Who takes care of the carer?

A few years ago, my Dad was suffering with heartburn and was having difficulties with swallowing. He was diagnosed with oesophageal cancer. Due to his age (69) he was not able to have an operation to remove the tumour and therefore started aggressive chemotherapy.

My mum, already retired, became a full-time carer. Both of their worlds completely changed. Mum was fit and healthy and very independent, attending her gym and tai chi and visiting me and my brother who now live far away. As time went on, she lost everything due to Dad’s illness.

After a few months, Dad stopped being able to eat entirely and was fed through a tube. He suffered terribly with the chemotherapy and, despite three rounds, it did not shrink the tumour. Dad lived another 18 months, deteriorating during this time.

My Mum received excellent support from local health services and Dad’s Macmillan nurse. Dad tried attending the local hospice for a few afternoons but didn’t like it so Mum had no respite from him. He was both physically and psychologically demanding, as you can imagine. Marie Curie nurses were also an outstanding support to us in his last few weeks, as they took over the night shift. Because of their support, Dad was able to die at home.

Mum and Dad were typical Care & Repair clients. They had both worked all their lives and owned their own home. Dad was a mechanic and was able to maintain their large three bedroomed house until their crisis occurred. They had never received any statutory services or benefits and were therefore unaware of how to access support.

Due to where they lived in England, they did not have access to Care & Repair services like the Care & Repair services we manage here in Wales. Upon leaving hospital after falling and breaking his leg, Dad would have been eligible for our Rapid Response Adaptations Programme for adaptations to help him and Mum move him safely around the home. Care & Repair would have helped to move the bed downstairs when necessary and would have supported Mum to access Attendance Allowance to fund the extra costs of caring for Dad. They could also have provided advice about the other services which Mum could access to support her needs as a carer. All of these things, of course, were implemented for Mum and Dad, but nowhere near as quickly and as smoothly as they would have been if they had one Agency like Care & Repair to manage this practical support.

Three years on; Mum lives alone. Her health suffered during the first few years but now she is back to her independent self. She not only lost Dad but lost all of her networks due to caring for Dad, so she has had to work hard at developing her own life again. What does she find most difficult? The answer is managing a three bedroom house and a garden, alone, without a Care & Repair handyperson to trust to do small jobs around the house and without a Care & Repair service to support her through larger works.

I wrote this blog to highlight the amazing work of carers and the agencies which supported Mum to care for Dad and allow him to die at home. I also wrote it to highlight the work of Care & Repair in Wales and why it is imperative that our services are protected in order to support the ever increasing numbers of older people in Wales to live their independent lives.

Rachel Gingell
Policy Officer, Care & Repair Cymru 

Care & Repair doctoral research project

The Care & Repair Swansea University Doctoral Research project is now live! Given many of the headline messages from social policy and Welsh Government strategy relating to housing, health, social services and primary care, around a community-based social model of healthcare and public service integration, this is an exciting opportunity. Detailed work around our main activity as a frontline, home-visiting casework service will undoubtedly trace a bigger community footprint, which should be useful for policy development at a crucial stage in the debate around future-proofing public services.

Care & Repair agencies provide a unique and standard approach to the housing, environmental and living circumstances of older people. It is a blended approach, combining social care and technical housing fabric to provide a person-centred and problem-led approach. The older person receives an individually tailored, bespoke service. This has always appeared to work well. However, in a world of integrated approaches, shrinking public investment and competitive approaches, does it still work? ‘Bespoke’ is an old-fashioned and possibly hackneyed term, so are we becoming an old-fashioned service? In a fast-moving world, where the old artisan and craft skills are disappearing, will our approach end up as ‘time consuming’ and ‘over promising and under delivering’? Living under the big community tent and marshalled by statutory partners, are we a pivotal hub and close to the tent pole, or are we a cheap resource, disappearing at the edge of the camp like a flapping guy-rope?

