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Considering the right elderly care for you and your family
When faced with the decision that one or both of your parents or a loved one needs elderly care, many of us do not know where to turn or what options are available to us. We may have been struggling on as a family caring for our loved one, but the time has come for a more permanent and manageable arrangement to be put in place, that is in the best interests of not just the person needing care, but for all the family.
Choosing elderly care is a significant, and sometimes very emotional decision. Many of us feel guilty about not being able to cope as a family carer anymore. In many cases, we have always vowed to look after our parents until the end of their life but sadly deteriorating health and the impact of other elderly conditions, like dementia make it no longer safe or practical.
It is worth acknowledging that by putting a suitable long term care arrangement in place it allows you to actually go back to being the loving son or daughter you used to be, with care and support being provided by a specialist carer – improving the quality of life not only for your loved one, but for you.
It is essential that you start by understanding the elderly care choices available to you and research options so an informed decision can be made. Planning your decision now, in advance of when a decision simply has to be made, promises a much better outcome than having to make a decision in a pressured situation or in crisis mode.
Firstly, you will need to decide whether receiving care at home or moving into a care home is right for you and your loved one.
So, what are the differences?
Residential/nursing care homes
For many years, the default care option for a person requiring long term care has been to move into a residential or nursing home care setting. Typically, a move into a care home involves selling the much-loved family home to fund the care home fees. Unsurprisingly, 97% of people do not want to move into institutional care according to a survey conducted by the Live-In Care Hub. A care home is a building specifically designed to care for a number of residents, usually between 60-80 individuals who will be cared for on a designated unit according to their care needs. Personal care, specialist care, meal provision and activities will be provided by carers and nurses who are on a rota to provide care around the clock to residents.
Care at home
Home care, or domiciliary care as it is sometimes referred to can be anything from short visits for an hour or less at times during the day, for some support with cooking, dressing and domestic tasks, right through to full time live-in care. This is where a carer lives with you in your home providing 24-hour, one-to-one care, support and companionship. It is likely that you may have already received hourly or visiting care at home at this stage but due to changing circumstances and needs, may now feel that you need to consider a more long-term arrangement. Live-in care is typically considered alongside the alternative of receiving care in a residential and/or nursing home setting. Home care can be provided on a permanent or as a respite care service, which is a short term arrangement, typically for a two week period to afford a family carer a break whilst their parents or loved one receives high quality, personalised care at home.
Live-in elderly care vs. care home
The case for elderly care in a care home
A safe environment
A residential care home or nursing home provides around the clock care in a safe and secure environment. The care home will have many security features to ensure the safety of its residents. You will be provided with your own room, which will typically be on a secure unit tailored to the needs of a group of residents.
No maintenance required
Moving out of your home means you will no longer need to be responsible for its maintenance, paying the bills or housework, which can be a relief for those who struggle to keep up with the day-to-day running of a property.
Meals are planned
All your meals will be prepared and served to you at set times, so you don’t need to worry about cooking or having to choose your weekly meals if you don’t want to.
Arranged activities and social events
Most good quality care homes have lots of communal space both indoors and outdoors for residents to meet up and socialise with each other. There will be a programme of activities, events and trips out that residents can take part in if they chose to.
Limitations of care homes
The upheaval of moving home
Moving home at any age can be extremely stressful. For those in their later years it can be difficult to contemplate and, to some very traumatic, especially if they are living with a condition like dementia.
Another challenge presented is having to downsize and move from what might be a fair-sized family home into one single room. Very few care homes have double rooms and the ones that do would charge two weekly fees based on the room size.
Leaving your life behind
Many older people have lived in their homes for a number of years and have deep rooted connections to it, including treasured memories and possessions, as well as local friendship groups and community ties – all of which just cannot be transferred into a care home.
The emotional wrench of losing this connection can be for some heart-breaking. Parting with a much-loved pet is one of the most distressing consequences of moving into a care home. Shockingly, over 2 million people in the UK know an elderly person who has had to either have their pet put down or given it away when faced with having to move into a care home.
