Are your clients playing the lottery?

Tens of thousands of older people enter the lottery each year, but they are not playing in order to win cash prizes, instead they are trying to choose care to suit their needs. When an individual can no longer manage at home without help, why is finding out about the alternatives such a mammoth task and why does choosing care so often feel like a lottery? The Elderly Accommodation Counsel reports.

The answer is simple, if somewhat dispiriting. There are few information and advice services that specialise in this area and, far from evolving, many services have actually moved backward in recent years. They have demonstrated no appetite for extending their advice to cover the complex area of long-term care. Certainly, it is a challenging job. Keeping up with legislative changes, new developments in residential care and care-home closures all form part of the advice service role. Providing inaccurate information is little improvement on no information at all. Indeed, it could be argued that being misled is worse that not being led at all.

A little knowledge is a dangerous thing

In an ideal world, older people and their families would merely need to pop down to their local library, Age Concern office or log online to access comprehensive factual detail – the nuts and bolts aspects of the care and facilities provided in their local area. The reality is that obtaining information has become increasingly more difficult and a major problem.

For the minority who use them, local voluntary groups can be helpful but research has shown that the poorest sources are the very ones that people are most likely to turn to first. These include the Yellow Pages, adverts in local papers and some websites.

Lack of knowledge has a limiting effect on older people's ability to exercise choice, but the problem goes deeper than a mere lack of information. Understanding the options for care is fraught with difficulty and causes further stress in what is already likely to be a highly emotional situation. Few people want to go into residential care and most relatives feel hugely guilty about the whole issue.

The fact is that the care sector can be totally incomprehensible to the general public – even to the professionals. Local-authority staff and voluntary group representatives admit that it is almost impossible to educate people adequately in the short timescales that are typical when these decisions are being made. In a recent research study looking at what people really need to know when seeking care, one senior, local authority care manager commented: “At the end of the day, you need to know what you want to know, and if you don't know what you want to know, then you don't know what you are looking at.”

All too often, because they don't expect to need care, people are unprepared and end up floundering in the dark. As one relative put it: “You learn by bitter experience.” For example, choosing a care home is very difficult because, although it is relatively easy to compare the tangible aspects of each care home, such as the décor, the facilities and cleanliness, the most important factor when choosing an appropriate home is also the most difficult to assess – what is it actually like to live there?

One size does not fit all

Delivering care services is not an exact science. Present a care need to a number of care-home managers and you are likely to get a variety of different solutions. Despite the national minimum standards – the Commission for Social Care Inspectorate (formerly the National Care Standards Commission) recruitment and training requirements – there is no prescriptive approach to handling delivery of day-to-day care and the issues that inevitably arise. A manager's personality will, therefore, generate an individual style. All approaches could be effective in their own way, but what the public need to be made aware of is the impact that the manager's approach will have on their experience of care in the home.

Management culture and service delivery influence the culture and ethos of a home, and these factors have the greatest impact on conviviality of homes for individual residents. Regulation aims to ensure that care needs are met professionally, but how does an older person decide which home's atmosphere would feel most like home to them? People need to know whether there is a choice of menus, of decoration in their room, or social activities. People want to know whether or not staff will refer to them as 'love' or 'dear', or will accept them as normal whether they want privacy or companionship, read books or watch television, or have familiar or unfamiliar cultural, personal or other traits and habits. The all-important 'personality' of a care home is the key factor that will determine whether a resident settles comfortably into the life of the home or not. Obtaining the best match possible between the care available and the personality of the person seeking care should be the main goal of professionals and advisers. Too often it is more likely to rest on where there is a vacancy.

A better approach

The Elderly Accommodation Counsel (EAC) set out to develop a service that aims to deliver high-quality information and advice to help older people to meet their care needs. Following extensive research and intensive focus groups among residents, potential residents, their families and carers, statutory and voluntary organisations and a broad mix of providers, the care options service was conceived. The study not only proved the role that the culture and ethos of a home have on the lifestyle within the home, it also led to the development of a unique tool that helps older people and their families to identify those homes in which the prospective resident might feel most comfortable.

