Lasting Power of Attorney (LPA)

Guide to lasting power of attorney

What is a Lasting Power of Attorney? – a guide

The principle behind lasting power of attorney (LPA) is to make provision in case your mental capacity deteriorates and consequently you are unable to make decisions and manage your financial affairs. The scenario often thought of is a person with dementia, but lasting power of attorney may be needed for many other situations too, such as after a stroke or car accident.

Why make a Lasting Power of Attorney?

It is only possible to apply for Legal Power of Attorney while you have capacity. If you suddenly lose mental capacity, it will be too late to apply for an LPA. In this situation, your relatives would need to apply to the Court of Protection in order to act on your behalf. This process is far most costly and time consuming than applying for an LPA in advance while you are well and have mental capacity.

Two types of Lasting Power of Attorney

There are two different LPAs which carry distinct rights and responsibilities. You can apply for one only or both. They cover:

  • Health and well-being
  • Property and financial affairs

Health and welfare LPA

This gives the individual/individuals acting on your behalf (called attorneys) the power to make decisions about:

  • Your day-to-day personal care, such as eating, washing and dressing
  • Your medical care
  • Whether you need to move into a care home
  • Decisions about life-sustaining treatment

Property and financial affairs LPA

This gives your attorney/attorneys the power to:

  • Manage your bank or building society accounts
  • Collect your pension or benefits
  • Make a decision about and manage the sale of your home

Choosing your attorney

The first step in making an LPA is choosing your attorney or attorneys. In legal terms, you are called the ‘donor’ giving provision for ‘attorneys’ to act in your best interests should you lose mental capacity. This is very important decision: an attorney needs to be someone who you can trust to make decisions on your behalf. You can choose more than one attorney; there is no limit to the number of attorneys you can appoint. But having lots of people may make decision making more difficult. Often, people appoint their children as attorneys. There are some rules about who can act as attorney, according to LPA type:

Health and Care LPA

  • Attorneys must be 18 and over with mental capacity

Financial LPA

  • Attorneys must be 18 and over, with mental capacity and must not have been made bankrupt
  • A trust corporation can act as financial attorney. This may be a good option for individuals who do not have a spouse, children or close family, although they will charge for acting

What do I have to do to make a LPA?

You can make your LPA application in three different ways:

  • You can go through the process yourself online through the Government website. Start here: https://www.gov.uk/power-of-attorney/overview
  • If you are making an application by yourself and need help, the Office of the Public Guardian is the best place to ask for advice and support. They can be contacted by calling 0300 456 0300 or email: customerservices@publicguardian.gsi.gov.uk
  • If you would like to make the application yourself but want to apply with paperwork, rather than online, you can contact the Office of the Public Guardian for the relevant forms. Your local Citizens Advice Centre should also be able to provide them
  • You may prefer to make a LPA with the advice and guidance of a solicitor. If you know a reputable local firm, you may find this is a good choice. Solicitors fees for working on your LPA are likely to be upwards of £250 but should be no more than approximately £500.

The process: step-by-step

There is a form for each of the two types of LPA, health and well-being, financial and property. Once you have completed the form, a number of signatures are required. If you are making your application online, you will need to print off the forms so they can be signed.

  • An independent professional will need to sign the form to state that you have the mental capacity to make an LPA, that you understand what an LPA is and that you made the decision yourself. This person is called the certificate provider and they are usually a professional such as a doctor, social worker or solicitor.
  • The certificate provider must have known you for two years, but they need to be independent; they are not a family member nor are they named as an attorney
  • You need a person to witness you signing the form
  • Each attorney must sign the form, agreeing to act as attorney if needed and stating they understand what their duties involve

How long does it take?

It currently takes eight to 12 weeks for applications to be registered (this means the process is complete and the LPA is legally binding). It costs £82 for each LPA you apply for, therefore £220 if you are applying for both Health and Well Being and Financial and Property. However, if you do the application yourself without using solicitors, there are no other fees. If you would struggle to pay the application fee, the fee may be waived; you can ask advice from the Office of the Public Guardian or your Citizens Advice bureau.

Who is in control?

A common barrier to people applying for a LPA is a fear it means they will lose control over their life and their money. Registering an LPA does not change who is in control: no changes will take place unless you lose mental capacity.

