing with them.

Personal Assistants

You could use the fund money, or your own resources, to employ a personal assistant, guaranteeing continuity of care. But this can be a complicated business since you effectively become an employer and have to pay tax and NI contributions on the assistant’s behalf and give holiday pay and so on.

This is an area, though, which is ripe for development.

Alternatives?

For the future we need to think beyond the stark alternatives of either home care or going into a residential home.

Perhaps ‘Granny Minding’ services, along the lines of baby minders, may emerge? Or ‘Granny share’ arrangements, along the lines of nanny sharing could split the cost of a full time carer between families. Obviously, there would be issues to do with both safeguarding and locations, but it is important that people to start thinking beyond the current options, if families are to be able to cope both financially and socially.

Live-in Care

There are agencies and individuals that will come to live in with an elderly person, effectively becoming their main carer and helper. This can allow an elderly person to stay at home, even if they are living alone, and means they receive individual care.  When the carer takes a break, agencies can send a stand-in or relatives can take over, if the person cannot be left at all.

While this could be a costly business, it can be less expensive than a care home and more appealing to families because it offers their relative a continued normal existence.

Some agencies sort out the carer’s tax and national insurance on behalf of the client and this means that they are more expensive than others, which simply introduce you to a carer. But it removes any hassle for the family.

Charges for such live-in care in southern England can range between £700 and £900 per week, depending on needs and are likely to be less elsewhere. It sounds a lot but when you think about the cost of residential homes, live-in care can offer a real alternative. If you pay the carer’s tax and NI yourself, then you can pay less.

There are around 70 live-in agencies throughout the country, many operate on a local basis others are nationwide. You obviously will want to take a close interest in any live-in carer’s background and experience but reputable agencies will carry out rigorous tests and training and will be happy to explain these.

If you are a fund holder, you can use this money to pay for live-in care and top-up if necessary and, of course, property is not taken into account in means testing for home care. Some local authorities will not pay directly to such agencies.

Local Authority-Instructed Care

If you do not want to be a fund holder or are not able to manage such an arrangement, the council will instruct and pay a home care agency directly. This puts you in a less strong position, as far as the carers are concerned, since you are not their employer and they will only carry out the tasks that the social services specify.

The whole process of being assessed and funding being approved and allocated can take months. But funding will be backdated to the time when the approval is given.

You may need to appoint carers even if an elderly person is not deemed by the local authority to have substantial or critical need. You may not qualify for funding  but an elderly person may nevertheless, need and benefit from home care.

Once you have decided to employ an agency, whether or not you have council funding, it is important to ensure they will give the care you want and need.

Questions to ask home care agencies

What qualifications or experience do your carer workers have? There are recognised care qualifications – not that these are necessarily hallmarks of good practice.  And most agencies will claim that their staff are very experienced and well qualified. So ask them how many carers they have and what their staff turnover rate is. This can be an indication of a happy workforce. If the staff are under too much pressure, they will not stick around for long and are unlikely to  offer a good service.

How many carers will my relative see? If an agency burbles about time pressure and fitting people in, or even claims that it is good to see a range of people, then don’t consider them. It is unlikely that an agency will appoint only one carer. They have to go home sometime. But you wouldn’t want more than five in a week. That’s when things can get slap dash. You might want to ask if you can request particular carers, if your relative gets on well with someone.

What time will the carers come? If they say they cannot give a time or say that they will try to come between 8 and 10, then strike them from the list. It is only reasonable to be able to ask that they come within a given time period – not more than an hour. Everyone wants the same times, they will say. But it can be very distressing if an elderly person is left waiting until 11am to get out of bed or hasn’t been given their lunch by 3pm so it’s worth sticking to your guns and insisting on particular time periods.

What will be covered by the carers? Will they just help an elderly person to get dressed and then leave them to try to change the bed on their own? Will they keep an eye on the client’s health?  Some carers seem not to know what to do if they arrive and find an elderly person unwell. In there is an emergency, will they wait with them until an ambulance comes? You can ask to provide a check list of all the things that you want done. If the agency won’t accept one, then you have to ask why not?

