Residential Care and Nursing Home Services

We need to put Dad in a home

What are care homes?

There are 2 types - residential homes and nursing homes - and there are differences in the type of care they provide. Both types of homes must be registered and inspected by the Commission for Social Care Inspection. Care homes provide accommodation, meals, and care and support from staff, which is available at all times.

Residential homes provide support to people who cannot live in their own homes even if they have a lot of support and care. Residential homes have trained care staff, and residents can be visited by district nurses.

Nursing homes have qualified nursing staff on duty at all times. They support people whose needs are too complicated to be dealt with in residential homes.

Who pays for care homes?

A local council may pay for a place in a care home for an adult who has complicated needs. An assessment team will consider their needs to see if a care home is the best way of meeting those needs. The assessment team will also decide if the person can pay some or all of the cost for a place in a care home.

They will take the person's savings and property into account when they work this out. Councils will pay a certain amount each week towards a place in a care home. Sometimes, family members want their relative to live in a care home that costs more than what the council will pay. In these situations, the family can pay the difference between what the council will pay and the amount the care home charges.

In some cases, the NHS will pay the full cost of a place in a care home if they believe that a person needs long-term, full-time health care. (You can get more information about this from your local Primary Care Trust).

Some people pay for their own place in a care home by using their savings or property. Before they arrange this, they should ask their local social services for an assessment, which will consider other options. In some cases, people move into a care home, and after a few years the money from their savings or property has run out. If they then ask their local council to consider paying for them to stay in the care home, the council may not agree that a care home is appropriate and they may offer different support services.

Who runs care homes?

Most care homes today are run by the private sector or owned by charitable or voluntary organisations. Generally, councils do not own and run care homes, but they pay for many of the places in care homes.

How does a council decide whether to offer someone a place in a care home?

In the London Borough of Barking and Dagenham, the social services are provided through the Adult and Community Services Department. Care managers and social workers assess adults' need for community care services. They assess people's needs against our conditions for offering care services.

You can find more information about these conditions in our leaflet 'Fair Access to Care Services'. You can get this from our local offices or by phoning our Intake and Access Team on 020 8227 2915.

We may offer a place in a care home, depending on the type of care someone needs, but most of the time we support people to live in their own homes. We will consider the wishes of the adult we are assessing, their family and any advice from professionals (such as doctors and nurses) when we decide whether to offer someone a place in a care home.

Why a care home isn't always the best option

If an older person's husband, wife or partner dies

This can be a difficult but important time to go through for the person whose partner has died. Someone in this situation should wait at least a year before they make any major decisions such as selling their home, moving to another area or moving in with relatives. Family members should not encourage someone to move simply because that person's partner has died.

If a person becomes confused or develops dementia

Sometimes, age can affect a person's memory. They may start to forget dates, or become confused in places they do not know well. Most people who experience some loss of memory will be more comfortable in their own homes - where they feel secure and they know where things are.

If an older person starts to forget things or shows signs of being confused, families may feel that they want the 'peace of mind' of having their mum or dad cared for in a care home.

During the assessment process, families will often say:

'Mum keeps telephoning, day and night'
'Mum might wander off and get hit by a car'; or
'Dad could fall down the stairs'

We recognise that you may feel anxious about your mum or dad, and that placing them in a care home where they will be looked after will put your mind at ease. However, we must put their needs first. We know that, for many people, leaving their own home adds to their confusion.

Being in a place they don't know can quickly make them more anxious and confused. Some people in care homes do not see their families as much as they did when they were in their own homes.

People can choose to take risks in their lives. Some people enjoy the excitement of hang-gliding, snow boarding, or climbing Mount Everest. Others take a risk by running across a road without using a crossing or by driving too fast. Often, taking a risk makes someone feel alive and that they have control over their life.

For some people, getting in and out of the bath, getting down the stairs or making a cup of tea by themselves provides the same sense of achievement and satisfaction. Many older people can face barriers to taking any risks. Some people in their 70s or 80s feel that their family thinks they should not live alone, because 'something might happen'.

Often with the best intentions, families can put their own peace of mind above the needs of their vulnerable older relatives. But life does involve taking risks.

