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Most carents find it difficult to navigate all the different types of care service.
This guide explains different types of care services so that you can make the most of them. We have separate guides to help you arrange specific care services such as a home care service or a live in care service.
This guide aims to help you understand how care services work and to help you to arrange a care service.
Government plans to fund Social Care keep changing – under PM Boris Johnson there were plans to introduce a cap on lifetime charges but these plans have been put on hold by subsequent governments.
If you are trying to help your older parent to live independently at home, there are four types of care to consider.
These problems are wide ranging and can include emergencies, acute and long term illnesses. In the UK, the majority of these services are delivered by our NHS which is free for all and includes a wide range of specialist services such as GP surgeries, hospitals, pharmacies and community nursing.
Personal care is all about everyday activities like bathing, dressing, toileting, eating, getting about.
In the UK, these services are often labelled as adult social care services.
Although Local Government plays a key role, adult social care services are actually delivered by a wide range of organisations alongside families and communities.
Unlike health care, these services are NOT free for all. Any public funding – mainly from Local Government or in some cases from the NHS – is only provided according to strict criteria.
We describe more about the funding and delivery arrangements for these services below and we have also recommended some videos which help to explain these services.
Older people can become too unwell, weak or disabled to do essential household tasks like laundry, shopping, cleaning, gardening, rubbish, security etc.
Although a small proportion of these responsibilities might be delivered by social care services according to strict eligibility criteria, in most cases they must be met through some combination of personal, charitable or private resources.
This can entail organising, funding and coordinating appropriate cleaning and gardening services or moving to alternative accommodation eg a residential care home, assisted living facility, sheltered accommodation, or living with a son or daughter.
Your local council adult social care service can help your parent to adapt their home. They will undertake an assessment and recommend equipment or adaptations. Having a home assessment is free and the Council will pay for equipment under £1000.
The final piece of the jigsaw relates to everything else people need so that they can live life to the full eg get out and about, socialise, attend appointments, organise their affairs, get a haircut, buy new clothes. Again, in most instances, these needs can only be met through some combination of personal, charitable or private resources.
It is this aspect of care which is often overlooked by the public sector with a reliance on families, friends and 3rd sector organisations to bridge this gap. Our neighbourhood directory will help you identify local and national 3rd sector services for specific problems. Many of these groups focus on medical problems, provide transport for older people and tackling isolation.
In our experience this can be challenging and time consuming especially if you are organising care from a distance.
Although we have used the word jigsaw to emphasise the way care is pieced together, it is misleading to suggest that the various pieces are always available and that they fit together effectively. In our experience, lack of funds or services combined with a plethora of different funding mechanisms and providers often results in a mismatched and incomplete patchwork of formal and informal care which needs to adapt to your parent’s evolving and fluctuating needs. We have found that it can be an ongoing challenge to piece all the fragments together and ensure your parent doesn’t slip through the gaps.
A plethora of paperwork and guidance exists to assure and organise the various care services.
Each service – public or private – will often be provided on the basis of a “needs assessment”.
The needs assessment identifies and documents your parent’s preferences and care requirements in order to shape the nature of the care they receive. This care is often described and documented in a “care plan”. You might find that your parent has multiple needs assessments and care plans, all of which are updated as circumstances change.
The results of a needs assessment can also inform decisions around care funding. It can be helpful if you attend the needs assessment which could take between 30 minutes and one hour.
If you know your parent will not be eligible for LA funded home care then you might find it easier to avoid undergoing the Council needs assessment and means testing process and approach a private home care company directly. However, the test can help to facilitate access to equipment to help adapt your parents home to create a safer and healthier environment.
There are other care plans and guidance which, if relevant to your parent, you might want to be aware of and understand and which we cover in other The Carents Room guides.
A lot of carents are surprised to find that social care is organised very differently to the NHS
There are two main types of social care:
1. Domiciliary care provided in a person’s own home
2. Residential care provided in an institutional setting such as a care or nursing home.
In England social care is primarily provided delivered by three overlapping sectors, with different responsibilities. The majority of social care services are provided by the private or 3rd sector – this is well illustrated by the care home market which is provided by:
• The public sector – 10%
• The non profit sector – 14%
• The private profit sector – 76%
Local authorities (LAs) have overall responsibility for “maintaining a functioning social care market” in their locality. They commission services only for those individuals who meet their eligibility criteria. They also provide information and advice, undertake social care needs assessments, provide short-term support, safeguard vulnerable people and buy and monitor care from a large range of organisations.
Adults who do not meet LA eligibility criteria must organise and fund their own social care.
Each UK country has its own criteria. Currently, England is considered to be the least generous country, as Wales, Scotland and Northern Ireland offer additional support outside of the means test. In England and Northern Ireland, your parent will not be eligible for state funded home care if they have over £23,250 in savings.
Some adults with long-term complex needs qualify for free social care which is arranged and funded solely by the NHS – this is known as NHS continuing healthcare.
Eligibility for NHS continuing healthcare depends on the results of a needs assessment which explores the intensity and nature of support required.
The assessment process can be complex and so the NHS signposts families to an organisation called Beacon which gives free independent advice about the process.
It can take up to a month to get a decision although there is a fast track process for people who are deteriorating rapidly and nearing the end of their life.
In an emergency you can phone your local Council for advice – each Council has an emergency Adult Social Care contact number which will feature on their website.
Most local authorities will provide some free short term home care for up to six weeks, often in the form of something called a reablement package (see below for more detail). The package is focused on building confidence and promoting independence and is often provided following a crisis or on discharge from hospital.
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Did you find this information helpful? Let us know what you think or pass on some advice to other carents by emailing us at [email protected]
Originally published September 2020, updated November 2021, November 2022, December 2022, July 2023
