It is one of the most difficult decisions you might have to make. An elderly relative - a parent, grandparent, auntie or uncle or even your own spouse - is showing signs of declining health and increasing frailty. It is clear they are struggling to cope. Perhaps they are suffering from the onset of dementia, or physically they are finding it difficult to keep up with the basic tasks required to live independently. Do you place them in a care home or provide them with care at home?
You face a difficult choice. Do you put them through the upheaval of moving them out of the place they have called home for decades and into a residential or nursing home? Or do you look at other alternatives, such as arranging and managing support and care in their own home, or even moving them in with you?
What doesn’t make the decision any easier is the fact that the overwhelming majority of people don’t want to end up in a care home at the end of their lives - 97%, according to one 2014 poll. It is fair to say that residential care does not have a great reputation.
But care at home comes with its own challenges and complexities. People lead busy lives, with couples having to juggle full-time work and a house full of children. You might not even live close to your elderly relative. How do you go about finding the right support to meet their needs, and how do you find the time to manage everything and ensure they are always getting appropriate care?
And that is even before you have considered how the care is going to be paid for.
Most people realise that the most important factor in all of this is doing what is best for your relative. But that doesn’t make the process any less emotional or painful. All you can do is try to be as practical in your thinking as possible, in order to do what feels right for your relative, yourself and your whole family.
With that in mind, here is an overview of the main factors to weigh up when choosing between a care home or care at home for an elderly relative.
Where will they be safest and receive the best care?
What you don’t want to do is make a decision that suits yourself but is actually detrimental to the well-being of an elderly relative. Care homes have a fear factor associated with them, as already noted, but are things really that bad?
It is hard to get a clear picture. Care homes are professionally run, closely regulated organisations that specialise in providing care to the elderly and infirm. Particularly in cases where a decline in health has severely limited a person’s ability to take care of themselves, whether through acute illness or immobility, care homes provide the comfort of dedicated, round-the-clock support.
On the other hand, it is hard to look past the fact that, in the majority of cases, the mental and clinical conditions of people admitted into residential or nursing care declines, rather than improves. Mortality rates in care homes are high, with an average life expectancy of between 12 and 30 months.
This is the by-product of families independently caring for a relative for as long as possible. Care homes are often the last resort.
There is a strong association between care home admissions and loss of independence and institutionalisation amongst elderly people. Although this might be unavoidable when health declines past a certain point, official government policy is now to keep people in their own homes as long as possible. As well as promoting independence, home care maintains familiarity and routines that are thought to be more beneficial to dementia sufferers - despite the fact that some 80% of people living in care homes have a form of dementia.
Home care can also give relatives a greater level of input and control in how an elderly person is looked after. One common complaint about residential and nursing homes is that concerned relatives say they feel helpless if they don’t agree with an aspect of the care being provided. With home care, you have the freedom to recruit the carers that you feel will provide the best support possible for your loved one’s needs.
A word about Lasting Powers of Attorney: it is very important to ensure that the individual concerned has both forms of LPoA (Finance and Property and Health and Welfare). These will be essential for your family, the medical professional, the care home and the patient. Don’t delay until it is too late. Click here to learn more about the benefits of LPA.
The caveat to that is you actually have to be able to find suitably qualified carers in the first place. There is not the same level of scrutiny and regulatory oversight of home care as there is in a nursing home. Plus, as a relative you are responsible for managing the provision, which can be a burden.
Other drawbacks of home care include the fact that, when provided in the elderly person’s own home, it is usually not 24/7, so isolation and loneliness can be risk factors. In addition, the home might need considerable alterations to accommodate changing physical and mental needs. For example, the home may require adaptation for wheelchair access, the installation of stairlifts, a downstairs bathroom, and so on.
What option is most cost-effective?
It may surprise you to know that home care often works out to be more affordable than residential care. There are significant regional variations, including large discrepancies between private homes and publicly funded organisations. In 2018, the average annual cost range for residential care was £27,000 to £39,000, and for nursing care £35,000 to £55,000.
Based on local authority pay scales for community care workers, employing a home carer for 14 hours a week would cost in the region of £14,000 a year, doubling for full-time day care. If you wanted to go down the route of live-in care for someone with complex care needs, this could rise to over £80,000 a year. This online calculator is useful for getting a more accurate sense of home care costs.
Clearly, whichever option you pursue, there is cost involved. State support for long-term care costs falls into two categories. For people with long-term disabilities and complex health issues, the NHS Continuing Healthcare scheme pays for residential or at-home care whenever it is required at any stage of the person’s life. If that doesn’t apply, local authorities means-test care costs for elderly people on two criteria - an assessment of the individual’s care needs, and an assessment of their financial circumstances, to ascertain what they can contribute to the costs (up to 100%).
The reality of all this is, for many people, later life care must be self-funded. This means that either the individual receiving care must pay out of their assets, or their relatives pick up the bill. It is worth taking financial advice to weigh up the best funding options available to you, which in general terms focus on how to make the most efficient use of available assets.
One thing worth bearing in mind is that, if you opt for at-home care in your relative’s main place of residence, the value of their property is not counted in the assessment of their financial means.
How do you deal with any guilt of putting an elderly relative in a care home?
One of the hardest things you may have to deal with in making a decision on the care of an elderly relative is your own feelings of guilt around residential care. You might know full well that your mum, dad, grandfather, grandmother or so on absolutely want to remain in their own home no matter what. You might know that the idea of an old people’s home terrifies them (warning: video content may be disturbing. BBC Panorama 2014).
But that doesn’t mean putting them into a care home isn’t the right decision. They might have reached such a stage of infirmity that remaining in their own home alone just isn’t in their best interests anymore. You might have looked into live-in care, but when you find out that the costs of having a full-time carer could be double the cost of a nursing home, it just isn’t financially viable. And that’s assuming you can find someone suitably qualified to take on the role in the first place.
Plus, the negative reputation that care homes possess is in many cases ill-deserved. Yes, your relative might have always said that they never wanted to end up in such a place. But thousands of elderly people, once they actually move into one, find it a relief and a comfort. If they have lived on their own for a long time, with family living away in different places, and have increasingly found it harder to maintain their independence, the attention, company and quality of care offered in a well-run home can transform their later years.
It is primarily about finding the right solution for your elderly relative, but also for you, your partner and your immediate family. If home care makes financial sense and is manageable, then go for it, at least as the first step. But don’t bite off more than you can chew or potentially let the on-going management of your relative’s care slip, leaving them vulnerable.
Can you be hands-on enough to know when you need to step up care, or recognise when their needs change? Can you manage the burden as it gets progressively heavier? If you have doubts, then there comes a point where residential care provides the safe, practical solution for everyone involved.
If you or a family member would benefit from an impartial financial assessment, contact us today to speak to one of our Chartered Financial Planners.