The demographic shift taking place in the UK and the impact an ageing population is having on elderly care services is now well documented. Despite this, all too often the process of considering elderly care remains the response to an accident, illness or significant decline in health resulting in many individuals and families having to make life changing decisions at short notice. It is therefore increasingly important that individuals and families consider their future needs as early as possible so as they can remain in control of decisions regarding their care to the greatest extent possible.
There are various living options available to elderly people today which can be split into ‘home care services’ (hourly home care or live-in care) and ‘specialist residential accommodation’. Residential accommodation can itself be into two categories, ‘institutional accommodation’ (nursing homes and care homes) and ‘specialist housing’ (retirement housing, assisted living and retirement villages).
Hourly home care
With an increased focus on enabling elderly people to remain in the comfort of their own home for as long as possible, hourly home care is growing in popularity. An individual or a couple can receive the support of a home carer which may include anything from basic domestic support, companionship, personal care, medication help through to support for more complex conditions such as dementia or Parkinson’s. Some providers will offer visits for anything from 15 minutes upwards, albeit organisations striving for the highest standards don’t tend to provide visits of less than 1 hour.
Home care providers are required to be registered with the Care Quality Commission (“CQC”) and because the service can be tailored to each individual (according to a bespoke care plan) a wide range of care needs can be supported effectively. However, there are instances where either practicalities or costs can result in live-in care or specialist residential accommodation being more appropriate (e.g. where there is a need for full-time 24-hour nursing).
As the name suggests, a live-in care service provides the support and assistance of a home carer living with an elderly person or couple on a 24-hour basis in their own home. Typically, a client will be assigned a minimum of two home carers who will live with them on a one or two-week on / off basis. The type of care provided, like hourly home care services, can range from basic domestic support through to more complex support such as dementia care, Parkinson’s care and even nursing care. However, because the home carer is present 24-hours a day a more extensive, consistent level of support can be achieved enabling people with higher needs to remain at home for longer.
The cost of live-in care generally depends on whether the care provider employs their home carers or simply acts as an ‘introductory agency’ whereby the client employs the home carer directly. Typically it is considered preferable that a provider employs the home carer ensuring that they take full responsibility for training, supporting and managing staff whilst also providing cover in the event of sickness or holidays. In the case of a couple, live-in care can result in significant savings versus residential accommodation since the weekly fee is typically fixed and is not based on the number of beds being used.
Nursing homes offer suites of bedrooms in which care and / or nursing needs are met on a 24-hour basis. They generally have a minimum of 60 beds (albeit older properties may be smaller) and include additional communal facilities such as a residents’ lounge. Levels of care include personal care, nursing and medical care under the supervision of professionally qualified nurse. Nursing homes may also include specialist facilities designed for people with dementia. Key drivers for moving into a nursing home may be a significant decline in health, the need for 24-hour care including during the night or a specialist condition such as dementia. Residents pay a fixed, all-inclusive rent for their room, food and up to 24-hour care by way of a license or short-term lease agreement.
Care homes offer the same type of accommodation as nursing homes however care services do not include medical or nursing care and they are often not well-suited to supporting people with dementia. Like nursing homes, residents pay a fixed, all-inclusive rent for their room, food and up to 24-hour care by way of a license or short-term lease agreement.
Retirement housing typically comprises a block of apartments with a warden on-site and a communal residents’ lounge. Residents live an entirely independent lifestyle and there is no care service available on-site. Apartments are typically purchased on a long-leasehold basis and residents pay a weekly service charge to cover estate management and maintenance costs. Retirement housing can bring benefits for residents driven by the fact that accommodation is better designed to suit their lifestyle and they have a smaller household to maintain. However, these benefits can be limited by the fact that (i) many buildings have been developed with inadequate space and accessibility standards, (ii) they may not be designed to cater for the increasing needs of residents as they age and (iii) support services are not easily available on-site should these be required.
Assisted living, also referred to as ‘extra care housing’, is evolving as an alternative to both retirement housing and the traditional institutional care home. Typically, an assisted living building will include a block of 50+ apartments or bungalows plus communal facilities including a residents’ lounge, café / bistro and assisted bathroom. There may also be a 24-hour home care service on-site registered to provide personal care. Apartments are typically purchased on a long-leasehold basis and residents pay a weekly service charge to cover estate management and maintenance costs, basic catering costs of the café / bistro and the core costs of maintaining an on-site care team.
Retirement villages / care villages are larger schemes (often 100+ units) which can encompass a mix of retirement housing, assisted living and a care / nursing home. Close care is a similar concept whereby retirement apartments are located adjacent to a care / nursing home from which care services can be provided.