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Living with

broken bones
making life easier after osteoporotic
fracture including a guide to welfare
benefits and social care
What is osteoporosis? C

Osteoporosis occurs when the struts which


make up the mesh-like structure within bones I
become thin causing them to become fragile
H
and break easily, often following a minor
i
bump or fall. These broken bones are
often referred to as 'fragility fractures'. The P
terms fracture and broken bone mean the a
same thing. Although fractures can occur in
different parts of the body, the wrists, hips E
and spine are most commonly affected. It i
is these broken bones or fractures which H
can lead to the pain associated with
osteoporosis. Spinal fractures can also B
cause loss of height and curvature of the
C
spine.
O
o

Strong Fragile
dense osteoporotic
bone bone

This leaflet gives helpful hints and tips


for people with osteoporosis. If you
would like more general information on
osteoporosis, please ask us for a copy
of our publication All about osteoporosis.

ew Back Page.indd 1 01/06/2012 13:50


Contents

Introduction...................................................... 4

How can fractures affect me


in my daily life?................................................ 5

Practical tips to help in the home


and with day-to-day life................................... 8

Equipment and aids for


independent living......................................... 26

Holidays and travel insurance....................... 29

Benefits and financial assistance.................. 33

Community care services.............................. 42

Other useful sources


of information and advice.............................. 47

3
Living with broken bones

Living with fractures, caused by osteoporosis,


can be challenging and sometimes the day-
to-day activities you have previously taken
for granted can become more difficult. This
publication gives an overview of various sources
of information and support that may be available
to help people disabled as a result of broken
bones. Most fragility fractures affect older
people so many of the suggestions here will
be most relevant as you move into later life
however younger people who are affected will
find some of the ideas helpful.

If you would like more general information


on osteoporosis or specific help with the pain
caused by compression fractures in the spine
please ask for a copy of our publication
All about osteoporosis.

4
How can fractures affect
me in my daily life
Although other bones in the skeleton may break
if they are fragile, most fractures related to
osteoporosis occur in one of three sites - the
hips, the spinal bones, or the wrists.
Osteoporotic fractures in the spine are often
referred to as vertebral compression fractures.
Bones become squashed or compressed
because of their reduced strength. These spinal
bones heal like any other bone but do not return
to their previous shape. If a number of fractures
occur together then the spine can tip forward
causing an outward curve (kyphosis). If the
bones are flattened, the trunk can be shortened
in length causing loss of height. As well as
causing chronic long-term back pain, postural
changes and spinal curvature may also affect
balance and gait. This can make older people
more unsteady on their feet and at risk of falls.
The effect of compression fractures is very
varied. Some people dont have severe
problems but for those that do, many things can
make life easier.
Hip fractures as a result of osteoporosis occur
most commonly in our late 70s or 80s. They
happen as a result of a fall and can affect all
aspects of life.

5
Full recovery is always possible but will often
depend on how well someone is before the
broken hip occurs. Getting back to being fully
mobile and independent can be difficult and
physiotherapy and social care services are often
essential.
Broken wrists often occur in middle-aged
women who have put out their arm to break a
fall. The impact of a wrist fracture is not usually
associated with the same level of debility as
fractures of the hip and spine. However, normal
wrist and hand functioning is needed for most
daily activities. A wrist fracture in an older, more
frail person may therefore temporarily affect
their ability to look after themselves.
Many older people have disabilities associated
with other conditions such as osteoarthritis, as
well as osteoporosis which can also impact on
their day-to-day living.

6
Falls
Many people worry about breaking another
bone and for some, the fear of falling can have
a significant effect on their quality of life.
A serious consequence of falling is a broken hip,
an injury which is more common in older people.
As well as causing potential injury, falls can lead
to loss of confidence and independence; a fear
of falling can affect the tasks and activities you
undertake in your daily life and feeling unsafe
outside the home is not uncommon.
Limitations on your ability to get out and about
may make you feel less in touch with the
outside world and lead to social isolation and
a sense of loneliness and even depression.
However there are many self-help steps older
people can take to help to maintain their safety
and independence at home. For those who
need them, there are also a range of support
services accessible through health and social
services.

7
Practical tips to help in the
home and with day-to-day life
Its always a real comfort to find out how other
people affected by fragility fractures cope with
the problems that they can cause. The following
information gives tips and advice - some from
members of the National Osteoporosis Society
- on how they have personally overcome a
number of problems. Many of these suggestions
relate specifically to those with compression
fractures in the spine although some might be
useful for people with other fractures affecting
their day-to-day life. These tips are suggestions
which may help you overcome
some problems but may not
be suitable for everyone.

