Here are details of my recent book on support for older people. You can read reviews of it by clicking the button to your right. Several recent articles I have written are reproduced in full below, after the material about the book."

Books
A Survival Guide to Later Life
published in 2004 by Constable & Robinson)
price £9.99
ISBN: 1-84119-372-0
available at bookshops or through Amazon


Contents
Acknowledgements
Foreword by Dr James Le Fanu
How to Use This Book
Introduction

Part One: Growing Older
1: The Ageing Body

2: Changing Needs
The Body
The Mind
The Spirit

Part Two: The Care Machine
3: State Support
Social Care
The Health Service

4: The Voluntary World

Part Three: Staying Independent
5: Adapting Surroundings
Gadgets and Aids
Incontinence

6: Moving Around
Mobility
Exercise
Falls

7: Where to Live
Moving House
Retirement Housing
At Home

8: Keeping in Touch
Making Friends
Day Centres
Faith Groups
Animal Magic

9: Professional Helpers
Your GP
In the Home

Part Four: Care Homes
10: Choosing a Home
Basics
The Selection Process

11: The Cost
Fees
Paying the Bills
Spouses and Partners

12: Going In
A Trial Stay
Preparing for Entry
The First Few Weeks
Life in the Home
Moving Out
Respite and Intermediate Care
Advice

Part Five: Hospitals
13: Treatment
Ageism
Rehabilitation and Other Care (Example: Strokes)

14: Your Life in their Hands
Withholding and Withdrawing Medical Treatment

15: Discharge
Living with Continuing Care

Part Six: Money
16: State Benefits
Fundamentals
Benefits for All
Benefits for the Needy
Administration and Advice

17: Self-help
Private Pensions
Insurance
Living off your House
Protecting Inheritance

Part Seven: Representation
18: Legal and Financial
Granting Enduring Power of Attorney

19: Nursing and Other Care

Part Eight: Carers
20: A Vital Role
A Statutory Carer

21: Practicalities
Carers' Assessments
State Benefits for Carers
Other Calculations
The Main Caring Relative

Conclusion

Appendix: Complaints
Complaints about Local Government
Complaints about the NHS
References
Useful Contacts
Index

How to Use This Book
This is not a book that has to be read from beginning to end (although I hope many people will do so). Perhaps you have grabbed this volume in the hope that it will help you with a crisis that has suddenly overwhelmed you. Maybe you are in hospital, still unwell, but told you must leave immediately because you are bed-blocking. Or an elderly relative faces this situation. If so, you can turn straight to Chapter 15: Discharge, which forms the final section of Part 5: Hospitals. You will not need to have read everything before the bit you need. Throughout the book, cross-references are provided to other sections likely to be relevant to the immediate subject matter.

Reading the introductory material in the Introduction and Part One: Growing Older is not essential, but it is intended to provide a useful context for specific problems confronting you. It describes the differences between the bodies of older and younger people and some of the psychological as well as physical needs of older people. It is intended to provide a framework that will help you to understand problems of mind and body. For instance, the lighting in a care home you are touring may take on a new significance when you realize that older eyes need between two and three times as much light as younger eyes.

Equally, grappling with an outpost of the social services system may prove easier if you grasp the underlying logic which drives such establishments. The essentials of the machinery of support provided for older people by government and non-governmental organizations are set out in Part Two: The Care Machine.

The next section of the book (Parts Three, Four and Five) is organized chronologically, following the developing stages of ageing. Part Three: Staying Independent suggests ways in which you can continue to live independently and happily at home, rather than going into a care home, even in the face of considerable disability. This may involve not just guaranteeing warmth and safety but also fitting helpful equipment and acquiring ingenious gadgets. It may mean hiring help in the home, making new social contacts and finding out about what are often extremely generous travel concessions. There is also the question of where to live - staying put, moving in with others, or opting for retirement housing.

One in 20 people over the age of 65 lives in a care home, and the choice of such an establishment may be one of the most important decisions anyone has to make. Part Four: Care Homes tells you not just how to choose a home, but how to prepare for entry and how to make sure life inside is as enjoyable as possible.

Part Five: Hospitals tackles the contentious topics of ageist discrimination and withholding life-sustaining treatment, but more mundane issues like infection control and continence care, which often matter far more, are also explored. There are separate sections on strokes, a particular source of widespread misunderstanding, and on long-stay NHS care.

