Moving in to Mellor Nook
People move into residential care for a variety of reasons but for each person it is a major life event. Wherever possible, it should be the result of an individual's own informed decision but this may not always be the case. Some come direct from hospital because a decision to discharge the patient into a supported environment where care is available has been made on the basis of assessment. Some may come in as the result of decisions made by their relatives or as a result of a crisis. The clinical and other care needs of individuals will vary substantially. In many cases, residents will have been assessed by their local authority social services in consultation with medical and nursing colleagues as requiring residential home care and some of them will be paid for in part by the local authority under the NHS and Community Care Act 1990. Others will be paying for themselves.
A prospective resident is likely to be anxious that the decision is the correct one, however it was arrived at. Coming into Mellor Nook may mean a move away from a familiar area, away from neighbours and friends. It almost certainly means a move into smaller accommodation and the giving up of many personal possessions. Moving into residential care may be occurring at a time of other significant change in the person's life of crisis or emergency. That change may be due to the loss of a partner or carer with all the accompanying grief which that will entail. To be moving into care can itself sometimes feel like a bereavement.
Choice
Individuals should make their own informed decision to come into Mellor Nook. Other non-residential options should have been considered for example, packages of care organised after local authority assessment by a care manager which enable both health and social care services to be delivered in the individual's own home.
Making the decision
People contemplating entering Mellor Nook should have the opportunity to explore the advantages and disadvantages. A sympathetic and knowledgeable person such as an advocate, social worker or health visitor may be appropriate especially if they have no relative or friend to offer advice. Relevant questions to ask will be:
· Why is life difficult?
· Why is care needed?
· Are there any particular worries and anxieties ?
· Are these to do with housing, health, disability or other crisis ?
· What are the preferred options ?
· Have any been tried?
· What other circumstances are affecting the situation (for example, are relatives involved and if so are they trying to influence the individual) ?
All people have the right to fund their own stay or seek an assessment of their needs by the local authority social services and this should form part of the decision-making process. Under the Carers (Recognition and Services) Act 1995, their carers also have the right to be assessed by the local authority.
Reasons for moving into Mellor Nook
The reasons for deciding to move into care may be varied. Some people may feel they have no other option because of their current circumstances. Some may be faced with the decision suddenly; others may have planned the move for some time.
It may be a combination of several of the following:
· deteriorating mental or physical health;
· general frailty or increasing disability;
· a specific incident such as a fall or illness and hospital admission;
· inability, or fear of being unable, to cope with living at home;
· wanting to be looked after;
· feelings of isolation and loneliness;
· fear of crime;
· fear of falling and not being found;
· bereavement;
· desire for companionship;
· enjoyment of living in a group;
· wish for more convenient accommodation;
· membership of a group or organisation;
· poor housing;
· inability to manage a large house and garden.
The reasons why people come into Mellor Nook have changed in recent years. More are coming in because of failing health and increased dependency than for social reasons. This has consequences for the levels of care required in homes. Managers and staff understand the varying reasons why, and in what circumstances, residents have come into care. Some individuals may need more support than others in coming to terms with the major change in their lives and the home is sensitive to this. In all circumstances, however, new residents are made welcome and supported through the period of adjustment which all will experience as newcomers.
Assessment prior to care
Increasingly people moving into Mellor Nook come via the route of a social services-led assessment under the NHS and Community Care Act 1990. They may have been the subject of a joint assessment between social services and the health service prior to hospital discharge. The social services may also have instituted an assessment of their needs while they were still living in their own homes. There may have also been an assessment of their financial means.
The assessment of needs covers a wide range of topics, once the person has moved in, a comprehensive care plan drawn up. Topics covered in the assessment include:
· the wishes of the older person;
· problems and difficulties as seen by the older person;
· general and specific health problems and any current medication;
· mental health problems;
· social concerns;
· living situation and any housing problems;
· any financial worries;
· pattern of daily life and activities;
· mobility and sensory functioning;
· difficulties in carrying out activities of daily living for example, dressing, cooking;
· eating, going to the toilet; bathing and personal hygiene.
· position of carers and relatives;
· medical assessment;
· nursing assessment;
Copies of the assessment are given to Mellor Nook as part of the admission process and form the first stage of care planning. Wherever possible, this begins before the person moves into the home. Planning starts as early as possible.