Capturing the ethos and culture of management was a formidable task but, using tried-and-tested statistical techniques from the world of commercial market segmentation, information from almost 300 homes was analysed to identify clusters of related management attitudes and characteristics. Determining which questions would accurately classify an individual home into one of seven 'types' involved testing over 240 separate pieces of information and condensing these into a short survey. As an industry tool, the segmentation provides diagnostic information to individually-owned homes and group providers, which helps them to identify their strengths and weaknesses. Homes can check whether there is correspondence between their classification category and how they 'see' themselves; or how they would aspire to be. However, the original seven types proved somewhat daunting for consumers, so EAC developed a simplified version of the segmentation to communicate four main care-home groups to potential residents and their families.

Matching lifestyles

Each of the four home types has a distinctive personality, and the outcome of the differences is to alter the nature and degree of flexibility, individuality, social interaction and facilities/services provisions within the home. These groupings do not correspond to particular physical or functional characteristics of homes. Each group contains: large and small residences; private and voluntary as well as local-authority-run homes; those homes offering nursing care and/or personal care, and homes in all types of locations – urban, rural and suburban.

The ethos-based nature of the EAC care options classification necessitates a tool to help people determine within which of the four types they are likely to find the best lifestyle match for them. People using 'care options' select from one of four descriptions that most closely corresponds to what they are looking for in their eventual care home. These descriptions tend to focus as much on the personality and characteristics of the prospective resident, as the characteristics of the home 'type'. The descriptions are denoted by a coloured box containing a smiling face.

The system is designed in such a way so that, although care homes are specifically placed in one of the four simplified categories, it also shows how suited any individual home might be for a person who has chosen one of the other three types by way of varied expressions on their smiling faces. This enables people to make judgements about each available home and create a shortlist regardless of whether a home of their ideal type is available. Of course, the reality is that to some degree every home is individual, which is why this system has been designed very carefully and intelligently.

Older people using the system can identify the best matches amongst the 'care options' home listings, by looking for distinctive 'smiley face' symbols in one of the four colours corresponding to the type they have selected. Professionals involved in helping place older people are also encouraged to adopt the system, as it sits well with statutory obligations to inform and empower older people to make their own informed choices.

Support and encouragement

A paper titled The Future of Care: From Rhetoric to Resolution, recently prepared by the Fair Rate for Care coalition and launched at the House of Commons by Kerry Pollard MP, commended the EAC care options service to the government. The paper recommended the integration and 'mainstreaming' of the EAC service in to the existing basic information systems in operation at local level, to raise the standard of the information available to older people, and empower older people as consumers of care, rather than as passive recipients.

Commenting on the paper, Annie Stevenson, a senior policy officer at Help the Aged, said: “This is really ground-breaking research that sheds new light on the care sector as well as helping older people find care that is best suited to their individual needs.”

The EAC phone advice team have been testing the approach among their enquirers. Consumers have responded eagerly to this new and innovative tool and the colour-coded 'smiley face' icon that illustrates each home's classification is proving both easy to use and reassuring.

This new classification addresses the need to ensure client fit drives placements and, by unravelling the lifestyle 'personalities' of homes and related 'ideal' client profiles, EAC's 'care options' service is helping consumers to realise the implications of their decisions.

An added-value service all round

All of us that deal with older people (and their families and carers) have a store of experience and anecdotes that serve to illustrate how hard it can be to provide people with what they actually want. It is frustrating and the extent to which the public depend upon outside help, delivered at the precise point of need, can seem daunting. It is often not immediately perceived as 'part of the job' by professionals, who are otherwise more focused on the legal and financial aspects and implications of ageing. However, the very real vulnerability of this client group demands involvement. In practice, people lack confidence and real understanding. They often take the safe route, making decisions based on facilities and fabric, even when they may suspect that this is not the best method.

In devising this service, EAC aims to ensure that older people, supported by their families, carers and advisers, have sufficient meaningful information to take the lead in choosing suitable care. Home classifications have gradually been appearing on the EAC online care and housing information service at www.housingcare.org

EAC's 'care options' provides a valuable, free-of-charge service for families facing one of the greatest decisions of their lives. It helps people make individual choices by identifying qualitatively-different types of environments to meet very individual needs.

Further information may be obtained by contacting EAC via telephone 020 7828 3755 or by visiting the website: www.housingcare.org EAC strongly supports collaboration with organisations and individuals that will result in wider availability of the care options service and care services directory, together with the delivery of better advice and information to help older people and their families.