Care team ratios
Even the very best care homes simply cannot offer one-to-one elderly care and carer-to-resident ratios vary considerably depending on the type of home and the quality of care offered. Staff in care homes will typically share their time between a group of residents all with very different needs. Many care homes also rely heavily on agency staff to cover holidays and periods of sickness.
Living our life the way we choose should be our basic right. Life in a care home is driven by routine with meals served at certain times, time is set aside for getting up and washing and dressing, activities starting at certain times of the day – all of which can be unfamiliar and therefore upsetting. Fixed daily patterns can contribute to the feelings of losing your independence and ability to make your own decision.
Healthcare outcomes and admission to hospital
As a resident of a care home you are sadly more likely to have a fall or be admitted to hospital than if you were receiving one-to-one elderly care in your own home. Reports also suggest that infection rates are rising in care home settings, where lack of mobility puts you at greater risk of pressure sores and urinary tract infections.
How elderly care at home could benefit you
Personalised one-to-one care
Receiving care in the comfort and familiarity of your own home, whilst receiving the highest level of care tailored to your specific needs is now the preferred choice by a growing number of people across the country. One-to-one care allows for a strong relationship to be formed with a carer based on trust and an understanding of a person’s individual needs. One-to-one care simply cannot be delivered in even the very best care home.
Live life on your terms
You are able to continue to live life in a way that you always have with the dedicated support from an expert and compassionate carer. The carer adapts to your routine providing as much or as little help and support as you wish. You will continue to make your own decisions about how you live – when you sleep, when and what you eat and when you see friends and family.
Help as and when you need it
Your carer will provide support with personal care, do the housekeeping, prepare and cook meals, shop for you or with you, handle paperwork and other administrative tasks. Importantly, the carer will ensure you socialise in the way you wish – whether that is helping you get out to see your friends or supporting you to invite your friends to your home, just as you always have.
Peace of mind for all the family
Elderly care at home provides reassurance for families that a highly trained and expert carer is there with your loved one 24 hours a day responding to their every need. The carer is trained to monitor health and wellbeing, guard against accidents and respond to any changing needs or wishes. By choosing live-in elderly care over a move into a care home means the much-loved family home will not need to be sold to fund care home fees and remains in the family.
Care and support for specialist needs
Carers are trained in specialist conditions that impact elderly people, including dementia, Parkinson’s and stroke care. A team of experts is a phone call away to provide back up should they need advice or guidance.
Comparable costs to a care home
Live-in care costs are typically in line with a care home, and sometimes less. Costs in care homes can be much more if you need nursing care. With live-in care you have the added value of being able to keep your family home and the fee you pay for your care is purely for the quality support you receive and not the room and board of a residential home. If you are a couple live-in care really is a cost effective option. In a care home you would be charged double for two beds. With live-in care there is only a nominal cost if two people receive care at the same address.
Live-in care considerations
A new face at home
Like with anything new there will be a period of adjustment when the carer comes to your home. A good quality company will ensure you are matched with a carer who not only has the skills to provide you with the care you need, but you live with one who shares common interests so you feel as comfortable as possible with the new addition to your home. In many cases, carers become ‘part of the family’ – not just for the person receiving care but also the wider family – by providing much needed reassurance and companionship to live healthy and happily at home.
Accommodation for your carer
You will need to have a spare room for your carers use. This private space is essential for the carer to have privacy, complete paperwork and rest and recharge to ensure they maintain their wellbeing which is essential to the quality of care provided. The room must have a television and internet access.
How to choose an elderly care provider
Once you have decided that elderly care at home is the best option for you and your family, you will need to find and choose a suitable provider in the area where care is needed and really think about what is best for you as there are further options to consider.
Key questions to ask home care providers
Once you have your short list of potential providers it is important to be prepared with a set of questions to ask that ensure you get an in-depth understanding of the level and quality of care they provide.
Below is a set of useful questions and considerations that will help you with this.
How can you support my loved one’s needs?
