Chapter 7 – External Support7.0 External Support7.1 GeneralAs with the population in general, almshouse residents are living longer. The number of people in the UK aged 65 years and over is expected to rise by 65% to over 16.4 million by 2033. Many residents become frail or disabled during their occupancy of their home. This condition may be reached many years before their stay in an almshouse comes to an end. At the same time, Local Authorities are finding it more difficult to fund the services that may be needed to support the residents as they become less able to look after themselves. Trustees and staff need to be aware of the various sources of support that might be available to their residents when this is needed. By building a relationship with these support groups they may be able to contribute a great deal, without necessarily having direct involvement themselves.7.2 FamilyGood family support can be extremely valuable. It not only enhances the quality of life for the residents, it will also mean that the responsibility for their welfare does not fall entirely on trustees’ shoulders. Trustees would be wise to encourage family involvement from the beginning of the occupancy. Making sure that family and friends are familiar with the contents of the Residents’ Handbook and perhaps providing them with their own copy, may help this process. It will also help them to understand the limits of support and responsibility that residents and their families can expect from the trustees. Where the trustees provide an alarm call service through an external provider, it is ideal for the resident's emergency key holders to be family members or friends living within easy reach of the almshouses.7.3 Next of KinResidents should provide details of their next of kin. It is important, however, to be aware that this term has no particular legal definition. It is as well to advise residents that it usually means the person or persons the resident would like kept informed about his or her health, particularly in the event of hospitalisation or sudden illness. It can be made clear that in the event of the resident’s health failing in some way, the charity would normally share information with the next of kin, unless the resident requires the charity not to do so. It could also be indicated that the charity would try to involve them in decisions about the resident’s future care, particularly in the event of the resident being less able to contribute to such decision making, such as after a stroke. If there are a number of people whom the resident specifies as next of kin, the resident should be encouraged to select one person with whom the charity can specifically deal in priority over the others. If, for example, a resident has a number of children, it is not always feasible to communicate with each of them in a crisis.7.4 Lasting Power of AttorneyAn extension of the support role that can be played by family members and friends can arise from the residents putting in place a Lasting Power of Attorney (LPA). The LPA in England and Wales was created under the Mental Capacity Act 2005 and came into effect on 1 October 2007. The LPA replaced the former Enduring Powers of Attorney which were narrower in scope. Their purpose is to meet the needs of those who can see a time ahead when they will not be able to look after their own personal and financial affairs. The LPA allows them to make appropriate arrangements for family members, or trusted friends or advisors, to be authorised to make decisions on their behalf.Having an LPA in place could avoid problems for the resident and family members in the future. It would also enable the trustees to have a formal relationship with the person appointed as the resident's attorney, if the resident is no longer able to look after their own affairs. Trustees may wish to advise residents and their families of the availability of the LPA system. However, creating an LPA is now quite expensive and may be beyond the financial means of many residents. Trustees should take care not to imply that an LPA must be in place for the resident to remain in their home.Further information is available from the government website, www.gov.uk/power-of-attorney. Age UK have a useful fact sheet (FS22 – ‘Arranging for someone to make decisions about your finance or welfare’) which provides detailed information about setting up an LPA.7.5 The General PractitionerSome almshouse charities seek to build up a relationship with the medical profession and, without coercion, encourage residents to sign on with one particular GP. This both helps the GP to be familiar with the resident’s circumstances and provides a source of knowledgeable support that the trustees can approach when seeking to help the resident. This can be particularly useful when the resident has no family support. If the charity is large enough, it may be possible for the doctor to hold a regular surgery on site. This helps residents, who no longer have to travel to the doctor’s premises, and also sets up a relationship between the charity and doctor. The GP should have a good knowledge of both statutory and non-statutory help available to residents.The charity may wish to consider obtaining permission from their residents to discuss general welfare issues with their GP.7.6 Community Care ServicesSince the full implementation of the National Health Service and Community Care Act 1990 local authority Adult Social Care Teams can arrange support for a range of home care for those assessed as needing it.It is not yet clear to what extent the Health and Social Care Act 2012 may affect this. However, public services, including social services, are undergoing radical reform and many local authorities are seeking to manage their resources by tightening eligibility criteria, and limiting support to essential care only. As public funding for social care will always be limited there is a move to allocating resources according to individual needs. This includes the introduction of personal budgets for benefits and other services (see Chapter 8).If a resident has difficulty with their personal care, the trustees, staff or the resident should consider contacting the local Adult Social Care Team to ask them to arrange a community care assessment, which the Local Authority is obliged to carry out.Normally, an assessment is carried out before a service can be provided, but if the services are needed urgently the Local Authority can provide a service without carrying out the assessment. The Local Authority uses the assessment to decide whether the resident needs a community care service and, if they do, what type of service is needed and whether it can be provided by the Local Authority.Once a Local Authority has established that there