Making Decisions about Care
Families often have to make difficult decisions about arranging care for a family member, and this can be a challenging time.
It can be especially difficult if the family member either does not have the mental capacity to make their own decisions about their future care arrangements, or their mental capacity is in doubt. If this is the case, advice should be sought from an appropriate health professional, such as a GP or District Nurse.
If the family member is assessed as not having the mental capacity to make decisions about their care arrangements, a previously appointed Health and Welfare Attorney will be responsible for making such decisions on their behalf.
In the absence of a Health and Welfare Deputy, family and friends will be consulted by the health and social care professionals involved in the family member’s care, in order that decisions are being made in their best interests. If the family member does have mental capacity to make decisions about their care arrangements, they should be supported in doing so and their wishes respected.
What are my options?
There are varying care options available and there are practical, financial and emotional implications involved when making decisions regarding long-term care. Families may need to consider the following factors when discussing care for a member of the family, such as:
- The level of care required
- What funding is available
- The personal wishes of the older person.
Decisions regarding care options can be complex, and if there are several family members involved there can be varying views and opinions as to the most appropriate option for their relative.
Some members of the family will want the best possible care regardless of cost, whilst others may have be concerned about future finances when deciding on a care provider.
These factors can be potentially divisive and often the best course of action is to enlist an experienced mediator to help with the process. It’s important to remember that the more involved the older person is with the decision making process, the more likely it is that the care arrangements will succeed.
Most older people would prefer to stay in their own homes for as long as possible. At home they are independent and in familiar surroundings. However, staying at home may not always be appropriate or practical.
There are other options available to older people, including Sheltered Housing, Close Care (or Very Sheltered Housing) and Care Homes.
The advantages and considerations of each are considered below.
Care in your own home
Most people prefer to stay in their own home for as long as possible, living independently in familiar surroundings. When considering care at home, a family should ask themselves a number of questions including:
- What level of support does the older person require?
- Can the family provide any practical assistance?
- What about social stimulation for the older person?
- Are there reputable home care agencies available to provide assistance?
- Will Social Services provide any support?
- Does the older person require assistive devices or adaptations to their home?
- Will the District Nurse visit?
- What if the carer does not turn up for work?
- Can care at home be afforded on a long-term basis?
- Would the older person accept a carer on a live-in basis?
- How much does care at home cost?
This is usually the preferred option when an older person starts to struggle with the tasks of daily living. Care provided at home can be medical and/or help with these everyday tasks and is intended to enable the individual to live in his or her own home for as long as possible.
Advantages
- The older person can choose their own routine
- The older person is in familiar surroundings
- The older person can choose how much help is provided (within financial restraints)
- The older person can receive domestic assistance and/or help with personal care
- If and when needs increase, so can the level of care
- No needs to down size and part with personal possessions.
Considerations
- The older person may not have one regular carer
- 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.
Sheltered Housing
Sheltered Housing typically comprises self-contained flats or bungalows within a complex. There is a scheme manager who will keep in regular contact with the residents and will call for help if needed but will not offer day to day assistance.
Sheltered Housing is for those who want to remain independent but like to have the security of someone close at hand.
Advantages
- Retain independence
- Gardens and property maintained by someone else
- Regular contact with scheme manager
- Emergency alarm call system fitted in each flat or bungalow
- Communal facilities sometimes available
- Properties usually available for rent or purchase.
Considerations
• No domestic or personal care provided. This would have to be arranged privately or through social services
- Accommodation can sometimes be small
- Meals not usually provided
- May have upheaval of another move if more care is needed in the future
- Service charge usually applicable
- Limited social contact with other residents, usually dependent on charisma of scheme manager and motivation of resident to get involved.
Extra Care Housing
Extra Care Housing is sheltered housing with a range of additional facilities and support. There is 24- hour care to meet individual care plans with the flexibility to respond to fluctuations in care needs. Some meals may also be provided.
Advantages
- Promotes independence
- Part of a community
- Own front door
- Support/care available 24 hours per day
- Meal services
- Assisted baths
- Launderette. Considerations
- Likely to have specific admission criteria
- May not be able to provide a home for life
- New concept so not widely available
- Largely rental schemes subject to joint assessment by housing and social services
- Not easily accessed by those with private funds or property to sell.
Assisted Living is another term commonly used for this level of support, however Assisted Living schemes vary from Extra Care Housing in that Assisted Living is generally available for purchase or 4 rent on a private basis and Extra Care Housing is generally only available for rent following joint assessment by both social services and housing. Close Care Close Care (or Very Sheltered Housing) is similar to sheltered housing in that residents retain their independence. However, close care flats/bungalows are situated within the grounds of a care home so care may be available if required.
