A complete guide to elderly care

02 February 2018

When it’s time for elderly care, what’s next? Residential, hourly or live-in care – your complete guide.

As our population gets older, we worry about keeping our loved ones independent for longer. When the time comes for finding additional support, care and companionship for an elderly relative, it can be confusing and complicated, not to mention a delicate subject to broach. Understanding the options for affordable long-term home care, residential care or respite care is incredibly helpful before you begin discussions with your loved one.
elderly care

Contents of this guide:

1. Introduction

2. Understanding a diagnosis

3. How to discuss care with your loved one

4. Your care options

5. Getting help and advice

6. Power of Attorney

7. Conclusions

Introduction

Whether your parent has been hospitalised and needs care quickly, or they are experiencing a slower decline in mental and physical ability, recognising that a close relative needs professional care can be overwhelming. There are a vast number of considerations to take on board, including the nature of their condition, their care options, helping your loved one maintain their independence, and working out how to pay for the care. You need to look after yourself during this time, too.

To keep the process positive try to ensure that your parent or loved one feels consulted as much as possible. Receiving care can be a scary, dramatic lifestyle change. It can take some mental adjustment, both for them and for you.

For a number of families, especially those with a loved one far away, residential care seems like the most appropriate or recommended form of care for elderly people. In some cases this is true, but the care industry is constantly evolving. There are other options like live-in care agencies and domiciliary care agencies which can be considered

In this guide, we look at the principal care options and the pros and cons of each, helping you work out which is the most appropriate for your loved one. We offer advice on having the ‘care conversation’ with your parents in the most positive way. Finally, we help you identify where to go for legal information, and discuss financial support for long term care costs.

Understanding a diagnosis

If you are worried that your loved one needs elderly care, try not to panic. The first step is to contact your local council’s adult social services department to arrange a care assessment.

Everyone is automatically entitled to a Section 47 assessment, no matter their means, income or savings. A care advisor will visit your loved one at home, go through care options with them and draw up a care plan. It’s worth noting that your local council may not always put forward all forms of elderly care; live-in care for example. It’s a good idea to ask them questions about additional options that you’re interested in, at this point.

Attending this meeting provides extra support for your loved one and enables you to get a sense of what each type of care entails, and what the next steps are.

Old age, dementia or stroke?

The three most common health problems afflicting older people, resulting in a need for care are dementia, stroke or simply disability or immobility from old age. Understanding the care requirements of your loved one’s condition can be intimidating, but it’s essential.

Today, scientists and doctors are becoming increasingly aware of the links between stroke and dementia. The same risk factors apply to both diseases, implying some degree of common development. Historically, dementia – especially Alzheimer’s disease – was diagnosed by psychiatrists and neurologists, while stroke remained in general medicine or geriatrics.

“Strokes can bring on the sudden appearance of dementia symptoms that are caused by the rupture or blockage of a blood vessel. In contrast, the symptoms of Alzheimer’s disease usually progress slowly. However, with advancing age, these two diseases may become intertwined and confused.”
Dr. David Snowdon

Dementia

Dementia is a set of symptoms that may include memory loss and difficulty with thinking, problem-solving or language. A person with dementia may also experience changes in their mood or behaviour.

It is important that, where possible, loved ones support the person to do things for themselves rather than taking over. Focus on things the person can do, rather than those they can’t.

Stroke

A stroke, meanwhile, is a medical emergency. Early action is necessary to minimise damage to the brain and reduce the potential complications. A related condition known as a transient ischaemic attack (TIA), interrupts the blood supply to the brain temporarily. This causes what’s known as a mini-stroke, often lasting between a few minutes and several hours.

A stroke survivor may prefer to live in their home with a live-in carer, family member or in a family member’s home to assist with recovery. Encourage your loved one to focus on life after stroke and help them to achieve their goals. This may include facilitating their participation in community activities, sports and leisure pursuits, visiting their place of worship and stroke support groups.

Post-stroke depression is relatively common; as many as 30–50% of stroke survivors develop the condition in the early or later phases. This, unfortunately, can significantly affect your loved one’s recovery and rehabilitation process. Bear this in mind when considering their care options.

Old age

If your relative is suffering from neither of these conditions, but is struggling to live alone or care for themselves in old age, or is suffering with immobility or poor physical health, they may still require professional elderly care. caring for someone with parkinson's

What next?

When your loved one is assessed, you may be given information and signposted to other services. Note that your local authority may not necessarily outline all the care options upfront, so asking questions about live-in care care can be helpful.

