Saturday 4 June 2022 10:19 PM Old-age care guide that NO family can afford to ignore trends now

Saturday 4 June 2022 10:19 PM Old-age care guide that NO family can afford to ignore trends now
Saturday 4 June 2022 10:19 PM Old-age care guide that NO family can afford to ignore trends now

Saturday 4 June 2022 10:19 PM Old-age care guide that NO family can afford to ignore trends now

If it ever gets to the stage when I can't look after myself, just take me outside and shoot me.

It's a blunt phrase, which I hate, but is probably familiar to many, no doubt meant in jest but with a bitter grain of truth to it.

As a dementia nurse with more than three decades of experience, I know it's something often said as a way of deflecting conversation about what may well be inevitable. And I understand the sentiment.

No grown-up likes the thought that, one day, we will lose our faculties; that we will need someone to help us with the most basic of tasks, from washing and dressing to eating and even going to the loo. Yet most of us will need to be cared for at some point, probably as we reach the later stages of life, whether by a family member or professional carers.

About 13 million Britons are currently caring for someone, and at least three million of us rely on this sort of support. But it's seldom talked about until problems become unbearable, or crisis strikes and an urgent decision is needed. 

The result can be a traumatic upheaval that affects the whole family, and often means that people don't have adequate care when they are at their most vulnerable.

It is rarely the case that someone becomes unable to care for themselves overnight. The problem is, families don't usually realise someone needs help until their loved one's behaviour, or difficulty, starts to put them at risk. (Posed by models)

It is rarely the case that someone becomes unable to care for themselves overnight. The problem is, families don't usually realise someone needs help until their loved one's behaviour, or difficulty, starts to put them at risk. (Posed by models)

One in seven over-65s struggle with everyday activities – from getting out of bed to basic hygiene and shopping for essentials – but don't get any assistance, according to Age UK.

I'd like to change that. I've written three books about adapting to life with dementia. I give lectures on the topic of geriatric care at universities across the UK and I am Professor of Dementia Studies at the University of Stirling.

And today, exclusively in The Mail on Sunday, you'll find extracts from Carers And Caring – my new guide about a subject no one can afford to ignore.

Over the next few pages I'll cover everything from how to choose the best care home and what financial support you're entitled to, to tackling intimate, personal care duties.

And we'll explore the emotional shift as relationships change to accommodate someone who's in need of care.

These situations might seem like a far-off concept, but my mission is to stop more families from having the regrets that I see most often: of failing to plan ahead.

Don't ignore the little warning signs

It is rarely the case that someone becomes unable to care for themselves overnight. The problem is, families don't usually realise someone needs help until their loved one's behaviour, or difficulty, starts to put them at risk.

It could be a gas hob that is left on and forgotten about, or someone becoming ill because they've forgotten to take their pills.

The daughter of one 92-year-old woman told me she hadn't even considered that her mother would need help until she was admitted to hospital after suffering a fall.

Make plans to hand over the financial reins

There may come a time when a person becomes unable to manage their own affairs – usually due to dementia.

It's never too soon to make plans for this happening.

I'm talking about lasting power of attorney, a legal document that allows someone to make decisions related to finances, property and health on behalf of another person if they are mentally unable to do so themselves.

The key thing is, the person has to be of sound mind to make these provisions – it can't be done when someone is already deemed incapable.

'We left it too late with Dad,' says Janice, a young woman I know whose father suffered from dementia.

'He reached the stage where a person can't grant power of attorney or make a will because his dementia was too advanced. The doctor said he lacked mental capacity.'

Avoid this situation if possible, as it can result in the courts getting involved to appoint someone, which can take many months and involve large extra costs.

Many people choose to use a solicitor who can register the lasting power of attorney with the relevant authorities, but you don't have to. It can all be done online, via the gov.uk website – just search for 'government lasting power of attorney'.

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A physio assessment concluded that the elderly woman couldn't go back to her house as she was unable to climb the stairs to get to the toilet. The family had no choice but to put her in an old people's home, in one miles away from where they lived as it was the only place available at short notice.

This might have been avoided. A bit more help around the house, and an assessment from her GP's occupational therapist to look at ways in which the home might be better adapted for someone less mobile, could have prevented such rapid deterioration. It might even have staved off the need for residential care entirely.

