Before making any arrangements it is advisable to contact Health and Adult Social Care. This is an opportunity to discuss the help you need and to find out if you are eligible for any financial support. Carers’ Resource can provide information about assessments and means of paying for care.

You may of course decide to arrange and pay for domiciliary care as a totally private arrangement between you and the care provider.

When arranging care at home you will need to ask the right questions to find a high quality service to meet your needs. Reputable firms should visit to discuss your needs and then provide a clear, detailed confirmation of the work to be done and the costs involved.

What services are offered?

Nursing and Personal Care
N.B. All organisations offering nursing or personal care have to be registered with the Care Quality Commission (CQC).

Nursing care is given by qualified nurses and can include such tasks as changing dressings, giving injections etc., as well as general nursing care.

Personal care could include help with getting up, going to bed, dressing and undressing, washing and bathing, personal hygiene, using the toilet or managing incontinence. These are sometimes called ‘Activities of Daily Living’ or ADLs. It also includes help with health-related tasks such as dealing with pressure sores or stoma care that can be done under guidance from a doctor or community nurse.

Domestic help – tasks such as cleaning, washing-up, laundry, cooking or preparing meals, lighting fires.

Shopping – could also include collecting pensions, benefits or prescriptions.

Companion/social – could include spending time with someone to keep them company; helping with letters or phone calls; taking part in activities; going out on social trips.

Live-in help – could range from a few days to cover for an emergency, to permanent fulltime live in care.

Sitting services provide someone who will spend a few hours with the ‘cared for’ person so that his/her carer can have some free time to spend as they like.

Night care – can range from ‘sleeping over’ for reassurance to being available, awake, throughout the night to provide care. When arranging this type of care it’s important to make clear what level of care is likely to be needed. If any personal or nursing care is involved, it must be provided by an organisation registered with CQC.

Gardening – regular visits for grass cutting and weeding or major tidying and replanting.

Meals – help with meal preparation, provision of ready-cooked or frozen meals (meals on wheels or private firms), help with eating.

Some questions to ask care providers:

Charges:

• How much do you charge? Are there any ‘extras’ such as mileage payments?
• Do you charge more for weekends, evenings and bank holidays?
• Will you provide written confirmation of charges before care starts?
• Will I be notified in advance of any changes in charges?
• How do I pay you? (Do you bill me weekly, for example?)
• How much notice do I need to give if I need to cancel help for any reason
• How much notice is needed if I want to cancel services altogether?
• Is there a charge if I cancel at short notice?

Insurance:

• Do you, the service provider, have public and employer liability insurance
• Can I see confirmation in writing of your insurance cover?
• What household insurance do I need (in case a worker is injured or items get broken, for example)?

Carers:

• Have all your staff been interviewed and their references checked?
• Have they had DBS (Disclosure Barring Service) checks?
• What training/qualifications will staff have?
• Will I have a regular carer?
• Will you let me know if my carer cannot come at the usual time?
• How do you supervise the work your carers do?
• How do you check they are doing what has been agreed?

Complaints:

• What can I do if I don’t get on with my carer?
• How do I make a complaint – do you have a formal complaints procedure?

Equipment:

• Do I have to provide any equipment?
• What equipment does your staff provide?

Emergencies:

• Who do I contact in an emergency?
• What help could you provide in an emergency?
• How will carers get into my home if I can’t answer the door?
• Is there an outside office hours contact number?

Confidentiality:

• Who will have details about me and the care you provide?
• What personal information do I have to provide?
• What records do you ask your staff to keep – if they’re handling money, shopping, collecting pensions, for example?

Further reading:
Your rights as a carer – Carers’ Resource
Getting help at home – Age UK
Paying for care and support at home – Age UK

If you need further information or would like to discuss any aspect of your caring role, please contact Carers’ Resource. We can provide this information in another format, please contact us to discuss your requirements.

NHS continuing healthcare is the name given to a package of care which is arranged and funded by the NHS for people aged 18 or over who have considerable healthcare needs. It is sometimes known as fully funded NHS care.

Care may be provided in a variety of settings – at home, in a care home or at a hospice, for example. NHS continuing healthcare provided in your own home is free and could include services from a community nurse or specialist, therapy or personal care such as help with bathing and dressing. Any other services which are not health-related may be charged for, depending on income and savings. In a care home setting, the NHS will pay for everything – health and personal care as well as care home fees for board and accommodation.

Who is eligible?