Part Six: Money may bring welcome as well as unwelcome surprises. Those who have made respectable provision for their old age may find unexpected non-means-tested benefits available to them, while those with modest resources of their own may be better off than they imagine.

However much or little money you have, you need to make sure that your affairs are dealt with as you would wish if you become unable to direct them yourself. Part Seven: Representation steers you through the world of powers of attorney and the like, and makes suggestions about finding proxies in the medical and social care worlds too.

The needs of carers have long been unrecognized, but partners, close relatives or friends who support older people living in their own or the carer's home do now have statutory rights. Part Eight: Carers describes what these little-known rights are and helps you decide whether to become a carer or to allow yourself to be cared for by someone else.

Throughout the book there is help to be found in making the many decisions that may confront you, but if you have already made a crucial decision on, say, the selection of a care home or retirement accommodation, you may still find the relevant sections useful. They may give you ideas for improvements you could seek and a grasp of changes afoot which could help you. Although this book is directed primarily at older people themselves, their close relatives, partners and friends should find it equally useful. People working in one part of the eldercare world who want to improve their grasp of other areas may also find it helpful. The chapters on care homes and hospitals are addressed primarily to relatives and partners, since the reality is that the older people involved, who must of course be in ultimate control, are often not in a position to remonstrate with doctors or hospital administrators or trek round 30 care homes.

The terms 'disability' and 'disabled' are used broadly to embrace any kind of physical or mental disability, from an arthritic knee to dementia. Where I use the word 'disabled' in the sense of major incapacity, such as an amputated leg or near blindness, I make this clear.

Since the fundamentals of the health and social care system were set up before the establishment in 1999 of the Welsh Assembly and the Scottish Parliament, it is very similar throughout the United Kingdom. However, separate guidance to parts of the system, and in Scotland separate legislation, is being introduced. Where this differs fundamentally from that applying in England, I have indicated. I concentrate on guidance material provided in England, though I direct readers to equivalent documents from the Welsh, Scottish and Northern Irish authorities. The law, procedures and financial provisions described are as at 7 October 2003.

In the section called Useful Contacts you should find the address, telephone number, textphone number if available and the website of most of the organizations mentioned in the text, together with details of a few additional organizations which can provide useful help.

The author provides a consultancy service for individuals and organizations. If you wish to take advantage of this, you can contact her through her website or postal address, also provided in Useful Contacts.

Articles

‘The Day I Abducted my Mother’, published in The Sunday Telegraph Review, 29 February, 2004
It was my 50th birthday, but my daughter and I had more than celebration to contemplate over our restaurant lunch. With meticulous precision, we went over the details of our plan to spring my mother from custody in a residential care home five minutes’ walk away.

We weren’t informing the home in advance – we planned simply to abduct my mother – so we were worried that the staff would be less than cooperative. What if they refused to help us transfer my mother (who was then quite heavy) into her wheelchair? Supposing they wouldn’t let us leave from the back door, with its one low step, and we had to face a flight of steep steps at the front?

When we arrived, we held our breath to see who would open the door, but there were no hitches. The assistant who let us in co-operated with great dignity. Indeed she seemed unsurprised by our actions. I gained the impression that such theatrical manoeuvres are nothing out of the ordinary in the strangely macabre, Kafka-esque world of care homes
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I was snatching my mother, Gladys, away because I no longer felt I could trust the institution to look after her properly. Obviously, I should have given advance notice of her departure. But a friend had warned me that when he had done so at a different care home, his mother had fallen victim to a “mystery” illness – forcing her to remain at the home for several more weeks.

Three months earlier I would have been unable to imagine myself playing a part in a tragi-comedy of this kind. But my life had been transformed when my mother, then 87, had a fall in her own home in Kent.

Until then, her life had revolved around the small terraced house, not far from the sea, where she had lived nearly all her life. After I left for university, I would return to this house for holidays and long weekends, later brining my own family with me, so that own daughter Catherine, born when my mother was 68 and not long widowed, came to see her grandmother’s house as her second home.

Somehow we all fancifully assumed that our three generations’ leisurely summer days on the beach, and Christmases of breezy walks along the promenade, would never end. The sea would always glitter, albeit aroused by the occasional hailstorm. We would continue to return to homemade cake and Scrabble round the fire until death intervened in a dignified and swift manner.

