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A guide to selecting residential care for the vulnerable elderly

by Access Legal Solicitors

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Moving a relative into a residential care home or a nursing home can be a difficult and emotional experience. An increasing number of elderly people are living in their own homes for longer with assistance such as carers who visit to provide meals, assist with washing and personal hygiene and ensure medications are taken.

Such supported independent living can be funded entirely by the local authority but more usually is jointly funded by the council and direct payments by the individual themselves.

Concerned relatives may already be used to acting on behalf of an elderly person, especially if they have a Lasting Power of Attorney (LPA) for Health and Welfare. Under this arrangement the Attorney, with the donor’s agreement, can decide if moving into residential or nursing care (based on the donor’s previously expressed wishes) is in that person’s best interests.

Health and Welfare LPAs cannot be used until it is established that the donor lacks capacity to make those decisions themselves.

Whatever the legal arrangements you may have in place, you will want to ensure your relative receives good quality care and that they will be happy and comfortable. Given the seemingly constant press reports of care home abuse and neglect, it is sometimes difficult to be certain that will be the case. This guide is intended to give you some tips as to how to go about selecting the residential or nursing care that should best suit your loved one.

Deciding between a care home and a nursing home

The first decision many will face is whether a continuation of ‘supported living’ in their own home or a residential care home or nursing home would be more appropriate for their relative. The state of your relative’s health means that this decision may well be taken out of your hands. The average age of residents moving into care is now around 85 years old, with all the attendant health and medical issues that implies, so it’s increasingly likely that a nursing home rather than a residential care home will the better option.

It is possible to judge the suitability of any form of care through the independent assessments carried out by various regulatory bodies charged with oversight of the care sector. While such inspection reports can give a valuable insight, it is also advisable to visit candidate homes and form your own impression. Care homes and nursing homes are regulated and inspected by the:

Get a free needs assessment

Getting a free needs assessment from the adult social services department of your local council is an important first step in helping you determine which form of care might be best. It’s essential to get this assessment if your relative might need financial help from the local authority as councils will only fund care for someone who has been assessed as needing that support.

It’s also worth having the assessment done even if your relative has to pay for their own care since this report gives a professional assessment of the type of care and support your relative needs, which can inform your choice of a suitable care home.

Sheltered housing and residential care

Sheltered housing is appropriate for people who can live independently with some additional support, but whose medical needs are such that they don’t require any substantial nursing care.

Sheltered housing (often confused with retirement housing) accommodation can be bought or rented privately. If your relative meets certain eligibility criteria, they can apply to be allocated sheltered housing by their local council or housing association.

Such schemes usually consist of self-contained apartments/flats or bungalows on one site. All properties have their own front door, kitchen and bathroom, so that residents can continue to live independently and have the freedom to come and go as they please. Many however will not accept residents if they are not capable of independent living – with or without some degree of assistance.
Residents of sheltered housing have help at hand if they need it through a scheme manager (or warden) living on or off-site, who gives advice to residents and arranges maintenance and repairs. This person is not however usually qualified to give medical advice and is normally on site only during ‘working hours’. Most sheltered housing properties therefore also feature a 24-hour emergency ’pull cord’ alarm system so that residents can call for help if they have a fall for example.

Residential care homes are appropriate for people who struggle to live independently and may need substantial additional support, but aren’t yet in need of intensive nursing care. Staff are normally on hand to care for the residents 24 hours a day, although in residential care homes this won’t include nursing care.

There are advantages to residential care, such as staff on duty full time in an environment that is ideally physically safer, warmer and cleaner than the alternatives. Residents will get a room of their own which they can personalise with their own furniture, pictures and ornaments and regular meals are provided to ensure nutritional needs are met.

Perhaps the biggest advantage of residential care is companionship. Residents have the opportunity to socialise with others of their own age and take part in organised activities or outings which should benefit their mental health.

Conversely, residential care homes can be very costly, particularly if your relative has to fund their own care. Research by LaingBuisson, acknowledged as a leading health and social care market intelligence provider, for their ‘Care of older people UK market report’ - 28th edition, May 2017 indicates that the average weekly cost of residential care in the UK in the financial year 2016-17 was £600.

All homes have to achieve a minimum standard to ensure they can be registered, but the quality of care does vary from home to home. Doing your research, asking for recommendations, visiting candidate homes and checking CQC inspection reports should help you avoid the less suitable ones.

Residential nursing homes

Residential nursing homes are more appropriate if your relative’s health is such that they require considerable additional support as well as having complex medical needs that must be met by full time nursing care.

A nursing home will inevitably have fewer active residents than in a residential care home, but to all intents and purposes they will offer the same basic service and amenities as a residential care home but with additional nursing support from qualified nursing staff on-site full time, day and night, as well as regular visits from GPs and district nurses.

These institutions too are subject to inspection by the CQC and given the additional levels of support provided they are more expensive than purely residential care. The same LaingBuisson report indicates that the average weekly cost of residential nursing care in the UK in the financial year 2016-17 was £841.

Choosing residential care: further information

It’s worth taking time to find the right home. Check the regulator’s inspection reports and try to visit the home, have a look round and talk to staff members and residents. Some homes may invite you to spend the day there so you can get a feel for the place. You may be able to move your relation in on a trial basis before deciding whether to stay.

Make a list of all the questions you want to ask - the level of care provided, the fees and waiting list. The charity Age UK’s website features a useful downloadable checklist of what to look for in a care home.

How we can help

If you suspect that an elderly or vulnerable relative or friend has suffered harm as a consequence of physical, mental or financial abuse or neglect in a care or nursing home our specialist teams here at Access Legal Solicitors can help.

Call our client services team on 03700 868 686 for a free initial consultation. We have experience in this type of claim and will be glad to discuss the options that are available to you.

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