Options in Older Life

17th January 2009

Life expectancy is greater now, but maintaining quality of life into old age can be more challenging than ever, especially as families become more dispersed, and women (once the natural carers of older relatives) are more likely to be working. Emma Carter looks at some of the options available when you, or someone for whom you are responsible, needs help.

When everyday tasks become too difficult, older people must, reluctantly, accept that some compromise may be necessary to allow them to stay in their own home. It’s where most people want to remain, of course, and family or friends will usually be keen to support this as far as possible – but help with personal care etc may become essential.

Local councils are compelled to provide some assistance; this may take the form of a grant to allow the purchasing of care, but may also be by support (and ideally supportive) services. ‘Independent’ living at home may be sustained by visits from a community nurse, a psychiatric nurse or an occupational therapist. Care can also be provided by private nursing or care agencies, with a package tailored to individual needs – and budgets. Free care is usually only available to those on income support or in receipt of disability living allowance or other benefits. Attendance Allowance is available (£44.85 a week at the lower rate, £67 at the higher) for those with a physical or mental disability severe enough for require help in caring for him/herself.

Other options in support of staying at home include visits to a day centre, or an occasional respite stay in a residential home. This can be to give carers a break, or to provide some breathing space for the elderly person after an episode of ill-health.

Sheltered housing, with a warden on duty for emergencies, is ideal for an active elderly person, but when staying in the family or marital home is no longer viable because of failing ability, the most likely next step is a care home – and, of course, this choice is also available at any point in the ageing process, not just as a last resort. Far from a last resort, in fact, the best establishments aim to be a place of refuge and a real home from home…

…but how do you begin to choose?

For someone who remains reasonably active, but who would benefit from companionship and subtle supervision, a private (en-suite) room in a care home would be ideal. Look for one where 24-hour help is available, where safety is a priority, and where outings and activities are frequent and clearly enjoyable. Avoid the sort of institution where the television is constantly on, where there are no quiet areas for residents to sit and chat or read, and where staff seem preoccupied.

Consider locality and accessibility; the home may be fantastic, but if friends and family find it difficult to visit, then the experience will be very isolating for someone who is perhaps already sad that their life and routine are changing. A reasonably relaxed visiting policy is vital; this is not hospital, so being restricted to 3-4 and 7-8 is inappropriate, although clearly some respect for residents’ need for privacy at certain times should be factored in.

Someone with health issues beyond the normal condition of ageing may need medical care – and that means the choice must be a ‘Care Home with Nursing’. The actual nursing care is free but personal care – plus fees, of course – must be paid for.

There’s some limited state help available, but it is means-tested. If a needs assessment shows that you (or your parent/partner/ aunt etc) need to live in a care home and have capital below £22,250, you are entitled to some financial support from the council. Below £13,500, you receive maximum support although you still contribute your income (such as pension), retaining just £21.15 per week for personal expenses while in the care home. With capital between £13,500 and £22.250, you will contribute £1 per week for each £250 of capital between these two figures. Above this figure the burden is entirely your own.

Capital includes savings, assets, and the value of your current home, although this will be disregarded if you are in the care home only temporarily, or if your home is still occupied by your partner, or a relative over the age of 60 or who is incapacitated. If you’ve concluded that this means that if you’re single/widowed you may need to sell your home… you’re right.

If the council is paying, they will require that the home can meet your assessed care needs, that it complies with their standards, and that it is within the budget they set for someone with your needs – although you can get someone to ‘top up’ the difference if necesary.

See www.firststopcareadvice.org.uk for more information, or call 0800 377 7070.

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