My mother never talked about her death, and I think she probably believed that after she went to sleep one night a stroke or heart attack would sweep her painlessly into the next world. As she moved into her mid-eighties, though, life changed. She was no longer a familiar figure, much-valued Railcard in hand, boarding trains bound for Stockport, Penzance or Edinburgh. Urinary incontinence had set in, a condition shared by three million Britons but then little discussed: as a result, she politely deferred invitations involving overnight stays, except with me. For years she had suffered from osteo-arthritis, but the pain had increased. I can see her now, with hunched back and heavy legs as she struggled to church or the post office, until even the single step up to her front door presented a real barrier.

Next came age-related macular degeneration, which causes progressive loss of vision of what is directly in front, finally leaving only the periphery visible. Other changes were taking place in my mother's brain. One day she announced she would not play Scrabble again (she had been top-notch). Difficulties arose in dealing with bills and cheques. Trying to reassure her, I would laugh things off, pretending that I often forgot things too, but I should have taken the situation more seriously and pressed her GP for help. Once, my mother cooked a joint in the oven but forgot to take off the plastic wrapping. On another occasion, she fell headlong down a step because she had forgotten it was there. Sensing her growing frailty, I suggested she should come and live with me. I had grab rails fixed to the walls and commissioned estimates for the installation of a stairlift. Suddenly, though, it was too late
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My mother’s fall in her bedroom had catapulted us into a crisis. It injured her only temporarily but accelerated the mental decline that, we later discovered, was Alzheimer’s disease. When I brought her back home after a stay in a council-run respite care home, she didn’t know where she was: she no longer recognised family photos on the walls or model tortoises on the mantelpiece as her own
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For the first time, I had to confront the reality of my mother needed full-time care. The local socials services advised me to move her into a private care home, and to pay the bills by selling her house. As a mother, I had enjoyed good free healthcare; as a daughter, I came face to face with a system that cheats older citizens of care, even when their problems arise from ill health.

I desperately tried to convince myself that I could afford for my mother to live with me, but the figures would not add up. How could I support myself and find the cash to hire help during the night as well as the day? Since then I have gleaned more information about the rights of “carers” and now realise that I probably could have managed. At the time, however, I felt completely isolated: it was as if the anguish that I was facing had never been encountered by anyone before.

So every spare moment saw me hiking round care homes in my mother’s area and mine. Like so many other worried daughters and sons, I was wide open to anyone ready to reassure me that they could magic away my burden by expertly and kindly caring for my mother in a way I could not. Yet care home proprietors are not saints, but salespeople. What “customers” saw was carefully controlled. Interviews would often be conducted in an elegant lobby with walls covered in imposing-looking framed certificates. Now, having attended seminars for care home proprietors and staff, I know that you can get such certificates simply by attending a one-day course -- no exam required.

The first home – the one from which we snatched my mother - initially seemed impressive, with its attractive location and cosy atmosphere. (Looking back, I realise that this place and the care homes in which she lived subsequently were no worse, and probably better, than average.) We soon developed concerns. Why was my mother losing so much weight? Why was an assistant describing my mother as "not a breakfast person" when she had always relished her porridge, toast and marmalade? Did she really have to be wakened at two-hourly intervals through the night to be placed on the commode? The manager assured me there was no other way to cope with night-time incontinence; but I now know that there is.

So it was with great relief, after the taxi had rattled along seaside streets, that my mother, my daughter and I sank into comfortable chairs at a new home and consumed tea and biscuits to the strains of Singing in the Rain playing on the television. But problems arose here too. Although dementia affects more than a fifth of people over 85, this home seemed to have little idea of how to respond to its presence. Solutions were proffered as if all that was involved was some temporary aberration. I was told to buy soothing oils to sprinkle on my mother’s lapel. A post-prandial nap was suggested: perhaps she was simply tired. One day, my daughter and I arrived mid-afternoon to find her alone in her bedroom utterly distraught. She had no idea where she was and could not work the bell to summon assistance. “Thank God you’ve come”, she said, “I thought I would never see anybody again.”

This time the home itself prompted a move. The manager had approached the consultant specializing in Alzheimer’s at the local hospital, who had said my mother could go in for “assessment”. I had not realized that this kind of assessment takes longer than a few days. There was a clause in the home’s contract that allowed it to throw out a resident who had been in hospital for at least a fortnight and with no date for discharge within two weeks. This swung into action
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In the hospital my mother was treated with the utmost care and kindness, all of it based on real understanding of her condition. But the consultant wanted her out. “I can do no more for your mother, and the bed is needed for another patient”, he barked, during one of his intimidating case conferences. Once again, I set about combing care homes in my mother’s area and mine, interviewing proprietors and managers, and trying to make more informed judgements.

