Councils failing to stop people giving away cash to dodge care home fees

F​amilies are facing a care funding lottery as new figures reveal wide variations in the lengths to which councils will go to stop people giving away assets in an attempt to make the state pay instead.

Local authorities means-test residents of care homes to check if they should pay towards their costs.

The cut off point is £23,250 – if you have assets above this figure you are expected to fund your own care. If your assets are worth less than £23,250 the council will help to meet the costs. Average nursing home costs reached £1,000 for “self-funders” earlier this year.

The spiralling cost of care has created an incentive for families to give away property, investments and savings to bring their assets below the £23,250 limit.

Councils have powers to claw back money from people it can prove to have “deliberately deprived” themselves of assets to claim state aid. Yet it has long been suspected that they find it nearly impossible to prove that someone has given assets away deliberately to dodge care costs.

Giving to children and grandchildren as a way to limit inheritance tax bills has become increasingly common. High house prices and buoyant stock markets have increased families’ wealth, while the headline amount you can pass on tax free has not been increased for nearly a decade.

A series of Freedom of Information requests submitted by Telegraph Money has uncovered how often councils use their powers and the amounts they have managed to claw back.

Of the eight local authorities approached, North Somerset council, whose jurisdiction includes Weston-super-Mare and the outskirts of Bristol, had used its powers the most. Since 2012 it recorded 64 “deprivation” cases in relation to care funding. The total value of assets involved in the cases was £1.3m.

By contrast, the London borough of Westminster had no recorded cases. This is despite the area having a similar population to North Somerset, at around 200,000, and a similar proportion of elderly residents.

Likewise Southwark, which covers a large part of south-east London, had not used its powers at all. The north London borough of Camden had the second-highest number of cases, at 14, with a total value of £158,000 over five years. Liverpool and Hertfordshire councils refused to provide figures on the grounds of cost, while Nottingham City Council said it did not keep relevant records.

Steven Cameron, a care expert at Aegon, the insurer, warned that greater scrutiny of the sector meant individuals who attempted to dodge care fees were increasingly likely to be caught by councils.

“A few years ago it was highly unlikely that a council would have paid much attention to people who gave away assets to avoid paying,” he said. “But with the care crisis getting worse daily and with more public interest in getting out of paying for care by giving away assets, the attention councils will pay is certain to increase considerably.” 

Councils also take action that may not be reflected by official statistics, said Tracy Ashby a specialist legacy planner at Thursfields, the law firm.

She has seen cases in the West Midlands where instead of trying to claw back funds from families, councils simply cut off funding for care. Care homes are then left to pursue families themselves and in some cases have sought to evict patients, Ms Ashby said.

The "dementia tax" Telegraph Money has reported extensively on the anomalies of the care funding system. 

Self-funding patients effectively subsidise those funded by councils, which set strict limits on the fees they are prepared to pay. This leaves homes in areas with few private customers battling to stay open.

The Conservatives’ radical plans for reforming the care system have been blamed for the party’s disastrous showing in the general election. Under the plan, councils would have started to pick up the tab for care costs once a person’s assets fell below £100,000, as opposed to the current level of £23,250 in England.

But, crucially, family homes would also have been included in the means-testing formula for “at home” care for the first time.

At the same time, the plan for a lifetime cap – which would have helped those who needed long periods of care – was dropped. The Tories quickly backtracked over the latter, which Labour called the “dementia tax”.

SOURCE: The Telegraph, Sam Brodbeck

Two die in NHS every day of thirst or starvation with patients in hospitals and care homes being 'forgotten to death'

Two British people are dying each day in care of the NHS as a result of starvation or dehydration, shocking new statistics show.

Hunger or thirst were responsible for 1,022 registered deaths in 2015, with patients in hospitals and care homes being 'forgotten to death'.

Experts argue that the increasing demand on NHS staff is causing them to provide lower levels of care towards rising numbers of patients. 

This means they are unable to help elderly people eat and drink by holding their cups and cutlery for them - leading to them starving to death, some argue.

Hunger or thirst were responsible for 1,022 deaths registered in 2015, new figures show

Dehydration was recorded on 429 death certificates of patients who passed away during a period in hospital. 

While malnutrition was mentioned on 297, figures from the Office of National Statistics revealed.

Figures were based on deaths where either cause was mentioned somewhere on a death certificate, either as an underlying cause or a main factor.  

In care homes, 54 elderly patients passed away as a result of not being fed properly and 76 died from not consuming enough fluids.  

A further 80 people passed away from dehydration outside of hospital or care homes, while 86 starved to death in the same setting.  

