Guide Guide 8 Health difficulties: How to cope with changing needs As we age, we’re more likely to develop difficulties because of illhealth or disability. This guide explains what help and support is available from the local council and the National Health Service (NHS). The Independent Age advice service offers free information and advice on issues affecting older people. All the guides we publish are available from our website www.independentage.org and paper versions can be ordered by calling 020 7241 8522. You can also call our advice line on 0845 262 1863 to arrange an appointment to speak to one of our experienced advisers. Independent Age is a unique and growing charity providing information, advice and support for thousands of older people across the UK and the Republic of Ireland. There are differences in the ways each country cares for and supports older people. The information in this guide applies essentially to England, although there may be similarities with countries in the rest of the UK. We also produce five separate guides for both Scotland and Wales covering the needs assessment process; paying care home fees and making a formal complaint, which are the key areas where the policy and legislation differs significantly from England. All of the guides we publish may be downloaded from independentage.org or posted to you if you call our guide order line on 020 7241 8522. Guide 8: Health Difficulties: how to cope with changing needs August 2013 2 Contents 1. Health difficulties......................................................... 4 2. Assessment of your needs.............................................. 5 3. Equipment and adaptations in your home........................ 7 Occupational therapists................................................. 7 Specialist equipment..................................................... 8 Mobility equipment....................................................... 9 Motability.................................................................... 10 Disabled Facilities Grant................................................ 10 Home Improvement Agencies........................................ 11 4. Health services............................................................ 12 Your GP...................................................................... 12 Community nursing...................................................... 12 Intermediate care........................................................ 12 Re-ablement services................................................... 13 Foot care.................................................................... 13 Eye care..................................................................... 14 Dental care................................................................. 15 Stopping smoking........................................................ 15 Reducing alcohol consumption....................................... 15 5. Transport.................................................................... 17 6. Travelling to hospital.................................................... 19 Visiting someone in hospital.......................................... 20 7. Falls........................................................................... 21 8. Incontinence issues...................................................... 24 Types of incontinence.................................................... 24 What help is available.................................................... 26 9. Financial assistance towards health costs......................... 28 10.Health tips to remember............................................... 31 Guide 8: Health Difficulties: how to cope with changing needs August 2013 3 1 Health difficulties Many older people lead full, active and healthy lives, although some people will face health difficulties at different times, or over a longterm period. Health difficulties can be caused by different reasons, not all of which are related to your age. Physical illnesses, such as arthritis or a stroke, can affect your mobility, while mental health difficulties, such as memory loss or disorientation, can make it more difficult for you to go out alone. However, there may be help and advice available, as outlined in this guide, which can assist with your health problems and may go some way towards making you feel better or more able to cope with daily activities. Guide 8: Health Difficulties: how to cope with changing needs August 2013 4 2 An assessment of your needs The social services department at your local council can provide a needs assessment which will identify what your needs are, and will look at the types of care, support, aids or adaptations to your home that you may benefit from. If the council social services agree that your assessed needs meet the local eligibility criteria, they can organise support services directly from social services or through another organisation, such as a private home care agency or a voluntary group like Age UK. Support services may also be available from the housing department or health authority. If you are eligible, you can also arrange your own care and support by asking for a Direct Payment or a personal budget, which provides you with the money to directly ‘purchase’ your own care. For more information, see our guide, Home Care: using Direct Payments and Personal Budgets (Guide 23). The contact details for social services will be on the council’s website or in your local telephone directory. For more information about needs assessments, see our guide, Assessment and Service from your local council in England (Guide 12). Carers If you care for someone who has physical or mental health difficulties, you are