Slashed NHS Targets could put patients at risk

by Elizabeth Faye, Carepal 24^th August 2017

A recent letter issued by NHS England to all Clinical Commissioning Groups (CCGs), could mean patients lose out on funding they could be legally entitled to. 

NHS England have notified all CCG’s that less than 15% of all full NHS Continuing Healthcare assessments should take place in an acute hospital setting. Basically, if you have a relative who is currently in hospital and they need ongoing care, in a care home or at home, they are currently assessed as to whether the NHS will pay for or contribute towards their care, prior to their discharge from hospital. These new low targets mean that the NHS will have to potentially pressure families to discharge patients, before it’s known who is liable for paying for their care. To reduce this to less than 15% can only mean that patients and their families are going to be left at risk and out of pocket.

The recent letter from NHS England states that “CCGs are required to submit a plan for improving this to less than 15% by March 2018” and that “CCGs are expected to ensure that full assessments are only undertaken when required”.  As many of you will know, it is already difficult enough to ensure that patients are assessed as there is very little awareness that this funding even exists.

We see a large number of families who don’t even realise that their loved ones in hospital could qualify for funding under NHS Continuing Healthcare, let alone know who or how to ask for an assessment. At the present time, if they do get assessed, the process is so flawed and weighted in the favour of the NHS that we rarely see patients who are entitled to the funding granted it without an appeal.

If the plan is to discharge patients before these assessments are carried out, it will be so much more difficult for relatives to arrange for the assessments to be done. More worryingly, who is to say that their care needs are being met safely at the place they’ve been discharged to, without an assessment?

There is also the financial aspect as to who will pay for their care in the meantime and if they are found that the NHS should have been paying, no doubt they’ll have to appeal for a refund. Yet again, the elderly and most vulnerable in our society are put at risk and made to have to fight for what they have a legal right to.

5 ways to avoid the perfect care home being a recipe for disaster!

We thought the first care home we found for Nan was absolutely perfect. It was a second home from home, a large double fronted end terrace, where the aroma of lamb dinners whafted through the door as you walked in. It was immaculately clean, the staff were friendly and there was such a calmness to it. That was, until Gladys arrived. You see, she was in the midst of her 'argumentative phase', although if you ask my Mum Lyn, she'd have told you it was a phase she'd been in for 80 odd years!

Many families I deal with, just like us find this phase the hardest to cope with. It's the one where an individual will use every physical and verbal power that they have left, to tell you that they are frustrated and unhappy. Although they don't know exactly where they do want to be, they know it isn't here. This is the point Nan was at, after booking her into what we thought, was the most perfect home for her. How wrong we were.

Looking back, they key is right there in that sentence: "what we thought". It was perfect for us but Nan had other ideas. Within the first week, she had literally shook the front door off its hinges and walked across one of Manchester's busiest roads, in her nightie and scarf and walked into the bank asking politely for her money. Luckily for us, the banking staff were wonderful. They made her a cup of tea and called the police, who very quickly matched her up with the frantic care home staff that were walking the streets looking for her.  The home was far from perfect for Nan, as it couldn't keep her safe.

These next five points are what we've learned over the years and hopefully will help you choose the right care home for your loved one:

1) Location, Location, Location

The biggest mistake that can often be made is the location of the care home. If your relative needs care and they have always lived in the countryside, where it's quite and they can hear the birds & see the trees change colour over the seasons - whatever you do, don't put them in a busy care home, with it's own cafe, nestling in a suburban area! No matter how lovely it would be for you all to sit down in the cafe with a Latte. Think how it would be for them to live there and what they would miss.

2) Losing my Religion

"88% of the UK population aged 65 state their religion as Christian" [source: Age UK Later Life in the United Kingdom] To so many of our clients, their faith is very important to them and always has been. Why should this be any different just because they need care or have been diagnosed with dementia. On many occasions we have seen people who may not remember their own relatives names, come to life in church and sing beautifully to every hymm, not missing out one word.  Faith gives people familiarity and comfort - no matter what your church, mosque or temple looks like.

If the care home you have found ticks every box except the religious one, then arrange with the family or an external care agency to take your relative to a regular service, if possible.