8
Sleeping
For those affected by fractures as a result of
osteoporosis, going to bed and going to sleep
can present their own problems.
Here are some tips from our members which
may help:
If you sleep in a double bed on your own, sleep
in the middle you are less likely to turn over and
fall out.
Satin finish sheets or pyjamas can make
movement in the bed easier but do be careful
getting in and out of bed.
When sitting up in bed, having adequate back
support will help to relieve pain and encourages
good posture. There are a variety of specially
designed pillows, back rests and cushions available.
Some people find V pillows useful, particularly as
a short term measure, to relieve pressure on the
spine. However healthcare professionals will often
discourage their longer term use, since they tend to
push the shoulders forward and do not support the
lower back. Positioning a pillow or postural aid in
the small of the back helps to maintain normal back
curvature and may also help to relieve pain.
Your bed does not necessarily have to be very
expensive or hard to be comfortable. Always try
out a new bed and try to avoid mattresses that are
either very firm or too bouncy and soft.
When lying on your side in bed, try hugging a
pillow for comfort.
9
To make your bed more comfortable, try placing a
folded duvet under the bottom sheet or invest in
a mattress topper which are available from most
department stores or bed specialists.
When getting into or out of bed, you may
experience some pain. This could be helped by
placing a straight-backed, armless chair at the side
of the bed with the back adjacent to the pillows.
You can then sit on the chair and gently shuffle
your bottom onto the bed, carefully lifting your legs
one by one onto the mattress.
Reverse this procedure to get out of bed. You may
want to practice this with someone else present
until you are confident.
A neck cushion pillow filled with polystyrene beads
can give good neck support both sitting in bed and
during the day in a chair. On waking, your back
may be sore and painful. Gently stretching out
may be helpful to ease stiff muscles.
Try taking your pain relieving medication half an
hour before you get out of bed (except ibuprofen
or any other non-steroidal anti-inflammatory tablets
which must not be taken on an empty stomach).
This will not be possible for people taking a
bisphosphonate every day or on the day of your
weekly or monthly version.

The charity
BackCare produces
a publication about
the importance of
choosing a good
mattress entitled
Back in Bed.
10
Bathing
Although a relaxing bath can be the answer to
many problems, the process of having a bath can
be difficult for some people with fragility fractures.
The following tips should make this easier:

A warm bath or shower can help to get rid of any


residual soreness or stiffness when you get up.
There are various aids and lifts that can be helpful
if getting into or out of the bath is a problem.
Ensure there is a non-slip mat in both the bath
and the shower.
Grab rails can be fitted for safety at the side of
the bath.
Consider a regular trip to the hairdressers or
barbers or enlist the help of a friend if washing
your hair is a problem because of a curvature
of the spine and back pain.
Use a long-handled brush or comb for your hair.
Women may want to try keeping their hair short
and easy to manage
A long-handled bath brush can also help in the
shower to avoid bending over to reach ankles
and feet.
A raised toilet seat can be
helpful for those who have
difficulty with the usual
lower seat.

11
Chairs and sitting
Having a favourite comfortable chair is
always important. Here are some tips:

A comfortable chair should give support to the


head, spine and thighs and should be firm but
not hard.
Arm rests should not be too high, as this causes
the shoulders to be pushed upwards, or be too
low so that you lean to one side for support.
The chair should be the correct height to alleviate
stress and strain on the spine which can lead to
increased pain. When sitting down with your bottom
firmly against the back of the chair, your feet should
rest solidly on the floor with your thighs and knees
at a 90-degree angle to your upper body.

You can make the chair higher by using wooden


blocks under each chair leg or you can lower
the chair by shortening the chair legs. This
type of assessment is usually carried out by an
occupational therapist.

12
If you sit at a desk at work, the height and angle
of the seat and backrest should be adjustable with
the seat tilting slightly downwards to encourage
good posture. Ask for an occupational health
assessment of your work environment through
your Health and Safety representative.
Ensure that the desk height is correct for the height
of your chair.
A chair that is too high for your desk will result in
poor slumping posture and increased back pain.
Take regular breaks from your desk during the day
to reduce any stiffness or soreness caused by long
hours in one position.
When sitting, portable back supports can help to
reduce pain. Alternatively, a rolled up bath towel
in the small of your back can help.
Some people find relief from pain by using
reclining chairs with a high back and lumbar
support. Padded garden chairs can also be very
comfortable, especially with an added footrest, and
may be helpful to sleep in at night occasionally
if you are unable to settle in bed. Investing in an
electric riser-reclining chair may prove beneficial if
you spend a lot of time in an armchair, or if you find
it difficult to get in and out of your chair.

13
Safety in the home
Many falls, which can lead to fractures, happen
in the home. Some simple measures can help
to reduce the risk of this happening. Following
some or all of these tips can help you to be safer
in your home and will make some of your day-to-
day activities easier.

You may wish to consider a personal alarm in case


you do fall. (See Community Emergency Alarm
Service in social case section, page 45)
Avoid wearing long trailing garments which you
can trip over and consider your choice of footwear-
loose or backless slippers may increase your risk
of a fall
Ensure the lenses of glasses are kept clean and
hearing aid batteries should always be changed
regularly to keep your hearing aid working perfectly
Use non-slip mats under rugs.
Fit handrails on the stairs and, if necessary,
next to the toilet and by the bath.
Throw away old, frayed mats.
A letterbox cage fitted over your letterbox can
avoid the need to bend to pick up letters.
Avoid mats on highly polished floors

14
Buy long-life light bulbs so they do not need
changing so often and never stand on a chair to
change them. Ask a family member or friend to
change them for you.
Ensure stair carpets are not loose or frayed.
Use a high wattage light bulb on the landing
and stairs.
Ensure that wires and flexes are kept out of the way
Do not clutter up walkways with clothes, books,
washing etc.
Mop up spills immediately using a long-handled
mop to reduce the risk of slipping.
Turn on the lights at night if you need to go to the
bathroom.
Do not get up too quickly, either out of a chair or
out of bed, because you may feel dizzy.
Avoid climbing on chairs or stepladders for window
cleaning or over reaching to get items.
Use a long-handled window opener or rearrange
your cupboards!
Make sure items used regularly are within easy
reach to avoid stretching, bending down or having
to stand on a chair.
Wire baskets attached to the underside of shelves
provide extra storage space within easy reach.
Use a long-handled dustpan, brush and mops.