If you’re concerned that your loved one’s care needs to be arranged as a matter of urgency, it’s important to know that live-in care can often be arranged quickly and seamlessly. Your local authority may not always be aware of this, so arming yourself with as much information and research will put you one step ahead.

This meeting is your opportunity to ask questions, including:

  • What are the different care options for my parent or loved one in their local area?
  • What house modifications might be required, to keep my loved one in their own home?
  • Does my loved one need periodic or round-the-clock care?
  • What is the national eligibility criteria for care and support?
  • What are the financial support options for my family?
  • Can my loved one safely use facilities or services in the local community like public transport and recreational facilities or services?

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How to discuss care with your loved one

Broaching the subject of professional care for your elderly loved one can be difficult if they are resistant to change, unwilling to give up their independence or lose their home comforts.

Whether you need to talk about moving, giving up driving, or bringing in live-in care, knowing which words to use, and which to avoid, can improve the chances of moving towards a positive solution. Effective communication is essential, but it’s advisable to first collect information and research possible solutions so you can discuss all the options, including care in your loved one’s own home.

Ultimately, the goal is to solve the problem together through helpful discussions, not to dictate or to persuade too forcefully. What’s more, if you gather solid facts first, you’ll be able to help in a way that’s better informed.

Before you jump straight into the discussion, it might be helpful to test the water with your loved one. This should be an nonthreatening conversation without criticism or directly trying to solve the issue. For example, “It must be hard keeping up with cleaning and housework,” or, “How are you finding getting up and down the stairs these days?”

If the conversation is well received, perhaps move on to asking how you can help or suggest discussing it more when you’re next with them. Asking their opinions and feedback on the situation keeps the conversation positive and collaborative.

If the discussion is more resistant, consider bringing in a more authoritative figure like a doctor or family friend, and ask them to lay the groundwork.

When moving to the more serious part of the conversation, the key is to not criticise or dictate a preferred solution. Take time to observe your loved one’s feelings, sit together in person if possible, and discuss the pros and cons of the various options. Try to remain upbeat and supportive, even if you’re frustrated.

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Your care options

For many families with an elderly loved one, residential care can seem like the only form of care. It’s worth considering all the options before you discuss it, however, as there are other options that can enable your loved one to remain in the family home they love, whilst still receiving the companionship, care and support they need, at a comparable cost. These include domiciliary (hourly) care and live-in care.

Here we outline the scope, pros and cons of residential, domiciliary (hourly) and live-in care:

Residential care

Residential care is a long-term assisted living option in a residential setting away from your loved ones home. It is one of the most commonly known forms of elderly care. Care homes may be privately owned or run by charities or councils. Some will be small, based in domestic dwellings, while others will be large centres.

Most residential care options offer support for basic personal needs like meals, bathing, going to the toilet and taking medication. These facilities are not required to have nurses, certified assistants or doctors on staff. This level of care and supervision is for people who are unable to live by themselves but who do not need 24 hour medical care.

Some care homes are registered to provide nursing care. These are often referred to as nursing homes. For example, a care home might specialise in certain types of disability or conditions such as dementia.

Why is residential care helpful?

Residential care can be useful for a relative who needs round-the-clock care rather than periodic, and has no space for a live-in carer.

 

The benefits of residential care include:

  • 24/7 staff on duty, so your loved on is always safe
  • Your relative (usually) gets their own room for privacy
  • Meals are provided as part of the facility
  • Your loved one can make friends and get companionship from other residents
  • Medication is administered in a controlled way
  • No anxiety over keeping household finances or bills in check

 

Considerations of residential care should include:

  • Vacancies could be limited in your area
  • Surroundings are unfamiliar and can be disorientating
  • Your loved one may have to give up their pets and beloved possessions
  • The living space may be smaller than they are accustomed to
  • Your relative may be less mentally stimulated and lose a degree of independence
  • Residential care can be an expensive, ongoing cost.

Remember to check the care home’s most recent CQC inspection report. This will identify any concerning facts on the facilities and staff.

caring for elderly lady

Hourly care

Hourly care, also known as domiciliary care, is home care for the elderly in their own home, provided on an hour-by-hour basis. Hourly care is ideal for those who need only a short amount of assistance per day, perhaps with personal care like getting dressed or washing, house work or meal preparation.

Hourly care is a flexible approach to home care, and can be booked from 15-minute visits to 24-hour assistance, although this elderly care option is less suited to long term live-in care.