entitled to an assessment of your needs as a carer, from your local council social services. This is known as a carer’s assessment. The assessment might result in more services to help the person you look after, or services to support you in your role as a carer. Guide 8: Health Difficulties: how to cope with changing needs August 2013 5 For more information about carer’s assessments and Carer’s Allowance, contact Carers UK (0808 808 7777, carersuk.org.uk) - a national charity which gives advice and information to carers - or see our guide, Carers: what support is available (Guide 10). Guide 8: Health Difficulties: how to cope with changing needs August 2013 6 3 Equipment and adaptations in your home If you are experiencing health difficulties, you may benefit from having specialised equipment or adaptations added to your home to make it easier for you to carry out daily tasks or move about. Occupational therapists An occupational therapist (OT) is a professional trained to work with people who are ill, recovering from an illness, or have a chronic disability. They can advise you and refer you to receive disability equipment and adaptations to your home. Disability equipment (up to the value of £1,000) should be provided free of charge. OTs may be based in a hospital or in the social services department of your local council. If you are in hospital, the OT assessment and provision of any small items of portable equipment should take place as part of the discharge process. Once you are discharged from hospital, the hospital OT should refer your case to the OT in the community if you need any larger pieces of equipment or adaptations. Once discharged, any intermediate care services that you are eligible for should be provided free of charge for up to six weeks. For more information, see our guide, Hospital care in England: Everything you need to know before, during and after your stay (Guide 11). If you are living at home, the OT’s assessment and the provision of equipment or adaptations may be a longer process. If you need equipment urgently, you should make this clear when you contact social services or to the person making the referral to the OT department. Guide 8: Health Difficulties: how to cope with changing needs August 2013 7 To access the help of an OT, you may be referred by a social worker following a needs assessment. Alternatively, you can ask your GP to refer you or you can contact the OT department directly by calling social services. A friend, relative or carer can also contact them on your behalf. For more information about OT assessments, see our guides, Assessment and services from your local council in England (Guide 12) and Housing: adapting your home to stay independent (Guide 28). Specialist equipment If an OT assesses you as needing specialist equipment to help you in your home, social services have a duty to provide this equipment, as long as it can be installed or removed with little or no structural modification to your home. This equipment may include: • handrails next to the bath, toilet, stairs or front door • a community alarm system so that if you fall in your home your relatives and the emergency services can be alerted • specially designed or adapted furniture. Many councils have now implemented a new procedure for the provision of Simple Aids to Daily Living (SADLs) which may include eating and drinking utensils, grabrails, raised toilet seats and other small items which will help you remain independent in your home. These changes to the provision of community care equipment, known as Transforming Community Equipment Services (TCES), is part of the government’s ongoing programme of personalisation in social care services, and is aimed at giving users more control and choice over the equipment they receive. Following an assessment by an occupational therapist, a physiotherapist or a community nurse, you will be given a prescription in the form of a voucher which you can then exchange Guide 8: Health Difficulties: how to cope with changing needs August 2013 8 for suitable products at an accredited retailer. Information about local retailers may be found on your council’s website if they are operating this scheme. If you wish to purchase a better quality item, you will be able to pay the difference. You can also look up the range of equipment available on national-catalogue.org. If you need more substantial adaptations fitted inside your home, for example, a stair lift, a ramp or a walk-in shower, the local council have a ‘duty to assist’ in arranging for the work to be carried out, but they are not obliged to carry out the adaptation themselves. This may simply mean the the local council just advises you on a suitable company that will provide the equipment. However, the council is not allowed to use ‘lack of resources’ as a reason for not providing the assistance it has agreed that you need. For more information about getting adaptive equipment, see our guides, Assessment and services from your local council in England (Guide 12) and Housing: adapting your home to stay independent (Guide 28). Mobility equipment If you have difficulty walking, social services can assess you as needing a walking stick, a walker or even a wheelchair (either manual or automatic). You may prefer to use an electric mobility scooter to get about, but unfortunately this type of equipment is not available from your local council social services. It may be possible to get an electric scooter through the Motability scheme (see section below) or by raising the money through a charitable grant. For more information about applying for charitable grants, see our guide, Grants from charities for people on a low income (Guide 21). Guide 8: