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The process of choosing
a care home |
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DISC Tel: 0845 120 4048 email: info@disc.org.uk |
This
fact sheet offers information after the difficult decision has been made that
it is time for the person you care for to move into a care home. It will provide
guidance on selecting a suitable care home. You may also find the following fact sheets useful
The role of your local
authority social services
A
full assessment of someone’s needs is essential in finding a suitable care
home. Ask for an assessment of need
for the cared for person from your local authority social services
department. This is called a Community
Care Assessment but in some areas is now called a Single Assessment.
The
local authority is responsible for: ·
Arranging care for a person assessed as needing care in a
care home ·
Arranging funding for people who are assessed as needing
financial assistance Before you decide on which homes to look at check whether the person will be 1.
Totally self-funded. 2.
Partly self-funded or fully-funded. 1) Accommodation if you are self-funded The
person you care for will have the widest choice of care homes and still have
a right to help from social services in finding an appropriate placement. |
The following points are
worth considering
If
they can afford to pay for a home themselves now, what will happen in a few
years time? If there is a chance that
you may need help from the local authority, it is highly recommended that an
assessment be carried out before you make any private arrangements, so that the
choice of care home is made with this in mind.
Many care home accountants will want to know that someone has two years’ fees in the bank before agreeing to a placement. Fees add up very quickly. For example, if you are paying £650 a week for a home, this amounts to £33,800 a year. Two years’ fees would cost £67,600.
If
the funding of the person you care for drops down to a level where they are
entitled to local authority assistance and the person you care for is in a
preferred social services listed home, there may be less chance of them having
to move. As income
and capital approaches the £20,000 limit, contact the local authority social
services to make them aware of the situation.
2) Accommodation for local authority assisted funding
If the local authority is assisting with part or full-funding of the care
home fees, (Section
21 of the National Assistance Act 1948) the carer and cared for
person have the right to
choose the home the cared for person is moving into.
If
the person concerned expresses a preference for particular accommodation
(“preferred accommodation”) the council must arrange for care in that
accommodation as long as:
Further, the Department of Health
Local Authority Circular (2004)20 states:
“Where for any reason a council
decides not to arrange a place for someone in their preferred accommodation it
must have a clear and reasonable justification for that decision which relates
to the criteria of the Directions and is not in breach of any regulation”.
The location of the preferred
accommodation “need not be limited by the boundaries of the funding
council. Councils are obliged to cater
for placements falling within the Directions or the Regulations in any
permitted care home within
If the cared for person is assessed
as needing to move to another area then:
“Funding councils may refer to
their own costs when making placements in another council’s area. However,
because costs vary from area to area, if in order to meet a resident’s assessed
need, it is necessary to place an individual in another area at a higher rate
than the funding council’s usual cost the placing council should meet the
additional cost itself”.
If
an individual requests it, the council must also arrange for care in
accommodation more expensive than it would usually fund as long as a third
party, usually a family member or friend, or a charitable organisation is
willing to pay a “third party
top up”. In
certain circumstances, the resident can do this
themselves if they are willing and able to pay the difference between the cost
the council would usually expect to pay the actual cost of the accommodation.
If
this is an option being considered you will need to think what would happen if
the home increased the fees. Would the
local authority have a responsibility to cover part of the fees’ increase? How long would the third party be able to
carry on paying?
Government guidelines recommend that local authorities have a written agreement with the cared-for person (resident), third party (relative or charity) and the person providing the accommodation (care home) when they wish to use their right to have more expensive accommodation (to use third party top up fees) and this agreement specifies that:
·
If the
accommodation breaches its contractual conditions, the authority has the right
to terminate the contract
If
the person you care for was a teacher, member of the armed forces or a member
of a professional body, then there are charities such as SSAFA who may assist
with care home fees.
Make sure that any special circumstances are considered in the
assessment.
These issues need to be included in the decision
making process:
·
Is the home close enough to the person you care for, for
example, if you cannot drive or if you are elderly yourself?
·
Are there are religious reasons for wanting to move into a
certain home (eg the person you care for wants to move into a Roman Catholic
home)?
Many care homes will have a waiting list
Find out how long the person you care for may have
to wait before a place is available. In
many areas the number of care homes has decreased, which means that there are
fewer care home places.
