IN BRIEF - Elderly Client Adviser

Feature

posted 1 Jun 1999 in Volume 4 Issue 5

In Brief
Legal, Financial and Political Developments Affecting the Elderly

Withdrawal of medical treatment

New BMA guidelines on withdrawing treatment from terminally ill patients were published on 23rd June. The guidelines are considered necessary because of confusion and uncertainty among doctors over how to proceed when treatment is doing more harm than good - perhaps where treatment for a life threatening condition is proving unsuccessful, or where a patient is incapacitated after a severe stroke or has advanced dementia.

Doctors will be expected to consult the family, take into account the patient's own views (where possible) and also get a second medical opinion. Ultimately, however, the responsibility for the decision will rest with the doctor, and if the family disagrees it will have to bring a challenge through the courts. In many cases decisions will inevitably focus on stopping artificial nutrition and hydration, or not treating acute infections.

Where patients have lost mental capacity, previously executed living wills must be respected. Where it is impossible to ascertain the patient's wishes, doctors will be expected to consider, among other things, whether the invasiveness and pain of treatment are justifiable, how likely is any improvement, and how aware patients are of the world around them.

Tips for choosing a care home

About 130,000 people enter residential and nursing home care every year. Help the Aged's care fees advisory services have issued a list of Top Tips for people to bear in mind when choosing a care home:

Make sure you know much the fees are, what they include, and whether you can afford them now and in the long term;

Visit several homes before you make your final choice. Choose a home which offers the type of care you need. This may be residential or nursing home care, or both;

Consider the location of the home, the local area, and its proximity to local amenities and services;

Find out what the home is really like. Chat with staff and residents, and arrange an overnight stay, if possible;

Arrange initially for a trial period of residence;

Consider what facilities and amenities are available, such as hairdressing and library services. Find out which facilities are private, and which are shared.

Decide whether you want a shared or single room on the ground or a higher floor. Enquire whether you can bring your own furniture and consider how much privacy and independence you will have;

Consider the menus and whether the food is interesting, varied and good quality. Does the home cater for special dietary requirements?;

Ask for a full explanation of any rules or restrictions, such as whether pets are allowed or whether there are set visiting hours;

Do not be afraid to ask questions and make sure that the home will enable you to be independent and follow the lifestyle that you choose. Make sure that you are happy with the home.

New regulations on the definition of a day in hospital

The Government has announced new regulations which will specify that, for the purposes of attendance allowance and disability living allowance, the day a patient is admitted to hospital will be treated as a day out of hospital, and the day on which he or she is discharged as a day in hospital.

This will replace a ruling by the Social Security Commissioner in 1996 that both the day of admission and the day of discharge should be treated as days in hospital.

(Patients receiving attendance allowance or DLA (care) lose benefit after the first 28 days in hospital.)

(Patients receiving attendance allowance or DLA (care) lose benefit after the first 28 days in hospital).

Amendments to the CRAG

The DOH has reissued the Charging for Residential Accommodation Guide, incorporating amendments since 1995.

LAC (99) now replaces the Circulars issued since 1995, which are incorporated as Annex H.

CRAG is available on the internet at www.open.gov.uk/doh/coinh.htm

It can also be obtained free from DOH, PO Box 410, Wetherby, LS23 7LN

New Solution for nursing homes residents

The Pension Annuity Friendly Society has devised a new concept - Cost Over Run Cap (CORC) which can provide a very cost effective solution for some nursing homes residents.

The scheme utilises the Anderton Diagnosis Index which assesses the life expectancy of residents by taking into account the aging process, impairments common to older people and a scoring system which incorporates failure of "Activities of Daily Living" and an upheaval factor.

This information is used to provide the option of limiting the cost of fees and enabling capital to be preserved.

The Benefits

The exact cost of care is known regardless of how long the individual remains in care

The individual will be able to remain in the accommodation of their choice

Assets can be preserved for the next generation

The care home is assured of receiving full fees.