How are the carers supervised?  Does the agency have a system for checking to make sure that clients are satisfied and that the carers are doing their job well? Or do they leave it to the clients to complain? You want to be confident that they will be doing their job without you having constantly to check on them.

If you are not satisfied, how do you complain and what does the agency do?  You don’t want to start off on the wrong foot but you need to know that someone will listen to you if you have a problem.

It is in everyone’s interests, even the agency’s, for the care package to work.  So it is advisable to get all the awkwardness over at the beginning.

And if you are not satisfied, then step in quickly.

Do not allow poor care to pass without comment. If you don’t say something, then you will become the client who will put up with anything and on whom they will skimp.

Things will only get worse.

Dementia

Dementia in all its forms is becoming one of the great blights of old age. More than 750,000 people in Britain have it, most of whom are over 65, and this figure set to hit one million in ten years.

It is a dreadful condition, in the true sense of the word: a thing to be dreaded.

Dementia can rob an otherwise healthy person of their independence and enjoyment of life and leaves them isolated at the same time as their relations and friends struggle to cope while almost mourning the loss of the person.

Dementia Facts

While the popular picture of the complaint is of someone being rather forgetful or eccentric, it can actually leave an individual incapable even of standing up – they have forgotten how.

More often than not, it is perceived to be a long, progressive complaint. But what is not widely known is that it can happen virtually overnight – as it did to my  father. One day he was fine, the next day he was raving about wanting to go home, demanding to know who my mother was. He looked the same, spoke with the same clear voice and yet he was completely…demented. It seemed so bizarre, I asked him if he was mucking about. Sadly, he wasn’t.

There are actually a number of different conditions that are grouped together under the dementia umbrella and the Alzheimer’s Society website provides very helpful guidance alzheimers.org.uk and advice or you can call its helpline on 0845 300 0336.

Alzheimer’s itself is the most common condition and it generally progresses relatively steadily, although it varies greatly depending on the individual.

Vascular Dementia, which my father has, is very different. The second most common form of dementia, it can strike overnight and tends to progress in steps but can have the same impact on mental capacity as Alzheimer’s.  For full details of all the varieties of dementia, see the Alzheimer’s Society website.

Living with Dementia

One of the most distressing aspects of these conditions, is that the sufferer can be fully aware that they are losing their mental capacity. They will realise that they can no longer tell the time anymore or that they cannot read and write or that they cannot think clearly. And their distress and misery about this only adds to the impact of the condition and can lead to severe depression.

Sufferers frequently do not recognise their own family. They may want to see their mother or think that they are living in a television programme that they have just seen. And it can take an awful lot of convincing to get them to think otherwise as their distress heightens.

Some people argue that you should just play along with those who have dementia. But that may not be the appropriate strategy every time. If a 90-year old wants to see his grandmother and you say she is out, he may wait by the door for her return and not be deflected by attempts to distract him. Yet, if you point out that she died 70 years ago, he may descend into very real grief. You have to find your own strategies for dealing with situations as they arise.

My father was convinced that his grandmother had been driving a lorry that crashed into a train. He had seen an item about it on the news. I pointed out that she couldn’t drive and he was slightly mollified but nevertheless spent several days worrying about her until I pointed out that the police would have notified us, if there were a problem.

He wasn’t altogether happy with this but eventually forgot to be worried.

Dementia Drugs

There are drugs now available that really help some people, for a period anyway, and an early visit to the GP is highly advisable. A doctor can refer an individual to a mental health specialist who can prescribe the appropriate medication, sometimes even in quite mild cases of dementia. These drugs can slow the progression of the condition and offer some respite from the downward spiral. But, medical experts say, after around seven years the drugs no longer have the desired effect and the condition will worsen again.

The problem is that many people with early stage dementia will be reluctant or even refuse to seek treatment. They will only seek treatment when they have no option. But, even those in later stages, they may be able to pass the mental tests they are given with no problem. They may well know who is the prime minister or be able to write a sentence or spell a word backwards. But ask them what they had for breakfast, where they are or who the person who brought them is, and they may have problems.

It is different for everyone and it is essential, if you are to get help for your relative, for you to speak to their doctors at the earliest opportunity and tell them what the situation really is.