My take on our ‘big offer’ is that we are the most modern of public sector organisations, anticipating important strategic trends and in the vanguard of change. We are defined by our partnerships and our collaborative efforts - in the best sense, ‘co-production’ in action. Seeking to build service capacity, we were a ‘social enterprise’ brand before the social entrepreneurs moved in. If you are looking to define prevention, we are responding to the real challenges older people face before they escalate into crises. If we deconstruct the pseudo-sociological concepts of ‘social model’-speak, we are a plain-talking, honest and accessible community delivery model. For the 12,000 older people we visit in their homes each year, we are a future-proofing service, keeping them ‘ahead of the curve’ rather than ‘stuck in the past’. I would say that, wouldn’t I? What do you think? This is an opportunity to say what you want as research student Joanna Wolton begins her investigations.

Neil Williams
Head of Agency Performance and Funding, Care & Repair Cymru

At this early stage, please leave a comment on the blog if you'd like any further information. 

Winter is coming...

Jon Snow knew much of the perils that lurked in the coming winter. With his battle-hardened peers in the Night’s Watch, he could see from the wall, and through forays beyond, the danger that made its home in the cold and ice. But, apart from a bad case of frostbite, what did Jon Snow and those around him suffer as a result of? Well, a lack of shared ownership of the problem, poor collaboration and, as the issues intensified, a failure to use dwindling resources in a different, more efficient way.

You wouldn’t find many of us looking pensively into the distance, muttering 'winter is coming' during August. But, let’s face it, he had the right idea. We should have a joint sense of urgency, readiness and understanding of the challenges unique to this time of year.

Outside the world of  'Game of Thrones', the statistics around fuel poverty and winter deaths are sobering. In 2012, 30% of households in Wales (386,000 households) were estimated to be in fuel poverty. This is the equivalent to 54,000 more households than in 2008. Rising fuel prices have largely been counteracted by the increases in income and energy efficiency savings in the housing stock, and this has led to the increase in the number of fuel poor households.

Fuel poverty is a significant cause of excess winter deaths and, in 2012/13, there were 1,900 excess winter deaths in Wales. This was a 32% fall from the previous winter, which had seen the highest number since 1999/2000, but still above the 10 year average. 89% of these deaths involved people aged 65 or over, with the highest rate amongst those over 85 who constituted nearly 60% of the total.

There is much being done in an attempt to reduce these figures. For example, Care & Repair Cymru works with older people across Wales to support them to live in warm, safe and secure homes. This work is continued throughout the year; however, it is particularly pertinent heading toward the winter months. This year, Care & Repair agencies are offering free winter warm packs, containing a blanket and hot water bottle. These packs help to promote Care & Repair agencies as a service to help older people prepare for and manage safely through the winter.

Housing associations are doing much to offset the impact of fuel poverty, including:

• Improving the energy efficiency of homes through the Welsh Housing Quality Standard and energy programmes such as Arbed
• Helping tenants maximise their income through projects such as the Your Benefits are Changing (YBAC) campaign. YBAC helps tenants to claim benefits they are entitled to. One area of success has been the identification of the Warm Home Discount - YBAC last year successfully assisted over 914 people to claim a rebate which equates to an annual sum of £127,960. 
• Helping to try to negate energy price increases through such actions as behavioural change for energy use. 

Across public services, the impacts of winter are likely to be felt more profoundly in the Welsh NHS. Winter preparedness is a key task for Health Boards, and a hot topic within the media and public sphere. But it’s important, particularly now in the context of prudent healthcare, that we all take responsibility as individuals and organisations to meeting the winter challenge.

In terms of working with housing associations:

• Creating capacity for step down accommodation in Extra Care and Sheltered Housing
• Placing housing professionals within hospital discharge teams to decrease delayed transfer of care
• Working with housing associations to facilitate and coordinate community activity during the winter months
• Partnering to ensure that advice and information is accessible in a range of community settings and media formats. 