It's not unusual for problems to be linked to a person's environment, and all that's needed is a few small adjustments.

Someone who lacks the mobility to reach their arms above their head to get to the kitchen cabinets will be OK if their cupboards are rearranged. 

Similarly, whether you can order supermarket shopping and medication via the telephone or online, and whether there is public transport available, can make the difference between someone being disabled and not.

Underlying health problems and the side effects of medications can also affect an older person's ability to cope on their own. But getting these under control could improve the situation.

Ask the GP for a full health check, as well as a medication review, to see if worrying symptoms like confusion or agitation can in fact be explained by side effects of drugs they're taking.

Which brings us to the next hurdle: if it's clear a person does need help around the house, it's not always easy getting them to accept it.

A story I hear all too often is that of a son or daughter organising a care worker to drop by, only for the person needing care to tell them to go away. Or it might be that person's husband or wife who's resistant to outside help, holding on to the belief that they can cope alone.

It's a difficult situation, with no one set answer. However, it can often help to explain that, if a person doesn't eat and drink enough and has a fall, or develops an infection or even hypothermia from not heating their house properly, or whatever else, then they might end up in hospital. And later, they might be admitted to a care home, as there will be no other option. Most people don't want that.

Having someone checking up on them for an hour a day could be a way of making sure they stay put.

Of course, the best way to avoid all this confrontation is to start the conversation early: speak to your partner or children about how you want to be cared for in the future, without resorting to jokes about being shot in the back of the head.

That way, everyone in the family knows what people's wishes are and where they stand.

Make it official – get registered as a carer

If you have taken up caring duties – however few – it is vital that you register as a carer officially.

Too many carers spend years in denial about their role until they finally crash and burn, their own health suffering as a result.

Being a carer dramatically increases your risk of serious illness – the risk of stroke goes up by 23 per cent once you start caring for someone, for instance.

One woman I knew only recognised that she was a carer when she was admitted to hospital for exhaustion and became frantic about who was going to take her mother's meals out of the freezer. She had been coping with looking after her mum, her children and husband. Something had to give, eventually.

Being honest about your responsibilities, and getting the help you're entitled to, is vital.

You can register as a carer via your own GP or the GP of the person you care for – it just involves filling out a form they can provide. You can also download it yourself from the Carers UK website (carersuk.org) and send it in by post or email.

Once your role is recognised, it entitles many people to financial support from the Government, respite breaks – where the person being cared for is looked after at home or another facility by a care worker, for free – and other schemes that aim to protect your health. Some areas have an emergency plan for carers in place.

Registering as a carer will also grant you access to double GP appointments, so you have time to discuss your own health as well as that of the person you care for.

You must look after yourself if you are going to be able to help others.

Claim financial aid to avoid the money trap

Whether you do it yourself or have professional help, caring costs money. And even the little things you lay out for can quickly add up. Take Shirley, a carer who took her 82-year-old mother for a hot chocolate and an iced bun every Monday, as a treat. 

It cost her £7.50 a week, which, over a year, came to almost £400. Added to extra petrol costs, shopping and other bits and pieces her mother needed, she ended up spending a great deal more.

Often carers spend money on what is needed without noticing it – there's wear and tear on a vehicle, or other travel expenses. And time is money, and the unpaid carer puts in masses of hours.

But there is financial help available, and too few know about it.

As well as the Carer's Allowance – which is about £70 a week – there are a number of other benefits you, and the person you care for, can claim to help with extra costs.

There are too many to mention here, but I'd recommend visiting the Age UK website (ageuk.org.uk) where you'll find its 'Benefits Calculator' – simply tap in your information and it will tell you what you're entitled to.

How to harness the power of tech

Don't underestimate the power of devices that can make up for gaps in an older person's capabilities. I call these 'assistive technologies'.

And while even a rubber glove used to take lids off jam jars counts, these days there is so much more that can be done to make life easier.

For instance, a video camera to check who is at the door can reduce anxiety in older people. Carers can have the same pictures beamed to their smartphone, to put their mind at ease, too.