Even so, some local health authorities will be reluctant to prescribe medical help for people with early stage dementia. But it is worth persisting because, as we discovered in respect of my father, it can make a real difference – for years.

As the condition progresses, though, relatives will inevitably find themselves in the position of advocate and guardian. And their input is essential if the sufferer is to receive appropriate care and help.

Dementia Care

Many care homes now specialise in dementia cases and are specially set up, complete with locked doors and windows, for such residents. Since the condition is progressive, it can be alarming for someone with early stage dementia to be in such a place with much more serious cases. And, if you are seeking care for a relative in such a condition, you want to make sure that they will be with others in a similar phase of the illness.

But many people, particularly in the earlier stages of dementia, are able to stay at home, if they receive some care.  Basic hygiene can become a bit of a problem and a dementia sufferer may need to have carers come in to help them wash and dress. All the same rules apply in terms of getting care in the home as would for anyone with a physical condition.

A big problem for the family will that the sufferer may require constant supervision, to stop them wandering off or doing themselves harm by, for instance, putting something in the oven and forgetting about it. Obviously, this will have a major impact on the life of the spouse or other relations who will need to plan ahead and ensure that there is always someone with the sufferer.

Live-in Care

There are agencies and individuals that will come and live in with an elderly person, effectively becoming their main carer and helper. This can allow an elderly person, even one with dementia, to stay at home, even if they are living alone, and means they receive individual care.  When the carer takes a break, agencies can send a stand-in or relations can take over, if the person cannot be left at all.

While this could be a costly business, it can be less expensive than a care home and more appealing to families because it offers their relative a continued normal existence. See the section on living for more information.

Respite for Carers

Care agencies offer ‘sitting’ as part of their package of care but this can be expensive. Local carers’ groups can advise if there is a scheme operated by volunteers in your area.

Many local areas also offer day centres for dementia sufferers, which will give family members a day or more off a week. And, although the sufferer may not like the idea of it, it is important that the main carer manages to get some sort of break or their health will be affected.

Indeed, it is essential both for the sufferer and their main carer that they have frequent breaks. Many care homes offer respite breaks, where a person with dementia can spend a week or two in residence, allowing the carer to take a break or have a holiday. And social services can organise and fund these breaks as part of an individual’s funded care package.

So, if the dementia sufferer is receiving  funding for care at home, they may well qualify for a number of weeks a year in a respite home.  Social workers will be able to advise.

Residential Care for Dementia Sufferers.

It is particularly essential to ensure that someone with dementia is in a safe and comfortable residential home. Clearly, they may be unable to ask for help or be confused over their surroundings, so relatives need to be assured that they will be properly cared for. Imagine that the individual is a young child and ask yourself how they would fare.

Living and Residential Care

What on earth do I do with Mum/Dad?  It is an anguished and all too frequently heard cry these days.  An older relative is no longer able to cope in their own home, even with carers coming in, and a crisis ensues.

The questions are many. Should I have them to live with me? Is that really a good idea? Or is there a good local care home where their needs will be met? How much will it cost? And who is going to pay for it?

With care home fees running into tens of thousands of pounds a year, families up and down the country are currently struggling with such problems. And it is clear that there are no easy answers.

You may not want, or be able, to have your older relative living with you but, equally, you may not want them to go into residential care either. There are so many horror stories of older people being mistreated or neglected in homes and few older people want that loss of independence. Even the best homes are not their home and the best homes are hard to find. And finance can vary greatly depending on an individual’s needs and where they live since local authorities, who award funding, can set their own rules.

As with many other aspects of the carer’s role, it is not really desirable to begin this conversation at the point when you’re desperate. It may seem impossible to plan ahead, to know whether your relatives are going to need a care home in future. But, if older relatives are struggling to cope with the shopping now, they may be struggling to make meals in six months and unable to take a bath in a year. So it is important to read the writing on the wall and think ahead.

Sheltered Housing

For those canny enough to make plans, a popular solution is to buy a place in a Sheltered Housing development.  Unlike straightforward retirement properties, sheltered housing offers a degree of care and you can usually stay in them even if you become frail and dependent.