15
Fill a washing-up bowl in the sink and keep
specifically for washing the floor. Use it directly from
the sink which saves filling and moving a heavy
bucket or alternatively, use floor wipes, readily
available from supermarkets, on the end of a mop.
Consider a top loader washing machine to avoid
bending with heavy, wet washing, although you may
need tongs to reach washing at the bottom of the
machine. Some top loading washing machines have
wheels let down by a lever which means they can
be stored under surfaces but you will probably need
someone to help you to move the machine. Top
loaders are still available from several suppliers.
A washer-dryer avoids the need for a separate
dryer or the sometimes hazardous trip to the
washing line with a heavy basket of washing.
Use a perching stool for working at the sink.
Various aids for opening jars, cans and bottles
are available in department stores and chemists.
A built in oven at the correct height, instead of a
free-standing one, prevents unnecessary bending.
Have power points located at waist height to
avoid bending.
When choosing a fridge freezer consider the
position of the freezer compartment. It is better to
have the fresh food compartment on top since this

16
is used more frequently than the freezer and needs
to be accessible. Side by side integrated models
can be difficult to reach into.
Use a lightweight vacuum cleaner and avoid long
sessions concentrating on small areas to reduce
the strain on your back.
Use a cordless telephone to avoid having to get up
and down all the time. They are also light and the
push buttons are easy to use.
A grab, also known as an extending arm, can be
useful to pick things up with.
Do not try to lift heavy bin bags. Take an empty bin
bag to the dustbin or the end of the drive and carry
smaller, filled carrier bags to it.
Keep warm in your home. If your muscles get cold
they wont work so efficiently.

17
Staying steady
Choose the suggestions and activities that feel
right for you and make some positive changes.
Despite the fact that falling is common in old
age, its not inevitable and many of these
suggestions will make a difference.

If you have other medical conditions that make you


feel unsteady talk to your doctor. Treating other
conditions may make you feel safer.
If you are taking a number of different tablets ask
for your doctor to review them every few years.
Some tablets can cause unsteadiness.
If you enjoy an alcoholic drink be aware it might
make you less steady.
If you have been falling as you get older, talk to
your doctor or nurse there may be specialist
services in your local hospital with professionals
from different disciplines who can help you.
Eat food you enjoy but try and have a well
balanced diet with adequate calcium, protein etc.
Having low vitamin D levels may be a risk factor
for falling. If you are over 65 years and your dietary
vitamin D intake is low, or if you do not get enough
sunlight in the summer, talk to your doctor about
whether you need a supplement.
Staying active as you age is the best way to fight
frailty and stay independent. Strength and balance
exercises will really make you steadier. Ask your
doctor for a referral to a physiotherapist if you tend
to fall. Contact us for further information on exercise.
18
The Disabled Living Foundation produces lots of
The Disabled Living Foundation produces lots of
information about choosing equipment to maintain
information about choosing equipment to maintain
safety and independence at home. Also Help the
safety and independence at home. Also Age UK
Aged have a booklet with lots more advice entitled
have a booklet with lots more advice entitled
Staying
StayingSteady.
Steady.

e.
19
19

ew page 19.indd 1 20/06/2013 10:29


Enjoy your garden
Gardening is a pleasurable activity that many
people with osteoporosis enjoy, but, once they
are affected by compression fractures in the
spine, they often wonder whether to give it up.
There is no reason why, with forward planning
and useful aids, you cannot continue to enjoy
your garden, just not in quite the same way as
before. Gardening can act as a diversionary
therapy, taking your mind away from your pain
and generating a feeling of achievement and
well-being. So, when planning changes in the
garden, decide what is right for you and avoid
difficult or painful tasks. You may need to recruit
some willing family members to make some
of these changes or hire a gardener if you
have sufficient funds. Most advertise in local
newspapers. Some ideas that may be helpful
are listed below:

Replace lawns with paving or longer meadow


grasses.
Create narrow borders or beds so that you do not
have to stretch to reach the back.
Raise beds to cut out the need to bend forward,
particularly if beds are narrow.
Use ground cover or low-maintenance herbaceous
borders with plants that do not need pruning.
Avoid fast-growing bushes or hedges that need
regular pruning
20
Do a little bit of gardening often rather than
overdoing it. This can help to reduce muscle
fatigue and increased pain.
Stop and stretch in between jobs and try
to avoid repetitious tasks.
Stretch by squeezing your shoulder blades
together every 10 to 15 minutes.
Set yourself small attainable goals and enjoy
regular breaks to admire your work!
Look for different tools at your local gardening
centre, Disabled Living Centre or DIY superstore.
Tools that have interchangeable heads and
extended handles can be helpful.
When kneeling, a low padded stool with side
handles can help you to push up again and also
balance you.
Always lift correctly with bent knees and a straight
back and use wheelbarrows and trolleys to avoid
unnecessary lifting.
Use a hosepipe for watering rather than a heavy
watering can

21
Make sure there is clear access to all parts
of the garden
Try dwarf varieties of fruit trees to avoid climbing
ladders when pruning.
Use a perching stool in the greenhouse or
potting shed.
Attach a basket to your walking frame to leave
your hands free.
Wooden rails can help if garden levels are
changeable and slopes or ramps are better
than steps.