Mental capacity is something which is very carefully assessed with clear criteria. For example, becoming a little more forgetful and having difficulty with the more complex side of personal banking does not mean loss of mental capacity. Power is only transferred to your attorney if there is a substantial loss of capacity and it is in your best interests for someone to make decisions on your behalf.

It is helpful if you talk to the people you appoint as attorneys about your wishes, so you can have confidence that they fully understand your preferences if do they need to act on your behalf at a future stage.

Lifetime planning

Bear in mind, applying for a LPA is one aspect of lifetime planning and you may also wish to seek legal and financial advice on preparing a will and estate planning.

CHS Healthcare welcomes the 40 per cent increase in NHS funded nursing care payments to care homes

Dr Richard Newland NHS Nursing Funding

We welcome the significant 40 per cent rise in the amount the NHS pays to care homes for the cost of funded nursing care (FNC).

FNC is money paid by the NHS for the nursing carried out by nurses to support and care for residents in nursing homes (and care homes with nursing). The funding covers the nursing element of an individual’s care; it does not include other costs such as the accommodation and social care.

The standard rate has been increased to £156.25 per week (having previously been £112 per week) and the higher rate rises to £205.04 (previously £154.14), it was announced this week (July 13, 2016).

The changes are in response to an independent review by Mazars LLP, which recommended the 40 per cent rise. The increase for all eligible will be backdated to April 1, 2016.

Dr Richard Newland, chief executive of CHS Healthcare which provides the Care Home Selection service, commented: “This is very welcome news that recognises the extremely important work of nurses in care homes and the need for this to be properly funded.”

Professor Martin Green OBE, Chief Executive of Care England, the largest representative body for independent care homes said: “The care nurses give in nursing homes is a vital part of our whole care system and moving to a more realistic means of funding this care is an important step in the right direction. We must now also determine how the FNC should be reviewed annually going forward.”

To qualify for NHS funded nursing care, an individual should be resident in a care home that is registered to provide nursing care. The individual will have been assessed to see if they qualify for continuing healthcare funding and even if they don’t qualify for this type of funding, they may need nursing care and therefore be entitled to FNC. If you would like your relative to be assessed for NHS funding, the best place to start is to go to your clinical commissioning group (CCG) or ask your GP.

We explain more about the different types of funding for care homes here.

Jacki Bishop’s uncle had complex needs, was in hospital 50 miles away and needed a nursing home place. Jacki describes why our help was crucial.

Jacki & Paul Bishop Find A Nursing Home

“Uncle Albert is 96 and has paranoid schizophrenia, epilepsy and advanced vascular dementia. He is incredibly independent and until recently, was living in his own home in Portsmouth.

Albert never married, but lived with his sister until she died four years ago. At that stage, we took responsibility for Albert, as no-one else in the family was able/willing to do so. It proved very difficult as Albert’s condition started to deteriorate.

About ten times during the four years, we arranged home care for Albert, which fell apart because he frequently wouldn’t let carers into his house and in the early stages, when he was capable, would cancel the care package. He wasn’t managing on his own though and would call me up to ten times a day and call the police up to five times a day because he was suffering so much from paranoia.

We live in Guildford, Albert is in Southampton, so it was a round trip of 100 miles to see him. I have two A4 sheets of paper full of contacts who have been involved in Albert’s care – social workers, community mental health teams, hospital staff, GPs, carers and pharmacists and not a single one of them was communicating with any of the others.

From February, things rapidly went downhill for Albert, who was in and out of hospital with two failed discharges. Every time the phone went, my stomach would churn anticipating something else had gone wrong. At a Best Interests meeting in March, we were told Albert should have one more chance to live at home and if that did not work he would have to go to a nursing home.

We felt that was already the case but didn’t know where to start. We explained that we were doing everything we possibly could, but didn’t have the capacity or knowledge to take on the responsibility of finding a home. Nevertheless, I was handed a book listing different care homes and told to apply for Deputyship.

After the second failed discharge and a period in hospital during May and June, we agreed that Albert couldn’t return to living in his own home and we were told we needed to find a nursing home for him. I am the carer for my mother, I work and we have other family members who need support and we live in a different part of the country. I felt utterly desperate and overwhelmed and explained I could not do it.

The next day, I got a phone call from an adviser called Bob who introduced himself and said he understood my Uncle needed a place in a nursing home. We had a good discussion about Albert and his needs and Bob said he would find some homes which were suitable for him and had vacancies.