Some ordinary retirement properties actually require you to move out if you need care. But sheltered housing can be a real alternative to the isolation of the ordinary street while maintaining the independence of your own front door.

They vary greatly but many areas now have these developments of flats for the older person. People can live in their own homes with their own kitchens but often there will be a residents’ lounge, cafeteria, in-house activities and a watchful eye to make sure all is well. Carers can attend people in sheltered housing, if required for bathing etc, and it can mean that residential care is never needed.

Of course, some people need the attention that a care home provides but sheltered housing can offer a real chance for a continued independence and an  enjoyable life.

It is hard to make the decision to go into a sheltered development, particularly if an elderly person feels they are perfectly all right at present. But such places  can open up a new, social world leaving them less dependent on younger relatives.

If it is left until the person has deteriorated greatly before seeking such a place, then it may no longer be possible for them to live outside a care home. Also a sheltered development may not take them at this stage.

Prices of such properties vary greatly and there will be a service charge. But this will be a fraction of the cost of a care home.

Your Home is my Home

Some younger relatives are able to take on elderly and infirm members of the family, bringing them to live with them. Indeed, with the cost of residential care so high, it is a growing trend. But with people leaving starting a family until later in life, the generation gap has widened. So, the chances are, an older person’s children will still have young children dependent on them and they will not have the room or the capacity to take on another full time caring role.

There has been an expression coined for this group: the sandwich generation. And it is no picnic being one of them.

They can feel stretched or even come under real pressure from their older relatives to provide a home for them. With the help of carers, it can be made to work and it can save an elderly person from going into residential care. But it is not something to be taken on lightly – even if you do get on really well with your elderly parent. If you don’t, you need to think especially carefully.

It is quite likely that you will have to do some essential remodelling done on your home to provide a downstairs bathroom and bedroom. And you must really think as to whether you will be able to offer the care they need both now and in the future.

An older person might actually be worse off in some ways if they move to live with their younger relatives because they can lose any social network they had and become completely dependent on their younger relatives. Having said that, it is a hard decision to put your elderly relatives into a residential home – particularly if they don’t want to go.

Live-in Care

There are agencies and individuals that will come and live in with an elderly person, effectively becoming their main carer and helper. This can allow an elderly person to stay at home, even if they are living alone, and means they receive individual care.

When the carer takes a break, agencies can send a stand-in or relatives can take over, if the person cannot be left at all. While this could be a costly business, it can be less expensive than a care home and more appealing to families because it offers their relative a continued normal existence.

Some agencies sort out the carer’s tax and national insurance on behalf of the client and this means that they are more expensive than others, which simply introduce you to a carer. But it removes any hassle for the family. Charges for such live-in care in southern England can range between £700 and £900 per week, depending on needs. This will be less in some parts of the country and if you pay the carer’s tax and NI yourself, then you can pay less again.

It sounds a lot but when you think that residential homes can charge similar amounts, live-in care can offer a real alternative – particularly if you are receiving local authority funding for home care since that means test does not take your property into account.

There are around 70 live-in care agencies throughout the UK, many operate on a local basis others are nationwide. You obviously will want to take a close interest in any live-in carer’s background and experience but reputable agencies will carry out rigorous tests and training and will be happy to explain these.

If you are a fund holder, you can use this money to pay for live-in care and top-up if necessary. But it varies from one local authority to another whether they will pay directly to such agencies.

Residential Homes

With life expectancy increasing, an ever-growing number of older people find themselves left with no apparent alternative other than to go into residential care.  Some have complex medical needs that mean a nursing home is essential. Others need a care home that provides a safe and comfortable environment simply because they are very elderly.

Quite aside from the question of funding, it is not an easy move to make and finding a good place is even more challenging.

In 2010, there were 18,255 Care Quality Commission (CQC) -registered care homes in England, 13,869 of which were residential homes, 4,363 nursing homes and 23 non-medical care homes. The total number of places was just over 460,000. And it is big business. The residential care market is estimated to be £14 billion, of which the private sector is worth £9.9 billion.

