Caring Matters A Set of Guidelines - Elderly Client Adviser

Feature

posted 1 Jun 1999 in Volume 4 Issue 5

Caring Matters - A Set of Guidelines

An increasing proportion of the population is living longer and is likely at some time to need assistance with managing financial affairs or personal care. How can you as an adviser enable potential clients to feel confident in your skills and reassured by your experience in dealing with legal aspects of long-term care?

The responsibility of caring for someone can be assumed traumatically overnight, as a result of an accident or acute illness. Or one may gradually take on more and more responsibilities, realising in a moment of exhaustion and frustration that your partner or friend is totally dependent upon you. My own experience includes both situations, as my partner developed extremely debilitating symptoms almost overnight; followed by sudden improvement and then eight years of slowly progressive disability.

Carers find themselves in a quagmire of never-ending uncertainty about their rights and responsibilities in terms of: obtaining assessments; comprehending the complexities and challenges of accessing services from public and private sector providers; managing the affairs of a loved one; understanding care plans and agreements with providers; obtaining information about eligibility criteria and user priorities; and dealing with charging policies.

The first challenge might be the creation of an enduring power of attorney. Recognising when the donor is willing and also capable of assigning decision making powers to another is difficult, but in most cases it is important to take this step, rather than rely on receivership later on. The registration of an EPA may be stressful, especially when notification has to be given to the donor, and if registration is contested a nightmare scenario maybe created for all concerned. The present rules permit challenges to be made on five grounds, over a two year period. I have also found it difficult to obtain advice and/or definitive and concrete guidelines on managing the affairs of a spouse or partner.

If the Government decides to implement the current legislative proposal for Continuing Powers of Attorney - which would give authority in respect of health and personal care decisions as well as financial affairs - it will be important to clarify the requirements for registration.

The CPA form could, for example, facilitate the registration process by including guidance about the possible grounds for contesting the registration and when it would be helpful to have medical specialists as witnesses. It would be beneficial to have time limits for each aspect of the registration process with clear, concise, objective criteria defining grounds on which a person may be considered appropriate to act as a person's attorney. Criteria could include: having a good record; having been prosecuted of no major criminal offences; and knowing the donor for at least three years. Guidelines for people acting on a spouse's or partner's behalf would be helpful to the donor and donee as well.

Coping with the complexities of public services and procedures is a continually enlightening experience. When people acting on behalf of local or health authorities are unsure of their own roles and responsibilities, how can service users know where to turn? Those of us needing local authority or NHS services are vulnerable and, most likely, experiencing emotional and financial insecurities. When we obtain advice from advice lines or advice centres, from advocates or from legal professionals that conflicts with the behaviours and opinions of public service officials, whom do we believe?

There are currently no standards or accreditations recognised by the general public that can help carers or their loved ones make their decisions in full confidence that advice given is based on up-to-date and appropriate information. Indeed, even the Law Society is unable to recommend specialists in the field of community care.

Can you answer these questions, with knowledge of your local policies and procedures?

What are the priorities set out in your local community care plan?

What are the eligibility criteria for NHS funded continuing care?

What are the discharge procedures from hospital?

When is a multi-disciplinary assessment required?

What are the main provisions of standard form local authority contracts with providers?

When should care plans be provided to people receiving community care?

What are the statutory obligations for the local authority after performing a carer's assessment?

What services can be provided locally to enable people to live at home?

Who is responsible for managing a person's care once a person is involved with local or health authority services?

Is the opinion of a spouse or partner required when making decisions about nursing or residential home care?

After placement in a nursing home, is that a person's "home for life"?

Should next of kin be invited to reviews and assessments of care?

Should an advocate or next of kin be present when a person with cognitive impairment is interviewed?

Can a complaint be made anonymously?

What are the five grounds for contesting the registration of an enduring power of attorney?

When should medical advice/supervision be obtained in respect of the execution of an EPA?

When is the partner or spouse liable to contribute to nursing or residential home fees?

Can the financial situation of a spouse or partner be assessed and, if so, when?

To whom can you complain about the quality of care in a nursing or residential home?

How and to whom can you complain about poor community care services, or bad management/administration?

These questions are but a few that people facing the challenges of long-term are meeting day-to-day. Do you have the knowledge and experience to help us?

Caring Matters, a national charity, is seeking to develop legal training focusing on issues of long-term care to create an awareness of the rights and responsibilities of people receiving and providing care, and to develop a national network of accredited advisers.

Ruth Windsor, Founder, Caring Matters is registered charity (no.1075123). They can be contacted at: 132A Gloucester Place, London, NW1 6DT, tel. 0171 402 2702, fax: 0171 402 2925