Health Difficulties: how to cope with changing needs August 2013 9 Motability Motability (0845 456 4566, motability.co.uk) is a scheme that allows people to exchange the higher rate mobility element of their Disability Living Allowance, the enhanced rate of the mobility component of Personal Independence Payment (PIP), or their War Pensioners' Mobility Supplement to lease or hire purchase a motability car, electric scooter or automatic wheelchair. If you receive Attendance Allowance, this benefit does not qualify you for help from Motability. To find your nearest provider, visit the Motability website motability.co.uk. Disabled Facilities Grant A Disabled Facilities Grant helps disabled people in England and Wales to pay for essential adaptation work to make their home more suitable for their needs. This is conditional on you meeting the eligibility criteria, and on an occupational therapist recommending the work needed. Anyone aged over 18 with a disability is eligible to apply, whether they are a private tenant, housing association tenant, or an owner occupier. If you are a council tenant, the housing department will receive the grant directly. However, the grant is subject to a means test, and the person with the disability must agree to live in the property for at least five years after the work has been completed, unless this becomes impossible for health reasons. You can apply for a Disabled Facilities Grant from the council you pay your council tax to (or claim your Council Tax Benefit from). Social services can give you more information and your local Home Improvement Agency (see below) can help you through the application process. For more information, see our guide, Housing: adapting your home to stay independent (Guide 28). Guide 8: Health Difficulties: how to cope with changing needs August 2013 10 Home Improvement Agencies Home Improvement Agencies (HIAs) are local, not-for-profit organisations which help older or disabled, home owners on a low income and private tenants to have repairs carried out, as well as adaptations or improvements to their homes. They can tell you if you are entitled to any financial help, for example, grants such as the Disabled Facilities Grant, or disability benefits to help you pay for the work and can provide you with a list of local builders and contractors. Some HIAs can arrange for minor repairs or adaptations to be carried out at a subsidised rate by a member of their staff, or an approved company. HIAs are sometimes also known as Care and Repair agencies. They are provided by about two-thirds of local councils and their contact details may be obtained from their national body Foundations (08458 645 210, foundations.uk.com). If there is not a HIA in your area, you can contact your local council or advice centre to find out what help is available. If you are a council tenant and you need a repair to your property, contact the council housing department. If you rent your home privately and need a repair to your property, contact your landlord. You will need your landlord’s permission before any repairs or adaptations can be carried out. Guide 8: Health Difficulties: how to cope with changing needs August 2013 11 4 Health services There are many services available through the NHS which can help with any mobility or health needs you experience in older age. Your GP This should be your first port of call if you have a health difficulty which is causing you problems. It may be that you can be treated easily or your GP may need to refer you on to other services if you need more specialist advice. If you need non-urgent treatment and are referred to a hospital, you should be offered a choice of locations so you can choose which is most convenient for you. Community Nursing A community nurse can treat you for minor ailments in your local GP surgery or they can visit you in your own home. Community nurses can have a variety of specialisms for example, mental health, skin breakdown or continence (see chapter 8). Intermediate Care Your GP or your local A&E department may be able to refer you to a rapid response team who can set up a package of short-term (or intermediate) care funded by the NHS, to prevent you having to go into hospital. Rapid response intermediate care can be provided from anything between a few days up to a usual maximum of six weeks and should be provided in a community based setting or in your own home. A rapid response team can assess and provide the necessary care you require in your home. Some acute care can be provided at home from specialist teams, for example, the administration of intravenous antibiotics. Intermediate care may also be provided to help you recover after your hospital discharge. Guide 8: Health Difficulties: how to cope with changing needs August 2013 12 Re-ablement services If you are discharged from hospital or you have had a health crisis at home, you may be eligible for re-ablement services. Re-ablement services are provided free of charge, with the main purpose being to help you to regain your confidence and daily living skills so that you can stay at home for longer. Re-ablement is short-term help usually up to a maximum of six weeks - where carers visit you during a short period to help you to achieve daily tasks rather than doing them for you. Equipment may be provided to help you move around your home more easily and to achieve everyday tasks independently. You will need to be assessed for a re-ablement package either by the hospital social worker at the time of your hospital discharge, or by a local council social worker if you are at home. You can refer yourself to your local council social services to be assessed for a re-ablement service, or by someone