In terms of funding individual care, Age UK provides excellent fact sheets with full details of how much people can be expected to pay for residency in a care home. You can get this by contacting Age UK on 0800 169 6565 or through their website www.ageuk.org.uk.

Funding

Most people will expect to pay something towards their care, even if they don’t have any property or savings. Unlike local authority means testing in respect of care at home, the value of an individual’s property is taken into account when funding is considered for a residential home.

People with no assets will usually have to pay most of their pension towards the cost of their care. This can leave their spouse, if they have one, with a very low income and they may then have to claim Pension Credit and other benefits.

But, if people have a home and savings, then the contribution will be far greater and can potentially run into tens of thousands of pounds.

The average annual fee for a single room in a private residential home is £26,104 a year (£502 per week). For a nursing home, it is £36,296 (£698 per week). These are only average figures though and you can expect to pay much more for a home in London and the South East, where some charge up to £1,000 a week.

Local authorities will carry out means tests to assess an individual’s ability to pay and will inform an individual whether they qualify for assistance or not.

Even if an elderly person is awarded local authority funding, families often find themselves having to make substantial contributions to the cost of residential care because the local authority rate falls short of the cost of many homes.

The average shortfall is £60 a week but this can run into hundreds of pounds in London and the South East.

Some homes, often the national chains, will provide rooms at the local authority rate. But these are very popular and it is inevitably hard to secure a place. If you  receive funding, then a social worker will investigate vacant beds in your local area. It may be that there are no vacancies initially and you may be offered a place many miles from your home. You can take this on a temporary basis, if the need is urgent. Or you may prefer to wait until a space comes up closer to home on the basis that it could be out of sight out of mind, if you accept a placement.

Choosing a Residential Home

Funding is only one issue, when it comes to choosing a residential home. Age UK also provides a handy checklist for those looking at homes. (Tel 0800 169 6565 or vsit www.ageuk.org.uk) And you can look at inspection reports on the official Care Quality Care Commission’s website cqc.org.uk.

But it is only by visiting care homes that you can get a feel for what suits you or your relative and even some well-rated homes are hardly great.

Some of the grandest looking homes actually don’t provide a very grand standard of care. And comfortable trappings are not the best way of telling whether a home is actually a good place or not. Most homes now have en-suite rooms and are bright and attractive to look at.

Asking advice from others in a similar position can be useful. But often people do not want to admit to themselves that their relative’s care home is not what it should be. They will invariably tell you how great the home is, right up to the time they take their relative somewhere else.

On first glance, many homes will tick all the boxes and will have boards displaying numerous activities for residents and appealing menus and days out.  But what happens for the vast majority of the time when the activities are not taking place? Are the elderly people just left sitting in a chair in front of the television for hours on end? Yes, they probably are.

Red Lights

A couple of non-official warning signs you can look out for when you visit a home: If you hear the sound of alarms going off all the time, and yet no staff seem to be responding, then you must wonder why.

Also, look at the residents, are they appropriately dressed, hair brushed? Have they got long, dirty finger nails?

What are residents doing? Are they sitting in front of a television? If so, are they watching the programme or just sitting? Are they still sitting at the dining table long after their meal has finished? And what are the staff doing? Are they engaged with the residents or doing paperwork or chatting among themselves?

A Personal View

Having had my father in five different homes for various respite breaks and now for a permanent stay, I can say that the standard is very variable. Some places are definitely better than others – irrespective of their official rating. But it is the management and staff who make the home what it is.

If there is a culture of ‘letting them wait’, then that is what will happen. A home is very unlikely to provide the individual care a person will get within the family but, clearly, a good home is one in which the staff pay attention to the residents rather than chatting with each other.

In a good home, they notice if a resident is feeling unwell, or wants to lie down in their room. They will make sure that residents are all right between being brought out in the morning and going to bed at night.

Unfortunately, I have yet to find one where this really  is the case. All too often one has to ask for basic care such as cutting finger nails or dressing appropriately to be done and one has to tell staff that a resident is unwell, even if their symptoms are obvious.