Of course, this should all rightly go beyond what we plan as organisations and a mix of services. Last year, Public Health England called for 100,000 people to check on neighbours over the winter months.

We should be using this time to reignite our sense of community, decrease loneliness and isolation during months when these may be felt more profoundly and together contribute to managing the demand on GP or A&E service during these months. Everyone can help, from championing local services, clearing roads, communal snowman building, committing your long term future to the Night’s Watch – it’s the small gestures that will truly make a difference this Christmas. It could put a smile on someone’s face, it could save a life.

Matthew Kennedy
Policy Officer: Care, Support and Health

Prudent healthcare - a new approach

On a sunny afternoon in July 2013 we held our first Health & Housing conference – celebrating the 65th Birthday of the NHS. Housing associations have and continue to be vital partners of the health service. This year we broaden the scope and equally the message - health, housing and social care - doing the right thing at the right time.

It’s fair to say the last year has been a trying time for the NHS with high profile inquiries into standards of care, ambulances queuing outside hospital doors, and difficulties for most local health boards in balancing their books. On the flip side we've also seen an NHS that has taken action to change how services are delivered, engaged with political scrutiny on various areas of work and continued to deliver excellent levels of care to people in Wales.

That's not to paint over the cracks; there are clearly challenges around increasing demand and dwindling resources. Housing associations can and many are already helping to reduce this demand. The good news is that the links are simple, worryingly simple in fact, and as housing associations we need our health board colleagues to sit up and take notice when we say we can help with respite care, reducing delayed transfer of care and providing preventative services - which means people not turning up at their GP surgery, or their hospital A&E service.

At CHC we’ve worked with members to highlight the massive impact housing associations have on the health and wellbeing of the individuals and communities they work with. It really is about more than bricks and mortar. Housing associations have become experts at working closely with tenants, community regeneration and providing innovative care services.

Local health boards in Wales have taken advantage of these links in some areas as we highlight in the briefing launched at today's conference - Partnerships to deliver the NHS required now and in the future.

This publication doesn't pull any punches; it rightly doesn’t water down messages but highlights that there is highly positive work and projects taking place – but we can and must do more. As organisations and sectors, we serve people with multiple needs through a wide range of services and there are clearly opportunities to better coordinate how services are delivered by the right person at the right time.

Prudent Healthcare ushers in a new approach to providing healthcare which places the individual at the heart of service delivery, with responsibility on services to do only what is necessary and for individuals to take responsibility for their own health behaviours. In terms of the future of how health and housing work together, there should be no mistake that we are central to this approach - prudency is after all at the heart of what housing associations do.

Matt Kennedy
Policy Officer: Care, Support and Health 

Cardiff's Healthy @ Home Service - doing the right thing at the right time

Housing and health are closely linked and health related work has become a key part of what we in Care & Repair do, both to improve people’s overall health and to make them safer in their home by preventing accidents and potential hospital admission. Because we visit older people in their own homes, we have the ideal opportunity to discuss a range of healthy issues as well as their housing needs.

The Healthy @ Home Casework service is a partnership project, funded by the Welsh Government’s Intermediate Care Fund, which works with GP surgeries across Cardiff to offer the Care & Repair service to their patients on their 75th birthday. During the home visit to the client, we can offer a range of services that may be of interest to them now or in the future. Our aim is to support the client to stay safely living at home for longer, thus having a long term positive impact on their health and wellbeing.

We all know the saying: prevention is better than cure. Our service gives us access to older people who may benefit from our services and those of other organisations at an early stage to support them living independently and to prevent them from reaching a crisis situation in their home.

As well as discussing home repairs, maintenance and adaptations, we provide assistance with welfare benefits, home safety and fire safety checks and information on health and well being. If relevant, people are assessed for falls and referred back to their GP for a follow up appointment. Our project is unique in Cardiff and of real benefit and help to older people.