3) Safety First

We know from first hand experience how important it is to keep our loved ones safe in their most frustrated hours. When looking around a care home, ask them how they deal with unsettled residents and what their security measures are for keeping residents who wander safe from harm.

Ask them how they deal with erratic residents who may become violent.  Whether or not your relative falls into this category, you need to know, incase they could be unwitting victims of unintended violence.

4) Girls just want to have fun, but so do the Guys!!

The latest statistics from Age UK say that there are almost three women to every man who lives in care. This is plain to see from the number of bingo nights and hairdressing salons I see in care homes these days. Which is great if you're a woman! Spare a thought if you are one of the hundreds of families looking for a care home for a relative who is a man! What is there for him to do?

We know of a care home near to us that has an old Morris Minor that encourages its gents to tinker to their hearts content and are driven to the pub on a Saturday to watch their favourite football team play. Hobbies do matter so make sure you ask what there is for the men to do. Boredom can lead to frustration which in turn, can turn to problematic behaviour, so don't be afraid to ask about events and activities.

5) Food Glorious Food! 

As much as my generation loves variety and food from all over the world, neither of my grand-parents shared this enthusiasm and hated garlic with a passion. Don't forget to take into account what food is on offer at your care home of choice. A number of care homes I've been to, invite the families to join them for lunch so they can sample the food themselves and see how everyone is treated first hand.

If your relative is a fussy eater and likes only plain traditional food, then ask the care home if they can make sure this is known, as it can cause upset at meal times if they get it wrong. Something as simple as knowing that someone likes toast in the morning and not cereal, (like my lovely grand-dad) can make the world of difference.

If your relative has always liked a brandy before bed, or a gin & tonic at meal times, make sure that the care home allows alcohol and will allow it's consumption, in moderation of course.


I hope these tips have helped and by all means, if you have any others that can add to the list, please add them to the comments below and post a link to your blog - we'll make sure to share it!


About Liz Faye

Liz Faye is the Founder and Head of Care Services at Carepal Assist Limited
for further details go to:  www.carepal.org
or call on 0800 6891000

Five Point Plan for Care!

Having been involved in the care sector for over 10 years and financial services sector for nearly 30 years, I've seen first hand the actions that work and more importantly, the actions that don't work for families caught in the care maze for the first time.

Based on this experience, here are my top 5 recommendations if your loved one needs care:

1) Keep talking! That means you need to talk to family members about what is going on but more importantly, to the person at the centre of the care need. Whether or not they have a form of dementia, talk to them to tell them what's going on. Include them as much as possible and help to ease their fears about the changes. 

2) Keep smiling! One of the best and most useful things I have learned is "a smile is universal". It is one of the expressions that human's possess that helps put people at their ease and quickly. As 70% of all communication is NON verbal, you need to make sure that your expression is a positive one. By smiling when entering a care home or prior to talking to a person with dementia, you can immediately put the person at their ease. This can make for a much better, more positive conversation or visit so don't forget to SMILE! 

3) Get Organised! You are going to be asked a lot of questions and often, the same questions over and over, as you work through the different agencies involved, Pension Service, NHS, Care Home, Bank, Care Adviser (Yes, we need answers too!). You will need to be organised and have information to hand. Buy two leaver arch files and a set of dividers and get busy! One should be for Property and the other for Health. (This will help a lot with point 4).

4) Get Legal! The agencies mentioned above are unlikely to speak to you unless you have some form of legal authority from the person who needs care. This can be via a Lasting Power of Attorney (LPA) of which there are two types. Let me be clear on this.......get BOTH the Property & Affairs AND the Health & Welfare LPA. If you only get one, you can bet it's the other one you'll need! These powers can only be given to you whilst the person has the mental capacity to understand the powers they are giving you. It is always better to get the legal paperwork in place as soon as possible and there is no such thing as too early, so make this step a priority and when you become an attorney, keep good records, as per point 3 above.