In hospital:

Malnutrition: 297

Dehydration: 429

In care homes:

Malnutrition: 54

Dehydration: 76

Elsewhere:

Malnutrition: 86

Dehydration: 80 

But experts warn that many of these deaths overlap, and that some certificates will have recorded both causes as a means of death 

This comes after Stanley Mack, 77, was found to have died from dehydration while in hospital in 2008.

His son, Ian, told The Sun: 'He was absolutely forgotten to death.' 

Health Secretary Jeremy Hunt today admitted the NHS is also facing some 'very serious problems'. 

He told the Today programme: 'I don't want to pretend that we haven't - at this most difficult time of the year for the NHS - had some very serious problems in some hospitals.

'I think we need to listen to independent people like Chris Hopson - no friend of the Government when it comes to NHS policy, he speaks for all hospitals in the NHS - who rejects this idea...he says that the vast majority of hospitals are actually coping slightly better than this time last year.' 

Patient Concern's Joyce Robins also told the newspaper: 'Every one of these deaths is a tragedy.

'Hospital wards are full and staff are run off their feet looking after so many patients it is impossible to give them the care they need.

'Patients will need help eating or drinking but are being neglected.' 

Dehydration was recorded on 429 death certificates of patients who passed away during a period in hospital. While malnutrition was mentioned as a cause for 297

The British Red Cross last week claimed a winter surge in demand for the NHS had caused a 'humanitarian crisis' in hospitals across the country.  

Its chief executive said the charity had been 'called in' to help transport people home from hospital to free up beds.

But Prime Minister Theresa May rejected its claim and instead said the health service faces 'huge pressures'. 

Stanley Mack, 77, was admitted to Selly Oak Hospital in Birmingham with a chest infection and was later diagnosed with the superbug Clostridium difficile.

He died three weeks later in July 2008 and, during his final days, his family said hospital staff failed to realise he was rapidly deteriorating. 

His widow Carol previously said: 'There was no record that was reliable of what he was being given.

'He would be given drinks and they would be left there and occasionally they would be written up as given to him, but we knew when we were there that he was not drinking it.

'However, it was described, it wasn't run in a way that met the patient's needs. 

'And of course, because of that his condition was allowed to deteriorate and particularly, for him to become acutely dehydrated.' 

The family endured a five-year legal battle with the hospital to try to get to the bottom of exactly how the pensioner died. 

An initial inquest returned a narrative verdict – suggesting no-one was at fault. 

But the family appealed for a second inquest in 2013 which ruled Mr Mack had died from dehydration. 

Education Secretary Justine Greening told the BBC's Andrew Marr: 'I don't think it's appropriate to describe the challenges that the NHS faces this winter as a humanitarian crisis.'

She said the NHS was better prepared this winter than in previous years.

'We have put in £400 million of extra funding to particularly help these winter pressures and, indeed, the NHS is better prepared this year than it has been in the past,' she said. 

However, the claims emerged when two patients died on trolleys in Worcestershire Royal Hospital's accident and emergency department in the last week. 

Dr Taj Hassan, president of the Royal College of Emergency Medicine, warned last week: 'The emergency care system is on its knees, despite the huge efforts of staff.'  

Figures last year suggested that 7,949 deaths may be attributed to hunger and thirst in the past decade.

And just last month, a grandmother was found to have died of thirst after being given a powerful drug known to cause dehydration. 

An inquest into the death of Edna Thompson, 85, from Harrietsham in Kent, heard that she was the victim of a catalogue of errors at the hands of NHS staff.

Mrs Thompson was admitted to hospital after losing sight in her right eye with suspected malignant glaucoma, in September last year.

During her stay, she was prescribed the diurectic drug diamox to lower her blood pressure. 

On the same day, she was also given mannitol, a powerful drug normally used when medication such as diamox does not work.

Diuretics, known as 'water pills', work by ridding the body of unneeded water and salt through urine.

This means the blood is easier for the heart to pump and blood pressure falls as a result. 

A Department of Health spokesperson said: 'Any such case is unacceptable – that’s why we have introduced a new inspection regime to take tough action, including closure of services where they aren’t up to scratch.'

 SOURCE: Mail Online, Stephen Matthews

Chickens at Kapara aged-care home at Glenelg South helping residents with dementia

THE new residents of an aged care home in Glenelg South have quickly established themselves in the pecking order.

In a South Australian first, the ACH Group’s Kapara home has introduced HenPower, a program aimed at tackling social isolation and depression among people living with dementia.

Henny Penny, Chooky Looky, Chicken Licken and Priscilla have made themselves at home in Kapara’s memory support unit Rose Cottage since moving in two months ago.