This time round, I made sure that if a home looked promising, I would return to sit and watch life unfolding there on my own. At one establishment, there had seemed to be numerous residents when the proprietor showed me the place one bright morning: I wondered, on a return visit that afternoon, where many of them were. After much questioning, the proprietor at last opened a door. About 10 elderly people, probably all with dementia and looking extremely confused, were attempting to consume their tea – except that fragments of it smeared the table and the floor. Two young girls, perhaps in their late teens, were trying to supervise. It was bedlam
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Eventually, my mother moved into a specialist unit for elderly mentally ill people. I worried, however, that its owners were spending too much money on keeping their listed mansion freshly painted and not enough on hiring staff who were fluent in English and would engage in one-to-one interaction. Once, I visited later than usual because I had missed my bus. Instead of a lounge full of residents and care assistants presided over by a benevolent manager who sometimes danced with the residents, it was deserted. I stepped into the hall to hear my mother’s desperate cries for help from her bedroom: she had been left alone on the commode. Time for a second abduction.

I visited further homes, only to realise that none of them could provide even a minimal standard of comfort for my mother. Eventually, in 2000, I persuaded the health authority to grant her NHS Continuing Care, which means she is looked after in a long-stay unit. Successive governments have removed nearly two-thirds of these beds (50,600 in all) over the past 20 years. My mother lives there still, well cared for and visited by us - her family – and somebody we pay, using the proceeds from her house sale.

My mother’s mental anguish remains acute. She knows she is a human being, but is not aware of her personal identity. Explanations fashioned to reassure are forgotten in a matter of seconds. She lives in an endless, bewildering present. On a visit this week, she pleaded to me over and over again, just as she has been doing for four years: “Please. Please. Please. Where are you? Where am I? Who am I?” On other occasions: “Are the children all right?”

Unexpected blessings can come. I am overjoyed when she imagines that I am her mother, because that suggests a reassuring presence. This week she asked, “Are you my mother?” Me: “No, I’m your daughter”. Her response: “Oh, you’re so motherly”.

Similarly, four years ago, just after my mother had suffered a stroke while in hospital, my daughter and I waited to find out what the impact would be on a brain already thrown into the knots and tangles of Alzheimer’s. We were amazed when she opened her eyes and said, “Hello, hello, hello!” in a jaunty speech pattern familiar to us from the old days. As we took it in turn to stroke her head and talk to her, she replied with disjointed words and phrases. The three of us, with two heads often on the same pillow, experienced a quite unique and rewarding time of closeness and peacefulness.

While trying to cope with my mother's decline, I decided to write the handbook that I would have liked to read myself. I wanted to empower older people and their loved ones by providing the information that I wished I’d had at my fingertips. I can advise people who want to keep the family home, for example, to ask for a Deferred Payments Scheme from social services.

Not that coping with old age is all a matter of “crisis situations”: much of it is about trying to ensure these do not arise by addressing issues while elderly people are still healthy. My mother, who was the most generous of souls, would be happy to know that out of her anguish, some help for others might spring
.A Survival Guide to Later Life by Marion Shoard (Constable and Robinson), 640 pages, is available for £9.99 plus 99p p&p. To order please call Telegraph Books Direct 0870 155 7222.


‘A Better Deal for Older Church Members’, published in Plus (Journal of the Christian Council on Ageing), October, 2004
Marion Shoard’s book A Survival Guide to Later Life (Constable and Robinson, price £9.99) was reviewed in the last issue of Plus. Its 640 pages contain sections on the spiritual needs of older people and also on how they can make the most of faith groups. In the following article, Marion Shoard considers the challenge posed to the church by the needs of older people

.As a Methodist, earlier this year I attended a Love Feast, a service of testimony introduced by John Wesley. It was presided over by three well-meaning clergy who opted to group the congregation of perhaps 60, a good number of them grey-haired, not in the nave of the large, lofty Victorian church in question but in the choir stalls and on chairs placed in the chancel. Positioned at the far end of the choir, in front of the altar, none of the clergy used a microphone, as they would have had they been standing in the pulpit. Did they realise that nearly 40 per cent of people aged 75 and over have significant hearing loss? One minister sang an unfamiliar hymn from Wesley’s day one line at a time, inviting the congregation to repeat it. Sitting a few feet from the source, I found distinguishing these sung words a major challenge, and soon gave up. I am 55; how much more difficult would the task have proved for somebody much older and fifty feet or more away?

