Doing The Home Work

19th June 2015

To stay at home or to move on? It’s a tough decision, as Jill Glenn explains

The news that the Queen’s ‘birthday card team’ has recently expanded to cope with a surge of 100-year-olds is just one indication that we are, in general, living longer. The number of centenarians is likely to continue to increase, as the post World War One baby boom generation starts to reach that magic number. Moreover, estimates from the Office for National Statistics show that the traditional ‘three score years and 10’ is outdated now; think ‘three score years and 30’ instead – it’s becoming the norm for people to live until they are 90.

That’s the good news.

The not-so-good news, of course, is that we can’t cheat time and failing health for ever. However well and active we remain, the day may come when – in order to stay safe and well and happy – we need to consider a change in our living arrangements.

Don’t leap to conclusions, though. The first question, should not be ‘How do I choose a care home?’ but ‘What kind of care do I need / does my parent need?’ The secret of success in this tricky arena is to match personal and individual needs to one of the options available.

Most people hope to live independently for as long as possible, remaining active and in control of their lives. My own father managed to stay ‘home alone’ for the best part of 20 years after my mother passed away, eventually admitting defeat and moving at the age of 96. However, for most people, the time will come (as it did for him) when help with everyday living – from washing and dressing to cooking and cleaning – is critical.

Adult children might be able to step in – but generally have families and lives of their own, often living away (200 miles away, in my case); as much as they want to help out (and, of course, not all do) circumstances militate against it…

… so it’s time to look outside the family.

Technically there’s a wide range of help available – from day-to-day support in your own home, to a place at a day centre, to the provision of equipment (such as bath seats and foot rests) – although, of course, many of these services are means-tested.

The first step is to contact the adult social services department at your local council and ask for a care assessment to establish your needs. There’s no charge and you’re entitled to this regardless of your income and savings.

The assessment will usually take place in your home and, given that the need for support is often identified after a fall or a period of ill health, may include people such as an occupational therapist, social worker or nurse. If someone is already caring for you, they’ll generally be present, and their needs are considered as well as your own. At the end, there should be an agreed care plan.

Most local councils charge for services they provide at home (either via their own staff, or, more usually, via agencies), although they must work out how much you can afford, in order to leave you with a reasonable amount to live on. If you’re assessed as needing community care services you may be able to choose direct payments so that you can purchase and arrange your own care, or a ‘personal budget’, which aims to give people more choice over their social care services. Age UK, whose website groans with useful information, has more about all this.

When living at home is no longer tenable, sheltered accommodation may be an option for someone reasonably active and still independent but in need of companionship (there’s generally a communal area for socialising) and the security of someone on call for emergencies. Assisted living schemes, which consist of accommodation clustered around a social centre, are also a possibility.

And then there’s the biggie…

The words ‘care’ and ‘home’, so innocuous (indeed, so heart-warming) separately, are joined together – ‘care home’ – and whispered behind half-closed doors by family members. ‘Going into a home’ is a concept that strikes fear into many a heart, but, properly managed, it can be a fulfilling experience.

It’s a huge step, naturally, but care homes really can offer the opportunity to form new friendships, to restore failing health and spirits, and provide a safe, comfortable place to live, with staff on duty 24 hours a day and all meals provided.

In theory, they’re all called care homes now, but until recently were known as ‘residential’ and ‘nursing’, and the old terminology provides a good guide to their difference. Homes formerly classed as ‘residential’ offer accommodation and help with personal care – activities such as washing, dressing and going to the toilet; homes formerly classed as ‘nursing’ add nursing care. The nursing element is free, but the personal care, plus the residential fees, must be paid for. Some homes specialise in dementia care; others have dementia units.

How you pay for a care home depends on your personal situation. Your local council may be able to pay all or part of your fees if your capital and savings are below a certain limit. Again, Age UK has advice.

The choice is less complicated than it sounds, though, and is best made by going back to that first question – what kind of care is needed? If actual nursing is critical, then the chances are that you already know that.

If the answer is ‘a care home’, then the factors that should be considered include locality, ease of access by car or public transport, visiting arrangements, the level of nursing care available if needed, the quality and type of food on offer, what the bedroom looks like, how attractive and user-friendly are the communal areas and what sort of activities are available. The latter is important. Beware of homes that don’t seem to offer ‘activities’. Ask about shopping trips, outings to the theatre or outdoors, aromatherapy, arts and crafts, card games, talks, hairdressing, exercise and so on. Watch out for (and consider avoiding) homes where the television is on permanently or where residents seem to sleep all day. If you like to spend time alone, be certain that the home won’t pressurise you to spend time communally just for the staff’s convenience.

Planning ahead is the key. Visit some neighbourhood homes and get a feel for them. See if it’s possible for you (or the potential resident if you’re checking it on someone else’s behalf) to spend a day there as a visitor, or a few days for respite care, and decide whether you like the place. Work out what’s important to you and your loved ones. Decide if you want to stay in your local area, or whether you’re keen/willing to move nearer to family. Of course, circumstances may change between your research and your actual need to move, but if you’ve done the groundwork – and, if you’re going to be self-funding, worked out how you’ll manage your finances – you’ll be in a good position when the time comes.

And is this how I managed it for my father?

No.

He resisted all attempts to suggest that the house he’d lived in for over fifty years wasn’t suitable. There was probably a window of opportunity in which I could have persuaded him, but it was only 30 minutes long and I missed it. He soldiered on, with carers and frequent trips to A&E and regular visits plus twice daily telephone calls from me.

His cleaner told me he shouldn’t be at home. I said I knew.

His carers told me he shouldn’t be at home. I said I knew.

He looked at all of us as if we were talking a foreign language when we tried gently suggesting it might be time for a change. In his head he was twenty, and still capable of cycling across Europe.

In desperation, I begged him to consider just a couple of weeks’ respite care so that I could leave the country on a brief holiday and not spend the entire time worrying that he’d fallen downstairs while I was gone. Reluctantly, and to my astonishment, he said yes.

Within 24 hours I’d read a dozen CQC reports and found a place a couple of miles from his home, visited it (with him) and booked him in. Two days later he was there. A week after that (already looking healthier and more relaxed) he told me it wasn’t possible for him to go home – ‘I can’t manage,’ he said, forcefully, as if I was the one opposed to the move. I resisted saying ‘I know’ to him, and went off to ransack his bank accounts to sort out the fees.

He stayed there for five years, loved and looked after by a great team of people until a few weeks before his death. It was a good place, and I was damned lucky to find it in the circumstances – but I don’t recommend the ‘stab a pencil in a list’ approach’…

Find Your Local