Only recently, I called my father’s care home to ask how he was following a fall. A senior member of staff said he was absolutely fine, only to call me a couple of hours later to say he was actually very unwell and had fallen again. Clearly, neither she nor anybody else had been keeping an eye on him, despite his fall the previous day, and they told me what they thought I wanted to hear.

Although in many ways I have been satisfied with this home, I am now taking steps to have him moved nearer to us so that I can keep a closer eye on him.

Close to Home

Sadly, the above-mentioned episode is far from unusual.

So, if you really want to make sure your relative is being cared for properly, the best way is to choose a home very close to where you live so you can visit frequently. If you have to add in travel time to your visit, you will visit less often and be less assured about their care. Proximity avoids contempt and seems to be the only way to guarantee care.

Contacts

1. All the Department of Work and Pensions’ benefits are set out on the direct.gov.uk website. Call 08457 123 456

2. Age UK is Britain’s leading charity for the elderly and it offers help on a local level. The organisation was born from the merger of Help the Aged and Age Concern. Its website is ageuk.org.uk. Or you can contact them by phone on 0800 169 6565

3. The NHS nhs.uk/carersdirect also provides excellent advice and guidance on available help. Call Carers Direct on 0808 802 0202

4. The Alzheimer’s Society website, alzhiemers.org.uk,  provides very helpful guidance and advice or you can call its helpline on 0845 300 0336.

5. The Care Quality Care Commission’s website is cqc.org.uk. It provides reports on care homes and hospitals.

Patients are 16% more likely to die if they are admitted on a Sunday than a Wednesday, and 11% more likely to die if they are admitted on a Saturday.

For every 100 deaths following admissions on a Wednesday, 116 occur for admissions on a Sunday – a “significant increased risk”, the researchers said.

It follows a report in November which found patients needing emergency care are almost 10% more likely to die if they are admitted on weekends and are less likely to receive prompt treatment.

The new analysis covered all admissions – more than 14.2 million – to NHS hospitals in England during 2009/10, including both emergency and planned admissions.

It looked at more than 187,300 patient deaths within 30 days of being admitted to hospital.

The researchers found higher death rates if patients went in on a weekend but a slightly lower death rate if people were already in hospital on a weekend.

Being already in hospital on a Sunday led to an 8% reduced risk of dying on that day compared to already being in hospital on a Wednesday.

The medical conditions resulting in the biggest number of in-hospital deaths included pneumonia, congestive heart failure, heart attack, septicaemia, acute renal failure, urinary tract infections and neck or hip fracture.

The experts, including from University College London and the Universities of Birmingham and East Anglia, wrote in the Journal of the Royal Society of Medicine (JRSM): “We identified a significantly higher risk of subsequent in-hospital death during the 30-day follow-up period associated with admission during the weekend (Saturday or Sunday), compared to mid-week days.

“Admission on Tuesday through Friday was associated with the lowest risk of in-hospital death, while admission on Sunday was associated with the highest risk.

“Admission on Saturday was associated with a marked increased mortality (death) risk and admission on Monday was associated with a less, but statistically significant, increased risk.”

Lead researcher Professor Domenico Pagano, from the University Hospital Birmingham Foundation Trust, added: “These results offer conclusive evidence that confirms previous reports of increased 30-day mortality risk for patients admitted to hospital with emergency conditions at the weekend compared with the rest of the week.”

He said several reasons may be behind the findings, including that patients who are seriously ill can find themselves admitted on weekends.

If they were less ill, they would have had their admissions postponed until a week day.

Prof Pagano also said reduced staffing and fewer senior doctors on duty as well as poor access to diagnostic tests on weekends could have an effect.

His team said seven-day access to “all aspects of care” could improve the outcomes for higher-risk patients currently admitted on weekends.

On Sunday, Health Secretary Andrew Lansley suggested more could be done to boost the number of senior doctors working weekends.

Mr Lansley told the Sunday Telegraph: “By opening some services seven days a week, more patients will get the care and treatment that they need when they need it.

“In some parts of the NHS, this is already happening. We will work with all the professional associations to encourage progress on this across the NHS.

“By increasing the number of consultants who are on duty at the weekends, we will both strengthen the training of junior doctors and improve quality of care for patients.”