It would have been far better to provide a large-print song sheet or a large-type illuminated overhead. This church is not well-lit, and several of the light bulbs needed replacing; were the clergy aware of the fact that even without the eyesight ailments common in old age, the ageing process means that the eyes of an 80-year-old need four times as much light as those of a 20-year-old?

Changes to the kidneys and bladder which accompany ageing mean that elderly people need to visit the lavatory more frequently, while urinary incontinence affects a fifth of older men and nearly a third of older women. Yet no lavatories were available at this service. Ageing is often accompanied by the loss of subcutaneous fat that provides padding when we sit. This means that the wooden, unyielding choir stalls on which some of this elderly congregation were forced to lower themselves would have been decidedly uncomfortable. Those sitting on chairs were more fortunate, but had nowhere to put their walking sticks, spectacle cases, emergency medication and so on
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Encountering difficulties like these can make older people feel marginalised and even alienated where they should feel welcome.

Why is it that we take time and effort to conserve old churches, but pay little attention to the comfort of the old people who use them? Why do church mission statements so often speak of increasing the numbers of children and young people in congregations but not older people? Why does ministerial training provide so little guidance in the basic physical needs, not to speak of the psychological and spiritual needs, of older people? Ministers will not know what it is like to be old in the way that they know what it is like to have been a teenager or the parent of young children. They will have faced the stress of sitting examinations, but not the practical and emotional challenges of losing a life-long partner.

There are of course exceptions. In one church I know the minister’s wife runs a monthly meeting for older carers, which she sees as an important part of her pastoral work. Religious buildings (and these can be ancient country churches or rambling Victorian chapels) which have refitted their interiors with comfortable cushioned seating and adequate heating and lighting simply to make their premises more comfortable and welcoming for everybody are often best in terms of physical comfort for older people
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In his book Older People and the Church, based on a large number of interviews, Ian Knox commented, “I found it significant that no church leader or member spoke of helping older people to face their own death”. In old age, the quest for meaning in life can become more urgent as we are reminded of our own mortality. Today’s older citizens face the additional challenge that though in their youth they were expected to accept what they were told, they now live in a world in which beliefs, ideas and even facts are subjected to a constant barrage of questioning. Hilda Ashton, a Methodist in her eighties, asked me: “Everybody these days is talking about dinosaurs, so why don’t they figure in the Genesis account of creation?” The Revered Albert Jewell, then senior chaplain to the MHA Group, told a conference on the Church and Older People in London in 2001, “We assume that older people in the church have a blissful faith and an unwavering hope for the life to come. In fact, many of them wrestle with the dark night of the soul”
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Of course the church has a responsibility to the young, but the real reason why churches put so much effort into youth work often seems to be the desire to increase church membership. Though deployed for several decades, this strategy plainly has not worked. It might be far more fruitful to set out to attract older people, for whom impending demise often provides a persuasive reason to look again at a religion rejected in youth. Older people have the time to make the most of mission with like-minded people. They are up for useful tasks like selling second-hand books to help pay for a new church premises kitchen or joining committees, and can benefit from the sense of belonging and community which comes with such activities. Encouraging them to make the most of such opportunities can only strengthen faith groups. If they can provide a better deal for their older members, they might benefit at least as much as the elderly congregationalists they are currently letting down
.Reference:
Ian Knox (2003) Older People and the Church, London: T and T Clark


Choosing a Care Home’, published in Care Select 2005, published by Care Choices
Before you even think of choosing a care home, stop! Are you absolutely sure this is the right move? So you may have developed continence difficulties, while severe osteo-arthirtis is getting in the way of shopping, washing and dressing. A few such problems can be quite enough to get sons and daughters phoning round nursing homes. Yet you will probably be better off staying in your own home for as long as you can – with help summoned from outside as required.

Your council’s social services department has a duty to carry out an assessment of your need for such help free of charge, if you ask it to (page x). If it emerges that you do after all need to go into a care establishment, such an assessment will at least establish whether you really need a nursing home, or whether you would be OK in a less expensive, ordinary care home (page x).

