Mouth, nail and foot care: what a carer can do, and when to call a professional

Everything in the left-hand column is personal care, the same kind of help as washing and dressing, and a carer booked for the morning and evening visits can fit it into the time they are already there. What personal care covers sets out the rest of that range. Everything in the right-hand column is a reason to involve somebody who can diagnose and treat. A carer can notice these things, write them down and tell you, but deciding what they mean is not their job.

PrimeCarers does not check carers' qualifications or training. If you want somebody who has looked after dentures or cut an older person's toenails before, ask them directly, because what a profile says about experience is the carer's own account.

The NHS gives two reasons for taking dentures out at night: food trapped under them raises the risk of gum infections and tooth decay, and there is a risk of choking on them during sleep. The NHS page on dentures says they can become loose as the gums and jawbone change shape with age, so dentures that slip, click or rub need the dentist to look at them.

The NHS page on dry mouth says it makes tooth decay more likely, and that a pharmacist can suggest gels, sprays or lozenges.

If your parent pushes the toothbrush away, the approaches in when a parent refuses to wash apply here too. If dementia is part of the picture, when someone with dementia refuses care covers the conversation. Write whatever routine you settle on into your parent's washing and dressing care plan, so every carer and family member does it the same way.

1. 1

   Search for an NHS dentist near your parent

   nhs.uk

   Use the NHS "Find a dentist" search and ring the practices it lists to ask whether they are taking on NHS patients. A practice may ask your parent to fill in a registration form, but the NHS says this does not guarantee NHS care at that practice in future.
2. 2

   If you cannot find one, contact the integrated care board

   Your local ICB

   The NHS says the local integrated care board, which manages dental services in your area, is who to contact if you cannot find an NHS dentist. nhs.uk has a search to find yours.
3. 3

   If your parent cannot get to a surgery, ask about a home visit

   Community dental services

   Some areas have community dental services that visit people who cannot reach a surgery. Ask the dentist, the GP or the ICB what exists where your parent lives.
4. 4

   If it is urgent, ring the dentist or 111

   Pain or swelling

   Call your parent's dentist first. If they do not have one, or cannot get an urgent appointment, call 111 for advice on where to go.

The two-year advice comes from the NHS page on gum disease. The NHS also says general dental practices should be able to treat people with additional needs, and can refer somebody who needs specialised treatment to Special Care Dentistry. Home visits are called domiciliary dental care. As one example, Kent Community Health NHS Foundation Trust's leaflet describes fillings, dentures, extractions and cleaning at home for people who cannot reach a surgery, with NHS charges still applying. Services differ from area to area, so treat a home visit as something to ask about rather than something to count on. How to find an NHS dentist on nhs.uk is the place to start, and find your local integrated care board gives you the ICB's contact details.

The advice on how to cut comes from the Royal College of Podiatry, which says to cut straight across and not too low at the edges, because cutting down the sides can leave a spike that grows into the skin. The same page says that people who have diabetes, take steroids or are on anticoagulants should not cut their nails or remove an ingrowing spike of nail themselves. Its page on ageing feet adds that nails left too long can press against the end of a shoe and cause soreness, infection and ulceration.

Some NHS podiatry services treat routine toenail cutting as personal care. Harrogate and District NHS Foundation Trust's podiatry service, for example, says it does not routinely see people who cannot cut their own toenails, and that it can show relatives and carers how to do it.

The NHS page on fungal nail infection says to see a GP if your parent has diabetes, if it has spread to other nails, or if pharmacy treatment has not worked. For an ingrowing toenail with pus, swelling or a high temperature, the NHS page on ingrown toenails says to see a GP, and a GP can refer to a podiatrist.

The Royal College of Podiatry says that as we get older an annual foot health check is as important as a sight or hearing test. Its Find a Podiatrist search and the nhs.uk search for podiatrists and chiropodists list private practitioners, and the HCPC register confirms registration. Age UK's foot care page finds a local Age UK that offers foot care or nail cutting.

If your parent has diabetesSection titled If%20your%20parent%20has%20diabetes

Diabetes can damage the nerves and blood supply to the feet, so a cut or blister may go unnoticed and heal slowly. The NHS lists foot problems such as ulcers and infections among the complications of type 2 diabetes, and says to see a GP or diabetes nurse about blisters or cracked skin on the feet. Diabetes UK's guide to diabetes and the feet advises checking the feet every day, and contacting the GP or local foot protection team straight away about a cut or blister, or calling 111 if they are not available. What diabetes is covers the condition itself.

Everybody with diabetes should have a foot check at least once a year as part of their annual review, or sometimes every two years if nothing was found last time, arranged by the GP practice or diabetes clinic. Diabetes UK's page on the annual foot check explains what happens, and if your parent has not had one, ask the practice. A carer can look at both feet during the daily wash and tell you about anything new, but treating a wound belongs with the nurse or podiatrist. If a professional wants a carer to take on a specific healthcare task for your parent, they need to assess, train and sign that carer off first, and delegated healthcare tasks explains how that works.

A day in the life of a personal carer shows how morning and evening visits are built. Agree with the carer what they will do and what they will pass on to you, and ask them to note anything they see, such as bleeding gums, a denture that has started to rub or a red patch on a foot. Keep dental and podiatry appointments with the rest of the plan, so somebody knows when the next one is due.

If you want regular help with washing, teeth and nails, you can search for carers near you and compare their rates. Carers on PrimeCarers charge £18 to £25 an hour with our fee included, and the hourly cost of care at home compares that with agency rates. Carers are self-employed and you agree visits with them directly. Every visit booked through PrimeCarers is insured, by the carer's own policy or by cover PrimeCarers arranges where they do not hold one. How we vet every carer lists exactly what is checked before a profile appears.