NHS health care older adult carer chc continuous health care

The gateway to older adult social support varies across the UK from local authority to local authority (LA).  The GP is the gateway to all health services, whatever your LA.  Find out how to get the most from your GP in this post.

How your GP can help you and your elder

It’s likely that your elder will welcome or need you to join them at GP appointments, especially if your elder can’t travel to the surgery easily.  They may need help arranging GP appointments too.  Try booking double appointments (20mins) if there’s a complex topic to discuss.

Explain your relationship with the elder to the GP (take the health LPA with you if you have one). Help share your elder’s health status, concerns, current or future treatment.

At the GP surgery, ask about:

  • Current health issues, meds or treatment and whether a review is due. All adults over 40yrs are entitled to an annual health check at their GP surgery.
  • Recent blood tests and what they revealed.  Consider arranging a blood test if there hasn’t been one recently.  There are treatable vitamin or mineral deficiencies that can impact older people, eg B12, D, Iron.
  • Repeat prescriptions re-ordering services (phone or online).  Can a home delivery can be set up to make things easier? Unfortunately my GP doesn’t support the new pharmacy2u service.  This is unhelpful of them.  My surgery says there have been issues with accuracy, but in my experience that can happen anyway. Fortunately many surgeries do support pharmacy2u, so ask your own GP. It’s important that prescribed drugs are taken consistently, at the right time, every day to be effective. Some medicines with strong side effects are better taken at bedtime. Discuss this with the GP and choose medicine dispensers and/or reminders to help.
  • Free continence support, use this link.
  • Access to social care support (occupational therapist assessment, care at home or moving to a care home) if likely to be needed in the short term.  While GP’s aren’t responsible for social care they’re likely to have useful local knowledge. There are signs of increasing collaboration too (yaye).

If you’re already concerned about your elder’s health or behaviour, arrange to take a urine sample to the GP on the elder’s behalf as it’s likely you will be asked for one.  It’ll save a return trip.  You can take the sample in any clean, labelled, sealed vessel and pick up a couple of sample pots when you’re at the GP’s for next time.  Urinary Tract Infections (UTIs) are an extremely common cause of a wide range of distressing symptoms for older people.  The symptoms can even mimic severe dementia. See post 29 for more on the importance of hydration and the extra care needed in high temperatures.

And for goodness sake, please let your own GP practise know that you are a carer.  GP surgeries hold a carers register and are increasingly organised to support carers better.  Some are more advanced than others.  At the very least you’ll be eligible for free flu jabs to help keep you on your feet in winter.

Marj and I share a GP which is helpful in many ways, but somewhat unusual nowadays with families tending to be scattered geographically.  If you do live close by or with your elder, consider using the same GP.  When our GP has popped out to see Marj at our home, she’s also given me a quick consultation (both kind and time saving).

Here’s a naughty but handy tip, don’t let on I told you.  One winter, years ago when Marj and other family members were constantly getting really sick (beyond usual viruses), I booked fortnightly GP appointments in advance.  Whoever needed the appointment went to it, which did surprise the GP a couple of times. They kindly agreed to continue with the consultation anyway. Of course if no one needed the appointment, I cancelled it early to free up the time.  This a last resort and is only for extreme circumstances.  The GP practise would have rumbled me if I’d done this for too long.

It’s a really good idea to keep your GP and their team ‘on side’, you never know when you’ll need a favour.  I’d advise nurturing a good relationship, being reasonable and never taking the mick.

NHS health care older adult carer chc continuous health care

Support from NHS continuing healthcare

When an elder (or anyone) needs care and support for a healthcare need, the theory is that this is paid for by the NHS. This is because healthcare is free at ‘point of delivery’ in the UK, as you’ll already know.

If your elder has a critical medical condition like a stroke and can’t manage without high-dependency nursing care, the burden of care moves from Social Services to the NHS. If your elder qualifies for NHS ‘continuing healthcare’ (CHC) then their care is fully paid for by the NHS.  This means that, unlike social care support, there is no means testing.  Assets and income are not taken into account nor are they used to fund the care received.