Once it is clear that entry into some such place is unavoidable, you need a completely comprehensive list of all the possible places. Once again, your council’s social services department should be approached for lists of homes, even if it is not actually going to be involved in the placement process. Voluntary bodies may be able to provide other types of lists: the Alzheimer's Society keeps details of homes specializing in care for people with dementia, for example.

Two tips before you start selecting. First, do not rely on the recommendation of one person, like, say, a GP or the relative of another resident, however well-qualified or well-intentioned. Care homes can change quite quickly as staff, including managers, come and go. Often, someone offering an opinion may base it on first-hand experience of only one aspect of the establishment. Second, do not assume that the most expensive homes are necessarily the best. Research has shown that modestly priced homes are sometimes better than much more expensive ones in important ways.

Once you have made an initial trawl of your list of possibilities, telephone those establishments which look interesting and make an appointment to look round and talk to the manager or proprietor. If you have time, look at the national minimum regulations and national minimum standards for care homes (page x) before you visit. There you will find details of what the home should be providing, and after the interview you can compare what you have been told with what the regulations require and the standards expect. If you are in England you can obtain these documents by post or from the website of the Commission for Social Care Inspection. Otherwise go to the Care Standards Inspectorate for Wales or the Scottish Commission for the Regulation of Care. You can also ask these organizations for inspection reports on the particular homes which you propose to visit, so that you are aware of any problems which have been picked up in the past. (They also provide comprehensive lists of homes.) In Northern Ireland a Health and Personal Social Services Regulation and Improvement Authority providing similar information should start to come into operation in April 2005; until then contact your local health and social services board for information.

During your interview with the manager and subsequent tour of the home, you need to obtain (and should write down) full details of many things. First, ask about the number, type and training of all the staff. Effective care requires trained staff who have sufficient time to carry out their tasks properly and to chat to residents and help them feel at home. Expect the majority of care workers to have received or at least be undergoing the basic training provided by National (or Scottish) Vocational Level 2. Find out how often the home employs agency staff.

As you tour the home with the manager, consider safety. Are residents evacuated from the building in the event of a fire? If not, what happens? How long would it take a fire engine to get to the home? Falls present a great danger for elderly people, because they often inflict a lot more damage on the older body than the younger. What does the home do to minimize the risk of falls? For example, are there enough grab rails? Are residents using mobility aids properly? Are all parts of the complex which residents use well lit? (Older people need a lot more light than younger people to see as well.) The manager ought to be able to explain precisely what steps have been taken in terms of design, day-to-day management, provision of equipment and training of staff to minimize the risk of falling
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Would you (or the relative on whose behalf you are enquiring) fit into the social ambience of the home? What social activities are on offer? Try to meet the home's activities organizer and sit in on at least one of her sessions, observing whether residents are finding them absorbing and whether all residents are included in some way or other. This member of staff, supervising anything from birthday parties, to light exercise, to games, to craft activities, to outings, can be the life and soul of a home, or she can be a damp squib, and, if not warm and responsive to residents and possessed of some training in interacting with frail and disabled people, probably worse than nothing.

It is easy to be charmed by an engaging manager against a backdrop of matching decor in the hall of a former stately home, but would your grandfather, say, really feel at home here? Would he be able to get across what might seem to him acres of floor? Where would he smoke his pipe? Who would he talk to? What would substitute for his garden-shed environment?

Bear in mind that you are being shown round by a sales-person. She will be trying to give you as favourable an impression as possible, perhaps conducting a large part of the interview at the window of the most attractive bedroom offering a fine view. She is also likely to want to conduct the interview at a time when her home is bustling with activity. But you have got to discover what the home would be like to live in. What would you be doing in the evening (when few prospective residents make advance visits)? If you should wake unwell or uncomfortable at 2am, would a care assistant respond swiftly, sympathetically and professionally? If you have difficulty in swallowing and moving as a result of Parkinson’s disease, would staff ensure you received your medication on time and spend sufficient time helping you eat and drink? You have to assemble all the evidence you can muster to decide whether you (or your relative) would be comfortable, warm, well-fed, happy, interested and cared for kindly, expertly and efficiently, day and night.

