The price of care for elderly relatives

Has a visit home revealed that grandparents can't cope any more? It's time to think about long-term care.
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The Independent Online

If you are wondering how to arrange long-term care for an elderly relative, then you are not alone. January is a time of peak activity in this sector. The Elderly Accommodation Counsel, for instance, always sees a surge in inquiries at the start of each year. And calls for help to the charity also went up 15 per cent at the beginning of this month, compared to the same period a year ago.

The main reason why issues come to a head in January is that many families discover at their Christmas reunions that an older relative is struggling to cope. On top of that, this year's bad weather has also shown up the failings of poorly insulated housing as well as exposing vulnerable people to very challenging conditions. Finding grandmother out in the snow in a summer dress is a common wake-up call for families. It usually confirms that she is becoming confused and does need some kind of help.

Advice is easier to get than it used to be. In some ways, the national system for providing care to older people is working far more efficiently than it did a few years ago. Organisations such as the Elderly Accommodation Counsel (EAC) and Symponia, a network of financial advisers, are not reporting a shortage of care homes or delays in responses from local Social Services departments.

The main problems appear to lie elsewhere, in the quality of the residential homes, for example, and in the unnecessary hardship suffered by disabled pensioners who do not claim all the benefits which may be due to them, particularly attendance allowance.

What many people will find hard to take, however, is that they will need to pay for some or all of their care. The proportion of elderly people getting financial assistance on care home fees has fallen 11 per cent to 59 per cent from 2002, according to the Liberal Democrats. And the numbers receiving funded care in their own homes have fallen over 16 per cent since 2000, according to Age Concern.

Local authorities are going to be under significant pressure to cut back even more over the next few years as the Government seeks to reduce the public debt. Average weekly fees in a UK residential home are £479, according to the researcher Laing & Buisson, and £669 for a nursing home. But, in England, only people who are assessed as having under £14,000 in capital assets will escape making contributions from their capital; and income from pensions, benefits and other sources will be assessed and, after certain deductions, will nearly always be put towards the cost of home fees.

If the local council is having to contribute, in England it can take all of the individual's income (subject to various rules which families should check are being followed), leaving the person with a weekly "personal expenses allowance" of £21.15 (a figure which rises to £21.90 in April).

If relatives want to do the best they can for elderly relatives, they should be very careful in choosing a home. A high fee level does not guarantee good service, and nor does a strong rating under the UK's care home inspection regime. Some homes can look nice on open days but are unpleasant places to live. Even expensive homes which have good inspection reports can be disappointing, according to Age Concern.

"It can often be extremely difficult for people to judge the true quality of care services for older people," says Andrew Harrop, head of public policy at the charity. "Better monitoring and inspection of care services is urgently needed."

Changes are happening, year by year, in this sector. This is both a good sign (as action is being taken to remedy problems) and a bad one (as those problems still persist despite a continuing national outcry about conditions in homes).

One of the more positive moves is that of helping people to maintain their independence, either by encouraging them to stay in their own homes as long as possible or by building more retirement villages and "extra care" flats for them. There are now about 35,000 extra care flats in England, providing people with their own space but easy access to care and facilities such as hairdressing and shops.

Ironically, local authorities often found it easier to put people into homes in the past, but attitudes are changing, says Colin Angel, head of policy at the United Kingdom Home Care Association. "Home care needs an awful lot more organisation than putting someone into a home but the Government has realised that it is far more cost-effective," he says.

We can expect more changes to follow this year's general election. All three main parties have announced policy changes. "We will see a resurgence of the pre-funding of long-term care," predicts Jeremy Davies, co-founder of Symponia. If that is true, then people in their fifties or younger could expect to be asked to pay some sort of contribution, if they can, ahead of the time when they need care. But these are controversial issues and could only be implemented following a national debate.

How to obtain long-term care

* Consider all the possibilities. A nursing home is the most extreme option. But many people prefer to downsize or get conversions made to their homes, such as walk-in showers, grab-rails and downstairs bathrooms. Care at home and "extra care housing" (where people live in their own flats but have access to personal care and shared facilities, such as cafes and laundries) are alternatives.

Help the elderly person to be as specific as possible about what they want. "Don't rush into things," says Sheila Coles of the Elderly Accommodation Counsel (EAC). Anyone with memory problems should have a medical assessment before they are moved, she says. While they may be able to cope in the home they have lived in for years, they may be unable to adapt to new surroundings. Loving children can also make the mistake of putting an elderly relative into an inappropriate environment, a sociable retirement village, for instance, when the person has become less outgoing.

Contact the numerous advice organisations (see box, above right) which provide lists of care providers, information on funding and, in many cases, experienced advisers who can chat through issues on the phone.

Ring the local social services department (at the local authority where the elderly person lives) if your relative has a physical or mental need for care and, especially, if they are also likely to qualify for financial help. For example, people living alone in England with assets (including their home) worth more than £23,000 will usually have to pay all their nursing or residential home fees. Many local authorities will ask questions over the phone and will immediately screen people out from being assessed if it seems that they do not need care. Sheila Coles of EAC says: "This is not the moment to be stoical but to describe your worst days." For example, when asked if they can get dressed unaided, many older people will say yes, even if it takes them an hour, when they should be saying no.

* Recognise that the rules on funding are very different for people receiving care at home. The home is taken out of the equation for this group. The Personal Care at Home Bill, now going through Parliament, is due to provide more free care at home from October for those with the most serious care needs who are still at home.

* Check to see if you are covered by some of the many exceptions and variations that apply. You can ask Age Concern, Citizens Advice or one of the other assistance agencies. For instance, different financial rules apply for couples, single people and those with dependents. Also, care in a home can be free for up to six weeks if it is arranged as part of a package of "intermediate care" after hospital treatment or to replace hospital treatment. In general, rules and thresholds vary between England, Wales, Scotland and Northern Ireland, and local authorities have their own systems, allowances and procedures.

* Visit care homes unannounced if you can. It is fairly easy for home owners to make their properties look welcoming if they know you are coming. But the true picture is more likely to emerge if you call round without an appointment.

* Expect to have a few issues that are very specific to your situation, and pursue them. An elderly person who is funded by their local authority can ask to be located outside that area, near their children, perhaps. But, in most cases, the local authority will only have to pay fees up to the level it would pay locally. This means that moves to London and more expensive areas are difficult to engineer but are far more feasible the other way round.

* Keep checking that your relative is being cared for adequately. Documents such as the contract with a care home and the assessment carried out by a local authority have legal implications, and you should read them with an inquisitive eye. They can be used to make complaints and get better services.

* Get financial advice from people who are experienced in the field. For instance, Attendance Allowance (available at rates of £47.10 and £70.35 a week) is not means-tested but is thought to be widely under-claimed by people aged 65 or over who have the physical or mental difficulties which make them eligible. Similarly, generalist financial advisers can make mistakes advising the elderly.

Getting help: Contacts

* offers a network of advisers with specialist qualifications *Age Concern: 0800 00 99 66 and

* Benefit Enquiry Line: 0800 88 22 00 and *Care Quality Commission:

* Counsel and Care: 0845 300 7585 and

* Elderly Accommodation Counsel: 0207 820 1343 and

* First Stop: 0800 377 7070 and

* UK Home Care Association: 020 8288 5291 and

* The thorny issue of termination rates, and who will pay for what if they are scrapped, is not the only point of contention between the European Commission and the mobile phone industry.

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