This ‘free care’ is a very attractive option for families.

In theory, an older adult can receive NHS continuing healthcare in any setting (in their own home or a care home).  Here is the AVDC (Aylesbury Vale District Council) position.  While it’s free of charge, I hear application isn’t straightforward and it’s very hard to get. The patient or whomever holds power of attorney needs to consent, the elder must pass through a national screening continuing care checklist and a full eligibility assessment.  A health professional tends to carry out the eligibility assessment using ‘the Decision Support Tool’ (?).

All this screening aims to confirm whether care needs are primarily due to poor health, measured in terms of its:

  • nature [the type of condition or treatment required (quality and quantity)].
  • complexity (symptoms that interact, hard to manage/control)
  • intensity (one or more health needs, so severe they require regular intervention)
  • unpredictability (unexpected changes in condition that are difficult to manage and present a risk to self or others).

So, for example, help with washing and dressing is a social need not a healthcare need.  Another way of thinking about it is that it’s not about the medical diagnosis itself but about the manageability of the condition. Funding is not automatically granted if you have been diagnosed with a particular condition, like dementia. Importantly, this is not a permanent ‘benefit’ to be relied upon and can be withdrawn at any time after a regular reassessment.  This has drawn criticism.

Nevertheless, please don’t be put off.

If you think your elder may be eligible (many who are may be missing out), your first step is to discuss CHC with the GP.  Apply sooner rather than later as I hear it is a lengthy process.  Funding is scarce and local health authorities are overwhelmed by demand. As always, be tenacious.

In an excerpt from The Sunday Times 25/3/18, the NHS came in for criticism about not raising the profile of CHC and the complexity involved in applying for it. CHC is also inconsistent in its assessment across different LAs and can pit health professionals, LAs and families against each other. Here’s the article…

NHS health care older adult carer chc continuous health care

Mental health support eg for dementia

Thankfully stigma around mental health is being slowly chipped away. Please ask for help if an elder’s behaviours are changing rapidly, they should be supported by their local mental health team. Responsibility for chronic brain diseases like dementia is held by older adult mental health services (not by the older adult social care service).

You can’t self-refer for mental health support, you can only be referred by your GP.  The Oxford Health Foundation Trust (OHFT) manages the Community Mental Health Team across both Oxon and Bucks.  Here’s detail from AVDC.  After a GP referral, your elder may be assigned a care coordinator.

Your elder may be referred to a ‘memory clinic’ from where chronic brain diseases are diagnosed and managed, at least initially.  Marj went to the memory clinic at Stoke Mandeville.  This is what the OHFT says about their memory service.  Expect your elder to undergo verbal and written tests. This is worrisome, so do go with for support and reassurance as some testers’ skills and sensitivity could be improved.

A CT scan may or may not be offered. Ask about the likely impact of any prescribed drugs, their side effects and discuss these before taking them.  If the side effects are distressing (we’re all affected differently by drugs) then ask about alternatives.  Your elder is then usually discharged back into the care of the GP until their condition becomes unmanageable, if at all.

In Bucks, an elder can self-refer to ‘Healthy Minds’ which is a free cognitive behavioural therapy (CBT) and counselling service, which is very helpful for many people.  Do consider.

Bucks Mind provides older adult counselling services too.

And lastly, be openminded about antidepressants which can be beneficial for some people.

Your advocacy

Whatever health support your elder needs, you’ll be increasingly needed to advocate on their behalf.  When it comes to keeping your elder well, your opinion is as important as any health professionals and should be taken into consideration.

Our elders sometimes show over deference to health professionals, especially those in authority, and may not speak up.  Take the time to understand any worries before a medical consultation, even if it’s in the car on the way there. Your advocacy is even more critical during a hospital admission.

If you live far from the elder you care for, google for organisations that can provide local advocacy.  I met the awesome Barbara, CEO of a Bucks charity Voices and Choices earlier this year who recruits and trains volunteers to provide this vital service.

Bucks Carers also have a carers lounge in Stoke Mandeville hospital to support you.

Keep well.



PS. Always seek your GPs advice on healthcare matters first.