During our home visit, the Healthy @ Home Caseworker will listen to what the client wants and needs, will make suggestions and offer solutions to address these issues. By addressing the needs of clients, we undertake and organise a variety of direct interventions or make referrals to existing voluntary and statutory agencies to draw in and co-ordinate with other services as appropriate. Through partnership working with other voluntary and statutory agencies, we can provide the right assistance at the right time.

There is so much information available, much of which is, or seen by our clients as, complex. Many clients are not accessing schemes due to a misunderstanding of the referral process.

It is our experience that our clients still prefer a home visit where someone speaks to them face to face, someone who is willing to understand and discuss their needs. That someone is a Care & Repair Healthy @ Home caseworker.

Julie Swain
Senior Caseworker, Care & Repair Cardiff

Reducing the risk of falling

As we grow older, gradual changes to our health and the medications we take can contribute to an increased risk of falling.

Every year, around one in three over-65s living in the community and one in two people aged over 85 will have a fall.

There are many reasons why the risk of falls and fractures increases with age, including weaker bones and muscles and being less mobile. However, many falls can be prevented and are often due to hazards that are easy to overlook but equally easy to fix.

Falls Awareness Week 2014 is about helping to reduce the risk of falls among older people by identifying some of those fixes.

There are many simple changes you can make around your home to reduce the risk of falls – indoors and out.

Checking for hazards which can cause a slip, trip or fall on floors, steps and stairs in the bathroom, bedroom, kitchen and garden can help you to reduce the risk of falling.

It is also important to look at and address the fear of falling that some people may have. This anxiety may stem from having already had a fall and can lead to older people losing confidence and becoming isolated and depressed.

We also need to consider the role that medication can play in falls. Some medications including sedatives or strong painkillers can cause drowsiness, while others may alter your vision, hearing or concentration.

If you are worried about falls, Age Cymru has produced a guide called ‘Avoiding slips, trips and falls’. It gives tips on how to reduce the risk of falling at home and includes a self-assessment form about your general wellbeing.

‘Avoiding slips, trips and falls’ is available for free from Age Cymru’s Healthy Ageing Team by contacting them on 029 2043 1555, or emailing ageingwell@agecymru.org.uk. You can also download it from the Age Cymru website – www.agecymru.org.uk.


Rosalyn Williams
Health Initiatives Officer, Age Cymru

Stepping stones to falls prevention

Older people have a right to expect the highest possible quality of life. Sadly a lot of older people have slips, trips or falls and falling can badly damage a person’s quality of life and level of independence.

Falls are not necessarily a natural consequence of ageing and many can be prevented through simple lifestyle changes.

A fall is often the trigger to make people look at their life and take the opportunity to improve their health and fitness and hopefully prevent themselves falling again.

In Bridgend, as part of a falls prevention project, a folder of information has been developed. The aim of the information is to enable people to get the help they need in the Bridgend County Borough Council area as well as good advice e.g. how to adapt their home environment, how to get up if they fall, strength and balance exercises for healthy ageing.

Here are some top tips on preventing slips, trips and falls:

• Remove or tape down loose rugs to avoid slips and trips
• Wipe up floor spills straight away 
• Minimise bending/climbing  
• If you must climb, use proper steps 
• Get up from chairs/bed slowly 
• Have a regular eye test/wear your spectacles and make sure they are clean 
• Avoid trailing clothes which may trip you up 
• Don’t wear sloppy slippers, buy a new pair that fit well 
• Keep stairs free from clutter 
• Keep stairways and halls well lit 
• If prescribed medication is making you feel dizzy, keep taking it, but consult your GP 
• Be aware of pets. Dogs and cats can cause trips and fall if they are around your feet

If you do have a fall:

• Don’t panic – you will probably feel a little shocked and shaken but try and stay calm
• If unhurt look for something to look onto 
• Hold onto a firm object for support, place one foot flat on the floor with the knee bent in front of the body 
• Lean forward putting weight on hands and foot until it is possible to place other foot beside the one on the floor and stand up slowly 
• Sit down and rest for a short time

In Bridgend the Bridgelink Telecare service is a home and personal alarm service which, in the event of an emergency/fall, can automatically contact a 24hour control centre to call assistance. A mobile response team is also available to assist. This service has prevented many hospital admissions and ambulance call outs as the mobile response team, following an assessment, have equipment that enables them to pick a client up from the floor, if they have fallen, to a bed or chair. This service is administered, installed and maintained by Bridgend County Care and Repair.

