Can't go home

More and more private client advisers are becoming involved in 'older age' advice for clients or their families. It's not all about wills, estate or care planning and it is often sought at the last minute.

One common example is where a medically fit person can't be safely discharged from hospital, because they need full time care at home and either no-one is available to provide it, or a residential care place can't be found. It is needed because of the high risk of falls or infections; something that may well result in them returning straight back to hospital.

The hospital 'bed blocking' issue is growing, particularly because families are often spread across disparate locations and can't be there to personally look after older parents or relatives, or have busy work lives and other pressures. According to the most recent NHS figures, 160,000 bed spaces were lost across October 2015, because of delays in finding somewhere for elderly patients to go. It is the highest number since records began five years ago.

But, the vast majority of older people in the UK (97 per cent according to recent research by One Poll for Consultus Care) don't want to move into residential care (the default advice position for many advisers) with what is often an institutional and regimented way of life.

Moving from hospital to the unsettling surroundings of a residential care home, especially with conditions such as dementia, can be upsetting, depressing and even frightening. Live-in homecare however is available nationwide, and involves carers living with an elderly person and being on-hand 24/7.

Where live-in care or live-in nursing is arranged, people have a safe and proactively monitored convalescence environment in their own home. The level of ongoing care given far outweighs that given in hospital or from a residential care or nursing home, meaning risks can be greatly mitigated.

This is especially important with older clients, given that a third of all people aged over 65 take a fall every year and falls account for 10-25 per cent of ambulance call-outs for people aged 65 and over. Half of those with a hip fracture never regain their former level of mobility.

Another concern that many people are unaware of is the risk of urinary tract infections (UTIs) in older people. In residential care homes, there is an incidence rate of up to 50 per cent as their environments provide the opportunity for transmission of infection.

These infections drive falls, behavioural challenges (which can be mistaken for dementia) and deterioration in health, resulting in increased hospital admissions again. With one-to-one live-in care at home, especially where help is given with personal hygiene and the risk of UTIs decreases significantly. Staff are trained to identify the symptoms early so that, where they do occur, the correct medical treatment can be sought.

Additionally, experienced live-in carers undertake around 85 per cemt of the work often conducted by nurses. They also often work under the auspices of Macmillan and community nurses, freeing up their time. Added to this are the benefits of companionship, help with domestic duties and pets. Clients with live-in homecare can retain a sense of independence and their dignity.

One typical example of a live-in homecare client is Donald Sturrock's father, whose Parkinson's and Lewy Body Dementia had worsened. Donald lives over an hour away and, when his father started to have some nasty falls, he had a camera installed in his home as a way of trying to keep track and race to help if needed.

Donald noticed that between 1-2am, his father would roam to make sure the windows were closed and would go round and round in a loop. Around the same time, he realised his father wasn't eating or drinking properly, which led to a hospital stay for severe dehydration. Live-in care was arranged. Donald's care is now ideal for his needs and the home environment has been revitalised. In addition, Donald found that having someone bright, aware and able to engage his father in conversation created a completely different atmosphere.

Trudi Scrivener, managing director of Universal Care and a founding member of The Live-in Homecare Information Hub

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