Ninety-seven per cent of families rate our support as “excellent” or “very good”

We are delighted that 97 per cent of families rate CHS support as either “excellent” or “very good” in figures recently published from one of our hospital based services.

The ratings come from recently published annual figures from one of our hospitals services for East Lancashire Teaching Hospital. Between April 2015 and March 2016, we worked with 698 patients and their families who needed to move from hospital into 24-hour residential or nursing care.

Our advisers supported them with every step of the process of looking for and choosing a care home, together with helping to make all the necessary arrangements. Our advisers work flexibly, which means they can support families during the evenings and weekends if that is the most convenient time for them.

A total of 59 per cent said our service was “excellent”. A further 38 per cent said it was “very good”. Only two per cent said it was satisfactory and just one per cent rated it as “poor”.

Rachael Hardbattle, regional manager, commented: “Any customer service would be extremely proud that 97 per cent of service users rate what we do so highly.

“We work very hard to achieve this fantastic feedback. This evaluation comes from nearly 700 patients and their families: it shows we consistently do an extremely good job for hundreds of families.

“This is the evaluation for one service but we achieve these high scores in our services across the country.”

Comments included: “The service was excellent, I couldn’t have done it on my own” and “I felt that having the advisers support was invaluable at such a vulnerable, emotional and horrendous time.”

We work in hospitals all over the country, helping patients and families who need to move into 24- hour care. We also arrange packages of care at home, enabling people to return to their own home after an episode in hospital and we also work with families in the community, who are concerned their love one is struggling to cope and needs more professional support.

Find out more about how we help people to choose a care home

Find out more about how we help to arrange care in your own home

What are the signs that your elderly relative is not coping living independently in their own home? What can you do?

For some, a defined crisis marks the point when an elderly person is unable to live independently in their own home. It is often precipitated by a fall, a stroke or other medical problem resulting in an emergency hospital admission. As well as the providing the necessary medical care, being admitted to hospital triggers a series of assessments of the elderly person’s ability to look after themselves thereafter. Consequently, a package of care may be organised in order for the elderly person to return to their own home, or they may need to move into the 24-hour care environment of a residential or nursing home.

Sometimes however, the transition from independence to needing support is gradual and less clearly defined. This can leave family members torn between concerns about whether the elderly person is coping while at the same time, respecting their cherished independence in their own home.

The first step to take is to talk to your relative about arranging for a care needs assessment. You can reassure your loved one that this is not the first step to going into a care home and they are entitled to a free, face-to-face assessment, even if they perceive their needs to be fairly low level. You need to contact the adult social services team at your local authority and request a community based care needs assessment for your relative. There may be a wait of four to six weeks but it should not be longer than that. The assessment will consider what the individual’s care needs are and how these might be met. Even if your loved one is likely to be self-funding because they are above the financial thresholds to qualify for social services funding, your assessor is still responsible for sign-posting local services that may help to meet needs. For a person funding their own care, a care needs assessment provides a good foundation, mapping out needs for you to then consider how services can be brought in to meet those needs.

There are practical things you can consider which can make a significant difference to the well-being of your loved one. Do you find your elderly relative takes much longer to get through food provisions than before? When you ask what they had for dinner, do they say they preferred a sandwich and salad to a full cooked meal? The process of ageing itself creates an inherent risk of malnutrition: elderly people have a much reduced sense of taste and smell compared to the young, particularly if they are taking regular medication and have a long term condition. With food so closely associated with family and company, elderly people living alone can struggle with the motivation to prepare and cook meals.

It is normal for appetite to reduce with age and for weight to stabilise or slightly fall after the age of 75. But any reduction should be very gradual. A loss of more than 5 per cent of body weight in three months or 10 per cent in six months is indicative of a strong risk of malnutrition. Even a mild degree of malnutrition will impair immunity, reducing the body’s ability to fight infection.

To consider this in practical terms, if your relative is relying on cold snacks rather than preparing meals, it may be worth trying a meal delivery service or bringing and sharing hot meals with them. An elderly person who is insufficiently prompted by their own appetite to prepare a meal may nonetheless enjoy a hot meal that is brought and served to them fully prepared.

Falls are another major concern: Government figures show one in three people aged over 65 will fall every year, with the rate increasing to one in two people aged over 80 living in their own homes. Up to a quarter will sustain a serious injury, with falls being the leading cause of mortality in the over 75s.

Consider the home itself: the physical space which your elderly relative managed perfectly during their 60s and often 70s may begin to pose serious risks as they become increasingly frail. Often, home adaptions are made after a fall or other health crisis. What adaptions could be made on a preventative basis? Some adaptions need not be expensive: correcting uneven paving stones in the garden (particularly if close to the washing line where your relative may regularly hang out clothes), adding non-slip rugs to a slippery tiled floor or additional lighting in poorly lit rooms can be a simple way of reducing hazards before falls occur.

Often the greatest cause of anxiety is elderly people negotiating stair cases (particularly in older houses where stairs can be very steep and narrow). Moving a bedroom downstairs can be a very good solution if space is available, although many older people, especially those who are relatively well, may dislike this suggestion. A compromise might be: organising belongings so they only need negotiate the stairs once in the morning and evening and considering having carers visit at these times to be there and support your relative while they negotiate the stairs.