Health, social care and voluntary agencies are now all actively involved in falls prevention campaigns across Bridgend County Borough Council, the aim being to develop a robust Integrated Falls Pathway for the people of Bridgend.


Anita Williams
Agency Occupational Therapist/Falls Coordinator
Bridgend County Care and Repair

1 in 8 adults in Wales are carers... did you know?

Carers Week is a celebration of the contribution the 370,000 unpaid family carers in Wales make to society on a daily basis. They provide hours of personal care, physical and emotional support, help with finances, checking on medication and a whole range of other practical support, which saves the state millions of pounds every year. 100s of local events are being held across Wales throughout the week.

Wales is a caring nation but there are big challenges ahead. A Carers Week/You Gov poll this week found that the majority of adults in Wales vastly underestimate the number of carers there are in Wales (most said 1 in 25 when in fact 1 in 8 of us are carers). The same poll showed that most adults in Wales do not think that they will ever become a carer, when in reality over 60% of us will at some point.

The IPPR Generation Strain report 2014 highlighted recently that many more adult children caring for elderly parents will have to provide more care for longer, carers of working age will increasingly struggle to balance care and more older people themselves will be carers.

All of which highlights the need for carers to be 'Prepared to Care' so that we can all make decisions in a planned and considered way rather than in a crisis.

Caring has always been a mixture of caring 'for' and 'about' someone but carers need to be prepared for the emotional, practical and financial implications caring can have. Unfortunately the Carers Week/You Gov poll also found that over half of current carers in Wales say that they do not receive enough support to do the role well. Carers’ biggest worries were money matters, the emotional strain of caring and not having the right skills for their role. They also said that the most important thing for them would be to know exactly what help is available right from the start.

Health and Local Authorities have a huge role to play, of course, but the third sector also plays a big part in supporting carers across Wales. Organisations such as Carers Wales, Carers Trust, MS Society, Macmillan, Marie Curie, Parkinsons UK, Stroke Association, Age Cymru, Alzheimer’s Society, Care & Repair Cymru and others all provide vital services to carers.

We all have two years to plan for the implementation of the Social Services and Wellbeing (Wales) Act 2014, which will bring major changes to social care in Wales, and the third sector will be keen to contribute fully. Although fundamental questions still remain about how, as a society, we invest in social care to meet the needs of carers and those they care for.

Keith Bowen

Director

Carers Wales

Homeless prevention - at the heart of what we do

In the summer of 2013, Community Housing Cymru commissioned research in partnership with the WLGA, funded by Welsh Government, to explore the opportunity for greater collaboration between housing associations and local authorities.

Reflecting on this, it's fair to say that the research challenges the sector and local authorities by, to some extent, putting the writing on the wall over what works and what doesn't. It highlights some issues around consistency, roles and responsibility and some contrasting priorities. But it also demonstrates the high volume of innovative projects that local authorities and housing associations have worked on together in using housing stock and the generally positive relationships that exist between housing associations and local authorities in Wales.

The workshop sessions conducted for the research revealed that some local authorities are concerned that with increasing pressure on housing association rental income, this will increasingly become the focus of business. It's important that we put such concerns to rest.

We've always said we're more about bricks and mortar and we've consistently shown this to be the case - you just need to look at the regeneration, innovative care provision, financial and digital inclusion initiatives, employment and skills projects provided by the sector to understand what housing associations are about. It's more than tackling homelessness - for our members it's about supporting individuals to build fulfilling, rewarding lives.