The benefits of hourly care are:

  • Your relative can remain in their own home for longer, keeping their independence
  • Your loved one can stay part of their local community
  • Peace of mind your relative is being checked on regularly
  • The service is flexible, meaning costs are relative according to the need
  • Carers go through national regulatory bodies to check they meet standards
  • If the need for care isn’t too high, costs of hourly care are much lower than residential care
  • Your loved one can keep their pets

 

Considerations of hourly care should include:

  • Unless your loved one opts for a live-in carer, your relative will not have 24/7 assistance
  • Staff turnaround of hourly care workers can be high, meaning less consistency of care
  • Your relative’s options for hourly care workers may be limited by geographical distance
  • You or your loved one must continue to manage household bills and finances
  • If your relative needs longer-term care, hourly care is very expensive on a full time basis.

If you’re unsure, find out the level of care your relative needs by arranging a Section 47 assessment.

Live-in care

If your loved one needs round-the-clock care, but you’d prefer them to stay in their cherished home surrounded by familiar belongings, live-in care is an excellent option. Live-in care helps people live independently at home for longer by providing specialist care in the comfort of their home. It can be arranged quickly at short notice, so live-in care is ideal for loved ones with high priority care needs.

Live-in care agencies enable loved ones to be cared for every minute of the day by a carefully chosen and trained carer, usually matched based on personality, interests and overall needs such as dementia or stroke. Live-in care can often be a more affordable long term care option. It is less suitable, however, to those residing in small properties like one-bedroom apartments.

The benefits of live-in care are:

  • Your loved one remains settled, independent and mentally stimulated in their own home with they familiar surroundings and their adored pets.
  • Your loved one will have a permanent companion to talk to and help them get around, while maintaining their current hobbies and social activities
  • The costs for dedicated, round-the-clock care are fixed and affordable (comparable to residential care)
  • Your relative will receive consistent care from one or two carers on an ongoing basis, helping form bonds and better companionship — many live-in carers become lifelong friends or a part of the family
  • Peace of mind your relative is being monitored and kept company around the clock
  • Your loved one can maintain their lifestyle, hobbies and remain integrated in their local community
  • Elderly couples with different conditions and needs can stay together
  • Your loved one will receive one-on-one, dedicated care

 

Considerations of live-in care should include:

  • Your relative’s property will need to have a spare room to accommodate a live-in carer
  • The living conditions for the live-in carer need to meet a certain standard
  • Having a live-in carer means adapting to living with a stranger, although it’s always possible to change your loved one’s carer if the chemistry isn’t quite right
  • Your loved ones’ home may need to be adapted to make living at home more comfortable in later life

Speak to Promedica24, a live-in care provider, if you’re unclear whether your relative’s home is appropriate for a live-in carer, or needs adapting for better accessibility.

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elderly couple dancing at home

Getting help and advice

Alongside all the complications of finding the right type of care for your loved one, being able to pay for elderly care can be challenging. There are various types of funding that can help, but understanding the eligibility criteria can be confusing.

If you’re unsure where to look for help with funding your loved one’s elderly care, it’s best to first discuss the options with your local council. If your relative’s needs meet the eligibility criteria and they have a limited ability to pay for the services, your local authority may pay for some or all of their support.

If your relative is assessed as having ‘eligible needs’ that can only be met with professional care, and he or she wishes to apply for financial help, the council will then carry out a financial assessment. Note that in some cases, a local authority can begin providing services before a care needs assessment has been carried out, if they believe you need support urgently.

In some instances, the NHS will contribute towards or cover the cost of elderly care. The NHS is responsible for funding certain types of healthcare equipment and in some situations will fund the provision of care. For more information visit the NHS’ website.

Financial support maybe available to your loved one, whether they need help to live safely and comfortably in their own home with live-in care or domiciliary care, or if they prefer to move into residential care.

Financing options

If your local authority is funding part or all of your care, you’ll need to provide some financial information, including:

  • Bank and building society statements.
  • National savings and premium bond certificates.
  • Details of any stocks, shares and any other financial products your elderly loved one owns.
  • Your loved one’s pension entitlements.
  • Details of property they own and its current value.

If your loved one is paying fees themselves — or self-funding — and their capital reaches less than £23,250, the local authority may assist with funding.

Your local authority may be able to help your relative with the costs of a care home, or if they prefer and it’s appropriate, they can help your loved one stay in your own home by providing carers, support for live-in carers, equipment and specialist services.

