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Thinking about care? 5 first steps

1. Care needs assessment
The first step to starting your ‘care journey’ is to request a care needs assessment, whether this be for yourself or a loved one.

Care needs assessments are free, and anyone can ask for one from their local council. They cannot refuse to complete a needs assessment if they don’t ‘think’ you will qualify.

They should provide a professional such as a social worker who will either phone or visit you to carry out the assessment. They will then make recommendations for services such as equipment, adaptations for your home or paid care.

They should also consider the current level of support for unpaid carers such as spouses or other family members.

Do not be afraid to challenge the outcome of a needs assessment if you feel it does not reflect your current situation or the support being offered is not enough.

If it is recommended that you require help from a paid carer or full-time care, a financial assessment should be carried out.


2. Financial assessment
A financial assessment will ‘means test’ yours or your relatives’ contribution toward the cost of care.

This will look at any income including pensions and benefits, financial assets such as property, and savings - National Insurance contributions do not count towards the cost of care.

A property will not be classed as capital in some circumstances, for instance, if there is a spouse or close relative still living there, and its value will not be considered if looking at care at home.

In England, if you have assets and savings of more than £23,250, including your home, you will usually have to pay for care. This amount varies if you live in Scotland, Wales or Northern Ireland. If you do not meet this threshold, you will have to sacrifice all of your income, including pensions and benefits, less a small allowance which is retained for ‘personal expenses’.

Don’t be tempted to move assets to family members to reduce your visible capital. The evidence you provide to support your financial assessment will likely uncover these transactions and the monetary value will still be counted toward your asset total whether you are legally in possession of it or not!

If you require a care home with nursing you may be entitled to assistance from the NHS, such as Funded Nursing Care (FNC) or Continuing Healthcare (CHC).


3. Choosing a Care Home Type
You should have some idea of what type of care you are looking for from your ‘need’s assessment’.

The term ‘care home’ is generally an overarching or umbrella term, which can then be narrowed down to need or care type.

In brief; Residential care homes do not generally employ registered nurses although it is not unheard for the deputy or home manager to be a registered nurse. However, they are designed for people who have non-nursing needs such as assistance with personal and continence care and assistance with mobility. They also support with meals, medication and laundry services.

Nursing homes or care homes with nursing, will provide all the services a residential home provide but will also have a registered nurse on duty 24 hours a day.

A care home with nursing should be considered if you or your loved one are suffering from a disability or long-term condition requiring medical management or other complex support. However, the criteria of a ‘nursing need’ may vary slightly depending on your funding source and the criteria set by the care home provider. This is one of the many ‘grey areas'.

Homes that offer dementia care may cross over with standard residential or nursing homes and offer dual services, however, some providers offer dementia only specialist homes which can be residential or nursing depending on the level of need. These homes should be adapted with the dementia sufferer in mind, offering facilities and décor to aid orientation.

Care homes, in the traditional sense, when looking for a home in older age usually fit into one of these categories.

Other services may be advertised alongside such as palliative care, respite care, cancer care, physiotherapy – the list is pretty exhaustive – but given the diverse range of people looking for care, any level of need or illness should fit into the categories described.


4. Choose your Location
Once you have established the type of care you are looking for and have some idea about the costs involved, you should shortlist homes based on the location which suits you best.

You may be looking to stay in the same area to maintain community and family connections, or you may be looking to move nearer family.

If the care home is to be funded by your local authority, and you transfer to another area, the local authority you are currently living in is still likely to be the funding source regardless of the distance.

The local authority will also have a price in mind, so unless you can afford a top-up, you are looking at fairly narrow parameters in terms of cost.

Care home directories online can provide a comprehensive list, which can be filtered by care type and location or alternatively your local council should have a care home catalogue. You may want to check care home reviews to aid your search, they can inform your choice but shouldn’t be the deciding factor.

Care homes tend to ‘push’ review cards onto happy campers and they certainly won’t be offering a card to any unhappy ones! The reviews are subjective and often influenced by personal tastes.

Care providers usually have the opportunity to assess any reviews pre-publication, so you may also find less favourable reviews are followed by a counter-argument or ‘softener’ from the care provider. What is considered a good review will vary from site to site and the comparative data, particularly with those using a number system (1 for good - 5 for bad etc) is not based on a like for like comparison.

A good example of this is the question that asks you to rate facilities. It is difficult to compare a purpose-built luxury provider offering a cinema, with a single site provider offering an adapted property, but that does not mean the care is not excellent if not better in the latter.

It is important to use other information to help you decide, and a visit is essential.


5. Arrange a visit and check out the small print

Visit each of the homes on your shortlist and think about what you want to ask prior to your visit.

Whichever care home you decide on, you will have to enter into a contractual agreement with that provider. Ask for a copy of the terms and conditions so you can take this home and read it at your leisure.

It is important to thoroughly check the small print and find out about any additional costs.

Here are some things to look out for:

• Notice periods will vary depending on the provider, you do not want to be in a position where you are facing 1 weeks’ notice of a fee increase or eviction.

• What happens if you or your loved one passes away? – some providers will charge for up to one month following the death of a resident.

• Do they discount an empty room, for instance, if your loved one has an extended hospital stay? Paying full price for an empty room under these circumstances can be incredibly frustrating.

• Do they charge for an ‘escort’? This is a care staff member who accompanies you or your loved one to a hospital or other appointment. Some providers will charge an hourly rate for this service.

• Look for other items which one would argue ethically and morally should be included in the price, but may not be, such as laundry, maintenance, entertainment or even care! I recently had the displeasure of meeting a care home provider, where the care was additional to the room rate and charged by the minute!

• Look at the cost of additional services such as chiropody, you may well qualify for this service free on the NHS but end up getting caught out where a home is using a private chiropody service charging extortionate prices.

• Check the hairdressing fees. A hairdresser may be employed by the care home or a mobile hairdresser using their facilities. Either way, they have a monopoly on the customers within the care home and can often charge ridiculous amounts. You are well within your rights to insist on employing your own hairdresser to visit the home.

• Do they charge an administration fee? This is a non-refundable set-up fee which in some cases can exceed £1000.00 and be in addition to the deposit. You could start your care home life paying a £3000.00 bill before you have even unpacked your suitcase.

• If you are paying for your own care home fee’s you also want to know what will happen when your money runs out. A provider operating a business that is fair and ethical will promote ‘a home for life’ ethos. If you switch to being local authority funded once your assets have reduced to below the threshold are you going to have to find somewhere else to live? One move is bad enough and the answer to this question speaks volumes about the motivation of the care provider or manager.

Choosing a care home is a big decision, and often without the luxury of having time to decide, particularly if there has been a health or safety crisis for the person involved. This, and trying to balance choice with finances can make it a very frustrating and stressful process.

Remember, there is a lot of help out there, know your rights and do not be afraid to ask. No matter where your finance is coming from you are making a huge purchase and deserve to be treated as a very important customer!

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