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When is the right time to consider moving into a care home?

For some individuals and their families, the decision about care is clear-cut because it is precipitated by a crisis. An elderly parent may have a fall or illness which leads to a period in hospital. During this time, it is clear that they will not be able to return to their own home. This is often very challenging and emotional, but there may be support via the hospital and the path to take is clearer.

This is not always the case. If an elderly person is living independently in their own home, changes to their well-being and abilities can be gradual. In this situation, it can be incredibly difficult to decide when to consider a move into a care home or sheltered accommodation.

There are certain signs to look out for. Keep a close eye on your elderly relative’s eating patterns – do you find meals untouched or food stocks not going down as would be expected? A report by the Patients’ Association in 2011 estimated that three million people in the UK are either malnourished or at risk of malnourishment. Those aged over 65 and living alone were the highest risk group.

Elderly people often have chronic conditions and rely on medication. This will be vital for their well-being and is also a clear sign for concerned relatives – keep a close eye on their medication, remind them to take it and try to find ways of helping them to remember. But if medication is consistently missed, this is a sign more support is needed.

Signs of disorientation and confusion need to be closely monitored because of the risks to personal safety. Typical issues are the elderly person going out at unexpected times, perhaps late in the evening and or disordered behaviour. For example, a relative spoke to a Carehome Selection adviser recently about finding an iron placed in her mother’s fridge. You may find that disorientation is worse at certain times of the day. For example, relatives often describe getting a flurry of anxious phone calls during the evening, but the following morning, the elderly person may be very lucid and capable.

The key advice in this scenario is obtaining a professional opinion. In the UK, anyone with concern about an elderly relative is entitled to ask for a Care Needs Assessment. Your local authority is obliged to carry this out for you, regardless of whether your relative will be self-funding or entitled to social services funding. This assessment is carried out by a social worker.

The timescales for this assessment vary according to where you live and the efficiency of your local authority. It typically takes two to three weeks in some areas and up to six in others and this can be a source of great anxiety if a family feels they are nearing a crisis point. It is a very good idea to ensure you can be present during a care needs assessment, so you can have some input in the process.

Sometimes, people disagree with the view of a care needs assessment and very often, the care needs of an elderly person changes over time. If you feel your relatives’ needs have changed, you are entitled to request another care needs assessment and there is no set amount of time which needs to pass between one assessment and another. With increasing pressures on social services resources, there can be a wait for assessments, so if you feel your relative may need one, or another assessment is required because needs have changed, it is better to apply sooner rather than later.

However, getting an independent, professional opinion (and indeed starting the process by applying for this assessment) takes away much of the pressure from the difficult question of ‘when’ should a care home be considered. If your relative has dementia, the Care Needs Assessment will also include input from what is described as a “trained mental health professional”. This may be your relative’s GP, or if they are under specialist dementia care, input may come from their hospital consultant or a community psychiatric nurse. If dementia is the primary reason why your relative may need 24-hour care, it is important to have a formal medical diagnosis of dementia.

Of course, considering a move to a care home involves complex emotions, relationships and difficult questions. Many families are reluctant to address the question of a care home, knowing it is likely to involve major financial issues, so they put it off. Often, the elderly person themself is strongly opposed to a move into a care home or would prefer to move into a relative’s home. It is better to address these issues sooner rather than waiting until a crisis point; although that may be easier said than done.

There are some good options which may help bridge the gap if an elderly person is struggling to manage independently, but feels very opposed to the idea of a care home. Some care homes offer a day care option, enabling a person to benefit from the meals, support and a social environment, but return to their own home during the evening. Respite care can also be a good option, for example for one or two weeks, allowing relatives to go on holiday without worrying. It also enables the elderly person to try a care home setting, sometimes overcoming their anxiety about what this might involve.

There are also some very good facilities, usually described as Senior Living accommodation, offering the option of self-contained flats; very different to the traditional ‘care home’ but with the option of accessing additional support within the same facility if needs increase.

In conclusion, if you feel very worried about an elderly parent or relative, your first step should be obtaining a Care Needs Assessment. This will provide a professional, independent view which will help you and your family to work out what to do next. Remember, there are an increasing number of options and ways to access respite and day support, which may help your elderly relative and your family to decide on and agree next steps.

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