is a need to provide a community care service and the service user meets eligibility criteria, they have a duty to provide that service. The Local Authority should not refuse to provide the service on the grounds of cost, although if there is more than one option it is allowed to choose the most cost-effective one.Community care assessments for older people can vary depending on the circumstances and what is appropriate. The following are types of assessment:A contact assessment is the most basic assessment. In some cases this is all that is necessary. In other cases this is the first assessment and others will followAn overview assessment is a more detailed assessmentA specialist assessment is where a specific need, such as a health problem, is assessedA comprehensive assessment is the most detailed level of assessment and is likely to consider personal care and hygiene, disease prevention, safety, mental health, and senses such as sight, hearing and communication.7.7 Funding of CareA support plan will be prepared and the Local Authority will confirm the amount of any contribution that the resident may be required to make. The resident will be means tested and may have to contribute to the cost of the care package. Applicants with less than £24,500 (in England) of capital or savings will probably receive financial assistance if their income is less than £193 per week (higher in some circumstances) and they are a single person aged over 60; those with more will be expected to pay towards any care provided. These figures for 2011-12 will change over time and the Local Authority should be contacted to confirm the current amounts. The amounts might also vary from one Local Authority to another. Where councils do not offer direct help following assessment, they should be prepared to provide residents with useful information and advice about other sources of support, including universal and open-access services, where appropriate.Often the care package is purchased from private agencies. The trustees, clerk or warden/scheme manager should know the name and contact details of the care manager for each resident so that any problems with the service may be reported. The Adult Social Care Team can also arrange for minor aids to be fitted as part of the care package (e.g. grab rails, bath seats, ramps) and can supply walking aids and other small pieces of equipment.By building a relationship with the local Adult Social Care Team, the charity will be able to advise residents who are in need of support about the service available to them from their Local Authority and the possible costs. The charity may wish to enquire when a case conference may be held and if appropriate, try to attend.7.8 Other Sources of InformationThe Disabled Living Foundation can be a source of useful information about disability equipment and training. It has a large database of equipment and the helpline operators will help to clarify which aids will meet residents’ needs. There are many Disabled Living Centres around the country which specialise in providing information and unbiased advice about products and offer the opportunity to see and try out samples. It is advisable to book an appointment before visiting so that an advisor is available.Social services departments of any size usually have information on voluntary organisations that can help individual cases. There are other sources of information; Citizens Advice Bureau (CAB) and Age UK are examples. Disablement Information Advice Line (DIAL) is a national information service for disabled people and their carers. It provides information on, for example, Social Security Benefits, holidays, aids and appliances, and mobility aids. Most libraries will have a list of local addresses of organisations that can help in individual cases. (See Appendix B).7.9 Visiting OrganisationsLoneliness can be a major problem for older people. Trustees should take advantage of outside organisations such as the Women’s Royal Voluntary Service (WRVS) and the St Vincent de Paul Society, which have volunteers who will befriend lonely people. The Soldiers, Sailors and Air Force Association (SSAFA) also provide a visiting service.Faith groups sometimes organise members of the congregation to call on housebound people in their local area. Some charities have a group of ‘Friends’ who visit residents in their own homes on a regular basis and take them out for tea or on shopping trips. Many local Age UK groups organise activities such as lunch clubs and have befriending services. Trustees may wish to add contact details for such organisations to their existing list of useful contacts in the Residents’ Handbook.7.10 Additional FundingFinding the organisation that can provide help may not be the end of the problem. There may be financial difficulties and these may not be solved by making sure that the resident receives all of the benefits to which they are entitled (more about Benefits in Chapter 8).The charity should build up a list of local contacts, especially with the Rotary Club and Lions. If Attendance Allowance and other statutory benefits are insufficient, discussion with the resident and family or friends should elicit any possible sources of funding from outside agencies. Ex-service personnel can apply for grants from the relevant benevolent funds. (See Appendix B).7.11 AdvocacyIn the ideal world residents would have the support of family and friends to help and advise on welfare and financial needs. They will assist the resident to get the help needed from the statutory authorities to stay in the almshouse. Some residents, however, may not have this support and the charity may need to assist in finding an independent advocate. Some local Age UK offices provide advocacy services.Form-filling and means-testing are necessary parts of the funding process. Many needy residents can easily be put off from applying for financial assistance by the lengthy forms sent by the various agencies. Trustees, clerks and warden/scheme managers should offer help if it becomes apparent that the resident may not be claiming all the benefits to which they are entitled.For Further Information:Age UK - www.ageuk.org.ukCitizens Advice Bureau – www.citizensadvice.org.ukDisabled Living Foundation – www.dlf.org.ukDisablement Information Advice Line (DIAL) – www.scope.org.uk/dialGovernment Website – www.gov.ukLions Club International – www.lionsmd105.orgRotary International – www.ribi.orgSoldiers, Sailors and Air Force Association (SSAFA) – www.ssafa.org.ukSt Vincent De Paul Society – www.svp.org.ukWomen’s Royal Voluntary Service (WRVS) – www.wrvs.org.uk© 2013. This document is copyright of the Almshouse Association and no part of it may be produced or published without the Association’s written consent.