Keeping older couples in care together

The wedding vow “till death do us part” has become impossible to fulfil for some older couples because of the way care home places are allocated. In recent months stories have come to light detailing how a number of couples who have been together for ­decades face being split up in their final years because they have different care needs.

Last month an older Monmouthshire couple, Tom and Nancie Hughes, were thought to have taken their own lives because they were horrified at the thought of being sent to different care homes.

Soon after the case hit the headlines, and many believe in response to it, the Department of Health pledged to hold talks with councils on the issue. A DH spokesperson said it would be making clear to councils that “other than in exceptional circumstances, couples requiring care should not be separated, and the needs of both people are properly taken into account”.

Older couples can face separation for different reasons: when both are assessed as entitled to varying levels of care, such as residential and nursing or, more often, when one is assessed as needing residential care while the other is deemed well enough to stay at home.

The government’s Fair Access to Care Services guidance states that assessments should take into account people’s need for social support systems and relationships and the maintenance of their family and social roles.

Paul Cann, director of policy at Help the Aged, says that, despite this, cases show some councils’ decisions are still financially driven. “It’s encouraging that the government is talking to councils about this. [But] we need to strengthen the guidance and get a grasp on this issue. We want to see action and no repetition of the cases [of elderly couples facing separation].”

Government directions to councils on choice of accommodation also state that people should be placed in homes near relatives and loved ones, even if they are more expensive. This is particularly important if their partner has remained at home.

Alison Clarke, advice worker at the Relatives and Residents Association, says that despite the guidance not all councils will pay for local care: “People have to know the system. If they don’t they can find that local proximity to relatives and loved ones isn’t really taken into account and pressure can be put on people to move further away particularly in rural areas.”

Clarke doesn’t think it’s the guidance that’s at fault, rather that the government should ensure local authorities stick to it.

Dwayne Johnson, joint chair of the Association of Directors of Adult Social Services’ older people network, says while Adass recognises there is an issue, apart from the cases raised in the media, it hasn’t any evidence that local authorities are separating couples. “We would support and encourage every local authority to consider every available avenue for couples to remain together,” he says.

Unthinkable prospect

For many older couples the thought of being apart from their loved one for even a few days is a traumatic one, so the prospect of living apart – as demonstrated by the Monmouthshire case – is unthinkable. Contrary to common belief, when one partner goes into residential care it isn’t always the situation that the other has been acting as their carer, says Clarke.

“In a lot of situations they complement each other and care for each other and when one goes it has a dramatic effect,” she says.

It is taken for granted by most that getting older often comes with associated health problems. Cann says many older people can cope with the aches and pains while they have their partners by their side and it’s only when this support is taken away they feel unable to cope.

“When people are put on their own in a care home you have taken away the most significant thing they have,” he says.

Space shortage

Alongside financial constraints, a shortage of care home spaces and supported housing can also cause couples to be separated. In March the government announced £80m worth of extra care housing from 2008 to 2010 to provide an alternative to residential care and keeping couples together.

Although Cann welcomes the funding, he says that with an ageing population it’s a drop in the ocean. “It’s still only 30,000 places when there are 400,000 residents living in care homes [now].”

The white paper on adult social care, Our Health, Our Care, Our Say, lays out choice as a cornerstone of the government’s policies for older people, but the lack of care home and supported housing spaces makes this ­unrealistic for many. Campaigners are ­looking to this autumn’s expected green paper on adult social care funding to address the issue.

Meanwhile, the limited provision of care in many areas can make it particularly difficult to keep couples together when they have different care needs.

“There’s actually not that much choice for a lot of people because a lot of care homes don’t have many excess places,” says Clarke.

“We would like to see flexibility in the system so people can go into the same care home if they want.”

Even when couples with different needs are placed in the same home the practicalities involved can make it difficult to keep them living together.

Clarke adds: “Couples [who have different care needs] can go into the same home but then be cared for on different floors so they are not actually living as a couple and it becomes more of a visiting relationship. The practicalities of caring can make it very difficult.”

As well as potentially harming the mental health of individuals, separation can have a major financial impact when it involves one spouse being left at home – particularly for women.

Caroline Bernard, policy and communications manager at older people’s charity Counsel and Care, says many of the calls about separation to its advice line concern financial difficulties. “Many older women did not work outside the home so if they lose their joint income [including any private pension their spouse may have had] they need to depend on means-tested benefits,” she says.

Financial implications

According to Clarke, the system itself is partly to blame for these women’s ­hardship. “The financial implications, particularly for women, are severe because of the way the means test is set up. If they are at home on a much-reduced income but have the expense of ­maintaining the family home that can have a real effect.”

For Clarke the government’s commitment to speak to councils is positive but she says this needs to be part of a wider piece of long-term work not influenced by the press.

“The government’s announcement was a response to those stories put out by the media and we would rather that the whole issue of support for couples was looked at with a clear head,” she says.

Whatever the reason behind it, at least the government has promised to tell councils that couples should not be separated except in exceptional circumstances. We can but hope that the government, at least, can stick to its vow.

Read about Tom and Nancie Hughes

 White paper

Check the policy and practice page of the Relatives and Residents Association

Counsel and Care’s policy page

This article is published in the 26 June issue of Community Care magazine under the heading We’ll never

meet again