Advantages
- Retain independence with reassurance of 24 hour care close by if needed
- Can usually use the facilities of the main house e.g. communal areas, join in activities and outings
- Meals are sometimes provided either as part of a package or at a small extra charge
- Domestic help can usually be provided
- Close care properties are usually available for rent or purchase
- Possibility of moving into main house if more care is needed.
Considerations
- Properties can sometimes be small
- Close care is not widely available
- Value of the property can be affected by the success of the whole complex
- The category of care provided in the home may differ from that required.
Residential Care
As people grow older, it is not always practical for them to remain living in their own home, so a family may need to consider the option of a care home or care home with nursing for their relative. The decision to move a relative into a care home is not usually an easy decision.
There are a number of emotional factors to contend with as well as practical. Families often feel guilty about moving their relative into a care home or some family members may disagree with the choices being made on behalf of their relative.
Some questions to consider are:
- Do you know the level of care required?
- What type of home would be preferred? (purpose-built or conversion)
- What facilities would be important to the older person?
- Where should the older person move?
- Should they remain in an area that is familiar to them or should they move into a home closer to a member of the family who will visit frequently?
- Who will fund the care? Can the older person fund his or her own care? Can the family provide a top-up to the Social Service funding?
Care Homes (known as Residential Care in Ireland)
Good care homes should provide care and security within a comfortable setting. Assistance with personal care is provided by trained carers. Limited nursing care, if needed, is provided by the District Nurse.
Care and community spirit within a care home may vary. In some homes, residents are encouraged to have an active role within the home, to some extent it depends on the type of residents at the home and the attitude of the Manager and her staff. Most residents have their own room, furnished as they wish, often with their own toilet and sink. There may be a choice of communal areas including a garden for residents to enjoy.
Advantages
- 24-hour assistance available
- Help with personal care if needed
- Activities/outings organised
- Company and companionship
- Safe environment
- Meals provided
- No worries about maintaining house/garden and paying household bills.
Considerations
- • Some loss of independence
- • Rooms sometimes small therefore not able to take many personal belongings / items of furniture
- • The home ownership may change, or the home may close
- • Other residents may not have similar abilities or interests
- • Would have to move to a Care Home with Nursing if care needs increased.
Care Homes with Nursing (known as Nursing Homes in Ireland)
Care Homes with Nursing provide care for the more infirm elderly. Residents usually require a high level of care and medical attention.
The homes are usually bigger than care homes and are often purpose built.
Advantages
- 24 hour assistance available
- Qualified nurses on duty at all times
- Assistance with personal care
- Safe / comfortable environment
- Stimulating activities organized
- Meals provided
- No worries about maintaining house/garden and paying household bills
- Can provide a home for life.
Considerations
- Loss of independence
- Rooms can sometimes be small
- Expensive
- Not suitable for active alert older people who need very little assistance
- May be in company of those significantly frailer.
Dual Registered Homes
Some homes have dual registration, which means that they are able to provide both residential and nursing care.
The main advantage is that if an older person does not need nursing care now but may in the future, there will be no need to face the upheaval of a further move.
Retirement villages Retirement villages are one such option. They are communities offering self-contained accommodation which can be bought or rented. Residents can enjoy personal care if needed and access additional services too, and it can provide a way for a couple to stay together if one has more serious care needs.
You can eat in your own home or in the communal restaurant, and the site often provides an active social programme. It's a relatively new concept in the UK, and the aim is to provide residents with a home for life, where they can “age in place”.
Advantages
- Independent living in your own home
- Excellent leisure facilities and communal areas
- Opportunity to remain living with a partner with different care needs
- Good opportunities for social interaction • No repairs or maintenance responsibilities
- May feel safer and more secure than living alone • Guest suites for visitors to rent when visiting
- Adaptable to future needs - help and care may be available in own home or on-site care home
Considerations
- Limited medical care - not all villages offer nursing or medical care options
- Expensive to buy - plus ongoing annual charges and exit fees
- Limited space - downsizing may well be required
- Lack of diversity - living exclusively among other older people
Making a Decision
Whichever setting is most appropriate to the older person, they are advised to view a number of homes and to discuss their requirements with the Manager. An assessment will be required to ensure that care needs can be met, prior to acceptance into care.
The older person should consider their own criteria such as location, accommodation, facilities offered and of course any budgetary constraints.