Bob came back to me and explained he had called 30 nursing homes and found three that were suitable. He asked whether I would like to look at them and whether I would like him to accompany me. I said yes and it turned out to be enormously helpful having him with mee. Going with him took away the stress of having to locate the nursing homes and if I forgot questions, he would ask them.

It was really useful too because the three homes were completely different. The first was a new, state-of-the-art facility with beautiful rooms. But I couldn’t see Albert there – it felt too isolated and quiet and just not the sort of place he would feel at home. The second home was at the other end of the spectrum, clean but pretty basic and very dementia based. It would have been quite challenging for some visitors, although because I work in healthcare, it didn’t trouble me and of the two, it would have suited Albert more.

We arrived at the third home at lunchtime. As a dietitian, I was pleased to see the food was obviously home cooked and their eggs came from their own chickens. They also had an aviary with canaries as well as hens, kept rabbits and encouraged the residents to help in the garden in any way they were able to. Everyone was very friendly and I was told that residents are encouraged to leave their room and sit and eat in the communal rooms. The residents seemed very settled and similar to Albert in his present condition.

After seeing all three homes, Bob asked what I thought. When I told him I preferred the third, he said he thought that was a good choice. It was very reassuring to have him alongside me – not influencing or pushing me but helping me to have confidence in the choice I was making.

> > Find a Nursing Home

Understanding frailty: a medical condition, not an inevitable part of ageing

Fit for frailty

We are all very familiar with the term ‘frail’ as a generalised description associated with age and poor health. Increasingly however, health professionals apply the term more precisely, to mean a specific condition which should be measured, diagnosed then carefully managed (just like a diagnosis of diabetes, arthritis or other condition).

Frailty is characterised by the following symptoms: weight loss, exhaustion, low activity levels, very slow walking speed, muscle weakness and poor ability to grip (this is known medically as the Frailty Phenotype).

The British Geriatric Society (BGS), the professional body for doctors, nurses and other professionals working with older people, is a leading advocate for better awareness and management of frailty. In their publication, Fit for Frailty, the society emphasises although the risk of frailty increases with age, not all elderly people are frail and some younger people, particularly those with long term health problems, can be frail.

Why is it important to have this better understanding and more precise meaning of frailty? There are two main reasons: the condition of being frail means a person is at risk of a relatively minor event having very serious and sometimes life-threatening consequences.

To take falls as one example of this: falls are an extremely common problem, with one in three people aged over 65 falling each year, rising to one in two aged over 80. What would be a very minor event for a younger or non-frail person, often has very serious consequences for the frail elderly: 10 to 25 per cent will sustain a major injury such as a hip fracture and for those aged over 75, falls are the leading cause of mortality (Chartered Society of Physiotherapists). There is a widely recognised spiralling of events: one fall results in increased frailty and loss of confidence, making further falls more likely. However, in a publication produced by Age UK (Falls Prevention Exercise – following the evidence) considering research from a number of different studies, suggests a tailored exercise programme for elderly people can reduce falls by as much as 54 per cent.

Similarly, the British Geriatrics Society (doctors, nurses and other health professionals working with the elderly) argues we should not see frailty as a fixed state but as a condition which can both worsen and improve (Fit for Frailty). Their report urges: “Older people should be assessed for the possible presence of frailty during all encounters with health and social care professionals.”

What does all this mean for families who are struggling to support an elderly relative still living in their own home? The advice from the British Geriatrics Society report emphasises frailty can escalate to a crisis point, when functions the individual was previously able to manage are no longer possible. The best place for the elderly person to be at this time is in a community setting, rather than an acute hospital, providing the necessary support is rapidly put in place. The society’s report states:

“If a patient is not severely unwell but is unable to maintain their usual status quo in the community due to a temporary change in their care needs, it is good practice and better for an older person with frailty to transfer care to a responsive community service rather than admission to hospital. This could be either a rapid response type ‘hospital at home’, or a community based intermediate care service such as a ‘step up bed’. There will be some variation in local schemes.”

In other words – elderly people who are losing their capacity to do things have the best chance of recovering that capacity to some extent if they are in their own home, or a community based setting. In the busy and unfamiliar environment of an acute hospital, it is much harder to regain lost capacity. But the frail, elderly individual must be safe above all and therefore community based support is vital.

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.

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