5) Start counting! Understanding the finances of the person needing care is a vital point to tackle. Again, make sure you involve the person as much as possible as they will undoubtedly be able to offer valuable insight into their affairs. You will need to know things such as whether they make regular gifts to charities, do they own 100% of their property (sometimes a surviving spouse only owns a percentage of their property, with a relative or trust sharing ownership). Understanding the expenses/purchases that are important to the person is vital, be it a certain talcum powder, brand of whiskey, magazine. (see the earlier blog below "what's my line" for further explanation). These familiar items, tastes, smells, textures really do help with keeping people calm in stressful situations.

Hopefully these pointers will help you begin your care journey. For everything else, you can give us a call!

Liz Faye is the Founder and Head of Care Services at Carepal Assist Limited
for further details go to:  www.carepal.org or call on 0800 6891000

Walk a mile in my shoes...

I've met hundreds of people with dementia since we started on our own care journey in 2004 and each person I've met has taught me something new or interesting either about the way they've had to change the way they communicate or shown me how to improve my own communication skills.

I have always tried to smile and be open with each person I've met and have sometimes been rewarded by a smile returned or a hand squeezed.  On a number of occasions, I was unable to even make eye contact, as the individual was so encased within their own world.  As empathetic as I try to be and as hard as I try to imagine, I had no idea what the world looks like or how it fees to them.

With my own Nan, Gladys, when she would loop her sentences or repeat the same names over and over, I knew who she was talking about and could add context to the conversation. Having been close to her all my life and spoken to her about her vast family over the years, even though "Aunty Lizzie" and "Mrs Payton" died many many years earlier, through her previous stories about them, they lived on in our conversations and in Nan's world.

It's always been different with my clients - as much as I've tried to help, you can't hope to have the same impact or relationship in a couple of meetings.  I've often come away longing to find something that I could leave with the families to give them even a bit of what I had with Nan.

And then came along this book, "Elizabeth is Missing" by Emma Healey.

The blurb on the back reads:

"Maud is forgetful. She makes a cup of tea and doesn't remember to drink it. She goes to the shops and forgets why she went. Sometimes her home is unrecognisable - or her daughter Helen, seems a total stranger. 

But there's one thing Maud is sure of: her friend Elizabeth is missing. The note in her pocket tells her so. And no matter who tells her to stop going on about it, to leave it alone, to shut up, Maud will get to the bottom of it.

Because somewhere in Maud's damaged mind lies the answer to an unsolved seventy-year-old mystery. One everyone has forgotten about.  Everyone except Maud..."

This book took me on a journey into the mind of someone with dementia and beautifully and painfully illustrates the impact this disease has on the persons own perception as well as how it affects her relationship with family and friends.

Written from Maud's perspective, the insight is invaluable and I will be recommending it to everyone I come across and each family meeting I go to.  I'll tell them all - everyone who has a loved one with dementia should read this book - it is the nearest you'll ever get to walking a mile in their shoes.

About Liz Faye

Liz Faye is the Founder and Head of Care Services at Carepal Assist Limited
for further details go to:  www.carepal.org
or call on 0800 6891000




Click here to purchase via Amazon.co.uk

When words aren't enough

Many of us will have known somebody who has some form of dementia but very little is known about how to communicate effectively with those who suffer from it. Granted, there are different types of dementia, but again, this is a little known fact. The best explanation as to how to understand dementia better, came from a talk I attended, given by Pat Pope from All About Dementia. http://www.allaboutdementia.co.uk/ In all the years I have been working in this sector, Pat is by far the most informatative, knowledgeable person on the subject of dementia I have ever met.

She describes dementia as an "umbrella term" and each form of it, Alzhiemer's, Lewy body's, Frontal Lobal comes under the umbrella. Each type presents itself differently and so it is essential to establish a diagnosis of more than "you have dementia" so you can learn how to communicate effectively with your loved ones, when words aren't enough.

Pat is the person responsible for making the last few months with my Nan, who had Alzheimers, so special. Unbeknown to Pat, she has also helped many of our clients and their families, through the information we have passed on. We tell each of them about Pat and her company and I hope that our paths will cross again soon, as she is also a delight to be around.