It is important here to learn here how the provider approaches assessment and understanding of a person’s care needs. Most good providers will undertake a comprehensive assessment of your loved ones needs, and with the input from you will create a tailored care plan driven by these needs, taking into account not just their health needs, but how to support their overall wellbeing to ensure a better quality of life. Clearly, you will need to understand here how they support any condition your loved one may be living with, like dementia or Parkinson’s. If this an important aspect of your requirement, ask them how they train their carers in these conditions. Anyone supporting a person living with these conditions should receive relevant training and have experience of supporting them.
Are your carers employed by you directly or do you use agency carers?
Carers who are employed by the provider are offered management, supervision and support which in turn leads to better quality care being delivered. Employed carers are generally valued more by their employer, which means they stay for longer allowing for improved levels of continuity of care to your loved one. The provider will also be regulated and inspected by The Care Quality Commission to ensure a high standard of care is provided. If you are introduced to a carer through an introduction agency, they are self-employed and the agency will not be able to direct, supervise or guide the care you receive, and they will not be regulated. That will be down to you to do as you effectively become the ‘employer’. Understanding your liability here is very important.
How do you recruit your carers?
It is sensible here to understand what their process is for recruiting carers. Good quality providers will ensure a stringent and rigorous process to ensure carers not only have the skills and experience to provide the care you require, but have the right aptitude and judgement to deliver care in what can be a very demanding role, as well as the right values to provide compassionate care.
What training and qualifications will they have?
Training is essential for any carer providing elderly care at home. A company who offers a training programme covering a variety of topics related to elderly care prior to a carer being able to be placed with a client is what is recommended. Regulated providers will also ensure their carers have their care certificate and some carers recruited will have sector relevant qualifications. A solid training programme will cover a range of subjects and will be developed to an industry standard with input from experts in the field of health and care. Also check what on-going training is provided to their carers – a high quality provider will ensure carers never stop learning new skills.
How is the service you provide managed?
A fully managed service means you have support. Carers are typically supported by a management structure; a regional manager, a local dedicated care manager and someone who co-ordinates the service. This structure ensures you have a ‘go-to person’ if an issue needs to be resolved. Good providers will ensure you meet these team members at the beginning of the service and have regular meetings to review progress, providing much comfort and reassurance for families. Some will have a 24/7 contact centre, so you know that you can call any time of the day or night to get help and support.
The care manager allocated to you will get to deeply understand you and your loved one’s needs and support the carer to really make a difference. Having a managed service also means that there is immediate cover should your carer feel unwell, which means you won’t be left without care for your loved one.
What happens if my loved one’s needs change or their condition deteriorates?
It is good at this stage to get an understanding of what conditions they support. Whilst you may not need specialist dementia care, or support for someone who has had a stroke at this stage it is beneficial to have an understanding as to what is offered and their approach to delivering this type of specialist care. Do they have medical experts who can support clinical needs? Good providers will have in-house clinical experts who provide leadership and development of the service provided. Ask them if they use any monitoring technology that enable them to respond to changing needs and conditions that prevent emergencies and potential hospital admissions. Also consider whether a provider is able to offer high quality care until the end of life. Whilst you may not want to consider that now, it is prudent to ensure your loved one won’t need to move into a residential setting should their situation change.
What support and advice can you offer families?
In addition to a fully managed service structure, many good providers offer other additional support for families, both practical and emotional. Good providers will also be able to offer support from in house experts – nurses and occupational therapists, providing families with specific guidance, advice and support. Some will offer information events for families providing an opportunity to meet other families in similar situations so you can share experiences and get much-needed advice and guidance. Ask if they have any links to charities and other specialist groups.
What happens if something goes wrong?
When talking to providers it is important to understand how problems are handled if they arise. If it is a fully managed service, they should have a care manager who is your first point of contact, but what is their approach to addressing concerns. Ensure they have a process for escalating any problems that may arise. You will get a good understanding by asking this question as to their level of care and compassion. Be sure to understand whether they are a regulated provider or not. There will be a difference in price, and the choice you make depends on whether you want to have a fully managed service with peace of mind, or whether you want to control and direct the carers yourself.