We know that Supporting People funding will also continue to be an important part of how we provide accommodation and support and the new collaborative arrangements which drive how this funding is used should be an opportunity to build and spread the highly positive practice that exists, much of which is highlighted in the report.

Welfare reform continues to be a shadow over the sector which, in the context of homelessness, undermines the ability of local authorities to house individuals quickly and reduce demand on temporary accommodation due to the 'bedroom tax'.

CHC will continue to challenge and support our members to deliver more, and explore new ways of delivering projects to meet increasing demand on both our own and other sectors. It's clear that the homelessness challenge facing Wales will continue to require dynamic thinking from housing, health, the third sector and Welsh Government to drive improvement in how we do things. It’s true that public services in many instances have no option but to change, so if we can’t control that then we should seek to control how we change in an informed way. This research is a stepping stone to doing that in the context of homelessness.

You can read the full report here.


Matt Kennedy
Policy Officer: Care, Support and Health

Why we need to make every visit count

During such difficult economic times, with public service budgets under severe pressure, there are many reasons why we must make every visit count. First and foremost, for our clients. Care & Repair in Wales visit around 30,000 clients every year and this is the opportunity for our caseworkers and technical officers to discuss what their concerns are and take action, either directly through Care & Repair’s services or in partnership with others who can help. We need to make visits count by comprehensively tackling the range of problems and concerns identified. These include: 'I’m worried about paying my gas and electricity bill'; 'what will I do this winter when it’s freezing again?'; 'how am I going to get my leaking roof seen to?'; 'I can’t use my bath anymore' and 'who can help me repair my broken steps?' For the sake of our clients, we aim to efficiently resolve as many of these problems as we can, either directly or making sure that we refer to other third sector organisations, local authority and health professionals if we can't.

Making every visit count is also about making it count in financial terms. Our services prevent or reduce admissions to hospital and residential care by making the home environment accessible, warm, safe and secure. What counts here is the way in which helping older people to live independently in their own homes can take pressure off Health and Social Care services by preventing falls, preventing cold-related respiratory and circulatory illness, or by preventing the need for residential care by making the home safe and accessible. This makes every visit count for public finances.

Making every visit count is about providing comprehensive solutions to older people who need our help. It’s about being efficient and about working in partnership with others. And finally, it’s about providing solutions to help older people to live independently and reduce demand for Health and Social Services who find themselves under increasing pressure.


Chris Jones
Chief Executive, Care & Repair Cymru

Care & Repair Cymru's conference, Every Visit Counts, took place on 18/19 September in Wrexham. Did you attend? Look out for a blog post on issues discussed at the conference!

What are the current challenges for the new Health Minister?

I have taken on the role of Health Minister at a time when there is no choice but change for the health service. The NHS has changed every single year since it was founded in 1948 and this is still the case.

My aim is to bring the process of NHS configuration in Wales to a conclusion and to provide people with certainty about the shape of healthcare to come.

The process is already underway. I understand that when decisions are made not everybody will be happy. Not everybody will get the decision that they would prefer, but we need to make changes and finish the process so people can get on with delivering important services.

The changes come at a time when the whole of the Welsh Government faces stringent cuts in the revenue provided to all the vital services that Wales needs. My job as Health Minister is to speak up as loudly and persuasively as I can to make sure that we have the money we need to provide a health service that meets people’s needs.

An important part of my role is to meet people and I’m keen to talk to people and explain why things are being done in the way that they are.

What I can promise people is that I’ll consider everything as thoroughly as I possibly can, I will weigh up the arguments, I will look at the evidence, and then I will give them a decision.

Dr Mark Drakeford
Health Minister


Dr Mark Drakeford will be speaking at CHC's Health and Housing Conference in Cardiff City Stadium on 18 July. For further information, please see CHC's website.