Understanding the self-funder journey to living in a care home

Surrey County Council commissioned Healthwatch Surrey to extend their research among self-funders, care arrangers and carers to understand more about behaviours, motivations and attitudes in planning for care. This phase focused specifically on understanding how people became care home residents. 97 people responded to a survey.

Only 33% said they had planned for paying for a care home prior to moving in. This demonstrates the need for the Planning for Your Future (PFYF) programme. Most people lived independently at home before moving into the care home. The majority of these people had made adaptations to their home, had carers, and been known to the social care system. However, some people who had lived independently at home, but with less support, had not made any adaptations to their home or used paid for care workers but had gone straight to living in a care home. Whether people had made adaptations or not to their home is a useful way of analysing the data, as it could also indicate the level of involvement of the local authority.

Those who had not made adaptations to their home stated fewer reasons for moving into a care home; they were more likely to have arrived at the care home because they chose to themselves, rather than being discharged from hospital or because a social care professional recommended it. They were more likely to have a suspected dementia diagnosis than those who hadn’t made adaptations (same level of confirmed diagnosis across both groups). They were more likely to have heard about the care home they chose via friends and family/the internet, rather than via a professional or Surrey Care services directory. Similarly, they are much less likely to have looked to SCC GP/other health professional or a charity for advice or information about care homes. They were also less likely to have got independent financial advice before moving to the care home. However, they were also more aware of the need to pay for a care home (through their own prior knowledge and family members), and they were more likely to have planned to pay for care before moving into the care home.

This cohort of people who have not made adaptations would appear to be critical in terms of SCC’s target of encouraging people to use services such as paid home care workers to carry on living in their own home for as long as possible. However, these people appear to have planned ahead financially for their future in a care home. They also feel strongly against having paid for care workers at home. It may be that, if they are financially able to , they’d prefer to go to a care home as a lifestyle choice rather than staying at home, especially with a suspected dementia diagnosis. 

Across the whole sample, relatively few accessed community services such as day centres or community groups. Very few accessed respite services. There was very low awareness of the 12-week property disregard, deferred payments and third party top ups. There was mixed understanding about what would happen if a resident depleted their funds. 

There was little difference in awareness of these mechanisms between those living in ‘national chain’ care homes vs smaller chain/ independents. Residents of ‘national chain’ care homes were more likely to have been told about third party top ups and to have been given a full breakdown of costs. Smaller chain/ independent care home residents were more likely to have had additional costs. The data also revealed that only 15% of respondents identify as a carer. This correlates with the findings from the Luminus Giving Carers a Voice work where once a person moves to a care home, the person who had been their unpaid carer felt their caring role was reduced; sometimes out of choice, sometimes because of practical issues and sometimes because they were not included in the care responsibilities by the care home.