It is generally accepted that the health and social care sector is facing some of its greatest challenges to date. People are living longer; there has been an increase in the number of people suffering from diseases such as dementia; and there is a general lack of funding for community services. The impact on society as a whole is well publicised, but what about the impact on rural communities?
Understanding the issues
A few years ago, a project to investigate the impact of dementia on farmers, their families and their carers was launched. The research, which was carried out by Plymouth University, identified a number of concerns specific to those living and working on farms:
The farm environment is more hazardous and therefore increases the risk of harm for someone suffering from dementia.
Farmers tend to be more self-sufficient and as a result there is a general reluctance to ask for help when it is needed. It’s not easy to find out what support is available in rural, rather than urban, settings. The cost, both in time and money, of attending appointments or accessing care and support can be restrictive.
Rural communities are changing. As not everyone who lives in the countryside works on the land, farmers are more isolated and can no longer rely on community support the way they might have been able to in the past.
Addressing the concerns
It is essential to ensure that farmers with dementia are provided with appropriate support to prevent the risk of further harm. Animals, heavy machinery and the landscape itself can all be dangerous to farmers who are suffering from symptoms of dementia such as memory loss, confusion or reduced mobility and co-ordination issues. Those who have developed a tendency to wander can be much more difficult to find in the countryside.
It is not only the dementia sufferer who is at risk of harm. Family members providing care and support will inevitably find themselves under more pressure both mentally and physically, managing the needs of their loved one as well as the needs of the farming business. Tiredness, a lack of concentration or trying to get things done faster can have a more serious outcome in such a hazardous environment.
With farmers less able to rely on support from the community and more heavily reliant on those closest to them, it is essential that they are able to access the support they are entitled to from the state. Equally important however is to ensure that those providing the support understand the very different priorities and consequences of dementia sufferers from farming environments to those from an urban city. One size does not fit all.
Provision of care and support is supposed to be person-centred and afford flexibility to meet the needs of the individual in their own home where appropriate.
There is a common misconception that both NHS or Local Authority funded support is rigid and does not fit with the lifestyle of a farmer. We hear stories of people being forced into care homes by the state because it is cheaper than providing care in the home environment. In many cases this is unlawful and can be challenged. Provision of care and support is supposed to be person-centred and afford flexibility to meet the needs of the individual in their own home where appropriate. There are a variety of ways to commission packages of care and support, giving the individual more control over the way in which their needs are met and the types of services used.
As well as assessments for those who have dementia themselves, a carer’s assessment is available from the Local Authority, to anyone caring for someone with dementia. If eligible, support could include providing services to the person with dementia or providing the carer with support directly.
Cost of care
The financial impact of dementia on a famer can also be worrying, particularly as it affects their home as well as their business. The cost of care for a farmer is not simply to do with paying for care, but also the loss of time, for example the impact of having to attend appointments and being able to do less on the farm. Less productivity means more expense and in an already challenging economic environment this can have as much of an impact on a farmer than the additional cost of care itself.
Understanding what support is available, both in terms of provision and funding is a good start.
Access to fully funded NHS care (NHS Continuing Healthcare) for famers with complex health needs; or a contribution to care and support from the Local Authority (means tested) can help to alleviate the burden on farming families. There are also benefits for those who are incapacitated or their carers.
Unfortunately, it is not always easy to navigate the health and social care arena and access to information can be disjointed. At Moore Barlow we have a specialist Community Care team who can provide advice and assistance in relation to provision of care and support services, entitlement to funding and challenging unlawful decisions.