We see many families who are often dealing with big emotions such as guilt and sorrow, but what causes them just as much pain and anquish is the frustration at no longer being able to communicate with their relative. As you may have read previously, what worked really well for our family, was living in Nan's world whilst we were with her. Not getting upset when she mentioned other members of our family who we had loved and lost. It became quite cathartic in a way. Talking about people who we'd lost as though they were still around. It brought them back in a way, albeit for a short time. We'd sit talking about what they were doing as opposed to what they had done. It made all of us smile and it helped Nan communicate with us and smile back.

That is another thing Pat taught me - a smile is Universal and shows that you are non-threatening. I visit many care homes in my line of work and there is nothing more noticable than how contagious a smile is and how much better you feel after forcing yourself to smile. We have had a tough year as a family, losing not only Nan but a wonderful cousin and friend to cancer. During this time, it was hard to go into work and looking back, on some days I don't know how I did it. I do know that on some of the worst days, when I just wanted to hide away and sink into my own grief, I walked into a couple of care homes with a very heavy heart. Putting into practice what Pat had taught me, I put on my best smile and walked inside, thinking how on earth I was going to keep this up for more than a minute. Yet my smiles were immediately reciprocated and one lady even took my hands in hers and kissed them!! She then started clapping, her beautiful blue eyes never leaving mine! My heart wanted to burst with the affection this stranger, who could no longer speak, showed to me and this type of thing happened over a number of visits to similar homes. It seems that it is true. There are no words that can lessen your grief, but the affection shown to me by those without words, undoubtedly helped and I will be forever grateful.

Home: Gladys Hughes 4th October 1918 - 23rd June 2013

It has been a very difficult couple of weeks for my family and I, as we all had to come to terms with the fact that our wonderful Mum, Nan and NannaG is gone. Despite her ailments that affected her memory and her pace, her true personality regularly shone through. Even down to the fact that she still loved having her nails done and painted pink! To the very last, Nan was Nan, even arguing about which pyjamas she wanted to wear. As ever, Nan got her way and fell asleep in her choice of pyjamas, forever.

As much as it's been painful to say goodbye to a very much loved lady, it has also been time to reflect on her amazing care and the difference it made to all our lives. For over the last 9 years, Nan lived at Marion Lauder care home and what a time she had!

When Nan first moved into the home, we hated leaving her there and for a while, we were really unhappy about the state of the home and that Nan didn't even seem to be wearing her own clothes!! Thanks to a change of ownership, we saw standards rapidly improve and also Nan's demeanour.

She walked the halls, fired the bosses and saw the home as though it was her own. It was her living room and everyone in it, worked for her. The best part is that from the management to the staff to the auxiliary's - every single one of them played along and allowed Nan to be "the boss". Going as far as when she stormed into the office in the early days, interrupted the call the MD was having, threw his phone down and ordered him and his co director out of the building, with some choice words, they both duly obliged. After walking around the block, walking back in the home, to be greeted by a beaming Gladys - "How lovely to see you both, I've not seen you for ages"!

The essence of this type of care is love. Simple as that. Nan had different carers over the years and we would often call in to see her, only to find her in the lounge with a host of different carers, sat with different residents. On one occasion, Nan had a carer next to her and one in front of her. The one next to her was chatting away to her and the one in front of her, well all Gladys was doing was sorting her collar out and stroking her hair, over and over. Fantastic to see time being given to keeping residents calm and happy. As the visit went on, everyone started talking to each other and the carers all started to ask about different names Gladys had mentioned as they wanted to know who they were. It was evident from this that they handn't all just spent time with Gladys, they had listened and really chatted to her, in her world of many many years ago. They were able to talk to her about her nephew's and nieces, her Mum and Dad and her daughter and grandchildren. Thanks to them, they helped Nan live on in this wonderful "time gone by" world she had lived in once and that her mind had recreated.

When we would ring to ask how Nan was doing, they reply was usually the same in as much as "she's on form today, she's fired me twice". If we were told that, we knew that all was well. Once when I rang and expected to be put through to the nurses station and said, "It's Elizabeth, (she never knew me as anything else) Gladys Hughes' grand daughter, just ringing to see how Gladys is doing?" the reply came back "I'm doing fine thank you, how are you?!" Priceless.