We try to tell family members that, while people may fall in their own homes, they may also fall in a care home. People may be more likely to fall in a care home because they are in a place they are not familiar with and there may be things (such as walking sticks) leaning against chairs, or spills on the floor. People who wander can still wander away from care homes.

People are not 'locked up' in care homes. If someone has tended not to mix with people all their life, they are not likely to want to mix with other people just because they live in the same care home. Residential care is not always the best way to provide company for lonely relatives.

Moving from hospital into a care home

Generally, we would not advise someone in hospital to move directly into a care home. It is too difficult to see what support someone in a hospital bed will need when they return home. People leaving hospital need carefully planned support so that we can see how they cope in their own homes.

Many people improve in stages when they return home from hospital. Often, they become less confused, their appetite increases and they sleep better in their own bed.

Changes in the law since the 1980s

The NHS and Community Care Act 1990 brought the main changes to the way that we support adults with care needs today. The law aims to help people to stay in their homes for as long as possible. This act has brought about a growing number of services to support people in their own homes, with a move away from placing people into care homes.

Other types of accommodation

There are many different types of accommodation offering different types and levels of care. Some types of accommodation have a warden who will support residents, and some, like Extra Care Housing, have qualified care staff who live on-site and who can give support to residents at any time of the day or night.

Different types of home care services

There is a range of services to support people to live in their own homes. We provide some of these, some are provided by the primary care trust (PCT) or other voluntary groups or charities. We provide funding to a range of voluntary organisations to provide community services to our residents.

Community services include the following:

Visits from home carers and district nurses
Daytime activities outside of the home, such as luncheon clubs, adult education, keep-fit classes or visiting the library
Delivering hot or frozen microwave meals to people's homes
Respite care, which allows carers and people they care for to have a short break from each other
A 'Careline' pendant alarm which a person wears and can use to call for help in an emergency, at any time of the day
Night time services - where a carer visits to help a person if, for example, they fall during the night
Befriending and advocacy - where an 'advocate' or 'friend' regularly visits or phones a person who lives alone or has no family or friends who can visit them
Help with filling in forms, applying for benefits and writing letters
Providing equipment to help with daily tasks - for example, we can provide a hoist to help a person get in and out of the shower
Arranging 'Telecare' - which uses modern technology and equipment, such as alarms that automatically contact someone if a person falls

Remember that the person, or their family, can buy or arrange extra care on top of the care we provide.

We are committed to helping people be more independent in their own homes. We can provide an individual budget, where we give money to a person or their carer and they use this money to pay for their own support services.

Things you can do

You can ask our social workers for advice about different ways you can help an adult to be supported in their home, but here are some examples of people's concerns.

'I'm worried that my mother, who is confused, may wander away from home and get lost or get hit by a car'

The Alzheimer's Society offers helpful advice and fact sheets. They have found that, for some people, placing a mirror by the front door in the hall or fixing a bead curtain across the front door can prevent the person from wandering from their home. Make sure your mother carries some form of identification or the name and phone number of someone to contact if she gets lost.

You could sew this into a jacket or a handbag so that it can not be removed easily. If you don't know where your mother is, tell the local police. Keep a recent photograph to help the police find her. Also, most people with dementia do not lose their road sense and they are rarely involved in traffic accidents.

'My father phones us all the time, even in the night'

People with dementia often become confused about the time. They may wake in the middle of the night and get dressed, ready for the next day. This confusion is easy to understand, especially in the winter, when it may be dark when we go to bed at night and dark when we get up in the morning.

Try to give him more things to do in the daytime to help him use up his energy. Or, you could persuade the person to go to bed later. It may help to have a clock that shows 'am' and 'pm' to keep at their bedside. Some clocks also show the day of the week and the date.

'I have my own responsibilities and I don't have time to do my mum's shopping and cleaning'

If your mum has a disability, she can claim benefits such as Attendance Allowance or Disability Living Allowance. These benefits can be used to pay for someone to clean or do the shopping for your mum.

If you think that a member of your family needs care services, you can ask for a care manager or social worker to assess their needs contact Adults Intake and Access Team at the address shown.

You can ask for an assessment by filling in a referral form.