How To Get Good Care Services
Physical health will influence the type of care a person requires, but it should not be the only factor when considering the most appropriate service. For example, some medical professionals may give an opinion that ‘medically’ a move into a nursing home is the right care solution for an older person, but that opinion should not automatically remove a person’s right to choice.
A qualification does not necessarily qualify a professional to know which type of care is right for the person requiring it.
There are ways that an individual can be cared for within their own home even with high-level medical needs if that is where they want to be.
So when at the planning stages of arranging a care service, think laterally about circumstances as a whole rather than focusing solely on healthcare needs.
POINTS TO CONSIDER WHEN PLANNING A CARE SERVICE
The following questions are in no order of importance nor by any means exhaustive. They are merely a starting point to provoke thought.
- Personal preference. Would staying at home be practical? If so, what level of care would be required?
- Age of person. Does the choice of care organisation have workers who are trained to care for a specific age group?
- Children. Does the person requiring care have young children or is a child themselves? Will this further limit care choices?
- Personality. If living in a care or group home is preferred, would a family-run business or one with the ambience of a quality hotel be the ideal place?
- Background. Is the individual insular and, if so, would one-onone care be a better choice and how could that be achieved?
- Social status. A high-flying lifestyle of exquisite restaurants or a down-to-earth working-class individual? How might social standing influence care choices?
- Religious and cultural beliefs. There may be important issues such as how a person dresses, diet, timetable, social calendar, etc. that need to be considered. How would the chosen care organisation continue to meet these needs?
- Sexual orientation. Would a transgender/gay or lesbian person feel that their needs are fully understood?
- Physical limitations. If an individual has physical limitations, might such limitations appear to restrict choice, making a care home seem the only valid option? Might equipment in the home make staying tenable?
- Long-term prognosis. Is there a terminal condition and, if so, how will quality of life be affected by care choices?
- Lifestyle. Smoker/drinker/pet owner? Will care choices compromise lifestyle?
- Cost of service/funding available. Who will pay for the care and how will this influence choices?
- Support available from family and friends. What support can family and friends offer, if any, to facilitate choices?
CHOOSING THE APPROPRIATE TYPE OF CARE
You may have a clear idea of the type of care preferred or you may still be unsure. At this very early stage of planning uncertainty is natural and a lot may depend on whether you are arranging care for yourself, on behalf of a family member or friend or in a professional capacity.
Choices will also be strongly influenced by whether care is for an elderly person, a young adult or a child, and will be dependent on the dynamics of their relationships and responsibility towards others.
For example, if care is sought for an adult with multiple sclerosis and the individual is married with children, is a long-term care home really a viable option?
Whatever your situation, I discourage you from closing your mind to the possibility of any type of care until all options have been given careful consideration.
I cover the most common services available and split them into two main categories – care homes and domiciliary care – with subcategories within each.
Care homes (the standards for this category include homes for young adults and those with learning disabilities) are:
- residential homes
- nursing homes.
Domiciliary care (this category of service does include registration for those providing services to children and their families) are:
- daily care
- live-in care
- employment agencies.
Respite and rehabilitation are addressed in Chapters 6 and 7 on care home and domiciliary care choices as they can be facilitated in either.
Also, Chapter 8 includes extensive information on privately employing a care worker for readers wishing to recruit their own workers.
If you are recruiting private care as part of a ‘brokerage scheme’ then visit the CSCI’s website http://www.csci.org.uk, follow the link for ‘care provider’ and read the latest guidance to clarify whether you will need to register with the Commission.
Now let us look at how to find care services.
In an ideal world, Social Services would be the first point of contact because they can assist with arranging health and social care even if they are not paying for it.
Unfortunately, many social workers have to work with increasing amounts of red tape and lack of resources and whether care is required for children, older people or adults with disabilities will influence the amount of money available to spend. The geographical area can also have an influence on available funding because some local authorities have more cash available than others.