Read more about how we can help you to arrange a package of care in the home

Read more about how we can help with an existing package of care

Worried about your loved one’s memory and abilities? Why it is important to consider the possibility of depression as well as dementia

There has been a much needed focused on dementia in recent years, resulting in some notable improvements in awareness and diagnosis. However, it is worth reflecting that depression is more common in old age than dementia and is particularly at risk of remaining untreated and underdiagnosed.

Although dementia and depression are distinct and different conditions, there are strong similarities in the way they present. Commonly, older people express concerns about their memory and their ability to do things. Dementia and depression share many symptoms, including anxiety, agitation, apathy, irritability, poor sleep, restlessness and difficulty concentrating. An older person with dementia may lose the ability to drive to the shops and accomplish tasks, an older person with depression may lose the motivation to do so, but the effect upon quality of life may be very similar.

We know that when older people develop depression (which 22 per cent of men and 28 per cent of women aged over 65), they usually don’t express it in the way younger people do. They may not talk about moods or how they feel. They are more likely to complain about their health in physical terms and about their ability to do things. Dementia is a brain problem that includes the impairment of memory and cognitive ability (knowing, understanding and reasoning). So both conditions can have the same effect of disrupting a person’s ability to accomplish basic day-to-day tasks.

Getting to the bottom of the root cause is essential as there may be a complex interaction of both issues. Dementia is frequently cited as the most feared health condition; it is recognised that people who have memory and functional ability impairment due may delay asking for help because they are frightened they could be told that they have dementia. In other words, an elderly person could struggle with untreated depression because they fear dementia. Equally, social workers have observed that the onset of dementia can produce an episode of depression; sadly, some individuals will be struggling with both.

The Mental Health Foundation provides a useful model of the five factors most closely related to depression in older people: physical health, poverty, relationships, participation in meaningful activities and discrimination. Some physical conditions, including vascular disease and diabetes increase the risk of depression, not only because of their psychological impact but also their direct effects on the brain. If an individual has had episodes of depression at a younger age in life, they are likely to be more vulnerable to the condition in old age.

Raising the subject of possible depression may be challenging or sensitive. Coming from a generation in which mental health was not openly discussed, they may feel very uncomfortable or embarrassed if asked directly about feelings. It may help to start with recognition of the factors which may be triggering their emotions (“I understand how much you must be missing playing golf with your friends”) to see if this opens up an avenue into a discussion.

The first practical step is going with your elderly relative to see their GP. Your GP will start with by taking a history, considering how the elderly person is functioning and feeling. Your GP may want to rule out other physical problems with a blood test. Some infections, diabetes or underactive thyroid can also produce symptoms of confusion and impairment of normal activities so will need to be ruled out.

There is no physical test for depression; it is diagnosed by careful history and discussion. If there is a suspicion of dementia, the elderly person is likely to have a neuropsychological tests (simple questionnaires to assess memory and cognition) and they may be referred for a brain scan.

Although this will be an anxious time for you and your relative, it is important to emphasise that not all memory problems are caused by dementia. If the changes they are experiencing are due to depression, they can be assured that there are very good treatments for depression and they will start to feel much better once treatment commences. They may need to face the very difficult diagnosis of dementia and although there is no cure, the importance of identifying the condition as soon as possible and starting treatment is well recognised. It is possible too that both depression and dementia are present, which will seem a very challenging diagnosis, but equally, the effected individual will be feeling very low and it is essential to have an accurate diagnosis and commence treatment and support as quickly as possible.

Should you consider live-in care? What are the advantages and disadvantages?

One care option which has been growing rapidly in recent years is live-in care. This involves the carer (or a team of two) living in your home to provide support on a 24- hour basis, seven days a week. The major advantage of live-in care is of course enabling the individual to continue to live in their own home with support at all times. Home life is maintained as far as possible: pets can be kept, for example and helping to look after pets can be part of the support provided by live-in carers.

Live-in care may be a particularly good option if an elderly couple need full-time care and support. The costs of live-in care are likely to be comparable or even a little less than the fees of two people moving into a care home. Live-in care is also being increasingly considered in rural areas: if carers have to travel long distances to reach people, it is difficult to find people for these roles. To drive 20 or 30 miles for a session of one hour or less with an individual is sometimes not viable, whereas with live-in care, carers will be prepared to travel much longer distances and thus the resource of potential carers becomes much larger.

Many live-in carers have specialist training in dementia, Parkinson’s, stroke and multiple sclerosis care and having live-in carers allows for great continuity and mutual understanding. There is often a benefit for the whole family as relatives are released from the demanding, time-consuming demands of day to day care and can focus on social and emotional support.

Of course, the success of a live-in care arrangement is highly dependent upon the relationship between the individual (or couple) and carer. It is important to carefully consider how you feel about the living arrangements and how well it will work to have a person who is not a family member permanently resident in the house. The needs of the carer must be carefully considered; they will be working but equally, while resident, your home will become their home. Some arrangements involve two carers rotating with each other to provide 24/7 support, others involve a main carer with others brought in to support and allow the main carer to have breaks.

Although the upheaval of moving from your own home into a care home is very significant, people often benefit from the social interaction and programme of activities available. Live-in care needs to consider and support the hobbies and activities the individual is engaged in and enable them to continue; it is important to guard against social isolation. An isolated individual supported by an isolated live-in carer is not likely to be a successful solution.

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