One room which will actually be most important but which you might only glimpse on your tour is the lavatory. Make sure you see all the lavatories you would use, and if you need a pause to take in the details, excuse yourself. Bring a thermometer so you can check the temperature. Older people need a higher ambient temperature than younger people; expect it to be 22 or 23°C. Has the room been kept scrupulously clean? Are the aids to help residents get up and down adequate? Is there sufficient space on both sides for care workers to help? Is it a pleasant, nicely-decorated, well-lit room? Answers to these questions will not only tell you about the toilet facility itself: they are also a more reliable means of ascertaining whether the home is prepared to spend money on the comfort and well-being of residents than the state of the grand lobby.

Take careful note of the availability of gadgets and aids which could assist daily living. For example, which rooms have been fitted with a hearing loop system? Are there also free-standing enhanced listening devices? Is the television switched to subtitling? Are books and other written materials available in large-print, Braille or audiotape? Is the home well signed?

Make sure your contract will specify which room you will occupy and inspect the one offered carefully. A single room should be at least 12 square metres (14 square yards), excluding en-suite facilities. Anything smaller is likely to feel cramped. Check on the alarm system for summoning assistance during the night. Is it easy to reach from the bed? Will you be able to work it if you have shaky hands or cannot see well? Good care homes will come up with imaginative solutions to such problems. Is there a pleasant view when somebody is sitting up in bed? Could you adjust the temperature controls yourself within the room? Is there adequate space for items like a radio, CD player, telephone and television? If you are hard of hearing, how will you be alerted in the event of a fire?

Don’t forget the wider environment. Do the grounds offer the sort of environment which you would like, and are they easy to cross both on foot and with mobility equipment? What of local streets and facilities outside the grounds? A grand country mansion may look impressive, but there will not be streets with shops close by along which wheelchair-users could be pushed, thus keeping in touch with everyday life. Is the home easily accessible by public transport for visitors without cars?

If you are pleased with a home, do not make a commitment until you have returned on at least one separate occasion to sit by yourself for some time to see what happens. If the manager resists this idea, be suspicious. Watch how staff interact with all residents (especially the most vulnerable) on a minute-to-minute basis, whether residents are happy, what they do all day, whether the food portions are adequate and whether seconds are available and so on. If possible, try to sit and watch several times, at different times and on different days of the week. One such visit is essential.

If the home passes these tests, start thinking about the contract. Residents in care homes do not have the security of tenure afforded to people in rented flats: their status is like that of a lodger and residence is based on the terms set out in the contract between the home and the resident or the person or organization paying the bills. Contracts vary a good deal. Go through yours very carefully and seek amendments if necessary. Above all, don’t enter the home on a permanent basis without having signed a contract: if you do and problems arise, like an uncalled-for hike in the fees, you won’t have a leg to stand on
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The home should provide you with details of its complaints procedure. Try to get a sense of how the home deals with complaints from the manager or indeed through talking to other residents or relatives. Complaints should not be brushed off, but dealt with seriously. You don't want a home which treats any complaint in a patronizing dismissive manner, perhaps over a cup of tea. You want one which looks at it objectively, is willing to apologize and most important of all to take action to prevent recurrence if the complaint is justified. Also look in the complaints procedure for reassurance that no resident will be penalized in any way because they complain
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Visiting is an important area. Some people like to visit for several hours every day. Is this going to be acceptable? If you are the partner of somebody who is going into a care home, it is especially important that you should feel that you will always be welcome. Some husbands or wives go into a home with a partner even though their needs for care are less than their spouse’s. They will wish to make absolutely sure that the home will provide them with a double room and that they will not be split up
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The level of fees, who is going to pay them and the circumstances under which the home can increase them should be set down in the contract. Other matters may matter particularly to you. For instance, are religious services held in the home? If you hail from an ethnic minority group, will the home be able to accommodate any special requirements or preferences you may have, for instance, in the area of diet? Can residents bring their pets and if so, how are they managed?

If after you have considered all these matters a home looks promising, ask the manager if you or your relative could move in for a trial stay. If after that all goes well, sign the contract and count yourself lucky.

Marion Shoard is the author of A Survival Guide to Later Life (Constable and Robinson, 640 pages, £9.99).