else, such as a family member, friend or your GP. Footcare Looking after your feet can help with mobility problems and also reduce the risk of falls. Older feet tend to develop more problems because the skin is thinner, and wear and tear on the joints over the years can cause discomfort or pain. However, this is not an inevitable part of growing old, and there are treatments available which can improve the condition of your feet. If you have problems with your feet because of ageing, diabetes, osteoarthritis or rheumatoid arthritis, you should be a priority for NHS foot care services. Make an appointment to see your GP, and ask them to refer you to a podiatrist or chiropodist. Chiropody is available on the NHS free of charge in most areas, but what is available will depend on health care provision in your local area. Guide 8: Health Difficulties: how to cope with changing needs August 2013 13 If you are not eligible for footcare from the NHS you will need to arrange to see a chiropodist privately. Some local Age UK or Age Concerns (0800 169 65 65, ageuk.org.uk) arrange group chiropody appointments at a subsidised rate. Eyecare It is important that you have your eyes checked regularly. You are entitled to a free eye test every two years if you are aged between 60 and 70, and every year if you are aged over 70. For contact details of opticians in your local area, visit the NHS Choices website (nhs.uk) or contact NHS Direct (111). Some areas of the country are still covered by the old NHS Direct telephone number: 0845 46 47, nhsdirect.nhs.uk). For more information on the financial help available to purchase glasses or contact lenses, see chapter 9. If you are unable to leave your home because of physical or mental health reasons, you may be eligible to have an NHS-funded sight test at home. This is known as a domiciliary sight test and a qualified optometrist will visit you at home to carry out the sight test. To arrange this and obtain a list of optometrists providing this service, you will need to contact your local NHS Clinical Commissioning Group (CCG), or Local Area Team (LAT), as these have replaced Primary Care Trusts in local areas. To contact your local Clinical Commissioning Group for details, you can either phone NHS Direct (0845 46 47) or visit the NHS website nhs.uk/ServiceSearch/Clinical-Commissioning-Group/LocationSearch If your sight cannot be corrected by wearing prescription lenses, you may wish to register as sight impaired (also called partially sighted), or severely sight impaired (also called blind). Your ophthalmologist, usually at an eye clinic, will ask you to sign a ‘Certificate of Vision Impairment’ and will notify your local sensory Guide 8: Health Difficulties: how to cope with changing needs August 2013 14 service. Registration is voluntary and may bring concessionary benefits. For more information about sight loss, contact the Royal National Institute for the Blind (0303 123 9999, rnib.org.uk). Dental care To find an NHS dentist, contact NHS Direct (111, nhs.uk) or the NHS dental helpline (0300 1000 899, nhsdentistlocator.co.uk ). If you are unable to find a dentist who accepts NHS patients you may have to go on a waiting list or pay privately for treatment. If you have a mobility problem that means you find it difficult to visit your dentist, you may be able to arrange for a dentist to treat you in your own home. You should contact your local Clinical Commissioning Group (CCG) and ask for a visit from a domiciliary dentist. There is a variation in availability depending where you live in the country. The NHS dental helpline (0300 1000 899) can tell you if this service is available in your local area. Stopping Smoking Smoking can have serious effects on your health. The NHS offers free local support to help people quit smoking. A trained adviser will help you put a plan into action to stop smoking. Your adviser will also explain to you about the range of nicotine replacement products and other stop smoking medications that are available. For further advice or to find your local service, contact the NHS Quit Smoking service (0800 022 4 332, smokefree.nhs.uk). Reducing alcohol consumption Having a glass of alcohol can be one of life’s pleasures, but drinking too much can have a detrimental effect on your physical and mental health. It can cause insomnia and anxiety, and increase the risk of falls and accidents, incontinence and depression for older people. In Guide 8: Health Difficulties: how to cope with changing needs August 2013 15 more severe cases, heavy drinking can lead to dementia, neurological (brain) disease and self neglect. If you think that you have a problem with alcohol, you may want to discuss this with your GP and could even ask about being referred to cognitive behaviour therapy (CBT), or a group support programme. If you are concerned about your own or someone else’s drinking, you can contact Alcohol Concern (0800 917 8282, alcoholconcern.org.uk) to discuss safe drinking limits and how to get help and support. If you believe that you have a severe problem with alcohol which is affecting the quality of your life and your relationships, you may wish to contact Alcoholics Anonymous (0845 769 7555, alcoholics-anonymous.org.uk). Alcoholics Anonymous is a self-help organisation that runs support groups throughout the UK. Guide 8: Health Difficulties: how to cope with changing needs August 2013 16 5 Transport If you have difficulties with mobility, you may have problems using public transport. Community transport schemes, such as Dial-a-ride, can provide door-to-door transport for older or disabled people. In some areas, there are taxis or community buses that can transport people with disabilities. For