Explaining benefits for older people

If your relative has to self-fund or top the costs of their care, they may still be entitled to claim benefits. These aren’t means tested, so your loved one could claim if they qualify, regardless of their income.

These benefits include:

  • Attendance Allowance
  • Personal Independence Payment

Your relative might be entitled to Attendance Allowance if they’re over 65 and need help with their personal care. They will get a lower rate if they need help in the day or night, and a higher rate if they need help both day and night — for example if they need live-in care. Read more about claiming for your Attendance Allowance here.

There are two parts to the Personal Independence Payment, a mobility component if your loved one needs help getting around, and a daily living component if you need personal care. There are two rates for each part, depending how severe your relative’s needs are. Find out more here.

Power of Attorney

Power of Attorney is a legal agreement to enable you or other close family members to act on behalf of your parent or loved one, if they develop decision-making impairments.

There are two principal types of Power of Attorney — Ordinary (OPA) and Lasting (LPA). OPA is a short term solution for an individual who is either overseas, suffered an accident or has a physical illness, preventing them from managing their own financial affairs for a certain period of time. Ordinary Power of Attorney is not used for an individual with impaired decision making, a degenerative illness like dementia, or a reduced mental capacity.

Lasting Power of Attorney is more appropriate for an aging or elderly parent. It can be put in place at any time, as long as the individual is capable of making their own decisions when the document is signed. LPA can be appointed for two types of affairs:

Property and finances: for the practical management of finances, debts, benefits and buying or selling property.
Health and welfare: for medical treatment, care and housing issues.
Your loved one may feel uncomfortable discussing this step, so it can be helpful to frame it as a backup measure rather than a vital step in his or her ongoing care.

It is vital, meanwhile, to plan ahead and act sooner rather than later to prepare LPA; registration can take up to eight weeks. If it is not registered while your loved one has full mental capacity, their affairs pass to the control of the Court of Protection; applications to which are an expensive and time-consuming process.

Lasting Power of Attorney can be arranged either though a will writer, a family solicitor or by paying £110 and completing the online forms from the Office of the Public Guardian. Your loved one or parent will be asked to provide supporting evidence from a doctor or other health professional to confirm that they are still capable of making decisions.

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Conclusions

1. Provide positive and supportive words

Recognising that your parent needs professional care can be a difficult process for you and for them. Before you make any care decisions, it’s important that they feel as consulted as possible throughout the process, to minimise the worry that comes with it.

Researching all the possible solutions in advance, so you can discuss all the options together in a positive way is key to a positive dialogue. The goal should be to solve the problem together through helpful discussions.

Ensuring your loved one feels supported and consulted throughout will make it easier to come to a solution together, collaboratively.

2. Consider your loved one’s condition when choosing their care.

If you believe your loved one needs some form of professional elderly care, or has been admitted to hospital with an age-related condition, the first step is to seek a Section 47 care assessment by your local authority. This will help establish the level of care your loved one needs.

If your parent has developed Alzheimer’s, or another form of dementia, medical professionals advise that you encourage them to do things for themselves. Letting them remain as independent at home as possible can benefit the development of their condition.

A stroke survivor may also prefer to live in their home with a live-in carer; this helps maintain participation in their favourite activities and social community.

3. There is financial help available.

Whatever the ultimate care choice for your parent or loved one, financial support like Attendance Allowance and Personal Independence Payments will often be available. These benefits are not based on income or savings, and will help cover the costs of a live-in carer, to receive domiciliary care, or if your loved one prefers to move into residential care.

Your local authority will complete a Section 47 care assessment to establish your relative’s needs, but you can help them claim benefits directly by downloading and posting the relevant forms.

4. Staying at home is a viable choice.

We all want to ensure our loved ones are safe and comfortable in later life, maintaining a familiar and mentally stimulating environment. Whether it’s keeping elderly parents together happily without the mutual strain of caring for each other, or ensuring your loved one has a companion and friend whenever they need it, their comfort comes first.

If your loved one needs long-term elderly care, and would benefit from the familiarity, security and comfort of staying in their own family home, live-in care is the ideal solution. With live-in care, from Promedica24 UK, you can help prevent your parent from suffering from loneliness or deteriorating mental health. Your loved one keeps their home comforts, their cherished pets, their precious belongings and favourite local activities, with the added companionship and peace-of-mind that having a live-in carer brings. Live-in care is available at a comparable cost to residential care.

To find out if your loved one would benefit from live-in care, get in touch with Promedica24.

 


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