Help at Home : A guide to Elderly Care

Your home is your personal space, somewhere that you can relax and be yourself. Many of your fondest memories are likely to be here as are items which are precious to you.

Running a home can be hard work but we usually manage, often by being organised and having a daily routine.

But there may come a time when you need a bit of help with doing this. This can occur at any time in life not just when you are older. If you have had an accident or a serious illness then you may need someone to undertake a few household jobs for you.

But you may find it harder to do some of these jobs as you get older. Tasks such as shopping, cooking or cleaning are easy enough to do when you are younger but can become awkward or difficult when you get older.

If your partner or a relative can help then that’s fine. If you have a good neighbour or a friend then that’s also fine but sadly, not everyone is lucky enough to have this. There are people who live on their own without any family or anyone to give them a hand. In this situation those people require some form of help at home.

If you, for whatever reason, feel that you need some help at home then please don’t assume that you will have to leave your home and go into residential care. You can stay in your own house but with the addition of some extra help via your local authority.

Do you need help at home?

Consider applying for help at home if you are experiencing any of the following:

  • Problems getting in or out of the bath
  • Finding it difficult to cook or do your laundry
  • Unable to walk to the shops
  • Difficulty in cleaning, making the bed or other household jobs
  • Difficulty in remembering to take medication
  • Problems with getting around
  • Difficulty with using the toilet
  • Problems with getting dressed/undressed

There are services available which can help with any of these. These range from someone who ‘pops in’ to 24 hour live in care.

So what type of help is available?

Home-based services for the elderly

There are a range of services designed to assist older people at home which include:

  • Home help
  • ‘Pop in’ help
  • Meals on wheels
  • Personal/intimate care
  • Day/respite care
  • Live in care
  • Personal alarm system
  • Minor medical help
  • Night sitting

Home help

This is a service in which someone helps you with shopping, cooking and doing your housework. If you have a garden then someone can help you with that. ‘Pop in’ help

This is as the name says: it is a service in which someone will call around to help you with small types of jobs but those which are essential. For example, taking a prescription to the chemist or pharmacy.

Meals on wheels

This is a popular service which delivers ready cooked meals to your home. These meals are usually hot when delivered but there is the option of frozen meals. These just need to be put in the freezer until you are ready to eat them.

Personal/intimate care

If you find it difficult to wash yourself, go to the toilet or have a bath then you can get help with this. This will be carried out by someone who will respect your dignity at all times.

Day/respite care

This involves a trip out to a day care centre where you will be able to take part in a number of activities. It can also involve care at a specialist centre.

You are usually picked up and taken home afterwards.

It gives you the chance to meet with others, take part in social activities such as bingo and have a hot meal. There may also be the opportunity to re-learn skills which you had forgotten or are unable to do because of a disability or illness.

This is often known as respite care as it can give a carer or relative a break as well. Live in care This is a 24 hour service in which a specially trained carer lives in your home. This person will have their own room and will assist you with all household jobs and personal care if needed. One of the biggest benefits from this is the fact that you will company throughout that time. This is useful for the family of an elderly person as it means that they are free to spend time with their parent or relative without worrying about things which need doing.

Personal alarm system

These provide 24 hour help whenever needed. This consists of a base unit and a pendant or wrist band and allows you to contact a Response Centre 24 hours a day, 365 days of the year.

The base unit looks like a telephone answering machine. It comes with a couple of speakers and enables you to speak to someone at the Response Centre. The alarm itself is set within a wrist band or pedant which you wear around your neck. It contains a large red button which you press in case of an emergency. The Response Centre will contact two people – relatives, friends or neighbours who you have designated to be your ‘emergency contacts’.

If they are unable to reach them then they call an ambulance or any of the emergency services.

Minor medical help

This is a service provided by a nurse or specially trained carer. They help with minor medical tasks such as changing a dressing.

Night sitting This service provides a carer to help you at night time whether this includes assistance with going to the toilet or reminding you to take your medication.

This can be reassuring for both you and your family.

If you think that you might need some help then speak to your GP. He or she may be able to advise you on services within your area.

Other forms of help

Other types of help include adapting areas of your home so that they are suitable for your needs, for example, a stair lift or handrails. If you find it difficult to walk then you can apply for a walking stick or Zimmer frame. Wheelchairs are another option.

These are free on the NHS or available via your social services department. Speak to your doctor about these.

Other ways of adapting your home include fitting a rail outside your front door if you have steps; grab rails by the bath, plastic tap turners in the kitchen and an intercom at your front door.

On a smaller level if you find it difficult to open a tin or turn a tap then there is specialist equipment such as jar openers which you can buy.

Further advice can be found at the Citizen’s Advice Bureau and social services – as part of your local authority. See our links page for further details.

Your local social services department may provide some of these services but not all. If they don’t then you can try a voluntary organisation such as Age Concern or the WRVS. Another option is help from a member of your family, a friend or a neighbour.

Help from your local authority

If you decide to apply for help from your local authority then you will find that the type and amount of care you receive does vary between local authorities.

This is mainly due to funding as local authority budgets are finite and subject to need. Your local authority will have many competing demands upon its budget and has to allocate funding according to priority.