example, Taxicard is a scheme run by the 32 London boroughs and similar schemes can be found in other parts of the country. The service provides a subsidised door to door taxi service for people with mobility problems. Contact your local council or your nearest Disability Information and Advice Line service (DIAL) (01302 310 123, dialuk.info/findadial/index.asp) to find out what transport services are available in your local area. In some areas, there are schemes that can arrange transport by trained volunteers who have had security checks. Contact your local Age UK or Age Concern (0800 169 65 65, ageuk.org.uk), Women’s Royal Voluntary Service (WRVS) (845 600 5885, wrvs.org.uk), or Red Cross (0844 871 1111, redcross.org.uk) to see if a service is available in your area. You may be able to find details of schemes in your local telephone directory or local library. Some local branches of national charities, such as the Multiple Sclerosis Society (0808 800 8000, mssociety.org.uk) or Mind (0300 123 3393, mind.org.uk) have their own transport schemes. If you drive a car and have mobility problems, you may be eligible for a Blue Badge from your local council social services. A Blue Badge gives you access to priority parking so you can park closer to where you need to go. It can also be used for your escort, providing you, the disabled person, are a passenger. You can get information about Guide 8: Health Difficulties: how to cope with changing needs August 2013 17 the Blue Badge scheme from your local council or the website, gov.uk/apply-blue-badge You are entitled to a free annual bus pass, often called a ‘freedom pass’, which gives you free off-peak travel on local buses anywhere in England if you are of ‘eligible age’ or are ‘eligible disabled’. The age of eligibility is rising in stages between 2010 and 2018 in line with the government changes to the qualifying age for the state pension. This means that the earliest age for men and women to get concessionary travel passes will gradually increase from 60 to 65. These changes do not affect existing ‘freedom pass’ holders. You are eligible for an older person's bus pass from your 60th birthday if you were born before 6 April 1950. If you were born after 6 April 1950, you will become eligible when you reach pensionable age (if you are a woman) or when you reach the pensionable age of a woman born on the same day as you (if you are a man). Some local councils may offer free travel outside off-peak hours, or free or reduced price tram or rail travel within the local area. People who live in Greater London can apply for a Freedom Pass from their local council, or obtain an application form from the Post Office. People who live outside the Greater London area should apply to their local pass provider. The Gov.UK website gov.uk/apply-for-elderly-personbus-pass has further information on free bus travel and a list of England’s concessionary pass providers. Guide 8: Health Difficulties: how to cope with changing needs August 2013 18 6 Travelling to hospital The Healthcare Travel Costs Scheme (HTCS) is available to patients who do not have a medical need for ambulance transport but who cannot meet the cost of travel to hospital. If you are on a low income, you may be entitled to a full or partial reimbursement of your travel costs to the hospital under the HTCS scheme. To be eligible, you must complete form HC1 available from your GP surgery or hospital. You can call the HTCS customer enquiry line (0845 850 1166) if you need help to fill in the form. If you receive Pension Guarantee Credit or other qualifying benefits, you will be entitled to full reimbursement of your travel costs to hospital. You will not need to complete an HC1 form, but you will need to show evidence of receipt of your benefits. Under the HTCS scheme, eligible patients are also entitled to claim for the travelling expenses of escorts/carers where their presence is considered to be medically necessary by their GP or consultant. Most hospitals refund fares at reception, or if not, they can advise you on the procedure. You will have to produce evidence of receipt of Pension Guarantee Credit or other qualifying benefits or a current HC2 or HC3 certificate for entitlement to full or partial refund under the NHS Low Income Scheme. If you are unable to claim at the time of the appointment, you can apply for a refund using the HC5 form but you must claim within three months. For more information on help with health costs, contact the NHS Business Services Authority on 0300 330 1343, nhsbsa.nhs.uk/HelpWithHealthCosts.aspx Guide 8: Health Difficulties: how to cope with changing needs August 2013 19 Visiting someone in hospital If you are visiting someone in hospital, you cannot claim under the HTCS scheme. It was previously possible to receive assistance from a discretionary grant or loan through the Social Fund, as long as you were in receipt of Pension Guarantee Credit. However, the Social Fund changed in April 2013 and your local council has now taken over the funding, although they are allowed to decide how the money will be spent. You could check with your council to see if they are able to assist you with these travel costs. For more information, see our guide, The Social Fund: Grants and loans (Guide 4). Guide 8: Health Difficulties: how to cope with changing needs August 2013 20 7 Falls As you grow older you may become more prone to falls. Falls can cause serious injury and leave long-lasting physiological effects. Many falls can be prevented by following simple steps, such as: staying active. Falls can be caused by weak muscles and • poor balance. You can improve muscle tone by taking regular exercise, such as walking, swimming, gentle