Care for the elderly

Care (also known as social care) comes in many forms, including:

• informal care carried out by a spouse, relative or friend
• care at home provided by a professional carer, and
• residential care provided in a care home.

The type of care you’re looking for usually depends on the reason why you’re looking for care. For example:

• if you have a degenerative neurological condition you may want specialist assistance in a residential setting, or
• if you need physical help due to reduced mobility or frailty, care could be provided in your home. This would be once your home has been adapted to make it safe and easy to move around.

Moving into a care home permanently isn’t always the most appropriate way to meet someone’s care or support needs.

There are services that can help you to carry on living in your own home. These include:

• domiciliary care (also known as ‘care at home’ and ‘home care’)
• meals on wheels, and
• home adaptations.

There’s also lots of innovations that can help you stay in your home. These include:

• stair lifts
• sensors
• community alarms
• assistive technology, and
• other specialist aids.

Your local authority's adult social services team may be able to arrange appropriate care and support services for you. These can include services like re-enablement – helping you relearn skills you may have lost through being ill or a disability.

Some of these services are free. Others may be subsidised, have vat relief or be means-tested – such as grants for adaptations to a home.

Home care

Given the opportunity, most of us would choose to stay living in our own home for as long as possible.

The benefits include staying close to our social and personal support network and retaining a greater degree of independence.

It’s possible to stay in your home if you get the right level of care and support for your needs. This can include making any necessary changes to your home, such as:

• installing a stair lift
• adapting the bathroom
• widening doors to accommodate a wheelchair, or
• moving to a more suitable property.

If you’re staying in your own home, you can arrange nursing home care. You can also consider:

• using a day centre
• attending a lunch club, or
• visiting a dementia café (if appropriate) to help involve you in your local community.

You can also employ somebody directly to help you at home (either as an employee or on a self-employed basis). This will cost money, but it’ll also give you more control over who provides your care for you.

If you’re employing someone to care for you at home, make sure you get proper contracts drawn up. It’s also a good idea to take legal advice before you enter into such an agreement.

While receiving care in your home, you may want to consider using respite care (a short care home stay) to:

• allow your carers to have a holiday or short break, or
• to support your own recovery from an illness, surgery or a hospital stay.

With respite care, you move into a care home for a short stay and then go back home.

If staying in your home isn’t possible, other options include:

• living with family or moving nearer to supportive relatives
• moving to sheltered, retirement, extra care or assisted-living housing, or
• moving to a care home.

Your local authority can offer help and advice regarding:

• minor adaptations to your property
• home aids, or
• organising an occupational therapy assessment or a means-tested grant.

Home Improvement Agencies (HIAs) – also known as ‘care and repair’ or ‘staying put’ agencies – are local not-for-profit organisations.

They’re set up to help older or disabled homeowners, as well as private tenants. They can arrange and pay for repairs, improvements and adaptations to people’s private homes.

Many HIAs also offer additional services, such as:

• a handyperson
• help with gardening
• checking home security, or
• preparing for coming home from hospital.

The Elderly Accommodation Counsel (EAC) is a national charity supporting older people that has a comprehensive directory of home services .

Sheltered housing – and other special types of accommodation

Sheltered housing allows over-55s to live in self-contained flats or bungalows, helped by support workers and sometimes a warden.

It’s a type of accommodation that promotes independent living and provides varying care and support services. It’s also often seen as an alternative to residential care homes.

Sheltered housing often includes communal areas such as a garden, laundry room and lounge. There’s also 24-hour emergency help available.

This type of accommodation is designed so residents can keep their independence and enjoy the company of their neighbours.

Sheltered housing can be:

• privately-rented accommodation
• privately-owned property
• shared-ownership property, or
• accommodation with a social housing landlord.

There are also a number of shared lives schemes available, which provide care in a family home. In this scenario, you can live with an approved carer, sharing their family and community life.

If you’re looking for more support you can also access something called extra care housing. Extra care housing offers self-contained homes with special design features – for example, special bathroom facilities. To help residents continue to be independent, extra care housing offers a greater level of care and support such as:

• extra wardens
• full-time carers
• home help, and
• provision of meals.

This type of housing is also known as:

• very sheltered housing
• housing with care
• retirement communities
• retirement villages, or
• assisted living.

You can sometimes own or part-own your extra care accommodation.

Another type of elderly sheltered housing is an almshouse. These are run by charitable trusts, with each charity having a policy on who’ll be assisted. (For example, people who’ve retired from a particular trade or those living in a specific area.)

There are also Abbeyfield societies. These are voluntary organisations that provide a smaller, more family-orientated style of sheltered housing for around eight to 12 residents. Abbeyfield societies aren’t appropriate for anyone who wants nursing care. If you want nursing care, you can consider moving into a nursing home.

Residential care homes

Residential care homes are often referred to more simply as ‘care homes’. They provide personal care such as help with getting dressed, washing and other day-to-day tasks.

In a care home, a number of older people live together and are cared for by care workers. Typically, residents have their own bedroom which may also have an en-suite toilet or shower room.

As well as being registered to provide residential care, some care homes are registered to provide nursing care as well. If you think your care needs might change over time, you can consider care homes with a dual registration.

Sometimes you might want more specific care – like those living with dementia. If this is the case, you have the choice of residential care homes that can deliver your dementia care needs.

There are also dedicated dementia care homes. Care homes providing dementia care sometimes refer to their service as EMI (elderly mentally infirm) care.

In some circumstances, you can get help with your care costs.

Nursing homes

If you want medical or nursing care, look for an establishment registered as a care home with nursing. This is also known as a nursing home.

A nursing home has qualified nursing staff on duty 24 hours a day. That’s why nursing home fees may be significantly higher than a residential care home (which provides only personal care).

If you want specialised nursing care, there are nursing homes with trained staff to deal with specific needs. This includes nursing homes which specialise in caring for residents with dementia.

Again, a nursing home which caters for specific medical needs will involve higher home fees. However, dementia care doesn’t necessarily need to be provided in a nursing home – or by nurses.

If you’re looking for a nursing home, it’s a good idea to:

• Pick one where you won't be spending money on services you don’t need.
• Think ahead to make sure your preferred home can provide higher levels of care for you in the future. This is so you can avoid having to move from one home to another. This is especially relevant if your health is rapidly declining.

What are nursing needs?

Examples of nursing needs include:

• dressing an open or closed wound
• artificial feeding
• medicine through injections, and
• intensive rehabilitation resulting from a debilitating disease or surgery.

Your GP (or the doctor discharging you from hospital) will advise you if they think you may need nursing care. They’ll also be able to advise you regarding how long you might need it for.

Your doctor can advise you if you’ll need a recuperative nursing-home stay or a more permanent arrangement.

You can sometimes have to choose a care home or nursing home in a hurry. This can happen after:

• an illness
• a hospital stay, or
• a fall.

This can give you limited time to decide on where to go – and how to pay the care costs.

Your choices may also be limited because some care homes have waiting lists. The more time you can spend choosing the right care home for your situation, the better.

Working out your care needs

If you’re not sure what level or type of care you need, you can get a free care-needs assessment. You can get this from your local adult social services department.

They’ll visit you at home to discuss your situation with you. They’ll also be able to work out the type and frequency of care to fit your needs.

You can take a friend or family member to the meeting with you – to help make sure everything’s covered.

Some common examples of care needs include:

• managing healthy eating
• maintaining personal hygiene
• using the toilet
• getting dressed and wearing the right clothes
• using your home safely
• managing your home
• maintaining personal relationships with family and friends
• going to work and learning opportunities
• accessing the local community
• caring for a young person