22
Driving and getting around
Driving may become uncomfortable but, for
many, it is important not to lose this lifeline to
independence. If you are able, change your car
from a manual one to an automatic one with
power-assisted steering, which may make driving
much easier for you. The type of car seat, leg
room and seat height can all contribute to your
comfort. Car seats should give good support to
your spine and thighs.

A rolled up towel or lumbar support in the small


of the back can help.
Remember not all seats suit everyone, so if buying
a new car give it an adequate test drive to assess
the comfort of the seat (30 minutes if possible).
As a passenger, you may find it helpful to recline the
seat to lessen the pressure on the hip area (pelvis).
Adequate legroom enables you to stretch and
change position, although on long journeys
frequent rest stops that allow you to get out and
move around are also advised.
Head restraints/rests are not there as a
convenient place to rest your head, they have a very
important role in helping to minimise the very real
risk of a whiplash-type injury occurring should you
be unfortunate enough to be involved in a collision.
They should be positioned approximately three
inches behind the head and not in the nape of the
neck. If a spinal curvature greatly increases this
gap, your head restraint may need a bigger cushion.

23
Check the level of the upper seat belt attachment
point because these can sometimes be lowered
to allow the seat belt to move away from the side
of the neck.
If, when driving, you find it difficult to see all
around, convex or panoramic mirrors can be
attached to the interior mirror but be aware that
it may be more difficult to judge the speed or
distance of approaching vehicles.
Parking lenses (small plastic mirrors) can be
attached to the back window of a car to help
reverse parking. (Available from car accessory
shops.)
If you have difficulty in walking, you may qualify
for a disabled badge that will allow you to park
closer to places you wish to go. Apply to your local
council for more information.
Use a walking stick or umbrella to help with
balance if necessary, ensuring it is the right height
for you.
Avoid very crowded areas where you may be
easily jostled or pushed.
Always use a trolley in a supermarket rather than a
basket. Some shops now have trolleys specifically
designed for disabled shoppers and you can
always ask for help with packing and the carry-out
service. Use a shopping basket on wheels that can
be pulled along.

24
When getting out and about take your time and
plan ahead. Poor weather and road conditions can
contribute to the frequency of falls and accidents.
Ice and snow or wet leaves on pavements can
make walking outside hazardous. If you do need to
go out on these occasions consider asking a friend
or relative to accompany you.
You may qualify for the governments Motability
Scheme to help purchase a new car, scooter
or powered wheelchair. The Scheme is open
to anyone who receives either the Higher Rate
Mobility Component of the Disability Living
Allowance or the War Pensioners Mobility
Supplement. (See page 33 for details
on benefits)

25
Equipment and aids for
independent living
When you have to cope with a disability, having
the right equipment and aids can make all the
difference.
How to acquire the equipment you need
Some standard equipment is provided free or
on loan from your local council social services
department or health authority (depending
on your situation, assessment criteria and
resources). It is always worth making enquiries
and the best starting point is to speak to your
GP or social services department.
You may be able to get help with funding for
certain equipment or qualify for a Disabled
Facilities Grant towards the cost of providing
adaptations to your home. The Disabled Living
Foundation have produced a very helpful fact
sheet entitled Sources of funding for obtaining
equipment for disabled and older people.
Equipment for help with everyday living will
usually be provided by social services following
an assessment by an occupational therapist
(OT). This can include the provision of home
safety aids such as grab rails or equipment to
help with personal care such as bath aids or
a raised toilet seat.

26
The health service is responsible for providing
medical support equipment. For nursing
equipment such as a pressure relieving mattress
or cushion you would need to contact your GP or
district (or specialist) nurse. A physiotherapist will
generally be responsible for assessing a persons
mobility, and choosing an appropriate walking aid
or wheelchair as necessary.
However this is just a general guide about
who does what. There can be considerable
overlap between services and the way they are
organised can vary from area to area.
If you do decide to purchase your own
equipment it is always worth seeking
professional advice and finding out whether any
funding is available. Disabled Living Centres

27
Holidays and travel
insurance
(DLCs) can provide independent advice and Holidays are events to look forward to. For
assessment before you buy, to help to identify some, this can be overshadowed by concerns
the right equipment for you and can tell you about the facilities at the destination and also
how much it should cost. While DLCs do not the very real problems posed by travelling.
sell equipment they do have a large range Some travel companies specialise in providing
of products on display. These include highly information for disabled travellers - your travel
specialised equipment such as electric powered agent should be able to provide further advice.
beds, hoists and wheelchairs to smaller
If travelling to a European country, remember
everyday items such as aids for the kitchen.
to obtain a European Health Insurance Card
Most DLCs employ their own OTs and you can (EHIC) which entitles you to the health care in
arrange to have an individual assessment at the that particular country. This is available from
centre. The OT can then provide tailored advice your local Post Office or you can apply online.
about the choice of equipment to help meet any Insurance is also very important and you may
specific needs and problems that you may have. find that some insurance companies will not
You can also, where this is appropriate, arrange insure someone with a chronic condition, while
for your own OT to accompany you to a centre. some offer cover for an increased fee. Others
To find out where your nearest Disabled Living do not automatically exclude people with a
Centre is located call Assist on pre-existing condition, providing you are able
or visit their website www.assist-uk.org to comply with their conditions on the policy. In
most cases these will include requirements such
Hiring equipment
as the following:
You can also hire equipment on a temporary You have sought medical advice on the advisability
basis, from organisations like the British Red of your journey and destination including climate
Cross (for example the loan of a wheelchair and medical services available there, especially if
for a holiday). Also some specialist suppliers you have received medical treatment as an in-
operate a hire scheme for larger items such patient in hospital during the previous six to twelve
as stair lifts, powered wheelchairs or scooters. months.
Your local DLC will often hold a list of local You are not travelling against medical advice or
companies that provide this type of service. specifically to obtain medical treatment.

