With the average age of church members increasing in most churches and the numbers of those in the fourth age rising, the likelihood of members needing to find an appropriate care home to meet their needs is also increasing. It is not unusual for there to be a number of church members residing in care homes at any one time – whether for short-term placement following illness or bereavement or long-term residency due to the individual’s increased care needs or end-stage illness.
With a lack of experience of how care homes work, knowledge about the type of care different registrations provide and an understanding of how to reach out and engage with residents and staff, there can be a fear and reluctance to visit and get involved with local care homes. By spending time getting to know the different care homes in the neighbourhood of the church, understanding the sort of care provided and needs of residents, and making introductions to the care home management and staff teams, local churches can help bridge the gap towards care homes, establish regular contact and relationships with staff and residents and thus reduce the fear of moving into care home settings.
The Care Quality Commission (2015) define a care home as “a place where personal care and accommodation are provided together”. People may live in the service for short or long periods. For many people, it is their sole place of residence and so it becomes their home, although they do not legally own or rent it. Both the care that people receive and the premises are regulated by the CQC. The care and activities which care homes provide are defined as ‘regulated activities’, which include personal care, accommodation, nursing care, treatment of disease or injury, management of long-term conditions.
Care homes for adults will be registered specifically for people who are:
- Over 65
- Living with Dementia
- Have long-term mental health conditions
- Require treatment for substance misuse
- Living with Learning Disabilities
- Living with Physical Disabilities.
The majority of care homes are registered as ‘Residential’ homes – providing long-term care, convalescence, crisis support or respite care on a 24-hour basis. Where the care and support for individuals require the ongoing input of registered/qualified nurses, the care home will have to be registered as a ‘Nursing Home’.
There are also other forms of registration, where people live independently, receiving regular personal care and support with long-term conditions on a daily or regular basis (but not 24 hours) – these include ‘Supported Living’ and ‘Extra-care Housing’. Details of registration and the scope of regulated activities can be found on the CQC website: www.cqc.org.uk/
Funding for Care Home Placements
Funding for care home placements can be complex; the arrangements for funding will often change, as the needs of the individual change. For example, funding of a specialist placement for someone with Dementia may be higher for the first few weeks, as the person needs more care to settle into the home; someone whose condition rapidly deteriorates may require more care and the funding may need to be increased. Care home fees are set by the provider organisation – but the local authority and NHS will agree and set parameters for public funding of placements; this will include resource for the provision of care according to the regulated activity of the care home – it will not include additional costs for extra services, activities or specific aspects of the accommodation such as a view, garden access, etc.
A now chronic funding situation in Adult Social Care means that year on year there have been fewer local authority funded placements. Some care homes struggle to maintain financial viability and the Care Home sector represents one of the lower paid, with high vacancy rates and turnover of staff. The lack of public funding for care home placements means that many people have to use their own income and savings to fund their care home. In these cases, the individual agrees the fee and services direct with the care home manager. The local authority could pay for some or most of the care home fees, following a care needs assessment which is undertaken by an Adult Social Care department. Any care home funding which is met by the local authority is ‘means-tested’, so that the individual makes a contribution to the costs of their care, according to their ability to pay.
The Funding of Care Homes by Local Authorities
The following applies to the funding of care homes by local authority:
- The ‘care needs assessment’ identifies the individual’s needs for care home placement and the associated costs for this.
- The ‘care needs assessment’ will identify the cost of actual care and support required from a care home. Costs of additional services or extra aspects of care home fees, will not be included in the cost of care, e.g. hairdressing, social outings/activities, rooms with a view or garden.
- For the local authority to contribute to costs of a care home placement, a financial assessment of the individual will be undertaken. This includes the ‘means-test’ of the individual’s financial assets.
- The ‘means-test’ includes consideration of the individual’s income, savings and value of their property, to calculate how much they need to contribute towards the cost of care home placement.
- Where placement in a care home is a permanent arrangement, the value of property is included in the ‘means-test’.
- A person’s property will be included in the means test at its present market value, but less any mortgage or loan remaining and less 10% of its value where there would be expenses to sell it.
