The First Step: Discussing Options and Assessing Need
Moving an elderly loved one into a care home is a major life change that must be approached with sensitivity and clear communication. The first step is to have an open conversation with your relative to understand their preferences, concerns, and their overall feelings about the prospect. This should happen well before a crisis point, if possible, allowing them to feel involved and respected throughout the process.
Initiating the Conversation
Start by focusing on their well-being and the benefits of a care setting, such as safety, security, and a built-in community. A move should be framed as a positive step towards ensuring their needs are consistently met in a supportive environment, rather than a loss of independence. If they are resistant, it is vital to acknowledge their feelings and explore all available options. Sometimes, the conversation itself can reveal that a different level of care, such as live-in or domiciliary care, might be more appropriate for the time being.
Requesting a Care Needs Assessment
Regardless of initial reluctance, the next and most important step is to contact the adult social services department of your local council to request a care needs assessment. This free assessment can be requested by the individual, a family member, or even a healthcare professional. During the assessment, a social care professional will visit to discuss the person's daily life and capabilities, considering factors like:
- Daily Living Tasks: How they manage washing, dressing, and eating.
- Current Living Arrangements: Their home environment and any potential risks.
- Social Support: The support they currently receive from family or friends.
- Personal Preferences: Their cultural, religious, and personal wishes for care.
The assessment will determine if they are eligible for council support based on national criteria. It's crucial for the elderly person to be honest and not downplay their difficulties, even if they are worried about losing independence. A friend or family member can be present to help them articulate their needs effectively.
Financial Assessment and Funding Options
Once the needs assessment is complete and a care home is recommended, the local council will perform a financial assessment, or 'means test', to determine who pays for the care. Funding is means-tested, and the amount of council support depends on the person's income, savings, and assets.
Understanding the Means Test
In England, if an individual has over £23,250 in savings and capital (including assets, but often excluding the value of their main home under specific circumstances), they are usually expected to self-fund their care. For those with assets between £14,250 and £23,250, the council may contribute partially. For individuals with less than £14,250, the council is likely to pay most or all of the fees, though contributions from income like pensions may still be required.
The Role of Property in Funding
If the elderly person owns their home, its value may be included in the financial assessment unless certain relatives (such as a spouse or civil partner) still live there. However, councils can offer a Deferred Payment Agreement (DPA). A DPA allows the local authority to pay for care home fees upfront, with the amount being repaid later, typically from the sale of the person's home after they pass away.
NHS Continuing Healthcare (CHC) and Funded Nursing Care (FNC)
Some individuals with significant, complex health needs may be eligible for NHS Continuing Healthcare, which is not means-tested and covers all care costs, including accommodation. If someone needs nursing care but does not qualify for CHC, they may receive NHS-funded nursing care (FNC), a fixed weekly amount paid by the NHS directly to the care home. The care needs assessment is the first step in the CHC process.
Choosing the Right Care Home
Choosing a care home requires careful consideration to ensure it is the right fit for your loved one's personality, needs, and preferences.
Research and Vetting
Before visiting, create a shortlist of potential homes based on the type of care required (residential or nursing). Websites like the Care Quality Commission (CQC) in England provide inspection reports and ratings, offering crucial insights into a home's quality of care.
Visiting and Evaluating
When visiting shortlisted homes, pay attention to the atmosphere, staff-to-resident ratio, cleanliness, and facilities. Speak with staff, managers, and, if possible, other residents and their families. Consider a trial stay, if offered, to get a real sense of daily life. Important questions to ask include:
- How are personal routines (e.g., mealtimes, bedtimes) accommodated?
- What social activities are available and how are they encouraged?
- How is communication managed with families?
- What happens if the resident's care needs change?
Residential vs. Nursing Care
Care homes typically fall into two main types, distinguished by the level of medical support provided. Understanding the difference is critical for making an informed choice.
| Feature | Residential Care Home | Nursing Care Home |
|---|---|---|
| Purpose | Provides personal care and accommodation for those needing help with daily tasks. | Provides personal care, accommodation, and round-the-clock medical nursing care. |
| Staffing | Trained care staff assist with washing, dressing, and medication management. | Qualified nurses are on duty 24/7 to provide medical care. |
| Suitable For | Individuals who are largely independent but need support with personal care and companionship. | Those with complex medical conditions, severe disabilities, or ongoing health needs requiring qualified nursing intervention. |
| Cost | Generally less expensive than nursing care. | Typically more expensive due to higher staffing costs and medical facilities. |
Legal Aspects: Mental Capacity and Lasting Power of Attorney
Mental Capacity
In the UK, an elderly person with the mental capacity to make their own decisions cannot be forced into a care home. If they refuse care, their wishes must be respected. However, if they lack the mental capacity to make decisions due to conditions like advanced dementia, decisions must be made in their 'best interests'. A social worker can make this decision, especially if the person is a risk to themselves or others, or if their needs are not being met at home.
Lasting Power of Attorney (LPA)
For family members to make decisions on behalf of an elderly relative, especially regarding health and welfare or finances, a Lasting Power of Attorney (LPA) is essential. A health and welfare LPA covers decisions about medical care, daily routines, and where they live, including a care home. A property and financial affairs LPA covers financial matters, such as managing bank accounts or selling a property.
Crucially, an LPA can only be set up while the person has the mental capacity to do so. If they have already lost capacity, an application to the Court of Protection is required to appoint a deputy, a much lengthier and more complex process. It is therefore strongly advised to arrange an LPA well in advance.
The Final Steps: Transitioning to the Care Home
After selecting a home and securing funding, the final stage is the move itself. This should be a well-planned transition, not rushed, to minimise stress for the resident. The care home will likely perform their own assessment to ensure they can meet all needs identified during the council assessment. A contract will be issued, outlining the terms, fees, and care to be provided. It is wise to review this contract carefully or seek legal advice.
Involving the elderly person in personalising their new space with familiar belongings and photos can help ease the transition and make the new environment feel like home. Open communication with the care home staff is vital during this period to address any issues and ensure the settling-in process is as smooth as possible.
For more detailed information on care options and funding, refer to Age UK.
Conclusion
Getting an elderly person into a care home in the UK is a structured process involving needs assessment, financial planning, and careful selection of a suitable home. Starting with open family discussions and arranging a care needs assessment are the foundational steps. Understanding the financial implications and legal requirements, such as Lasting Power of Attorney, is crucial for navigating the journey effectively. By following these steps and working with social services, families can ensure their loved one receives the best possible care in an appropriate setting.