28 29
Holidays and travel
insurance
Holidays are events to look forward to. For
some, this can be overshadowed by concerns
about the facilities at the destination and also
the very real problems posed by travelling.
Some travel companies specialise in providing
information for disabled travellers - your travel
agent should be able to provide further advice.

If travelling to a European country, remember


to obtain a European Health Insurance Card
(EHIC) which entitles you to the health care in
that particular country. This is available from
your local Post Office or you can apply online.
Insurance is also very important and you may
find that some insurance companies will not
insure someone with a chronic condition, while
some offer cover for an increased fee. Others
do not automatically exclude people with a
pre-existing condition, providing you are able
to comply with their conditions on the policy. In
most cases these will include requirements such
as the following:
You have sought medical advice on the advisability
of your journey and destination including climate
and medical services available there, especially if
you have received medical treatment as an in-
patient in hospital during the previous six to twelve
months.
You are not travelling against medical advice or
specifically to obtain medical treatment.

29
You are not awaiting treatment as a hospital patient
at the date of issue of the policy.
The British Insurance Brokers Association can direct
customers to an appropriate insurance broker and
can be contacted on 0870 950 1790 and accessed
by the internet at www.biba.org.uk Some of the
larger charities who work with older people often
have competitive insurance rates, so it is worth
shopping around.

30
Accessibility
Travelling to and from your holiday destination
can be made easier with a little forward
planning. The facilities at airports vary, so a
telephone call prior to your departure checking
the assistance they can give is a good idea.
In return, the airline will probably need exact
details of the assistance you need, both moving
through the airport and on board the plane, such
as how far you can walk and any equipment
you need (some offer a wheelchair or buggy
service). The Disabled Living Foundation have
a fact sheet called Out and about with your
wheelchair. If travelling by rail in the UK, train
t
companies have adopted a code of practice for
disabled travellers. If notified at least 24 hours
prior to your journey, they will endeavour to give
you assistance at every stage of your journey
and pre-book your seat. Dont forget your
lumbar back support for longer journeys.

If you are unsure about travelling by rail, contact


National Rail Enquiries on 08457 484950 for
details of stations and the local train company
telephone numbers you need to call to plan
your journey. More detailed information is

31

ew page 31.indd 1 19/06/2013 13:52


B
a
available in the booklet Rail Travel Made Easy U
available from most staffed railway stations, b
libraries and Citizens Advice Bureaus a
or by contacting the Disabled Persons Rail
T
Card helpline on 0845 6050525. Do not feel
o
that holidays are no longer for you help is out
p
there, you just need to look for it!
H
e
t
t
c
d
n
i
p
i
t

32

ew page 32.indd 1 19/06/2013 13:53


Benefits and
Benefits andfinancial
financial
assistance
assistance
Understanding the state benefit system can
Understanding the state benefit system can
be difficult and may deter many people from
be difficult and may deter many people from
applying for the help that they are entitled to.
applying for the help that they are entitled to.
The following section looks at the main types
The following section looks at the main types
of financial support available for the older
of financial support available for the older
person and those who are disabled.
person and those who are disabled.
Having osteoporosis does not automatically
Having osteoporosis does not automatically
entitle you to benefits, they are awarded on
entitle you to benefits, they are awarded on
the basis of a persons level of disability, and
the basis of a persons level of disability, and
their needs, not the actual disease or condition
their needs, not the actual disease or
causing the problem. As osteoporosis alone
condition causing the problem. As
does not cause any pain or symptoms it does
osteoporosis alone does not cause any pain
or symptoms it does not automatically qualify
not automatically qualify as a disability. Rather
as a disability. Rather it is the pain, postural
it is the pain, postural changes and mobility
changes and mobility problems resulting from
problems resulting from fractures that cause an
fractures that cause an individual to have a
individual to have a disability and may entitle
disability and may entitle them to benefits.
them to benefits.

The following information was correct at the


time of publication, however considerable
changes to the current benefit system are
The following information was correct at the
due to take place as part of the governments
time of publication, however considerable
plans for reforming welfare. Pages 38-39
explains some of these proposed changes.
changes to the current benefit system
The full extent of these changes will be
are due to take place as part of the
included in the planned in-depth review of
governments plans for reforming welfare.
this booklet in 2014.
Pages 38-39 explain some of these
proposed changes.

33

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Who is responsible for
specific benefits?

The Department for Work and Pensions


(DWP) is divided up into several divisions
and deals with most social security benefits.

The Disability and Carers Service responsible


for Disability Living Allowance, Attendance
Allowance and Carers Allowance
The Pension Service, provides benefits for
people of pensionable age (e.g. Pension Credit
and Retirement Pensions)
Jobcentre Plus deals with all claims for people
of working age (e.g. Income Support and
Employment and Support Allowance)
Child Maintenance and Enforcement Commission
(formerly the Child Support Agency)
responsible for child support and maintenance
The Debt Management Department responsible
for recovering funds owed to the DWP

Local Authorities are responsible for Housing


and Council Tax Benefit

The HM Revenue and Customs (HMRC)


administers benefits such as Tax Credits and
Child Benefit.