- Where a property or savings is jointly owned, the values will be considered equally and only a proportion of the value of assets will be included in the ‘means-test’.
- The local authority sets a national range of value of financial assets, above which an individual must pay for their own care home placement (this is classed as self-funding).
- If a person’s financial assets fall between the lower and higher value set nationally, the local authority will fund some of the care home fees, but the individual will have to pay the rest.
- Once an individual’s assets fall below the lower value – the local authority will fund the cost of care home placement, identified through the ‘care needs assessment’.
- Anyone paying for their own care home placement should not be left with less than the Personal Expenses Allowance per week. This is set nationally and reviewed annually.
- Where the value of a property is included in the financial assessment and results in the individual contributing to or paying in full for their care home placements, payments may be deferred until the property is sold and funding available. (further information from www.ageuk.org.uk)
When the care of the individual is to meet a primary healthcare need, and the individual needs ongoing, specialist nursing, therapy or medical input, the funding may be met by the NHS. In this case, the individual is not required to contribute to any costs of the care home placement.
NHS Funding for Care Home Placement
Individuals should be considered for NHS funding of care home placement when:
- Plans are being made for a care home placement on discharge from hospital.
- It is believed by health and social care staff that the person’s significant health needs are unlikely to improve after a period of rehabilitation – in hospital or the community.
- Prior to moving to a Nursing registered care home.
- There is a significant deterioration in the individual’s physical or mental state and the current level of care seems inadequate.
- On an annual basis, when an individual is living in a Nursing registered care home.
- If the person’s health and condition rapidly deteriorate and they may be approaching the end of life.
There are a wide range of advice for individuals and families regarding choosing a care home – from statutory, voluntary and private organisations. As with any accommodation or housing, the choice of care home is very personal – with the added requirement that the care provider must be able to meet the personal needs for care and support, nursing and long-term management of their condition. Older people may turn to the church for support and advice about moving into a care home – whether for short or long-term care. If the individual has no local family, has become unwell and frail or needs to make a decision when being discharged from hospital or to avoid a hospital admission, they may look to the church fellowship for support, guidance and advice.
Whilst church members or leaders have no legal or formal input to decisions about care homes – unless someone has been appointed Lasting Power of Attorney for health & wellbeing for an individual – older people may need and appreciate the pastoral support in helping them choose a care home and make the necessary arrangements for this.
How to Help Someone Choose an Appropriate Care Home
The following may be helpful in supporting someone to choose an appropriate care home:
- Be clear what needs the individual has, in terms of care and support.
- Where does the individual want to live – at home? locally? near to family?
- Understand all the options – can the care be provided at home? could the placement be short-term? what type of care is needed?
- Make a short-list of suitable care homes.
- Read the inspection reports – www.cqc.org.uk.
- Contact the care homes – to discuss the type of care they provide, fees and vacancies.
- Visit the care homes, with the individual to get a feel for the place, residents, staff.
- Look at the layout of the care home, the garden, communal spaces, corridors.
- Ask about social and spiritual care – mealtimes, social activities, pastoral support, religious activities, links with local churches and the community.
- Ask family, friends, neighbours for recommendations.
- Offer prayer and pastoral support to the individual – as with any big decision of life, moving into a care home is better undertaken in a planned and prayerful way, if this is possible and time allows.
Sources to Help Choose the Right Care Home
- Age UK (2019) – Choosing the right care home – www.ageuk.org.uk Care Quality Commission (2019)
- Help Choosing Care – www.cqc.org.uk Healthwatch (2017)
- Five Steps to follow when choosing a care home – www.healthwatch.co.uk Healthwatch (2017
- Choosing a Care Home, The Mum’s test – www.healthwatchlancashire.co.uk Independent Age (2020)
- How to Find the Right Care Home – www.independentage.org.uk Which? (2020)
- Later Life Care; Tips for choosing a Care Home – www.which.co.uk
© Professor Keith Brown from ‘Guidance for Christian Faith Organisations in the Support and Value of Older People’