As a family we know that care, no matter how appropriate or fantastic, can never totally remove the guilt that is felt when you pass a loved one into the care of others. It is only looking back with a clear head and a heavy heart that I can see that the staff at Marion Lauder were Nan's adopted family and family they were. Eleven of them attended her funeral, (we were told they had to draw a ballot as the whole shift wanted to attend),and were as much a part of the funeral service as her immediate family. They hurt with us and laughed with us, at the tales "of what Gladys did/said". We were so fortunate that it was like that for us.

The fact that Nan was 94 when she died means that her passing isn't a tragedy, though we're hurting and grieving, we all have fantastic memories of this feisty lady whose essence remained until the very end.

One of the staff members said as we left the grave side, "We'll never forget her". The truth is, we'll never forget you either!

(Readers of the previous blogs will understand why Nan was sent on her way with, amongst other items, a bag of Maltesers in her pocket!!).

Unforgettable Carers Week & National Care Homes Day

Carers Week

Working within the care sector, we have the opportunity to meet and directly help those who need it most. This was evident when we were fortunate enough to be a part of Carers Week "Prepared to Care" event, which we held at Sainsbury's Clitheroe. We were really pleased when their Client Services Manager, Craig Lister happily gave us a prime position in his busy store and made an ordinary Wednesday in June one that will be unforgettable for many reasons.

Reason 1 - The chance to connect directly with Carers

Having the opportunity to meet so many amazing carers and the people they looked after, without hardly a thought for their own health or sanity. Many were amazed that there was actually a week dedicated to ensuring that they had access to a host of services that could make their lives easier. We gave leaflets and stickers out by the dozen!


Reason 2 The kindness of strangers

Despite the fact that we had no collection boxes and were only present to GIVE information and advice, many people walked up to us, ready to donate to a cause even before they knew what were doing. One lovely man even said "I can't pass by a collection pot" with his hand full of change! When we said we couldn't accept it, he walked away laughing as I don't think many people have refused his donations before! (We have since discussed who our nominated charity is going to be and decided on Dementia UK, to support the fantastic work the Admiral Nurses do).

Reason 3 The one that got away

One lady walked past with a full trolley of shopping and when I offered her a leaflet she didn't take it. She looked at me with tears welling up in her eyes and held my hand so tightly, as though her life depended on it. She told me in as few words she could manage, that she was going home to put her husband into care. She was totally bereft and with tears flowing down her face and welling up in my eyes, she let go of my hand. I tried to gently talk her into coming back in the store to talk to me, so I could help her in any way I could, but the emotion just got too much for her and she walked through the automatic doors. I wanted to run after her into the car park but I could see that she didn't want to speak about it. I watched her shaking her head from side to side as she put her shopping in her car and drove off. The emotional pain she was feeling was tangible, even from a distance.

I have run through my head on many occasions since, what I would have said to her had she been able to stay a while; I would have tried to give her some hope that the future for her and her husband, although nothing like the life they have had in the past, could still have moments of joy and laughter. Just like day to day life even without a care need, there will be tough times, but that she would still be able to hold his hand, hear his voice, and make him laugh. I would have told her about all the wonderful support there is out there for people going through the same thing she was; the amazing experiences of care in a care home that I witness every day but that never gets talked about on Panorama. The people who I am lucky to call friends who run care homes and love, talk and care for the residents as though they were members of their own family. I would have told her that there was hope that her days ahead would get easier.

I want to say to whoever is reading this that is struggling on their own with a loved one who they are caring for, please don't struggle on. The situation can get better, help is available and you don't have to continue on your journey alone.

National Care Homes Day

This was a different event altogether! We had reserved a table at the Thornton Hill Care Home's Annual Summer Fair. We pitched up to find a fun filled foyer, tombola, raffle, cake stall, bottle on a string game and we joined in by raffling off a huge bear called Riley, complete with Carepal T-Shirt. There was even an ice cream van that pulled up right outside to offer all the residents the chance of a traditional ice cream cornett.

It would serve the Government & the public well to be able to see how good care homes are run. How the residents and families feel and how uplifting an experience it can be when care is delivered in the right way, by the right people!