The chooks appear to be relishing their role in the “creative ageing” program that mixes hen-keeping with arts activities and visits from local children for a weekly “intergenerational playgroup”.

The residents and kids make chicken-themed artworks together, while volunteers have also helped residents paint and knit pieces for the SALA festival.

Kapara senior manager Lyn Bertram says the residents love the chooks.

“For many of them, it brings back memories of their younger days, and they really enjoy handling them and petting them, feeding and looking after them,” she says.

“This program is about building relationships through hen-keeping and we are delighted by the positive outcomes it has already delivered.”

Resident Rhonda Fitzgerald, 92, says: “Aren’t they gorgeous? You just want to pick them up and cuddle them. The chickens have brought so much joy to us all.”

Charity Equal Arts launched HenPower in 2011 in the UK, where it is now used in more than 40 care homes.

HenPower manager Jos Forester-Melville says the program “gives people a role and responsibility with the hens” and is “a catalyst for building relationships and exploring creativity”.

“Bringing creativity into care is a fantastic way to engage people and aid communication, especially for those living with dementia,” she says.

The hens, coop and feed needed to establish the program at Kapara were donated by the PetStock business

SOURCE: Tim Williams, The Advertiser

Japan rethinks care as it confronts ‘pandemic of dementia’

It was holding an umbrella over his mother Kinue, as she swept the yard in pouring rain, that made Yuji Ogawa realise how far her Alzheimer’s had gone.

Kinue had started making odd little mistakes after her retirement from a nearby confectionery factory — putting the wrong food in the freezer or the wrong top on a bottle of soy sauce. But gradually she became preoccupied with cleaning her yard in Fukuoka, the biggest city on Japan’s southern island of Kyushu.She would angrily refuse her son’s entreaties to come inside. “She started to do it obsessively. Even if it was snowing, she’d try to go and sweep,” says Mr Ogawa, 50.FT Seasonal Appeal 2017

          

Mr Ogawa had to quit his salaryman job at a co-operative society to care for his parents. That was seven years ago. Kinue is now 84 and her disease is in its final stages. “Looking back, I realise: she didn’t remember having done it,” he says. “She knew something was strange about herself. She was uncertain and bewildered and it changed her".

Since then, Mr Ogawa has helped set up an “Alzheimer’s café” where carers and people with the disease and other forms of dementia can go for advice and support. He wants people with dementia to encounter kindness, not despair. “I don’t want anyone else to suffer those terrible experiences,” Mr Ogawa says.

As the world’s fastest ageing country — more than a quarter of Japanese people are over the age of 65 — Japan confronts a “pandemic of dementia”, according to Masaki Muto of the International University of Health. 

By 2025, 7.3m Japanese will be living with the condition — one out of every 20 people in the country. By 2050, if nothing changes, it will be one in 10. The treatment and care of people with Alzheimer’s and other types of dementia costs Japan ¥14.5tn ($128bn) a year, according to a study by Keio University. The scale of the challenge for Japanese society has prompted a rethink on dementia, with a move away from medicine and institutional care towards care in the community. 

With Japan’s health system struggling with shortages of both staff and money, the goal is to make dementia care part of the fabric of local life. 

Mr Ogawa is one of many thousands of people in communities across Japan that are gearing up to help people with Alzheimer’s and dementia to stay in their homes. Mr Ogawa has an orange band on a cord around his neck, indicating that he is an “Alzheimer’s supporter”, and thus ready to offer help on the street. Municipalities are training police officers how to respond when they find an elderly person wandering the streets. Some towns have even begun tagging people who have dementia with QR codes that can be scanned by the authorities if they get lost. 

“The numbers aren’t the issue,” says Kumiko Nagata, a former nurse and now director of research at the Tokyo Centre for Dementia Care, of the staggering number of Japanese people living with the condition. “What we need most of all is a change of values. Even with Alzheimer’s, there are things a person can do. They don’t need to be expelled from society. We mustn’t repeat the mistakes of the past,” she added, referring to the 1960s and 1970s when people with dementia were institutionalised in large care facilities.

Community care offers hope of a kinder future for people with dementia and their families, she and others say. But it also relies on there being a community to offer that care. In the years ahead, the number of people with dementia in Japan’s large cities is set to grow and the childless postwar generation has no loving sons to help them. 

Mr Muto, a medical doctor who now works on health policy, highlights one example of how dementia care can go wrong. The country’s mental health hospitals have few young patients. At the same time, there are urban families desperate for somewhere to put their parents, and so they hospitalise them. It is a match made in hell: an alien environment where dementia patients are medicated and in danger of rapid decline. He admits: “We’re going from 4m to 7m with dementia and the number of young people to care for them is falling. Whatever the awareness and the clever schemes, it’s going to be tough.”