34
Are all benefits income dependent?
It varies. Some benefits are means-tested
for those with low incomes, or contributory
with entitlement based on National Insurance
contributions. Others are universal or non-
contributory and are not dependent on either
individual income or National Insurance history,
but may only be paid if you meet certain criteria
such as having a disability.

What are the main benefits for people


who are sick or disabled?
Disability Living Allowance (DLA)
For people (under 65) with an illness or
disability who need help or supervision with
personal care, or with mobility, or both. DLA can
also lead to other benefits and help.
DLA is non-contributory and has 2 components
care and mobility. The care component has 3
rates lower, middle and higher. The mobility
component has two rates lower and higher. An
individual claiming DLA must have needed care
or supervision for *3 months prior to the claim
and is likely to need it for the next 6 months and
have lived in the UK for six months out of the
last twelve months.

(*If you are terminally ill you do not have to


satisfy this qualifying period).

35
Attendance Allowance (AA)
Attendance Allowance is a non-contributory
tax free benefit for people aged 65 or over who
have an illness or disability and need help with
personal care.
AA is paid on top of other benefits and for some
people may increase the amount of benefit they
already get such as pension credit. AA is paid
at two rates depending on an individuals care
needs. To qualify for AA you must have needed
the care or supervision for *6 months; and have
lived in the UK for six months out of the last
twelve months.
(*If you are terminally ill you do not have to
satisfy this qualifying period)

Carers Allowance (CA)


A weekly benefit payable to a carer (aged 16 or
over), earning under a certain threshold, looking
after a disabled person receiving AA or DLA (at
the middle or highest rate for personal care), for
over 35 hours a week.

Employment and Support Allowance (ESA)


This replaced Incapacity Benefit in 2008 and is
for people under pension age who cannot work
due to illness or disability. This applies to people
who have either worked and paid sufficient
National Insurance (NI); or to those who havent
got a sufficient NI record but whose income is not
enough to live on.

36
Other benefits
Income Support (IS) provides a basic income
for some single parents and carers under
pensionable age for women who are working for
less than 16 hours per week.
Pension Credit is a means-tested benefit to
raise pensioners minimum income. There are
two forms of this benefit:
Guarantee Credit is equivalent to income
support for people who have reached the
pensionable age for women. It ensures that
an individuals weekly income is brought up
to a guaranteed minimum level. Additional
amounts may be paid over and above this set
rate to people with disabilities or to a carer.

Savings Credit is payable to people over


65 years who have made some provision
for their retirement in addition to their basic
state pension (e.g. modest savings or a small
occupational pension).
Housing/Council Tax Benefit (dealt with by
the local authority) is for people who are on
a low income and paying rent or council tax.
The local authority also administers the Blue
Badge Scheme (for disabled car drivers and
passengers) and is responsible for Disabled
Facilities Grants helping to fund special
adaptations to the home.
The Social Fund provides grants and loans
to people on low incomes to meet exceptional
expenses such as funeral expenses and winter
fuel payments.
37
Future changes to the benefit system
what we know so far.
In February 2011 the Department for Work and
Pensions published the Welfare Reform Bill.
As of March 2011 and, subject to parliamentary
approval, this will involve some major changes.
These will include simplifying the working age
related benefits with the introduction of a single
benefit called Universal Credit. This is likely to
be introduced across the whole of the UK by
2013.

In brief, what is Universal credit (U.C)?:


U.C is a new integrated working age benefit to
support people in and out of work. It will provide
a basic personal allowance with additional
amounts for children, housing costs, disability
and caring responsibilities.

U.C will replace the following means-tested


benefits and tax credits: Working Tax Credit,
Child Tax Credit, Housing Benefit, Income
Support, income-based Jobseekers Allowance
and income-related Employment and Support
Allowance.

U.C does not include: Disability Living


Allowance (see below), the non-means
tested forms of Job Seekers Allowance and
Employment and Support Allowance, Pension
Credit, Bereavement benefits, Industrial Injuries
Disablement Benefit, Maternity Allowance, Child
Benefit, Statutory Maternity Pay, and Statutory
Sick Pay.

38
Other significant changes for disabled
people of working age:
Personal Independence Payment (PIP) : will be
replacing Disability Living Allowance (DLA). This
will continue to be a non-means tested benefit
however there are some significant changes
proposed as follows:
People claiming this new benefit will need to
have experienced a disability for longer before
they can apply a qualifying period of six months
is required compared to three months for DLA.
People in receipt of PIP will be assessed more
often. It is likely that the new benefit will be
introduced in 2013/2014 and existing claimants
of DLA will be reassessed and moved across to
PIP shortly after this time frame.
The new benefit will only have two levels of
payment for the care component (currently with
DLA there are three levels low, middle and
high)
The DLA mobility component for those in
care homes will be retained until March 2013,
however it likely that this may change in the
future.
People will not be paid PIP once they reach
the age of 65 or pensionable age (whichever is
higher).
Other benefits under review
Decisions concerning other key benefits such
as Council Tax Benefit or Carers Allowance are
still being considered. It is not clear yet whether
those above working age (or children) will also
be reassessed. 39
Where to go for advice
advice and
and support
support G
The Citizens Advice Bureau (CAB) is a good
The Citizens Advice Bureau (CAB) is a good
source of free advice; your local branch should
source of free advice; your local branch should
be listed in your phone directory or visit
be listed in your phone directory or visit
www.citizensadvice.org.uk
www.citizensadvice.org.uk
(for England and Wales)
(for England and Wales)
www.citizensadvice.co.uk for bureaux
www.citizensadvice.co.uk for bureaux
in Northern Ireland and www.cas.org.uk
in Northern Ireland and www.cas.org.uk
for Scotland.
You can also contact the Benefits Enquiry
You can also contact the Benefits Enquiry
Line on 0800 882200. They can arrange for
Line on 0800 882200. They can arrange for
someone to help you to fill out the form if
someone to help you to fill out the form if
required.
required.

