Comparing Care Home Costs

All homes have their own fee structure. Most homes charge different rates for single rooms, double rooms and for en suite facilities. Some homes will only admit residents who are self-funding, others will also admit those who are being helped by Social Services; some homes only admit residents who rely on Social Services for their funding.

It is sensible to contact your local Social Services offices and ask for a financial assessment before making any final decisions regarding your relative's transfer to a care home.

Your relative's care manager will assess the needs of your relative and decide the type of care which is most appropriate for them. This may be a residential care home, a nursing home or another type of care. If you disagree with their decision you may ask for a second opinion.

They will give you a list of homes in the area and guidance regarding the listed homes which may be suitable for your relative. However, care managers are not allowed to recommend any particular home. Before you visit the various homes jot down a list of financial issues you need to know about, for instance.

• Will a monthly account be sent to me?
• Do the fees cover everything?
• Are there any extra charges for anything?
• When are fees due?
• Can fees be paid by direct debit?
• Who are the direct debit or cheques made payable to?
• Do Social Services send their contribution to the home?

Your care manager will arrange for your relative to have a financial assessment. This is mandatory if they hope to have financial help from Social Services. Even those people who expect to be self-funding may benefit from such an assessment because the assessor will ensure your relative is getting all the allowances to which they are entitled.

Care Home Finance

Whilst it is not obligatory to involve Social Services, particularly if your relative is going to be self-funding (being totally responsible for their own fees) it is best to inform them and ask for advice as soon as you or your doctor realise your relative needs full-time care. A care manager will be appointed to help and advise. They will:

• Make an assessment regarding the most appropriate type of care required.
• Arrange a financial assessment if required.
• Give you a comprehensive list of homes in the area.
• Inform you which homes will give the type of care your relative needs.
• Arrange respite care during the waiting period if necessary.
• Reassess the placement of your relative during the first few weeks.
• Advise you if the placement is unsuitable and help find a more appropriate home for your relative.

If Social Services is involved four assessments will be made:

1. Assessment by a care manager to establish the type of care required.
2. A financial assessment to determine your relative's contribution towards care.
3. An assessment by the matron of the care home to establish whether the chosen home is the best possible home for your relative.
4. An assessment by the health authority to determine if your relative requires nursing care. If they do it will be decided how much nursing care need.

If Social Services are not involved only assessments 3 and 4 will apply.

The reason for the last assessment to determine the amount of nursing care a resident will need is because the National Health Service now pays for nursing services within nursing homes. This means that the resident no longer has to pay for this component of their care.

Finding a Care Home: Essential Facilities

Laundry services

Almost all homes have an in-house laundry where residents' clothing is washed and ironed and taken back to the person's room and put away. Unfortunately if clothing is not marked with the resident's name it can get mislaid.

Laundry services do not generally include articles that need to be dry-cleaned and it is usually the responsibility of the resident's relatives to take the clothes to the dry cleaners and pay for this service themselves.

GP services

Your relative's current doctor may be willing to continue to visit, monitor their progress, advise, and prescribe for them if and when they succumb to illness, on condition the surgery is near the home.

However, if it is not practical for your relative's own doctor to continue caring for them, they will have the opportunity to change to a more local practice. The matron will advise in this case.

Activities

Many care establishments have an activities programme. Some employ a person to draw up a daily activities list and put it into operation. It is difficult to suit all the residents all the time. They may enjoy some activities more than others but if they join in they will make new friends and enrich their lives.

Library services

There is generally a library within the homes for those residents who like to read. Sometimes the books are donated but in some areas the local library is able to bring a selection of books initially and change them at regular intervals. If there is no such facility, books can be borrowed by friends or relatives on a resident's behalf from the local library. However, the person borrowing the books is generally responsible for their safe return at the proper time.

Trolley shop

There are always a few residents who are too disabled or who have no inclination to go out. In nursing homes the residents are often too sick or frail to even think of leaving the home. With this in mind some matrons organise a weekly shopping trolley with things such as writing paper, envelopes, stamps and other useful items that the residents can purchase.

Gardens

Many homes have lovely gardens for the residents to rest or walk in. Sometimes the home's gardener or handyman will help residents to plant hanging baskets or tubs or even bulbs for them to have in their rooms or communal areas. It may even be possible to have raised flower beds to enable keen gardeners, if they are fit and well enough, to enjoy gardening again.

Religious services

The matron may already have arranged to have church services held within the home by the local clergy or pastors. If there is no religious service suitable for your relative, bring the matter up with the matron. They may be able to contact the appropriate minister and ask them to visit your relative when admitted. Alternatively, depending on distance, you could ask their own minister to visit.

Car parking

Many of the residents' visitors will have their own transport. One of their biggest worries is where they can park the car.

Most homes outside a city or town have car parking facilities both for staff and visitors. It is sometimes more difficult if the home is situated on a busy road with little or no space to park a car. The matron or the staff will know where the nearest parking places are. If the home is fortunate enough to have a car park it may prove difficult to find. When you phone to make an appointment to view the home, ask how to find it.

Sheltered Housing

Sheltered Housing or warden controlled flats are not classed as care homes but they deserve a mention here.

A warden is employed to ensure that residents who live in these flats are well enough and able to care for themselves on a daily basis, and to answer any emergency calls when they are on duty.

