I’m worried about my sister, who is in her 90s and lives alone. The Guardian.

By Annalisa Barbieri, October 2, 2015

Dear Annalisa

I am in my 80s and my sister is in her 90s. I am her main carer and only other family member. I visit her several times a week using public transport, a round trip that takes two to three hours. I am happy to do this, but it is getting harder as I get older. I am also growing more concerned for my sister. Although she is fairly sprightly, she has fallen over once but, thankfully, was found quickly. She has an alarm to wear around her neck but doesn’t always put it on.

She lives alone in a large house. She has lots of lovely neighbours who look out for her but I still worry. I have suggested a paid carer, but she will not entertain this. I have my own family so cannot move in with her and we do not have the space to have her with us.

She has suggested that maybe she should move into a home, although she keeps changing her mind. I’m not sure what is right for her and feel she is leaving the decision to me.

How can I find out what her options are? Can she move to a nursing home near to where my family and I live so we can visit more easily or does it need to be in her council borough? What are the different homes she could move into and how do I find out which is best for her?

I feel for you. When we all lived close to family, concerns like this were easier to deal with, because popping in and out wasn’t such a big deal. But now that families are more fragmented, it is necessary to factor travelling into what is already a full-on caring role.

I consulted Stephen Lowe, care policy adviser at Age UK (ageuk.org.uk). There are various options for your sister: employing a live-in/out care worker/assistant might help, and would enable her to continue living at home. She could move into sheltered housing where she would have independence, but would have a warden to call on her or visit regularly, or to “extra care” sheltered housing, which offers other services. Or she could move into a residential care home, or one that offers nursing if she needs that.

It sounds as if sheltered housing probably wouldn’t give your sister what she wants, simply moving her away from all she knows. I understand the importance of staying in her own home and being near people she knows. Some people are able to move into nursing homes, but keep their own homes, at least for a time, while they see how they get on.

But check individual terms and contracts: some residential homes ask you to sign a contract up front – sometimes for lengthy periods – and some could evict your sister with only a month’s notice. If she were to move full time into a residential home, she could only take with her what would fit into one room. Understandably, many people find this very stressful.

Lowe suggests that the first thing to do is to establish what sort of care your sister needs – get an assessment from her GP and social services. Anyone who might have care needs is entitled to this. The former will be able to ascertain her medical needs (you may already know this) and social services can help your sister work out what help she needs and the choices available.

Any local authority (LA) care provision is means tested. From the sound of it, if your sister needs to go into care, she would need to pay herself (the value of her home would be taken into account). However, she is not restricted to her local borough: she can choose where she goes. Even if the LA is paying, she can choose, although she may need to top up the fees if it will only pay up to a certain amount.

All residential homes are regulated by the Care Quality Commission (you can find all inspection reports at cqc.org.uk). But word of mouth, as in all things, is also valuable and, of course, a personal inspection by the person going into the home is vital.

If she decides to go down the paid carer route, a good first step is via the LA, which should be able to advise you on some registered care agencies.

I’m concerned that you also look after yourself. Given what you’ve told me, perhaps getting a taxi one way at least might help if you or your sister can afford it. You can also ask your council about subsidised taxis for the elderly for your sister, and a carer’s assessment for yourself (carersuk.org; tel 0808 808 7777).

There’s lots more information here: ageuk.org.uk/home-and-care/care-homes.

Any other helpful insights from readers would be welcome.

This article first appeared in The Guardian Family section on 2 October 2015.