I do not wish to add to the already overburdened resources of Social Services by insisting that everyone requiring care rushes to their local authority for an assessment but you should feel free to do so. However, there are situations when I would strongly recommend that even if care is likely to be self-funded, Social Services should always be involved. These are:
- When someone is providing unpaid care to loved ones/ relatives or neighbours and they require a break. Social services may be able to fund/assist with respite help.
- If a person requiring care does not have immediate family or friends to monitor their well-being.
- When a professional without healthcare experience has arranged care for a third party, e.g. a solicitor who organises care for an elderly client through their power of attorney and, once care is organised, they withdraw their involvement.
IT’S A FACT
In June 2007 the 13th annual Carers Week, a week dedicated to raising awareness of what carers do and celebrating the contribution they make in our communities, was held. The publicity generated during Carers Week enables tens of thousands more carers to be contacted and told about the support and services available to them. A dedicated website (www.newdealforcarers.org) will allow carers and professionals to feed in their views on how to improve carers’ lives. This is a welcome development as too many carers are living in poverty, giving up work, risking their health and finding themselves unable to prepare for the future. Yet their contribution was, at the time of the 13th annual carers week, worth £57bn.
Regardless of whether involved in planning, Social Services will have a list of companies registered to provide care services and should be able to recommend organisations within your area. Be specific and ask social services for their experience of local care providers, not just for telephone numbers. This could save you a lot of time calling substandard organisations.
Funding of care services
If an assessment by social services is undertaken, it may be decided that care services will be funded by the local authority. If so then a review of that care should be carried out at least every 12 months or more regularly if there are issues or as problems arise. In between reviews, social services representatives will take up matters with the care providers on behalf of consumers should they need to. They can also coordinate additional services such as occupational therapists.
It is important to understand that if Social Services agree to fund care, they will have some control over which services are used.
Direct payment scheme
There is also a direct payment scheme whereby the local authority passes directly to individuals funds which may be spent on any chosen care service, subject to some reasonable conditions. However, when older people require care, eligibility for direct payments becomes less common (but not unheard of) than when funding care for those aged 65 and under.
Be a smart consumer and claim benefits to which you are entitled.
If in doubt as to whether you are eligible for funding you should call Social Services or an independent financial adviser with experience of care funding. There are many non-means tested benefits that can be claimed even by those who have the resources to self-fund care.
COMMISSION FOR SOCIAL CARE INSPECTION
A brief overview of the Commission for Social Care Inspection (CSCI) can be found in the Introduction and Chapter 11. As the organisation responsible for inspection and regulation of all care services throughout England, they hold a database of organisations registered to carry out the provision of care and all care services must be registered to legally operate.
Scotland, Wales and Northern Ireland have their own inspection and regulatory bodies.
You should be looking to buy into organisations that generally meet all of the National Minimum Care Standards but no service will be perfect and some standards are more important than others. You will know your own priorities and will naturally make purchasing decisions based on these. Searching the CSCI database The CSCI database can be searched for: & Care homes with or without nursing and further broken down into categories of:
- learning disability
old age only
physical disability – drug dependency – alcohol dependency.
Home care (domiciliary agencies).
Nurses agencies (private nursing for hospital or home care).
Adult placement schemes.
It can also be searched by:
- name of care provider.
You can also conduct an independent search of the database online by going to:
- & www.csci.org.uk
- 0845 015 0120
- 0191 233 3323
- 0845 015 2255
- 0191 233 3588
and a CSCI representative will undertake a search on your behalf. Alternatively, you may choose to make use of the database when you have identified service providers via another means.
Information held by the CSCI
If you choose to call the helpline, they should be able to give you information on services within your area. If you choose to research services online, you will see the site holds a considerable amount of information such as the following.
Past inspection reports
Although reading reports might be a tedious task for some, it would not be awasted exercise. A copy of an inspection report will highlight issues of real relevance and the CSCI have made reports reader-friendly. You can view reports online by following the simple steps given on the site. You can search by company, or by finding a list of companies in your geographical area and then going through each company and their reports individually. You can print reports free of charge.