stretching exercises or doing light gardening. Weight-bearing exercises such as walking, tennis and lifting weights can strengthen bone density. Your local leisure centre or swimming pool may offer free or concessionary exercise classes and swimming for older people. You can find out about local walking schemes by visiting your local library or by visiting the Walking for Health website (wfh.naturalengland.org.uk) reducing the risk. When you get out of bed or up from a • chair, try to do it slowly, as a sudden drop in blood pressure when you stand quickly can make you feel dizzy. Try tensing and then relaxing your arms and legs a few times before you stand. Make sure your feet are firmly placed on the ground before getting up. If you are having difficulty with activities like getting into or out of a chair or getting to the toilet, you can ask for an occupational therapy assessment from your local council social services. The assessment will identify if there is any equipment or adaptations that can help you carry out daily tasks • visibility. You may wish to leave a dim light on at night in the bedroom or hallway, or have a touch-operated bedside light. Ensure good quality lighting is fitted throughout your property. Walkways, corridors and halls should be kept clear of objects, wires and clutter that could cause you to trip. Guide 8: Health Difficulties: how to cope with changing needs August 2013 21 • awareness of health changes. Have regular check-ups to monitor your health. If you are feeling unwell, let a relative, friend or neighbour know. You are entitled to a free NHS sight test if you are aged 60 or over. If you are taking several different types of medicine, your GP should review them on a regular basis. Let your GP know if the medicine causes you to feel dizzy or unwell. Ask your GP about having a flu jab. You are more at risk of developing a serious illness from catching flu as you get older. Illnesses such as flu can, in the short term, make you far more prone to falling. Each autumn, an annual flu vaccine is provided free to people aged 65 years and over • being aware of diet and fluids. Make sure you eat a balanced diet. Having a regular calcium intake by eating dairy products like cheese and milk can reduce the risk of bones becoming brittle and weak. Vitamin D helps the body absorb calcium so make sure you eat foods with high levels of vitamin D, like oily fish, sardines, mackerel, tuna, and meat. Remember also to make sure you drink enough fluids, including water. Your GP or pharmacist can advise you on nutritional supplements or any dietary concerns you have • suitable clothing and shoes. It may be a good idea to avoid wearing loose-fitting or open-backed slippers, sandals, shoes with heels, flared trousers, trailing nightdresses or other footwear or clothing that might cause you to slip or trip. Trainers can be comfortable to wear, and are sometimes recommended to reduce impact when walking, which may be helpful if you experience knee or back problems. If you feel you are at risk of falling, you might consider buying hip protector underwear that reduces the risk of a hip fracture as a result of a fall. It is washable, not visible under clothing and Guide 8: Health Difficulties: how to cope with changing needs August 2013 22 can be worn day and night. Ask your GP or a community nurse for further information about this • keeping warm. Try to keep your home warm as cold muscles work less effectively which can increase the risk of falls • reducing hazards. Small changes in your home can help reduce accidents, such as: o fitting a letterbox cage so you do not have to bend down to pick up your mail o highlighting the outer edge of steps with non-slip white paint to make them more visible o using non-slip mats under rugs to reduce the risk of you tripping or slipping on them o removing or repairing frayed carpet edges and loose carpets. o storing frequently used items somewhere easily accessible o asking for assistance with chores such as changing curtains or light bulbs o using a sturdy set of non-slip steps with a safety chain and handrail, rather than standing on a chair or table o spreading salt, salty sand, dishwasher ‘salt’ or cat litter on wet or icy steps to make them less slippery o keeping a mop to hand and always clear spills immediately to reduce the risk of slipping o having extra telephone extensions fitted around the home, or getting an answering machine, so that you do not have to rush to answer the phone o considering installing a community alarm system so that if you did fall, you can contact assistance and/or the emergency services. For more information about alarm systems, see our guide, Telecare and Telehealth: What it is and how to get it (Guide 6). Guide 8: Health Difficulties: how to cope with changing needs August 2013 23 8 Continence issues It is estimated that up to six million adults in the UK currently experience some form of incontinence. There may also be many more who do not seek help and are not formally diagnosed. Incontinence is not an inevitable result of growing older. However, certain age-related changes do occur in the nervous system, kidneys, bladder and urethra, which can make older people more vulnerable to developing incontinence. Incontinence can also be caused as a result of a trauma such as a stroke, an illness such as Parkinson’s disease, or external factors such as excessive alcohol consumption. Types of incontinence There are two main reasons for incontinence. One is physiological, and is caused because you do not know when you need to go to the toilet or you cannot control your bladder or bowels because of a disease, disability or illness. The other is environmental, and may