As dementia progresses people usually need increasing
care and support
Ask
the care homes you visit if they can cope with people with more advanced
dementia, otherwise the person you care for may
have to move later on. Some homes are
able to provide residential and nursing home care (called dual registered
homes) which would be an important consideration if you want the care home to
be a home for the rest of the person’s life.
The
person you care for still has the right to choose which care home they will
move into. Finding the right one takes
time and energy and the hospital staff should understand this. Often because of bed shortages, the staff feel pressured and want you to make a decision
quickly. Remind them of your right to
choose. There is detailed advice on
hospital discharge and the NHS complaints procedure in the Age Concern
Fact sheet 37.
This can be ordered from the Age Concern Information Line: 0800 00 99 66.
Hospital Discharge Arrangements
You could get in
touch with Senior Line: 0808 800 6565, your local Community Health
Council or Patient Advisory Liaison Service.
Care homes are divided into two types
‘Care home’ is a
general term used to describe an establishment that offers care, and sometimes nursing,
twenty four hours a day, seven days a week, to a person who lives on the
premises. Care home is the new name for
residential care. ‘Care home with nursing’ is the new
name for a nursing home. The old terms
(residential care and nursing home) are still sometimes used.
All care homes
must be registered with the Commission for Social Care Inspection. Some care homes have a specific registration
to care for people with dementia.
Whether your relative will require such a care
home depends on the type of dementia, stage of the condition and the help they
require. This should be fully discussed
with the care home and care manager if one is involved. Regardless of which registration of home is
decided upon you may wish to discuss how the home will meet changing needs as
the dementia progresses.
If
it is assessed at this point, or sometime in the future, that your relative has
nursing needs that cannot be met by community nursing staff, then they would
need a nursing home placement. Nursing
homes must have a registered nurse on duty at all times and must have more
staff to meet more complex needs. They
are therefore more expensive. If nursing care is assessed as being necessary
under the Health and Social Care Act 2001, or National Health Service Continuing
Health Care Needs, the cost of health care will be paid for by the NHS.
The role of health
In 2001, the government brought in new legislation so that nursing care
provided to people in care homes is free to people who are self-funded. The NHS now meets the costs of registered
nurse time spent on providing, delegating or supervising care in all
settings. The intention of this is to
get rid of the anomaly of people having to pay for care in a nursing home that
would be free in residential accommodation, hospital or at home.
If
you think that the person you are caring for has health needs and may need to
be considered for nursing care whether they are self funding or not, they will
need to be assessed for the Registered Nursing Care Contribution (RNCC) by a
nominated NHS nurse who will decide what level of nursing care the person needs
and which of three bands of nursing care need the person will be placed
in. If they are in the low nursing need
category, they may just need a district nurse input and would not necessarily
need a nursing home. However if they are placed in the medium or high bands a
nursing home placement is likely to be more appropriate and this should all be
part of the Single Assessment.
Nursing care is
not paid for by the local authority, or the individual, but by the NHS through
the cared for person’s Primary Care Trust.
There will be no charge to pay. Your health authority will carry out the assessment based on their eligibility criteria to determine if the cared-for person qualifies for Continuing NHS care. If assessed as being eligible the person you care for will not have a choice of accommodation. It is the specialist or consultant who will say what nursing home can meet the needs of the person.
Finding
the right home in your area:
·
Commission for Social Care
Inspection (CSCI). This used to be
called the Care Standards Commission.
All care homes have to be inspected twice a year. Reports on all registered homes are available
from the CSCI.
To order
inspection reports telephone: 0870 2407535
or visit the CSCI website: www.csci.org.uk
to view reports.
·
Your local social services department
will have information and advice about local homes in your area. They usually have a directory of care
homes. You will be able to find the
number in your Yellow Pages.
·
DISC has a list of organisations
that will provide further information.
This fact sheet can be made available in large
print.
We are constantly looking to improve our
information. It helps if you let us know
whether the information in this fact sheet was/was not useful and if there are
other fact sheets that you would have found helpful that we have not yet
provided.
While the information contained in this fact sheet is believed to be
correct, DISC does not accept liability for any error/s it may contain.