Alternatively you can obtain reports by:
- Contacting a care company direct and asking if they can send you a copy of their latest report (which aside from the website may be the quickest option). Even if there is not a recent report showing on the website, the care provider will have received a copy very soon after inspection and unless they are disputing an inspector’s findings, they should make a copy available to you.
- If time permits, you can obtain free copies of reports from your local CSCI area office via the post.
When reading reports, you will see that CSCI use a star rating system indicating whether providers of care are meeting the required standards. The rating of a care organisation determines the frequency with which an organisation will be inspected. To a degree, the process of inspection is in some ways self-monitoring. I cover the inspection process in greater detail in Chapter 11.
Other information held by the CSCI
- Ownership of the company. This section will tell you whether the care provider is privately owned or part of a larger organisation.& Registered manager’s name. This is an important point if you want to get straight to the top or know who has daily overall responsibility.
- Contact details. You can save time making contact with the relevant department if you have the correct contact details.
- Category of care provided. There is no point in pursuing a service that cannot provide for a person’s needs. This is especially important if you are arranging services on behalf of children who are to be cared for at home or where a consumer of a service has children. All home care organisations with workers who have access to children must be registered to care for this user group and their workers must be trained in child protection procedures.
Even though CSCI information can assist with decision-making, there may be services that at the time of inspection had no visible flaws, but questions must still be asked because an inspection report is only a snapshot in time.
Inspection reports are made available to service providers before being made publicly available and they are given an opportunity to dispute facts. Therefore considerable weight must be given to this method of shortlisting services.
Local GPs might have an association with care providers in their area and may have met some of the care workers or had dealings with managers of the service regarding their patients’ health. GPs may therefore hold a valuable view on the quality of local care services.
Solicitors can have some form of power of attorney for people who require care but are without family or close friends. Some solicitors may have been involved in the planning of care and may have access to the names of service provisions they have used in the past or are actively using.
HOSPITAL DISCHARGE TEAMS
If a hospital has indicated that a care service is required in order that an individual be discharged from hospital, then the discharge team should undertake an ‘assessment of need’. If they do not offer this, request one.
The assessment will be conducted by an employee of the hospital qualified in the process and is usually followed up with an occupational therapist’s assessment. Both assessments will help to determine what level of care is required.
The point of assessment is a good time to discuss preferences in respect of either a move into a residential/nursing facility or receiving care at home. The hospital may have worked with service providers during the discharge of previous patients and may have relevant information on local care companies.
Personal recommendations are a valuable means of accessing services.
DON’T THEY SAY?
Advertising is what they pay for but good publicity is what they pray for.
THE LADY MAGAZINE
The Lady is a weekly magazine available every Tuesday at most good newsagents or you can visit them at http://www.lady.co.uk. The magazine, established in 1885, has an excellent vetting system in respect of care organisation advertisements. Such vetting will include that all advertisers must provide details of their registration and CSCI and therefore The Lady would be unlikely to carry advertisements for a non-registered company.
The number of care service advertisements can run into double figures, so you won’t be short of choice.
Be aware though that there is not the same thorough vetting for The Lady’s private lineage advertisements, since the vetting of individuals would be an impossible task for the publication’s staff to undertake.
If you are considering the route of privately employing a care worker then see Chapter 8 for my advice on safe recruitment practices. Responding to an individual advertising their services as a care worker in any publication is not something I would recommend.
This is a free publication distributed throughout London. Although this magazine provides the details of many care companies, they are usually advertising for workers, not aiming their advertisement at consumers. However, a copy of this magazine will provide you with insight as to how care companies attract their care workers. For example, do they use promises of riches or do they offer quality support and training. You will also find the organisations’ contact details on the advertisement.
The traditional Yellow Pages will provide details of services in your area, but no more than that.
If you have access to the Internet, you can use another section of Yellow Pages simply called Yell. You will find this at http:// www.yell.com. This is a useful resource allowing searches by region and type of care business. It provides links to the websites of cited companies (if they have a website) as well as general contact information.