Mr Ogawa is also working on a brighter version of the future. At the Alzheimer’s café, one of more than 650 across the country, a few regulars chat over cups of tea, marshalled by a woman from the town council. At another table, Mr Ogawa advises an elderly gentleman on how to cope with swings in his wife’s condition. “There has been a lot of good in my experience. A salaryman doesn’t learn much about the real world,” he says. “In the future, I’ve thought about whether this house could become a co-op for local families with Alzheimer’s. I want to help.”

SOURCE: Financial Times, Robin Harding

Alzheimer’s just one of several types of Dementia

The first step may be to learn that Alzheimer’s is just one of many forms of Dementia which is why it is using the two word phrase can be helpful.

“Most people separate the diseases,” stated Teresa McDaniel who specialized in care of the elderly for the last 20 of her 35 year career as a nurse.

“Dementia is the broad medical term and Alzheimer’s is the worst form,” clarified McDaniel.

Pruitt Health Administrator Linda Reece agreed the more you learn the more confusing it gets, “because it’s progressive and there’s so many different types of dementia.”

Vascular Dementia, Frontotemporal Dementia and Lewy Body Dementia have unique attributes because they affect specific areas of the brain.

“With some types of dementia like the Lewy Body they’re much more aggressive. They’re much more agitated. They fall, “described Reece, “but Alzheimer’s just gradually eats away until there’s nothing left of that individual.”

“Alzheimer’s eats away at the brain a little bit every day,” continued Reece, “Our brain is what controls us. Up in our brain is stored all of our memories of our past life. With Alzheimer’s it just eats away until there’s only the shell of a person. It can be a slow agonizing death.”

Some of the agony comes in knowing there is something wrong but being unable to understand what it is.

Ruth Evans was a Hugh Chatham nurse as the hospital system was just preparing for long term care.

“I was nurse manager when we set that unit up until they moved it out into the new nursing home,” claimed Evans.

“At that time there were several freestanding long term care units but not that many in the hospital,” remembered Evans. “We wanted to be able to keep the patients, take care of them and not try to have to send them outside. When we open the new nursing home it helped because we still could keep them in the community.”

Evans recalled some of her patients as they experienced the process of Alzheimer’s.

“Once I had a gentleman that had no family to take care of him but he needed [help]. There was something wrong he just didn’t know what.”

Evans described the patient’s frustration at trying to talk but the words would come out garbled. “Once he passed the stage of knowing he was doing something wrong then he was happy. We became his family. In fact he even called us by some of his family‘s names.”

Once the disease progresses beyond where the person afflicted knows there is a problem it is often the families who suffer the most.

“It’s very hard for the families,” confirmed Reece, “I don’t care how much you know, that first time that you walk into the room and they don’t know you is like a knife goes through your heart but they can’t help it.”

That may be part of why it seems part of human nature to hide the loss of memory even though the brain is malfunctioning.

“I’ve had husbands come in and say I knew my wife was sick but when her parents came she hid it so they thought I was lying about her condition,” recalled Evans, “but as soon as they left the driveway she’d say ‘who was that,’ so she wasn’t able to recognize her family but she knew to hide her symptoms.”

This is the worst thing that can be done since treatments can prolong the stages allowing Alzheimer’s and other Dementia patients to enjoy their lives better longer.

Much of the Alzheimer’s Dementia experience is heartbreaking, but hidden within the seemingly endless sorrow are gems of hope.

“As the disease progresses they become more and more remembering 30 to 40 years ago but can’t remember what happened yesterday,” described Reece. “They still look for their children but their children being little.”

“We had one lady in particular who would roll up every evening at 3 o’clock because she was waiting for her children to get off the school bus,” revealed Reece. “We just learned that’s OK. That kept her calm. She would come up. The minute a child would come through the door she would roll herself back down the hall.”

“She was reliving another time, another place,” claimed Reece. “Her daughter said every single day her mother waited for her to get off the school bus. Even as the disease progressed she didn’t know her daughter because her daughter was little but she knew she had to get her off the school bus.”

SOURCE: The Tribune, Beanie Taylor

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Marriage linked to lower dementia risk

(Reuters Health) - Being married, or ever having been married, comes with a much lower risk of developing dementia compared to being a lifelong bachelor or bachelorette, a new analysis of previous studies suggests.

Researchers found that people who never married were 42 percent more likely than those who were married at midlife to ever be diagnosed with dementia. Being divorced, though, was not tied to higher dementia risk compared with the folks who stayed married.