Additionally, Social Services departments may also take advantage of the one off premium capping insurance (CORC) to limit the liability of the nursing home placements they are funding.

The Key Features

Designed for people who have an immediate need for care and cannot wait for the Government to act on any findings or recommendations from the Royal Commission.

Annuity and CORC provided by Pension Annuity Friendly Society

The cost varies and is dependent on the life expectancy prediction of between 1 and 4 years.

Unlike most forms of health or life insurance the greater the degree of impairment the lower the cost.

The payments are tax free if made directly to the care provider

The accommodating nursing home will enter into a 12 month non obligatory agreement with PAFS to ensure that all residents are aware of and can potentially take advantage of the concept.

The Anderton Diagnosis Index assessment requires the accurate completion of a simple tick box questionnaire by a senior nursing officer or doctor.

An Example

An 80n year nursing home resident, meeting fees of £400 per week from a state pension of £64.95 and attendance allowance of £51.30 per week leaving a shortfall in income (excluding spending money) of £283.75 per week to be met from capital.

If the proceeds from their former home was £75,000 after just 4 years she would be down to £16,000 and calling for the state to meet her costs. The problem is the state will normally only pay around £320 per week for nursing home fees and the family, not only having lost their inheritance, could be faced with finding an £80 per week bill to make up the difference.

The ADI assessment in this case reveals that the resident has heart/diabetic impairments, a fair degree of care dependency and predicted life expectancy of 2 years.

The scheme would offer this resident the peace of mind that no matter how long she survives in care her fees can be met through the option of:

1. Purchasing an immediate life annuity guaranteeing to meet the shortfall of £14,755 per annum for the rest of her life for a capital outlay of approximately £24,914 leaving £50, 086 for the family to invest for growth providing their eventual inheritance.

Or

2. If the family is worried about laying out money to purchase the lifetime plan they can purchase a CORC for a one off single premium payment of approximately £2,951. This will undertake to meet the shortfall in fees for the life of the resident but, only after having survived two years of being in care.

If you would like further information on this scheme contact Phillip Spiers on 01865 750665

Government slow to act on Commission report

Recent figures have revealed that although the Royal Commission on long term care presented its findings to the Government four months ago, the issue of arranging and paying for care continues to confront hundreds of thousands of older people.

Since March 1st 1999, 4,273 older people have called Help the Aged, anxious about their care and how they will pay for it.

Help the Aged is urging every MP to demand a clear and positive response from the Government to the Royal Commission's recommendations on paying for care. Recent official figures show thousands of older people needing care and having to make decisions about paying for it.

610,000 people received local authority home care and 670,000 paid for private home care

446,250 people were in nursing or residential care, of which 126,250 paid privately and 320,000 received local authority support to some degree

The charity has taken 18,000 calls on long term care in the past 12 months, and a catalogue of calls is being sent to MPs highlighting the difficulties faced by thousands of older people needing care at home or in a residential setting.

"Thousands of older people planning for the future or facing urgent needs waited anxiously for the Royal Commission's report," said Mervyn Kohler, head of public affairs at Help the Aged. "Now they wait again for the Government's intentions. How much longer will they be kept in the dark?"

FSA must keep watch on home plans `hard sell' says Age Concern

Age Concern is asking the Financial Services Authority to regulate equity release schemes and protect pensioners from `hard sell' strategies.

It is asking the FSA to fully regulate the schemes as well as the annuity-based schemes already covered. Age Concern has voiced the concerns that a growing number of older people are complaining about sales tactics.

"We have a number of complaints from elderly people about hard sales tactics," said a spokesperson for Age Concern. "Providers must be very careful because elderly people are often quite vulnerable."

"There is a sentiment among our members that the FSA should regulate equity release," added Cecil Hinton, chairman of Safe Home Income Plans (SHIP).

If you have news you feel is relevant for publication, contact Nick Hussey on tel: 0181 785 2700, fax 0181 785 9373
nhussey@ark-group.com