Last November, the Hospital Guide, from Dr Foster Intelligence, found that around one in eight trusts had higher-than-expected death rates on Saturdays and Sundays.

It said hospitals with the fewest senior doctors on duty have the highest death rates overall.

In a “handful” of trusts, the death rate rose by 20% or more at weekends.

Previous studies have also found the risk of dying in NHS hospitals on weekends and bank holidays is higher than during the week.

Mr Lansley added: “It is unacceptable that patients admitted to hospital on a Saturday or Sunday stay longer and have worse results.

“Much of the rest of the country continues to be open for the public’s needs at weekends – an NHS that revolves around patients should be the same.”

According to the NHS, 25,000 to 30,000 deaths are linked to the cold weather in the UK every year.

Here is some advice on staying warm and making the best use of heating at home:

:: Keep your home warm during the day

Heat your living room to 18C-21C (64F-70F) and the rest of the house to at least 16C (61F).

Heat all the rooms you use in the day and your bedroom before you go to bed.

Set the timer on your heating to come on before you wake up and switch off when you go to bed.

:: Stay warm and safe at night

Try to keep the temperature above 18C (65F) in your bedroom overnight.

Never use hot water bottles in the same bed as an electric blanket, even if the blanket is switched off.

:: Wrap up warm

Several thin layers are better than one thick one.

Wear clothes made of wool, cotton or fleecy synthetic fibres.

Remember a hat, scarf and gloves when you go out, and wear bed socks and thermal underwear at night.

:: Eat well

Have plenty of hot food and drinks.

Regular meals will help maintain your energy levels.

:: Keep moving

Exercise is good for keeping you warm in winter. Try to move around at least once an hour.

:: Insulation

Fit draught excluders to seal gaps around windows and doors.

Ensure your loft has at least 10in (25cm) of insulation.

:: Financial support

Money may be available through the Warm Front scheme, Winter Fuel Payments and Cold Weather Payments.

>> If you are worried about an elderly person you can contact Age UK on 0800 169 8787 or click the link to visit www.ageuk.org.uk

>> FMWF would like to know your views and hear about the issues affecting you and those you care for. You can comment below or email whocares@fmwf.com.

By Sarah Whitebloom

Another voice cried in the wilderness: something has to be done urgently over the mess that is care for the elderly in Britain today. Older people all over the country have been abandoned to their fate. It is a national disgrace. And lo it came to pass that nothing was done – or at least not yet.

Last week [24 February] the Commons Health Select Committee became the latest group to warn about the burgeoning crisis in care for the elderly. The Alzheimer’s Society, Age UK and a host of others must be hoarse by now with all the wilderness crying they have been doing. Even the Government, as Who Cares? noted last year, has been making all sorts of noise about the need to improve the way we treat the elderly.

Yet the King’s Fund estimates there are about 800,000 older people who need care but receive none. Many others get some help but are barely managing, despite being in chronic need.

And what has been the response of our local authorities? These august authorities, that are charged with delivering care to the elderly, are cutting care services and upping their charges. The Select Committee found that two thirds of councils were slashing their social care budgets while half had increased what the elderly have to pay. The fees that councils will pay for care homes have also gone down and it’s getting more difficult in some areas even to get hand rails and other living aids provided.

This will come as no surprise, of course, to anyone trying to get help for elderly relatives. The switchboard operator at our local authority told me last week that I would be lucky if the area adult help desk answered my call. She told me: ‘It’s easier to speak to God than one of them.’

Six phone calls later and I have managed only a brief conversation with someone from the Help Desk, who phoned to tell me he was going to get back to me. As yet, I have heard nothing, although my call concerned a pressing matter.

Of course, in this current climate, councils are having to make less money go further and they are having to make cuts in some of their services. Care budgets offer a big, fat opportunity for them to save money. And elderly people are not often in a position to complain or make a fuss. So, it may be a shocking disgrace, but it is not surprising that services for older people are being lined up to take such deep cuts.

One local authority chief told me that it was a difficult balancing act. He maintained they are trying to target the funding at people who really need it, cutting out those who abuse services.