“Our findings, from large populations across numerous countries and time periods, are the strongest evidence yet that married people are less likely to develop dementia. We can be fairly certain of this considering that we have looked at close to a million people,” said lead author Dr. Andrew Sommerlad of University College, London.

“What we can’t be certain of in this study is what the explanation for this is,” he said in a phone interview.

Sommerlad and his team analyzed 15 studies published up to the end of 2016 that looked at the potential role of marital status on dementia risk. The new analysis included more than 812,000 participants in those studies, half of whom were 65 years of age or older. The studies were done in Europe, North and South America and Asia.

Although one study from Sweden contributed the vast majority of participants, the other studies were also broadly in agreement with the results of that one, the authors note in the Journal of Neurology, Neurosurgery & Psychiatry.

“There’s a huge literature showing that marriage is beneficial for health in lots of different ways,” said Joan Monin of the Yale School of Public Health in New Haven, Connecticut, who wasn’t involved in the study. “Spouses share specific healthy behaviors for wellbeing like engaging in physical activities, watching their diet and limiting substance abuse,” she said in a phone interview.

The widowed have a 20 percent increased risk of developing dementia compared with married individuals, Sommerlad noted. He speculates that this may be due to the stress of bereavement, or a longer-term effect.

As for the lack of difference between married people and those who divorced, Sommerlad attributes it to the possibility that a lot of divorced people continue to keep in contact with each other, especially if they have children together.

Social isolation is one of the nine risk factors for dementia identified by the Lancet Commission on Dementia, Prevention, Intervention and Care in July.

Worldwide there are nearly 47 million people living with dementia, or a loss of brain function, including memory, thinking and behavior, according to the World Health Organization. Alzheimer’s disease is the most common cause of dementia.

Sommerlad emphasized that no cause-and-effect conclusions can be drawn from his team’s analysis because it’s not known what underpins the results. Another limitation is that the included studies lacked information about the duration of widowhood and divorce as well as the nature of the marriages.

“The institution of marriage is undergoing rapid changes with the acceptance of same-sex marriages and alternatives to marriage, such as cohabitation,” Dr. Christopher Chen of the Yong Loo Lin School of Medicine at the National University of Singapore and a co-author write in an editorial accompanying the study.

“There have been large changes in society so we need to be aware that the conclusions may not be as relevant,” Chen told Reuters Health by email.

SOURCE: Reuters, Cheryl Platzman Weinstock

Half of care homes failing in parts of England

 Which? investigation of care home inspections data reveals postcode lottery of care home quality across England

 More than half of care home places in some parts of England are in facilities rated as ‘inadequate’ or ‘requiring improvement’, according to analysis carried out by Which? of data released by the Care Quality Commission (CQC).

In six local authority areas, good quality care home places are so limited that 50% or more of local beds are in homes rated by CQC inspectors as requiring improvement or inadequate, making it less likely that people looking to move into a care home will able to find a good place close to home. 

The lack of good quality care is particularly acute in the London borough of Westminster, where seven in ten (69%) beds were found in care homes rated poor or inadequate. In Manchester and Wakefield, three in five beds (58%) are in care homes rated as poor or inadequate, closely followed by Kirklees (57%), Portsmouth (56%) and Tameside (55%). With demand for beds set to rise, the time for action is now.

Poor quality care homes

In 45 local authority areas a third or more care places are in poor quality care homes. Nine of these councils are in the capital and include Westminster (69% of beds are in failing homes), Tower Hamlets (48%), Islington (47%), Kensington and Chelsea (46%), Newham (41%), Haringey (41%), Barnet (40%), Ealing (35%) and Harrow (33%). While the research, which compared the quality of local provision in 151 council areas that provide adult social care, provides some worrying figures, there are a small number of areas where at least nine in 10 care home beds are in homes rated as good or outstanding. 

These include the Isles of Scilly (100%), Richmond upon Thames (94%), Rutland (91%) and Blackburn with Darwen (90%). Overall, the analysis highlights the huge regional variation in the provision of quality local care across the country that exists in the current care market.

Care provision ‘could get worse’

Which? has already heard from hundreds of relatives of care home residents, who have highlighted existing problems in the current care system. Some have had to wait years to find a suitable care home or have had to place their relative far away, as there was no suitable place available locally. Which? is warning that this picture could get worse, as the demand for places starts to outstrip supply in an increasing number of local areas.

 

Previous Which? research shows that almost nine in 10 council areas across England could see a shortfall in care home places by 2022. The research also raises questions around whether some councils will be able to continue to meet their statutory duty to offer local authority-funded individuals at least one suitable care home place that will meet the prospective resident’s needs.

SOURCE: Which, Joanna Pearl