To be eligible, the main need for care must be health-related. It may be because of physical or mental illness, a disability or serious injury. This is referred to as a ‘primary health need’. Having a long-term illness or condition does not mean someone is automatically entitled to NHS continuing healthcare.

People who are eligible are likely to have a complex medical condition which requires a lot of care and support. Someone with a terminal illness whose health is rapidly deteriorating may also be eligible.

Assessments

Local Clinical Care Commissioning Groups (CCGs) have responsibility for NHS continuing healthcare. CCGs carry out formal assessments to determine who is eligible to receive NHS continuing healthcare. Assessments may be carried out:

• If someone’s physical or mental health worsens significantly
• When someone is terminally ill
• When someone is discharged from hospital (the NHS should carry out this type of assessment before referring the patient to social care services for help with social care needs)
• Before any decision is made by the NHS to make a nursing care contribution when a person is going into a care home which provides nursing care

To ask for an assessment, talk to health or social care professionals or contact the Continuing Care Coordinator at the Clinical Care Commissioning Group, your GP, or the Patient Experience Team or PALS Team at your local hospital. You can also contact Beacon, the national continuing healthcare advice service for free and independent information and advice on 0345 548 0300.

NHS continuing healthcare assessments are made using a set of screening criteria called ‘tools’.

Initial screening using the Checklist Tool

For most people, the first step is to have an assessment with a health or social care professional using a screening tool called the Checklist Tool.

The Checklist Tool is usually completed when a nurse, doctor, other qualified healthcare professional or social worker is assessing or reviewing your health or social care needs. The needs of everyone involved should be taken into account.

If this screening suggests you may be eligible for NHS continuing healthcare, the person who completed the assessment should, with your consent, contact your CCG to arrange a full, up-to-date assessment of your needs using the Decision Support Tool.

Full assessment with the Decision Support Tool

In order to build an accurate picture of your needs, this assessment will be carried out by a team of people who have different roles related to your care, including contributions from relevant health and social care professionals. More detailed specialist assessments may also be required.

The assessment team will use the Decision Support Tool to decide whether someone is eligible for NHS continuing healthcare.

The following areas of care need will be considered:

1. behaviour
2. cognition (understanding)
3. communication
4. psychological and emotional needs
5. mobility
6. nutrition – food and drink
7. continence
8. skin (including wounds and ulcers)
9. breathing
10. symptom control
11. altered states of consciousness
12. other significant needs

A decision is made on the level of care needed for each topic – marked as ‘priority’, ‘severe’, ‘high’, ‘moderate’ or ‘low’.

Fast Track Tool

For people who need an urgent package of care because their condition is rapidly deteriorating, the Fast Track Tool may be used. This enables CCGs to arrange for care to be provided as quickly as possible.

What happens next?

CCGs must provide a written decision stating whether a person is entitled to NHS continuing healthcare. The CCG should also provide details of the complaints procedure, should you wish to challenge the decision. If Continuing Healthcare is granted, the CCG will then discuss how care will be arranged and managed and the best setting in which to do that – would it be best provided at home or in a care home, for example. When arranging care, the needs and wishes of the person concerned must be taken into account. The situation will be reviewed after three months and then at least on an annual basis.

NHS Continuing Healthcare and Personal Health Budgets

Since October 2014, people receiving NHS Continuing Healthcare have had the right to a personal health budget.

A personal budget is an amount of money to support someone’s health and well-being needs, planned and agreed with their local NHS team. The aim is to give people with a long-term condition or disability greater choice and control over their own care and support.

To arrange a personal health budget, a care plan must be developed with your NHS Team, setting out your health and well-being needs and the health outcomes which you hope to achieve.

Personal health budgets can be used to pay for a wide range of items and services, including therapies, personal care and equipment.

There is no obligation to have a personal health budget. They are not suitable for everyone and the NHS can still provide and pay for services, as they did before October 2014.

Further information:

NHS continuing healthcare and NHS-funded nursing care: public information leaflet. Available online: www.gov.uk/government/publications

Information on NHS continuing healthcare and personal health budgets can be found at: www.nhs.uk

NHS continuing healthcare and NHS-funded nursing care (Factsheet 20).  Available online: www.ageuk.org.uk or call Age UK on 0800 169 65 65.

Beacon, the national continuing healthcare advice service for free and independent information and advice. Telephone: 0345 548 0300. Online: www.beaconchc.co.uk

If you need further information or would like to discuss any aspect of your caring role, please contact Carers’ Resource. We can provide this information in another format, please contact us to discuss your requirements.