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 

Who says health, housing and social care can't work together?

I heard about The King's Fund ‘Innovations in the delivery of care for older people’ conference through Twitter. The King's Fund wanted to showcase different innovative projects at the event and were inviting submissions. I immediately thought of the Rapid Response Adaptations Programme (RRAP). While it's not a traditional ‘care’ project, it is an excellent example of a successful partnership between housing, health and social care sectors, which are usually more 'fragmented'.

The majority of referrals to the RRAP programme are received through social care and health practitioners such as occupational therapists, social workers, physiotherapists and discharge nurses, who are happy to place their trust in our voluntary sector organisation to support their work. It is a real achievement that each Care & Repair agency, across all of the 22 local authority areas in Wales, has been able to develop such positive relationships with their health and social care teams.

The Rapid Response Adaptations Programme is funded by the Welsh Government and allows Care & Repair agencies to carry out minor adaptations, such as ramps and handrails, to enable people to return safely to their own homes following hospital discharge. These adaptations can also prevent the need for admission to hospital or residential care. The programme requires these adaptations to be completed within 15 working days, although jobs can be carried out immediately in response to a crisis.

For health professionals, not only are ‘hospital beds unblocked’, allowing clinical scheduling and prioritisation to improve, there are clear indications of cost savings through the programme. It has been estimated that £7.50 is saved in Health and Social Care costs for every £1 of public funding invested in RRAP.

A recent report found that, by 2017, demand for unpaid care will begin to exceed supply, and the ‘care gap’ will grow sharply from then onwards. In turn, pressures on A&E departments and hospitals are likely to increase, as fewer older people receive the care they need and more are likely to slip into crisis (IPPR 2014).

Care & Repair Cymru carried out a survey of stakeholders in 2011. One hundred per cent of respondents felt that RRAP had helped to delay or prevent the need for social care services.


Stakeholders told us:

• RRAP promotes independence in the home and therefore reduces long term dependency on care. 'People are able to remain in their own homes for longer and it reduces the demand for more costly support from social services.'

• 'There is benefit (from RRAP) to the quality of service users’ lives which is greatly overlooked but of great significance.'


It is recognised that most people, as they grow older, would like to remain living in their own homes (Wanless, 2006). The demand for services such as RRAP which contribute to enabling older people to remain living independently in their own homes is likely to increase as the ageing demographic increases. The programme has proved to be extremely cost effective and yet the service remains unique to Wales.

The benefits of the RRAP programme were recognised by The King's Fund panel and were presented to the audience at the conference on 18 June.

Whilst attending the conference, it was clear that most of the innovations showcased, all immensely exciting and inspiring, were mostly carried out within the confines of one local health area. Care & Repair, however, supported by Welsh Government funding, work across the whole of Wales, ensuring equity of service for older homeowners and not confined by boundaries. Hopefully, by sharing good practice through such events, older people across the UK will gain greater access to excellent services such as those showcased at the conference.

NB. In the previous year, Care & Repair agencies carried out almost 15,500 works through the Rapid Response Adaptations Programme.


Rachel Gingell, Policy and Research Officer
Care & Repair Cymru