occur because you are not able to get to a toilet in time as a result of mobility difficulties. There are a number of different types of incontinence and the treatment and support may be different for each type. The different types are described below. Stress incontinence This is when you may ‘leak’ urine when you laugh, cough or sneeze. It is caused by muscles surrounding the base of the bladder becoming weak. It is possible to strengthen these muscles (pelvic floor muscles) by doing special exercises. Your GP or a continence advisor working Guide 8: Health Difficulties: how to cope with changing needs August 2013 24 with your local Clinical Commissioning Group can give advice about these exercises and other sources of help. Frequency incontinence You may find that you need to go to the toilet more often than normal. This can be caused by a number of conditions, although in most cases the reason is not known. Drinks with caffeine (such as tea, coffee and cola) or alcohol can increase symptoms. Urge incontinence This is a strong desire to go to the toilet, which you cannot ignore. Dribbling or leaking In men, this problem may be due to changes in the prostate gland. In both men and women, it may be because of constipation causing pressure on the bladder. Environmental incontinence This happens when your urinary system is working well but you cannot get to the toilet in time. This can happen if you have mobility difficulties or the toilet is difficult to access. There are a number of aids or adaptations to improve your home so that getting to the toilet is easier for you. Contact the occupational therapist at your local council social services to ask for an assessment or for further information, contact the Disability Living Foundation (0845 130 9177, dlf.org.uk), or home improvement agencies (0845 864 5210, foundations.uk.com). Bowel incontinence This can be caused by a number of things, for example, eating particular foods, not getting to the toilet in time or in combination with constipation. Guide 8: Health Difficulties: how to cope with changing needs August 2013 25 Unawareness People who have experienced physiological damage, for example, caused by a stroke, may no longer be aware of when they need to empty their bladder or bowels. Loss of mental capacity can also lead to people being unaware that they need to go to the toilet. If someone you care for may be having problems with continence because they lack awareness, you should seek professional advice to find out if the symptoms are temporary or likely to be permanent. Seeking help at an early stage increases the chances of the problem being resolved or at least improved. You may find that by changing diet, daily routine, carrying out special exercises and drinking at different times of the day, it is easier to cope with continence problems. What help is available The first step is to visit your GP for a check-up to see if there is a medical reason for the incontinence. If the problem cannot be resolved with medical treatment you can ask your GP to refer you to see a continence advisor, a health visitor or a community nurse. A continence advisor will be able to give you specific advice about ways of reducing and managing incontinence. They will discuss your problem with you in confidence, and together you can work out what can be done to help you cope with your continence difficulties. A full investigation will mean that your condition might be improved either by treatment, exercise, advice, training, suitable continence aids or adaptations to your home. Try to overcome any embarrassment you may feel to seek support as, in many situations, incontinence can be improved or even overcome. For more information and advice about continence issues, contact the Bladder and Bowel Foundation (0845 345 0165, Guide 8: Health Difficulties: how to cope with changing needs August 2013 26 bladderandbowelfoundation.org). This charity also produces a Toilet Card, ‘Just Can’t Wait’ which uses the universally recognised image for a toilet. This may help holders of the card find and access toilets in countries where English is not the spoken language. The toilet card states that the holder has a medical condition and needs to use the toilet quickly and may help you gain access to toilets in most places. The charity asks for a £5 donation towards the production and postage of the card. For more information, contact the Bladder and Bowel Foundation (0845 3450165, bladderandbowelfoundation.org). RADAR, the disability rights organisation, operate a National Key Scheme which provides, for a small price, a key to access locked disabled toilets and a guide to over 9000 disabled toilets across the UK.Toilets fitted with the National Key Scheme (NKS) can be found in shopping centres, department stores, restaurants, bus and train stations and many other locations, giving peace of mind to people who may need quick access to the toilet. For more information, go to the website radar-shop.org.uk. RADAR keys can also be purchased from other organisations, including the incontinence advice service of Age UK (0800 849 80322, ageukincontinence.co.uk). Guide 8: Health Difficulties: how to cope with changing needs August 2013 27 9 Financial assistance towards health costs Prescription costs If you are over 60 you are entitled to receive prescriptions free-ofcharge from your GP or hospital. On the back of the prescription form there is a box to tick to say you are over 60. The chemist may ask you to show proof that you are over 60. Glasses and sight tests You are entitled to free routine NHS eye examinations if you are aged 60 or over. You are also entitled to a free sight test if you have certain health conditions, such as