Preparation
People planning to enter Mellor Nook are able to visit the home Similarly, it is desirable if so wished that the manager of the home should visit potential residents to establish a personal relationship, gain information about their way of life and advise them about what possessions can be taken with them into the home.
Sources of advice
There are a number of organisations which can offer advice to people thinking of entering care. Information about them should be made available by social services/work departments, at GP surgeries, clinics, citizens advice bureau, community health councils (England and Wales), local health councils and councils of social service (Scotland), health and social services councils (Northern Ireland) and other advice agencies.
Terms and conditions
A clear statement of the terms and conditions of residence is given in writing to the resident before moving in. these are included in the Welcome pack. These include:
· The level of fees, time and method of payment;
· The services covered by the fees;
· Extra services which are charged for separately .
· Procedure for increasing fees;
· The personal items which the resident will be expected or is able to provide for himself or herself;
· The terms under which a resident can vacate the accommodation temporarily;
· The circumstances in which a resident might be asked to leave;
· The procedure under which the resident might be asked to leave;
· The procedure on either side for terminating the agreement or giving notice of changes;
· A statement of insurance cover of the home and where responsibility lies for insuring personal valuables (amounts of cover are made clear and details of insurers given);
· A statement to the effect that the home is registered as a residential care home by the local authority which are responsible for seeing that standards are maintained;
· The procedure for making complaints to the owner and information on how to contact the registration authority in the case of unresolved complaints which fall within the scope of the Registered Homes Act 1984;
· Procedure on the death of a resident;
· Information regarding the home's policy on pets.
Appropriateness
The first six weeks is a trial period to allow time to see how well the new resident settles in. Many people will come into care as the result of a crisis or direct from a period in hospital. Relatives or others concerned with their welfare should be made aware of the nature of the trial period. Residents coming from their own homes should be careful to delay selling their houses or terminating their tenancies until they are certain they want to remain in Mellor Nook.
Reviews
During the trial period, the suitability of the arrangements are discussed fully with the resident and whoever is the individual's key supporter (relative, friend, social worker). The possibility of transfer if the arrangement is turning out to be unsuitable may be considered. Review decisions are recorded and implemented.
Once the individual has become an established resident, a programme of regular reviews to monitor progress and to ensure the resident is satisfied with the home are agreed and their purpose explained. These reviews will become part of the care plan.
Short-term stays
A short stay may be planned for convalescence, rehabilitation or respite. In some cases, some people's health may improve so that they are able to return home. The aim of convalescence rehabilitation or respite (which is available to all residents) is to retrieve a person's functioning and to maintain it at its highest level.
Funding for individuals coming into Mellor Nook
By the social services department
Older people who qualify for statutory funding retain the right to choose which home they would like to live in even though the social services department is partly funding their care. The department will put an upper limit on the level of fees it is prepared to pay, If the resident wishes to come in to Mellor Nook which has a higher fee level this is still possible provided that the difference is guaranteed (usually by a relative or another organisation). This difference is referred to as (top up).
Support for residents paying their own fees
Where residents are paying full fees themselves and are likely to continue to do so for a minimum period of two years it is not necessary for the statutory services to be involved. However, if a resident becomes in need of financial assistance after the minimum period of two years social services should be approached This may also be available through independent organisations which specialise in helping people find suitable residential care, through welfare organisations or advice agencies. Prospective residents should also make clear their own financial position.
Good practice
As a matter of good practice Mellor Nook states that entering care should:
· Be the preferred option after considering alternatives (especially additional help at home);
· Be sensitively carried out and be unhurried;
· Take account of the person's wishes and lifestyle.
Mellor Nook Manager or Deputy
· Confirms that the home is able to provide the care needed by the person;
· Provides full details of conditions, fees, and services provided;
· Assess the residents needs.
· Records sufficient information to enable the home to carry out its responsibilities in caring for the resident;
· Develops a care plan detailing the care required to be provided;
· Has clear arrangements about the roles family and friends have in the care and life of the resident.
Prospective residents are
· Helped to find the best place to live;
· Not forced into care against their will;
· Not deceived or misled into entering care.