Essential contacts
Care Standards Inspectorate for Wales
Heol Billingley
Parc Nantgarw
Nanatgarw
CF15 7QZ
Tel: 01443 848450
www.wales.gov.uk/subisocial/policycarestandards

Commission for Social Care Inspection
St. Nicholas Building
St. Nicholas Street
Newcastle-upon-Tyne NE1 1NB
Tel: 0191 233 3600
Information: 0191 233 3556
www.carestandards.org.uk

Department of Health, Social Services and Public Safety for Northern Ireland
Castle Buildings
Stormont
Belfast
BT4 3SJ
Tel: 028 905 20 500
www.dhsspsni.gov.uk

Scottish Commission for the Regulation of Care
Compass House
11 Riverside Drive
Dundee
DD1 2NY
Tel: 01382 207100
www.carecommission.com

'Elderly Infirm Need Trained Care, not Tainted Cash' published as part of a feature on 'The People the Politicians Forgot' in The Tablet, 7 May, 2005
Free bus passes, council tax rebates, free personal care, higher pensions and benefits ... an inter-party auction for the grey vote appears to be raging. Elderly people ought to be one group whose problems will be sorted by Election 2005, you might be forgiven for thinking. But if this is what you do think, you could not be more wrong.

Almost all the concessions currently being offered to elderly people have one objective - an improvement in living standards through a transfer in resources to older from younger people.

It is debatable whether such a transfer is justifiable, since those becoming elderly now have enjoyed many advantages which will be denied to those expected to sustain their ever-growing numbers. Yet the 11 million people currently of pensionable age undoubtedly feel dissatisfied with their share of the national cake. As they tend to vote, and younger people increasingly neglect to, it is not surprising that they are getting something of what they want. This is how you might expect to democracy to work. So what's wrong with that?

What's wrong with it is that the standard of living of older people as a whole is very far from being the biggest problem presented by old age, and the hubbub currently surrounding it has completely obscured a far more important issue. This is the way we treat those members of the elderly population who find themselves bedevilled by chronic illness of one kind or another and are, as a result, condemned to eke out their lives in residential care establishments or to depend on the ministrations of paid care workers in their own homes.

Such people form only a smallish proportion of those of pensionable age - about 10 per cent. Yet that still means there are over a million of them. They are in no position to join pressure groups or lobby politicians, yet their needs are far more pressing than those of the ordinary over-65-year-olds noisily and, it seems, successfully demanding a few more quid a week. Many of them are enduring a daily regime of neglect, hardship, misery, humiliation and abuse which shames our nation. Their condition is an outrage. But, since they are largely devoid of political clout, none of the parties proposes to do much for them.

We all know that things are bad out on the granny farms, where compassion, concern and stimulation are available only from inadequate numbers of underpaid, undertrained staff, some of whom do their best while others ignore, bully or steal from their charges. Regulation is minimal, and the cash-starved local authorities which pick up most of the bills are far more concerned about cost than quality of provision. Concerned relatives, where these exist, may find their access to care home residents restricted, while complaints can result in eviction.

The plight of elderly people still living in their own homes but dependent on visits from unsupervised care workers is often even worse. A Panorama programme broadcast in 2003 showed bedbound, helpless old people confined within their own four walls waiting for rushed agency workers to change their continence pad and hand out medicine. Yet no-one wants to think about any of these people. All of us, not just politicians, would rather see elderly people as cheery grans happily enjoying cruises and going bungay-jumping than face up to the national scandal of the conditions endured by their less favoured contemporaries.

The plight of chronically sick elderly people has little to do with their personal incomes. Indeed, the current welfare regime ensures that no-one over 60 need fear the spectre of real poverty which used to haunt old age. It is not more cash in the pocket but proper care that our most vulnerable elderly citizens need. This would require an array of measures you will hear no party advocate in the coming campaign, with the possible exception of Plaid Cymru. The government's "vision" for the future of social care for adults in England, published in March, barely found space in its 90 pages to mention the care homes where nearly half a million elderly people live, let alone the quality of the care provided within them, or lack of it.

Standards in care establishments, and for care provided in elderly people's own homes, need to be transformed. New systems of regulation, training and inspection should be introduced to bring this about. In addition, it should be made far easier for families to care for frail relatives themselves, if they wish to do so. Of course, more money would have to be pumped into the system to ensure that these things could happen.
Until it is, politicians' promises to sort the problems of elderly people will be no more than a sham. Improvements in the financial position of those already doing OK may be good politics. But what elderly people really need is the elimination of gross and unnecessary suffering. Christians, at least, should be able to spot the difference.

Marion Shoard is a campaigner on older people's issues and the author of A Survival Guide to Later Life (Robinson, 2004)