diabetes or glaucoma. Before you have your eye test, tell your optician or the receptionist that you are eligible (or think you may be eligible) for a free eye test. You will be asked to sign a NHS Sight Test form. If your sight test shows you need glasses, you will be provided with a prescription which you can take to any optician or supplier to have prepared into glasses. If you are eligible for a NHS complex lens voucher (your optician will be able to advise you), you receive Pension Guarantee Credit, or you are named on a HC2 or HC3 form, you are also entitled to an NHS optical voucher to assist you with the cost of your glasses. For more information, ask for advice from your optician or contact the RNIB (0303 123 9999, rnib.org.uk) who have leaflets available on this subject. Dental work Free NHS dental treatment is provided to people who receive Pension Guarantee Credit. You may also be able to get help with Guide 8: Health Difficulties: how to cope with changing needs August 2013 28 paying for dental care if you are on a low income of this guide. There are maximum charges for NHS dental care; a complex course of treatment is currently £209 and other more straightforward treatments like check-ups, fillings and extractions cost either £17.50 or £48. Low income and health costs If you receive Pension Guarantee Credit, you can claim financial help with health costs for things like dental treatment, NHS prescriptions, sight tests, glasses and contact and travels costs to and from hospital for NHS treatment. You will need to show proof of age and qualifying benefit. If you do not receive Pension Guarantee Credit because your income or savings are too high, you may still be entitled to help toward the costs of dental treatment, sight tests, glasses and fares to hospital if you are on a low income. To claim this help, you have to fill in form HC1. The form HC1 is available from your GP surgery, dentist or optician. The Health Benefits Division can give you information on the NHS Low Income Scheme Patient Services (0845 850 1166). An advisor will ask you for information about your income and savings and inform you how much help you are entitled to. You are only eligible for financial help under the Low Income Scheme if you have savings of £16,000 or under. If you live permanetly in a care home and the council helps towards your fees, you are entitled to this service if you have savings of £23,250 or under. The Health Benefits Division will send you a certificate, which will show what help you are eligible for. You might receive help towards some or all of your charges. You will be sent an HC2 Certificate for Guide 8: Health Difficulties: how to cope with changing needs August 2013 29 full help, or an HC3 Certificate for partial help. The certificate will last for one year. If you have paid NHS charges in error you can fill in form HC5 to claim a refund. You must send the form to the Health Benefits Division within three months of the date that you paid the charges. War Pensioners If you are a War Pensioner you may be entitled to additional financial help with NHS treatment and other needs. Contact the Service Personnel and Veterans Agency (0800 169 22 77, veteransuk.info) for more information. Guide 8: Health Difficulties: how to cope with changing needs August 2013 30 10 Health tips to remember These tips will all be familiar, but can help towards making you feel better, despite your existing health conditions. • Exercise as often as you can – a little bit of exercise like a short walk or a gentle swim can tone your muscles, strengthen joints and make you feel better about yourself. • Go out and socialise – seeing friends and doing new things can make you feel good, reduce feelings of isolation and can take your mind off health worries. • Eat well – eating healthily, little and often, can help to keep your weight within a normal range and give you plenty of energy. Try to find new ways of preparing food that are likely to increase its flavour and thus increase your appetite. • Drink plenty of fluids – even if you are not thirsty, it is important to top up your fluid intake, as it is easy to become dehydrated. Having a drink of water, milk or juice every time you eat, for example, can make sure you are drinking enough which will give you more energy. • Get plenty of sleep – a good night’s sleep is sometimes hard to achieve, but is important for your wellbeing. Having a regular bedtime routine can help, as can reading a book or playing gentle music just before you go to bed in a suitably dark and quiet room. Guide 8: Health Difficulties: how to cope with changing needs August 2013 31 This guide is not a full explanation of the law and is aimed at people aged over 60. If you would like free, personal advice on coping with health difficulties or any issues related to social care, benefits, loneliness or isolation, please call our advice line on 0845 262 1863. If you have found our advice useful, please consider making a donation. We receive no state funding and rely on income from individuals, trusts and other sources to continue providing our services to hundreds of thousands of people in need. For further information on how to support us, please see our website independentage.org or call 020 7605 4288. © Independent Age, August 2013 Independent Age 6 Avonmore Road London W14 8RL T 020 7605 4200 E [email protected] www.independentage.org Advice line 0845 262 1863 View our page on Facebook Follow us on Twitter @IndependentAge The Royal United Kingdom Beneficent Association Independent Age is the operating name of the Royal United Kingdom Beneficent Association Registered charity number 210729
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