Given the rigorous means testing and interviews, it seems unlikely that there are legions of elderly care scroungers, sponging off local authorities. Indeed, it is difficult to get many older people to seek help, even if they need it and qualify for it. All too often, one hears stories of older people insisting that they can manage, even when they clearly cannot.  All this will only discourage them further.

But if all those 800,000, who receive no help, were given the assistance they need, how on earth would councils pay for it from their reduced care budgets?

The Select Committee said ‘fundamental changes are needed in the way social care is delivered’. But it acknowledged that until the Government puts a new system in place, there is not much that can be done.

So all eyes are now on the Government. It is due to put forward proposals on the future funding of social care this Spring. Finally an answer to those voices in the wilderness? It couldn’t get any worse… could it?

If that is the case, it will be another disgrace inflicted on older people (now or in the future) who are already suffering the consequences of low interest rates and rampant inflation – 5.5 per cent for the over-50s, not the official inflation rate of 4.8 per cent – while having to listen to Ministers suggest they leave their mansions and live in smaller homes to relieve the nation’s acute housing shortage (Read our story here).

Last summer, Andrew Dilnot, a distinguished economist, published a report commissioned by the Government into the future funding of long-term care in England.

It was radical in its thinking, and rightly so.

Dilnot proposed an end to the current system where people with assets above £23,250 (different levels apply in Wales and Scotland) must pay their own nursing care costs, albeit tempered by the availability of benefits such as Attendance Allowance. This often leaves families with no choice but to sell their parents’ home to pay care bills.

The new long-term care world envisaged by Dilnot was both kinder and fairer. He suggested a £35,000 lifetime cap on the care costs any person should have to meet from their own pocket.

At the same time, he said the £23,250 threshold above which financial assistance towards care costs is not available, should be raised to £100,000. So, anyone down to their last £100,000 would pay nothing towards their care costs (in a nursing home or their own home), although those in a nursing home would still have to pay towards their accommodation costs, capped at £10,000 a year.

Dilnot said his reforms would lead to a fairer deal for those currently excluded from any help – someone whose care bills hit £150,000 would pay about 30 per cent under his proposed regime compared with the 90 per cent they need now.

Unfortunately, it appears the Government now believes his proposals are too generous.

Dilnot admitted his funding model would cost the Government an extra £1.8 billion a year from 2015, rising to £3 billion a year by 2025 as demographic changes filter through the system (we all live longer and the nation gets older).

But to put this into perspective, Dilnot said it would represent only 1/400th of public spending – a ‘price worth paying’. Reports last week, however, suggested the Government would replace Dilnot’s £35,000 lifetime cap with one at £60,000, meaning a couple in need of care would end up paying £120,000 plus accommodation costs.

I hope this was only political posturing ahead of the White Paper due to be published in April or May. The current funding system is an ‘embarrassment’, according to Dilnot, but it would be even more embarrassing if it were replaced with one that still discriminated against those who instead of frittering away their wealth have scrimped and saved for their retirement.

Middle England is already paying a disproportionately heavy price for the banking crisis that brought Britain to its knees in 2008. It should not be burdened again.
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NOT all readers have supported Financial Mail’s plea for banks to offer current account customers a more transparent deal than they are getting at present – even if it means the introduction of monthly account fees. But surely the findings of a Which? report into the baffling way banks apply overdraft charges provide overwhelming evidence that what we have at the moment is neither fair, nor transparent. Which? asked a dozen individuals, including a maths PhD student, to work out the cost of an unauthorised overdraft by giving them each four mock bank statements on which the rules and charges were set out.

Between them, the volunteers got the costs right only seven times out of 48.

Bank customers, especially those who are financially stretched as the bank-fuelled economic crisis impinges on them personally, deserve a better deal.

Is it too much to ask for a current account where charges are explicit, transparent and customers do not require the assistance of Professor Stephen Hawking to calculate how much it will cost them for having the temerity to step into unauthorised overdraft territory?

Rather than altering complaints files to make themselves look good in the eyes of the regulator – Royal Bank of Scotland was fined £2.17 million last week for carrying out this scandalous practice – RBS et al should start altering their current account models. NOW.