To claim your State Pension or to apply for


To claim your State Pension or to apply for
Pension Credit contact the Pension Service
Pension Credit contact the Pension Service
on 08456 060 265 (forms can be completed
on 0800 991 234 (forms can be completed
over the phone) or visit
over the phone) or visit
www.thepensionservice.gov.uk
www.thepensionservice.gov.uk
Leaflets about various benefits are also
Leaflets about various benefits are also
available from Post Offices, libraries and Job
available from Post Offices, libraries and Job
centre/social security office.
centre/social security office.

40
40

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General considerations

When you apply for benefits such as DLA


and AA it is important not to under play your
problems. Give examples and detail about
how your disability affects your day-to-day life.
Although many people find it difficult to focus
on their limitations in this way, the assessor
looking at your claim needs to understand the
difficulties you face, rather than how you are
coping with it.
Seek specialist advice as getting one benefit
may entitle you to other benefits as well
Claim as soon as possible. The date of your
claim is usually the date it is received.
If your claim is refused you can challenge the
decision through an independent Tribunals
Service.

41
Community care services

Maintaining our independence is something we


all hold dear. However for the older person and
those who are disabled, additional support may
be required to enable people to continue to live
safely and independently in their own home.
The following information gives a general
overview of community care services available
in England. Service provision is similar in the
other three UK countries but may be organised
and funded slightly differently.
There are various support services which could
be available to you or someone you care for,
your local authority social services department
would be the first port of call for information
about service provision in your area. Social
services may be able to provide some help
directly or can arrange for services to be
provided to you by another organisation such
as a home care agency or a charity.
Getting an assessment
Under the NHS and Community Care Act 1990
local authorities have a duty to assess people
who may be in need of social care and support
and also to assess disabled people. If you are
finding it hard to cope with your day-to-day
activities you should first contact your local
social services department and request to have
a community care assessment (CCA).

42
On your initial telephone call you may be put
through to a duty social worker or someone in
a first point of contact team (in some areas
called Care Direct). You will be asked for basic
information such as your name, address and
the name of your GP as well as brief details
about your circumstances. Priority to have an
assessment is made according to need. Some
people will be seen very quickly, depending on
how urgent their situation is.
The second stage of the assessment process
will usually involve a home visit by a social
worker who will talk to you about your situation
and your individual needs, and decide what kind
of help that you or your carer may need and
whether this can be provided by social services.
Assessments if appropriate can also take place
at a relatives home or in hospital. Also if you are
a carer, you can ask for a separate assessment
to look at any support you may need.
Once your needs have been identified, social
services will then arrange for the services to be
set in place for you. Social services may provide
some services directly to meet your identified
needs or arrange for you to receive direct
payments (see page 46).

43
Is everyone eligible for community care?
Everyone can request to have a CCA, but not
everyone will be able to receive services from
social services after having an assessment.
It very much depends on an individuals level
of need and circumstances.
Local authorities are required to follow guidance
from the Department of Health called Fair
Access to Care Services which sets out
eligibility criteria to ensure that decisions
around assessment are applied fairly.
If you do not qualify for community care
services, social services may be able to offer
advice and information about alternative
organisations that could help you.
Paying for community care services
In England and Wales local authorities can
charge for some community care services
and charging arrangements can vary between
authorities. If you have a certain level of income
or savings you will be expected to contribute
towards the cost of any services you receive.
You will be asked to complete a financial
assessment form so that social services can
work out how much, if any, you will have to pay.
In Scotland personal care is free if you are over
65 and have been assessed by the local authority
social work department as needing it.
44
Whatever your circumstances your social
services department will be able to advise you.
Alternatively you can seek professional advice
from organisations such as the Citizens Advice
service.
Types of help
Home Carers will provide help with personal
care such as getting washed and dressed, or
practical assistance with tasks including preparing
meals or shopping.
Meals Service some councils offer a hot meal
delivery service or they can organise for you to
receive a delivery of frozen meals which can be
heated in a microwave.
Day Centres and Luncheon Clubs provide
locally based day care and lunch with a programme
of activities. Social services can often organise
transport to get you to the day centre.
Equipment for Daily Living occupational
therapists can provide disability equipment
and adaptations to your home to help you with
every day tasks. Simple equipment for help
with everyday living will usually be provided
free of charge following an assessment by an
occupational therapist. You may have to pay or
part fund the purchase of larger items of
equipment yourself.

45
Community Emergency Alarm Service this
is a special unit connected to your telephone line
which is fitted with an alarm button. It allows you to
summon help quickly any time of the day or night.
If you are receiving certain welfare benefits there
may be a reduction in the charge for this service.
Also some organisations such as the British Legion
or the ex-servicemens charity, SSAFA, may be
able to offer financial assistance towards the
installation of a phone alarm system.
Short Break Service following a Carers
Assessment there are a number of different short-
break schemes which may be available for you or
for someone who cares for you. It can include care
in the home or day care (away from home) and
residential breaks.