Each flat has a call bell or intercom which rings in the warden's office if they are in need of help during office hours. In order that the residents can call for help when the warden is off duty the residents are usually advised to hire a 'press-button-gadget' (sometimes called 'life line').

This is a call bell, usually in the form of a pendant, which residents can wear round their neck. When the bell is pressed it rings in an office in another building often miles away in another town or city. The person who answers will call the resident's next of kin and advise them of the problem.

Nursing Homes

Nursing homes have a higher ratio of staff to residents than residential care homes because the residents are less able than clients living in a residential care home. They need more help with their 'activities of daily living' such as personal hygiene, going to the toilet, bathing, etc. Some will need to be assisted with their feeding and drinking.

Clients who are admitted to nursing homes need nursing care. In all nursing homes the residents will be suffering from different illnesses and conditions.

Some people enjoy being in a home caring for a large number of residents. Others prefer to live and be cared for, in smaller ones. There are advantages and disadvantages in both cases.

The Larger Nursing Homes

Larger homes have 50 beds or more. It would be difficult and unusual to have this number of beds plus dining rooms, lounges, toilets and bathrooms, etc all on the ground floor. In view of this there may be two, three or possibly more floors depending on the number of elderly residents they care for.

The residents would be taken to their floor by lift. The largest homes may have two lifts. Access to each floor is also provided by stairways.

In some homes, particularly the more modern ones, the floors are complete with a small kitchen area, lounge and dining area, bathrooms, toilets, nurses' station and treatment room in addition to the bedrooms.

All nursing homes, whether large or small, have communal rooms for the use of residents and their visitors.

Smaller Nursing Homes

Some homes are designed to be a single storey building, depending on the number of residents they have been built to accommodate.

Residential Care Homes

Men and women are admitted to residential care homes for care such as bathing, meals, washing, etc. However, residential care homes are not usually allowed to admit anybody who needs nursing care. Most of these homes employ care assistants who work under the direction of the matron or manager. Usually a suitable weekly activities programme is arranged and even trips to the shops or various places of interest, for those residents who are interested.

The ratio of staff to residents may be lower than in a nursing home because the residents are usually able to do more for themselves. They are not expected to make their beds, do any housework or cooking but they should be able to carry out most of their own personal care when they are admitted.

The snag is that if any resident becomes ill and needs nursing care they may have to be transferred to a nursing home. Initially such a move often upsets the resident and they will need a lot of comforting and help until they learn the routine and make new friends in their new abode.

Care Options for Patients with Alzheimer's and Dementia

In England people diagnosed with Alzheimer's disease are usually cared for by the family in their own home in the early stages. There comes a time however, as the disease progresses and the behavioural pattern becomes more difficult to cope with, when carers find they can no longer cope with their relative's forgetfulness, odd behaviour and possible aggressiveness.

If you are a carer in this situation contact your relative's care manager and seek advice. They will be able to tell you which kind of home would be most suitable for them and give you a list of appropriate homes.

An EMI Home (Elderly Mentally Infirm)

An EMI home is usually the home where residents with dementia or Alzheimer's disease are cared for. A person suffering in this way will be happier in this type of home than in a nursing home. There are Registered Mental Nurses (RMNs) who are specially trained to care for residents with this kind of illness on duty at all times. They know how best to help and care for the residents.

Residential Care Homes for Elderly Folk with a Mental Disorder

These homes cater for elderly residents who suffer from such illnesses as depression or schizophrenia.

Some of the residents need to have regular medication administered by injection, usually fortnightly or monthly. The Community Psychiatric Nurse (CPN) visits frequently to monitor the residents, to give advice if necessary and to give the injections as they become due.

Causes and Symptoms of Alzheimer's Disease

This disease involves the parts of the brain which control thought, memory and language. Research is ongoing and although much has already been done neither the medical profession nor the scientists know the cause of this disease. So far, no cure has been found.

Signs and Symptoms

• Slow onset.
• Mild forgetfulness, patients may have difficulty in remembering recent events, the names of people they know - even their family members.
• Patients may not be able to solve simple problems or do simple sums which may cause minor difficulties. However, it's not usually serious enough to cause alarm.
• Most people will not suspect anything is wrong at this stage.
• The person may begin to forget how to do simple tasks such as combing their hair or cleaning their teeth.
• They can't seem to think clearly.
• They may ask the same question repeatedly, or repeat an activity, such as washing their hands, because they have forgotten they have asked the question or washed their hands already.
• Problems arise with speaking, reading, writing and understanding.
• As the disease develops the changes are more pronounced and more easily noticed. At this stage either the person or a family member, on their behalf, will seek medical advice.
• As time passes the person may become anxious, agitated, aggressive, suffer with insomnia and depression.
• They may become wanderers - going out and getting lost.
• Eventually they will need total care.

What Causes Alzheimer's Disease?

The cause is unknown at present but there are several factors which may be contributory.

Age

• The risk factor increases in people over 65.
• As people reach their seventies and eighties the risk factor increases. This is known as 'late onset Alzheimer's disease'.

Family History

There is a rare form of Alzheimer's which is familial. It usually occurs between the ages of 30 and 60 years of age and is inherited. This has led scientists to believe genetics may play a role in some cases. However, the more common form which occurs later in life shows no sign of being inherited.