The ironies of care

March 15: A momentous couple of days begins and I'm struggling to keep all the issues and questions straight in my mind.  Later today, the social services team will assess Dad's care needs at home; tomorrow we visit Grotsville's downtown hospital for an appointment with the mental health team.  While I'm with him I need to talk about power of attorney and stuff to do with his finances.

On Saturday a legal eagle who specialises in matters to do with care of the elderly offered an advice session in the village hall.  He mentioned in passing that he's worked inter alia for a national old folks' charity for the past 20 years, and had been in the habit of going on a refresher course to keep himself up to date with all the regulations.  "Now that's not enough", he complained.  "I need to go every three months".  Good grief, I thought, if even an expert needs to run just to keep up, what hope is there Joe Public?

Dad can manage at home, for the moment, but there's no telling right now how long the "moment" will last.  My feeling is that if he's still living where he does now at Christmas he'll be lucky, but Christmas 2012? - forget it, on his present rate of decline.  I'm guessing that within the next 18 months we'll need to have organised a move.

What might the options be at that stage?  Here I need to think about cost, quality of care, about what's right for Dad but also no more inconvenient for me than it has to be; and without being mercenary, I know that Dad would not want money that he would prefer to pass on to me to get swallowed up in the costs of residential (and maybe nursing) care.   I must work out a package in which neither he or (ultimately) I lose out more than we have to, but I'll need to do a lot of research and consultation before I know what the "right" package would look like.  It doesn't seem quite fair that a man who has always been careful and methodical with his money should have the bulk of it commandeered to pay for his care in his final years, when others who have squandered their substance wind up in care homes for which the state (or taxpayer if you prefer) foots the bill.

I don't know what a fair system would look like, but am conscious of many anomalies.

If you're ill the NHS will look after you, and no moral judgement is ever made nor could be.  Those who abuse their bodies in various ways - excessive eating, drinking, smoking, drug-taking - will contract a host of diseases which may be fearfully expensive to treat, but treated they will be.  No charge.  But the old man whose only crucial health problem - dementia - is in no way the result of a dissolute lifetsyle and doesn't need to be in hospital will face a hefty bill for his care.

If Dad had wanted, a couple of years ago before lameness slowed him right down, to go on a world cruise, he could have done so and no-one would have batted an eyelid.  But if he now offered me a couple of tickets for a world cruise, or the cash equivalent (which frankly I would rather have), the authorities would take a dim view of this when it came to assessing his financial circumstances: and interpret it as "voluntarily impoverishing himself", in order not to have to hand the money over to a care home.  So he'd be penalised for trying to help his son out, but not for indulging his own wishes.

I suspect this will be the first post of many on this subject.