Choosing Care at Home

When an older person starts to struggle with the tasks of daily living, the preferred option is usually to arrange suitable care at home. This will enable the individual to live in his or her own home for as long as possible.

Types of Care at Home

Care provided at home can be Domestic, Personal and Social and/or Nursing. Some examples of each are listed below:

Domestic help in the home

• Cleaning
• Shopping
• Collection of prescriptions etc.
• Bed-making
• Laundry

Personal and social care for the older person

• Washing and dressing (this might be simply having someone in the house whilst you shower or full assistance if required, for example)
• Toileting
• Feeding
• Meal preparation
• Assistance with mobility
• Prompting of medication
• Companionship and sitting services
• Accompanied trips out

Nursing care in the home

• Changing dressings
• Administering medication
• Artificial feeding
• Bowel and bladder management
• Monitoring symptoms
• Monitoring risk

Personal, social and domestic support is generally provided by family and friends and/or experienced and trained carers. A formal package of care with experienced and trained carers can be arranged privately, perhaps through a homecare agency or via Social Services. Nursing care is generally provided by the Community Nursing Services free of charge.

Levels of Domestic, Personal and Social Care at Home

These types of care can be delivered at a number of different levels, for example:

• Visits starting from 15 minutes e.g. for prompting of medication.
• Visits of 30 minutes or more, two, three or four times daily (more common)
• 24 hour care by rota, with separate day and night shifts
• Occasional escort duties
• Day sitting or respite care
• Night sitting, which can take the form of either:
  • Sleeping night care, where the individual being cared for simply needs a presence in the house or requires supervision or assistance no more than once or twice a night. The carer will expect to be able to sleep the rest of the night.
  • Waking night care, where the carer may need to monitor the individual being cared for throughout the night or where the individual needs assistance more than twice a night. The carer will be awake throughout the night.
• Live-in care, where a carer is a resident in the house of the individual requiring care, for a pre-determined period of time. This usually involves a rotation of carers, who may stay for 2 - 6 weeks each or for another pre-arranged period of time. It should be born in mind that if the individual requires care during the night and the day, additional care may be required.

Some local care agencies are able to offer both live-in care and visiting care. However, most live-in care is provided by specialist live -in care agencies. There are two types of these:

• Those that employ their carers and are responsible for training and paying the carers. This has the benefit of offering the individual and their family the peace of mind that the agencies have been inspected by the Care Quality Commission and that the way they are run and the care they offer are meeting certain standards. The individual or family normally receives a regular bill from the agency for a single amount.
• Those that provide more of an introductory service, where the carers are employed and paid directly by the individual requiring care (although the carers themselves are normally responsible for ensuring that their own tax and NI are paid), rather than the agency. A registration fee and regular weekly or monthly fee is also normally paid to the agency by the individual requiring care.
  Introduction agencies are not required to register with or be inspected by the Care Quality Commission. However, increasingly these types of agencies are choosing to do so, in order to demonstrate that they are meeting appropriate standards.

Visits required by the Community Nursing Services will be subject to an assessment of nursing need.

Assessment of Needs

When deciding on the type and level of care at home that is desired, there are a number of issues that should be considered. These may include the following:

• The specific tasks with which assistance is required
• The skills required of the person who will be providing this assistance
• The duration and frequency of the visits required
• The environment in which the care will be provided
• Whether any special adaptations and equipment are required
• The wishes of the older person about how they receive their care
• The cost implications of the required type and level of care
• How the care is to be funded
• Whether care at home is indeed the best option or whether residential care might be more suitable

Sourcing the Care

There are a number of organisations that can help with the process of assessment and sourcing the right type and level of care at home.

• If the older person is a patient in hospital, the multi-disciplinary hospital team will carry out an assessment prior to discharge.
• If the older person is not a patient, the Community Social Services Department or members of the local Clinical Commissioning Group (NHS) can carry out an assessment of an older person and make recommendations. Social Services should also advise on any state funding entitlements.
• An Occupational Therapy Assessment, which can be arranged via the hospital or Community Social Services department, will help to determine what adaptations and equipment may be required to promote independence and ensure safety in the home. Alternatively, this assessment can be arranged privately.
• Many older people will use an Independent Care Adviser to help them through the process.

Further information about assessments, the role of Social Services and how care is funded can be found in the Grace Consulting factsheets: "Paying for Care" and "The Role of Local Authority and Social Services".

Advantages and Disadvantages of Receiving Care in your own Home

The older person may find him or herself weighing up the benefits of receiving care at home as opposed to moving into a care home. Whilst each situation is unique the following can act as a general guide to the advantages and disadvantages of care at home:

Advantages

• Own choice of routine
• Familiar surroundings
• No need to downsize
• Own choice of how much help is provided (within financial restraints)
• Own choice of whether domestic assistance and/or help with personal and social care and /or support by the community nursing team
• If and when needs increase, so can the level of care

Disadvantages

• May not have one regular carer
• Timekeeping of visiting carers can be unpredictable
• Long-term expense
• Being at home can sometimes be lonely
• The house must be maintained and bills must be paid in addition to care costs

The amount of care delivered under Local Authority funding will be determined by a Social Services Assessment and the national eligibility criteria.

Decisions regarding the type, level and funding of Care at Home are clearly not to be taken lightly and expert advice should be sought at all stages of the process.

Call Grace Consulting on 01483 203066 for further information.