For carers of elders in Oxon/Bucks & beyond

How your GP can help you and your elder

While the gateway to older adult social support in different local authorities (LA’s) varies across the UK, the older adult’s GP is the only gateway to all health services, whatever your LA.

If you are starting to take on a little caring responsibility, even if it’s ‘just’ popping in from time to time, it’s likely that your elder will welcome you joining them for any GP appointments.  If your elder cannot travel to the surgery easily, it’s a good idea to arrange a GP appointment on behalf of your elder, perhaps a double appointment (20mins) and for you to go.  Explain your relationship to the GP (take the health LPA with you if you have one) and share your elder’s health status, health concerns, current or future treatment and ask for the GP’s opinion and about potentially useful local health services too.

When you see your elder’s GP, ask about your elder’s:

• current health issues, their treatment or management 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 has not been one recently.  Are there any easily treatable vitamin or mineral deficiencies that can impact older people, eg B12, D, Iron.
• repeat prescriptions and how they are reordered (by phone or online) and whether a home delivery service can be set up to make things easier. I am currently investigating whether my GP will support the pharmacy2u service to save me a monthly trip to the surgery.  Once drugs are prescribed, it is very important they are taken consistently, at the right time every day, for them to be effective.  Discuss this with the GP as you may need to investigate appropriate medicine dispensers and/or reminders.
• continence support.  Marj saved £85 a month which she put towards her home care by accessing the local continence service through her GP.  Every 3 months I ring the local adult community healthcare team to say we still need pants and then three months’ supply of pants are delivered free of charge.  Let me tell you, that’s a lot of pants (270 to be exact), you are going to need to find storage. People living with dementia qualify for this service, but other conditions may qualify too.  The great thing about Bucks is that Marj can have the brand she prefers rather than the NHS ‘standard issue’ which is not so comfortable I’ve heard (I’ve not seen them though).  Check whether your elder can choose the brand too or trial a variety for fit and functionality. Simply choosing a larger size made things a lot more comfortable and secure for us. Before we discovered and accessed the continence service (incidentally, years after Marj needed and was eligible for it), we ordered 6 packs for the price of 5 every month from Boots.
• 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, the GP is likely to have some useful local knowledge and there are signs of increasing, though patchy, collaboration (yaye).

If you are already concerned about your elder’s health or behaviour for some reason, arrange to take a urine sample to the GP on behalf of the elder as it’s likely you will be asked for one and this will save you a return trip.  You can take the sample in any clean, labelled, sealed vessel and pick up a couple of sample pots when you at the GP’s for next time.  Urinary Tract Infections (UTIs) are a too common cause of a wide range of distressing symptoms for older people and can even mimic dementia symptoms too.

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

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

Here’s a naughty but handy tip, please don’t let on I told you.  One winter, years ago now when Marj and other family members were constantly getting really sick (and I don’t mean just heavy colds), I booked GP appointments in advance, every two weeks.  Whoever needed the appointment went to it, which did surprise the GP I have to say, though they kindly agreed to continue with the consultation anyway. Of course if no one needed the appointment, I cancelled it as early as possible to free it up for someone else.  This a last resort and is only for extreme circumstances as I’m sure the GP practise would have rumbled me if I’d done this for too long.

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

Bigger support from NHS continuing healthcare

If your elder qualifies for NHS ‘continuing care’ then their care is fully paid for by the NHS.  That means that unlike social care, their assets and income are not taken into account nor are they used to fund the care they receive.  It goes without saying that this ‘free care’ is a very attractive option for families.

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 on it.  While it is free of charge, I hear application isn’t straightforward and it’s very hard to get. Consent is needed from the patient or whomever holds power of attorney, there is a national screening continuing care checklist and then there is a full eligibility assessment using the ‘Decision Support Tool’ (?) which is often carried out by a health professional.  Nevertheless, please don’t be put off.

When an elder needs care and support for a healthcare need, the theory is that this is paid for by the NHS, which is why it isn’t means tested (healthcare still being free at ‘point of delivery’ in the UK). The elder is first screened to see if they’re eligible for an assessment.  Their care needs have to be primarily due to poor health and this is measured in terms of:

• Its nature [the type of condition or treatment required (quality and quantity)].
• Its complexity (symptoms that interact, hard to manage/control)
• Its intensity (one or more health needs, so severe they require regular intervention)
• Its 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.  It’s not about the diagnosis but about the manageability of the condition.  It may also not be a permanent ‘benefit’ to be relied upon, and could be withdrawn at any time, which has drawn criticism.

If you think your elder may be eligible, your first step is to discuss it with your GP.  Apply sooner rather than later as I hear it is a lengthy process.  Be tenacious.

In an excerpt from The Sunday Times 25/3/18, the NHS comes in for criticism about not raising the profile of ‘continuing healthcare’ more and the complexity involved in applying for it. Here is the article…

Mental health support eg dementia

Thank goodness the 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 under older adult mental health services (not by the older adult social care service).

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

Your elder may also be referred to a ‘memory clinic’ from which 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 some verbal and written tests, which of course is worrisome, so you’ll need to accompany and provide reassurance. If the tester is skilled and sensitive, this need not be too onerous. Drugs or a CT scan may or may not be prescribed as a consequence. Ask about the likely impact of any drugs prescribed and their side effects and discuss these before taking them.  If the side effects turn out to be too distressing (we are all affected differently by drugs), then do ask about alternatives.  Your elder is usually then 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 that.

Bucks Mind provides older adult counselling services too.

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

Your advocacy

Lastly, whatever health support your elder needs, you are going to increasingly need to be their advocate.  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 may give health professionals, especially those in authority, a little too much deference and not speak up even when they have a concern.  Try to 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 important during a hospital admission.

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

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

Good luck in keeping well.

Love,

PS, if are under any impression I am a qualified medical professional, I am not.  Please always seek your GPs advice.