Don't underestimate the power of devices that can make up for gaps in an older person's capabilities. I call these 'assistive technologies'. (Posed by models)

Don't underestimate the power of devices that can make up for gaps in an older person's capabilities. I call these 'assistive technologies'. (Posed by models)

There are home automation systems that control lighting, heating and alarms which can be operated remotely by a carer's smartphone. Some people use an Alexa (above) or similar smart speaker to control various devices without having to remember which button to press. 

Digital door locks use fingerprint identification to help older people feel safe about who can get in, but they can also be used to monitor how long carers have been in the house, so they can't clock off early.

Some local authorities will provide care-related technology, such as an emergency call system that is operated by a button on a pendant worn round the neck, and digital fall detectors that can automatically summon help.

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Ignoring the red tape won't help anyone

If you think you need a carer, your local social services can help, and they might also cover the costs. But first you'll have to have a care needs assessment.

This involves answering questions about how the person is managing with everyday tasks, both physically and emotionally. This is usually done face-to-face, but some councils are offering telephone or online options.

While the local council has a legal duty to provide care to a person who has been assessed as needing it, they can also make that person pay for some of it.

After the care needs assessment comes the financial means test. You'll be asked about your income and savings to calculate how much you can contribute. Property is taken into account only if a care home is needed.

Professor June Andrews (above) has written three books about adapting to life with dementia. She gives lectures on the topic of geriatric care at universities across the UK and is Professor of Dementia Studies at the University of Stirling

Professor June Andrews (above) has written three books about adapting to life with dementia. She gives lectures on the topic of geriatric care at universities across the UK and is Professor of Dementia Studies at the University of Stirling

The council can either make a direct payment to the person needing care, allowing them (or you) to make the care arrangements or provide care workers. It is possible to opt for a mixture of both.

In England, the council will usually help to pay for care costs if you have savings of less than £23,250, not including the value of your home. If you have more, they won't.

I often hear of older people who are reluctant to spend money on their own care, struggling along without help because they want something to give to their children after they're gone. But then there's a crisis, that person ends up in a care home, and those savings have to be handed over to the council to pay for it anyway.

Take the cautionary tale of Jean, a 52-year-old carer for her elderly uncle, Jim. 'Uncle Jim said there was a 'nice pot of money' waiting for me,' she told me. 'I tried to persuade him to spend money on himself, but he lived like a pauper. That partly led to poor health and him having to move into a nursing home, and all his money was gone before he died.

'Financially I was worse off because I spent a lot on caring for him. In a way I'd subsidised his care, which delayed the date he went into the home. While that allowed him to preserve his 'pot', the care home got it in the end.'

If you, or an older person, wants to help the next generation financially, consider helping to pay for education or a first property. The best thing is to think about disposing of your worldly goods early on.

It is important that you claim all other benefits you are entitled to, because the financial means test will assume that you have these funds.

The best routes to find and fund good carers

If you're not being provided for, there are two main ways to find someone who can help with things such as cooking, shopping and personal care.

The first, and most popular, is via an agency which employs trained social care workers and nurses. You can search for local agencies via the NHS website (nhs.uk) and the Housing Care services directory (housingcare.org). Local social services may also have a list of agencies to recommend. Most agencies charge about £20 per hour for a carer, but will not guarantee that the same carer will visit every time. Make sure the agency is registered with the Care Quality Commission, which regulates providers.

A slightly cheaper option is to employ an independent carer. People often choose to do this if they already have someone in mind – perhaps someone they know who cared for a relative or friend.

If it is just a neighbour or friend who is popping in for an hour, picking up shopping or checking the person has eaten, some families will make the arrangement of paying the person in cash. But for anything more involved, you should employ the carer officially, granting them the legal rights all employees are entitled to.

The first step is to register yourself as an employer, which can be done via the Government's website (gov.uk), or by calling HM Revenue & Customs. It is a complicated process, however, and for this reason most people end up using casual arrangements or going to an agency instead.

There are two main types of care homes: nursing homes, which are staffed by qualified nurses who can offer healthcare, and care homes, where staff are not medically trained. Some facilities are hybrids, and some are dedicated to caring for people with dementia. (Posed by models)

There are two main types of care homes: nursing homes, which are staffed by qualified nurses who can offer healthcare, and care homes, where staff are not medically trained. Some facilities are hybrids, and some are dedicated to caring for people with dementia. (Posed by models)

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