What you (or your relative) do is to contact the social services department within your local authority and explain your situation. Then ask for a ‘needs assessment’.

Note: It’s a good idea before you visit them to make a note of what you would like and what you think you would need. If you are unable to travel to their premises then they will arrange a home visit.

Needs assessment

A ‘needs assessment’is a type of review in which your needs and requirements (and those of anyone who looks after you) are taken into account when deciding upon the type of service available.

As you might imagine, funding for this is limited and you may be asked to contribute towards the cost of help.

If social services decide that you need help then they will make the necessary arrangements. They have a duty to provide you with help according to your personal circumstances.

They will produce a ‘care plan’ for you which contain information about your needs, the type of help you require and your contribution. This should also contain the name of your ‘care manager’ – the person who is responsible for these services. They should then give you a copy of this plan.

Your help will be arranged through social services or a specialist provider.

Do you have to pay for care at home?

Social services will carry out a ‘financial assessment’following your needs assessment. This decides whether you qualify for financial help or not with your care.

They will look to see if you fall into one of the following categories:

  • Do not have to pay anything towards your care
  • Have to pay some of the costs of care
  • Have to pay for all of your care.

In basic terms it is a ‘means test’.

They will look at how much money you have and what you can pay towards the cost of your care. This includes your pension, savings, expenses and any other monies such as investments or shares.

You can use any of these to pay for care. If you have private health insurance then check to see if this will cover the cost of your care. Another option is to see if there are any social security benefits you can claim for which will help with this. In terms of how much it will cost there is no simple answer to that as every social services has its own rules on what it will pay for so you need to check beforehand. They will calculate this by looking at your total amount of income per week and then subtract expenses from this. By expenses we mean Council Tax and rent/mortgage payments.

Note: when they say ‘income’ they mean:

  • Interest on your savings
  • State/private pension
  • Certain social security benefits such as Pension Credit, the ‘care’ part of Disability Living Allowance and Attendance Allowance.

How do they calculate this?

They will use the following system based upon the government’s‘Fairing Charging’ guidelines.

How much you will pay (if at all) is calculated as follows:

  • You pay for your care in full if you or your partner has more than £23,000 in capital. Note: ‘Capital’ means savings and investments. It does NOT include the value of your home.
  • If your income is below £23,000 then you will still be means tested but you will be left with the basic amount of Pension Credit plus 25%.

(Source: FirstStop: advice for older people)

Some social services set a higher capital threshold. Others may have a fixed, maximum amount which everyone pays for their home care.

Social services in England, Wales and Northern Ireland can charge you for any services you need. But these must be set at a ‘reasonable’rate. If you feel that these are unreasonable then contact your local department and ask about their policy of home care charges.

This differs in Scotland where people can get ‘personal/intimate’care free of charge but may have to pay for other services such as meals on wheels or respite care.

You may feel that a financial assessment is intrusive and don’t want to give out details of your private affairs. But if you don’t then social services will charge you in full for your care.

Unhappy with the assessment?

If you are unhappy with the assessment then you have the right to appeal. You can contact the Financial Assessment Officer and ask for your case to be reviewed. If you are still not happy with this then you can make a formal complaint.

You can also complain if you feel that the services offered to you are unsuitable or are not enough to cope with your needs. Every social services department will (or must) have a complaints procedure.

If you require further help then contact your local Citizen’s Advice Bureau (see our links page).

What are ‘direct payments’?

If your social services department will pay for your care –either partial or in full then they offer you direct payments. These are cash payments which come directly to you so that you can buy the care you need. This money must be spent on your care needs and you will have to keep a record of what you have spent this money on. It must not be used by a relative or anyone living in your house unless they are a ‘live in carer’.

Your care manager will be able to advise you further about this.

Self-paying for care at home

You can always ‘self-pay’ if you can afford to do so. This can be an option if social services are unable to offer you the help that you need or if you want a carer. Choose a carer carefully. Look for a reputable care agency and make sure that you find someone you feel comfortable with and can trust.

Bear in mind that this person may be helping you with intimate aspects of care such as going to the toilet or bathing so it’s important that you find the right carer for you.

You have more say in the matter (and more choice) if you do this privately compared to going through social services. A good place to start is the United Kingdom Home Care Association, the address of which can be found on our links page. They can provide you with a list of care agencies. Another good contact is the charity Care and Counsel who have a very useful fact sheet on what to look for when choosing a care agency.

If you require a great deal of care at home then this can prove to be very expensive in the long run. In fact it could cost more than residential care or assisted living. There are several options open to you which includes moving to a smaller property or one which is part of a community. Some people decide to move nearer to their family or live with them.

A relatively new initiative called ‘Living Homes’looks at adapting new housing to fit the needs of elderly people and people with a disability. The idea behind this is that new homes are built according to set of ‘design standards’ which mean that they are suitable for people with differing needs.

If a care home is your best option then you will find that there is more than one type of home. There is residential care, specialist care and nursing homes.

This guide contains a comprehensive section on care homes with all the information you are likely to need in order to make an informed decision.

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