Choosing a care home for elderly parents

We investigate the increasing difficulty of finding a place for your parent in the care home of your choice, and offer key advice. By Kate Hilpern

 

Like most parents, Penny Whittle would have gone to the ends of the earth to get her daughter into the right school. ‘Sometimes it felt as if I did just that!' she says. ‘We moved to Buckinghamshire purely for its grammar school system and we paid out eye-watering sums for an after-school tutor so she would get in. Even getting her into the best primary school meant putting her name down before she'd turned one and going to church for the first time in years.'

 

What 48-year-old Penny did not expect was that, just four years later, she'd have to confront a similar series of hurdles to get her mother into the right care home. ‘She had a fall and the hospital said she would no longer be able to manage at home. We decided a care home was the best solution, but I had to look round 19 before finding the right one. Some smelt of urine; others had staff that cared more about gossiping than about the residents. Then there were the ones that felt perfect for Mum, but had waiting lists. Three homes said we might have to wait two years - possibly longer, since moving up the list depends on when the next person dies. The search literally felt like a déjà vu of school-hunting for my daughter - not least because care homes now have star ratings, just like Ofsted rankings for schools.'

 

There are already 418,000 older people in care homes in the UK. Now, a number of new factors, including our ageing population and the recession (which has caused many care home operators to go into receivership) mean that places at the best homes are more in demand than ever. The now-merged charity Age Concern and Help the Aged describes this trend as ‘startling'. ‘Government policy has for some time - quite rightly, I think - been pushing people to stay away from care homes and live more independently, which has resulted in care home places declining for the past 10 years,' says Lizzie Feltoe, its senior policy officer for care. ‘But the situation has become stark in some areas. We get calls from people feeling anything from panic to utter bewilderment, especially when they're forced to find a care home in just a few days because, for instance, their parent's stay in hospital is coming to an end and there's no way they can go home.'

 

Counsel and Care, a charity that works with older people, their families and carers, is also concerned. ‘There are several reasons for the rise in waiting lists,' believes chief executive Stephen Burke. ‘The number of older people is growing - as is the number of people diagnosed with dementia. The star rating system is also significant because it's attracting everyone towards the homes with two or three stars. Then there's the fact that care homes have been closing over the past decade as funding has changed and the emphasis has switched to promoting people's independence.

 

Finally, people are living longer - probably particularly so in the homes with the best quality care. For all these reasons, it seems to me that the issue of waiting lists is one that will only get worse.' Barchester Healthcare reports that many of its 200 care homes - 80% of which have two or three stars - are increasingly moving towards a waiting list system, simply because they're so popular. ‘It can be very frustrating for people,' admits managing director Tim Hammond. ‘In fact, every single person visiting us at the moment has a very emotional story to tell about their search for a care home place for their loved one.' The Government insists that there is no national shortage of care home places, although it does admit to ‘pressure on the availability of places in some areas'. One of the things it believes will improve matters is to raise the quality of the poorer care homes. To this end, from next year the Care Quality Commission (the regulator of the star system) will be given additional powers designed to make sure that failing care homes work towards improving their services.

 

The Department of Health adds that, in order to meet the challenges of the ageing population, the Government does accept that a radical rethink of the care and support system is required. ‘A Green Paper published this summer lays out options to ensure that care is high quality and cost effective; that people have choice and control over the care they receive; and the funding system is fair, sustainable and affordable for individuals and the state,' says a spokeswoman. Labour MP David Taylor - whose constituency of North-West Leicestershire does not have enough places for people with dementia - is among those who welcome the new proposals. ‘I've noticed in the past two years an increase in the number of people coming to me who are facing diffi culties in getting their relative into an appropriate care home,' he says, an observation echoed by the Alzheimer's Society, which says it receives more than 40 telephone calls a week from families and carers in this area of the country alone.

 

But, although the process can be difficult, it is possible to find a home in which an elderly parent will settle and even thrive. Sarah Sealous, 48, knows how emotional the journey towards a happy ending can be - she looked at a staggering 63 homes before finding the right one for her mother. While Sarah's mum jokingly called the nursing home they finally chose ‘Colditz', she did admit to feeling safer and less vulnerable having nurses and medical care on hand day and night. ‘My mother also said that she was less exhausted and worried, as she didn't have to run the family home and deal with its emergencies and problems - all that was lifted off her shoulders.' The right home, says Sarah, starts to feel like a warm and supportive place that the family want to be a part of. ‘It also becomes somewhere that benefits you, as you see your mother or father enjoying being there and having lots of laughs and fun while being properly looked after.' So not really unlike finding the perfectschool for your child.

 

Still need more information?

Visit these websites:

www.ageconcern.org.uk Age Concern and Help the Aged (the charities have now merged) provide factsheets and advice for people caring for an elderly relative.

www.alzheimers.org.uk The Alzheimer's Society offers specialist advice for people with dementia, their carers and families.

www.careaware.co.uk This website offers independent information crucial to making informed decisions about long-term care, including guidance on understanding funding, social services assessment procedures and selecting an appropriate care home.

www.caredirections.co.uk This is an information resource for middle-aged ‘children' needing to come to terms with a parent's care requirements and for older people themselves who want to know more about what care options are available.

www.carehome.co.uk This website includes an A-Z directory of care homes, incorporating advice on care home fees.

www.carechoices.co.uk This is a free information service, matching an individual's care requirements to suitable homes through a comprehensive database of UK registered providers of care.

www.counselandcare.org.uk Counsel and Care is a national charity working with older people, their families and carers to get the best care and support. It provides personalised, in-depth advice and information.

www.solicitorsfortheelderly.com This national association of lawyers is concerned with improving the availability and provision of specialist advice on legal issues that affect older and vulnerable people, along with their families and carers.

 

Funding: the facts

The complex journey towards finding the right home usually starts with the sticky issue of funding. The process should be simple - the local authority assesses your parent's wealth and, while about a third of people are deemed wealthy enough to pay for their own care (they have capital of over £23,000), the remainder receive Government funding. If the home you want for your parent costs more than the local authority will pay, you have the option of paying a top-up fee, but this must come from a third party, not the older person themselves.

 

The problem is that, according to Age Concern and Help the Aged, if there are no care home places locally within the local authority's budget - and you can't afford the top-up fee - your parent may be moved to another area altogether, leaving you having to travel considerable distances to visit them. A further hurdle is that some local authorities have been known to insist on families paying a top-up fee. ‘This is illegal and families should challenge it,' says Lizzie Feltoe, the charity's senior policy officer for care. ‘The local authority should be able to offer someone a care home that meets their assessed needs, at the rate the local authority is prepared to pay. And if that rate isn't high enough, the local authority should raise it. It's only when the family turns down the local authority's offer and chooses another more expensive care home that the authority is allowed to charge a top-up.'

 

Making the issue more complex, she says, is the fact that local authority budgets can vary. ‘While some areas have plenty of homes and an adequate number of places, others are cutting back, as they want to see more older people living in the community.'

 

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