Organising your own care


If you have been assessed as needing support
from social services, you may be offered
the option of receiving Direct Payments/
Individualised Budgets. Money can be given
directly to you to purchase your own care
services. This offers you more flexibility and
independence, so that you can arrange your
care and support in a way that suits you.

46
Other useful sources of
information and advice

Accessing services

Carers UK
Information and advice for carers providing
unpaid care to an ill or disabled relative or
family member.
CarersLine Tel: 0808 808 7777
(CarersLine is the same for the 3 UK
countries apart from Northern Ireland )
wwwcarersuk.org
www.carerswales.org
www.carersscotland.org

Carers Northern Ireland


Tel: 028 9043 9843
www.carersni.org

First Stop Care Advice


Provides information and advice about care
and housing options in later life. First Stop is a
joint collaboration between Counsel and Care,
Elderly Accommodation Counsel, Help the
Aged and NFFA Ltd.
Advice line Tel: 0800 377 7070
www.firststopcareadvice.org.uk

47
Driving and Travel
Driving and Travel

48
48

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Queen Elizabeths Foundation
Queen Elizabeths Foundation
(Mobility Centre)
(Mobility Centre)
Offers mobility assessment, and the opportunity
Offers mobility assessment, and the opportunity
for a product trial, training and advice. This
for a product trial, training and advice. This
service is for people who are hoping to return to
service is for people who are hoping to return to
driving (following illness or disability) and also for
driving (following illness or disability) and also for
non-drivers to help with independent mobility.
non-drivers to help with independent mobility.
1 Metcalfe Avenue
Carshalton
Damson Way
Surrey
Fountain Drive
SM5 4AW
Carshalton
Surrey SM5 4NR
Tel: 01372 841100
http://qef.org.uk/our-services/mobility-services/
Tel: 020 8770 1151
www.qefd.org/mobilitycentre/index.html
Tourism for All UK
Providing information to the public, especially
Tourism for All UK
to older people and those with disabilities
Providing information to the public, especially
on holiday and travel information including
to older people and those with disabilities
accessible accommodation and other tourism
on holiday and travel information including
services and needs.
accessible accommodation and other tourism
services and needs.
7A Pixel Mill
c/o Vitalise
44 Appleby Road
Shap Road Industrial Estate
Kendal
Cumbria LA9 6ES
Shap Road
Kendal
Tel: 0845 124 9971
Cumbria LA9 6NZ
49
Tel: 0845 124 9971

49

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General
General

Age
Age UK
UK B
The four national Age Concerns in the UK have
The four national Age Concerns in the UK have U
joined together with Help the Aged to form Age UK.
joined together with Help the Aged to form Age UK. 4
L
Age
Age UK
UK
Tavis House T
FREE POST (SWB 30375)
1-6 Tavistock Square se
Ashburton
London m
Devon 9NA
WC1H a
TQ13 7ZZ
p
Age
Age UK
UK Advice
Advice Tel:
Tel: 0800
0800169
1696565
6565 Te
www.ageuk.org.uk
www.ageuk.org.uk w
For Scotland, Wales and Northern Ireland contact
For Scotland, Wales and Northern Ireland contact
the helpline number above or visit the Age UK D
the helpline number above or visit the Age UK
website. A
website.
Arthritis Care D
Arthritis Care o
Floor 4
18 Stephenson Way L
Linen Court
London NW1 2HD
10 East Road p
London N1 6AD
Tel: 080 8800 4050 (Helpline) to
Tel: 080 8800 4050 (Helpline)
www.arthritiscare.org.uk liv
www.arthritiscare.org.uk
B
BackCare
S
16 Elmtree Road, Teddington
BackCare
T
Middlesex TW11 8ST
16 Elmtree Road, Teddington
D
Middlesex TW11 8ST
Tel: 0845 130 2704 (Helpline)
Tel: 0845 130 2704 (Helpline) Te
www.backpain.org.uk
www.backcare.org.uk w

50
50

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British Red Cross
British Red Cross
UK Office
UK Office
44 Moorfields
44 Moorfields
London EC2Y 9AL
London EC2Y 9AL
The British Red Cross provides a range of
The British Red Cross provides a range of
services across the UK, including the loan of
services across the UK, including the loan of
medical equipment such as wheelchairs. They
medical equipment such as wheelchairs. They
also have a range of aids and equipment to
also have a range of aids and equipment to
purchase.
purchase.
Tel: 0844 412 2804
Tel: 0844 412 2804
www.redcross.org.uk
www.redcross.org.uk
Disablement Information and
Disablement
Advice Information
Line Services (DIAL and
UK)
Advice Line Services (DIAL UK)
Dial UK is a national organisation for a network
Dial UK is a national organisation for a network
of 160 local Disability Information and Advice
of 160 local Disability Information and Advice
Line services (DIALs) run by and for disabled
Line services (DIALs) run by and for disabled
people. They provide information and advice
people. They provide information and advice
to disabled people and others on all aspects of
to disabled people and others on all aspects of
living with a disability within their own area.
living with a disability within their own area.

Tel: 01302 310123


Tel: 01302 310123
www.scope.org.uk/dial

51
51

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HM Revenue and Customs
Customs
For information on VAT relief on products
For information on VAT relief on products
and services for disabled people
and services for disabled people
HM Revenue and customs
HM Revenue and customs
VAT Disabled and Elderly Reliefs
VAT relief for disabled people
Correspondence
St Johns House SO708
PO Box 205
Merton Road
Bootle
L75 1BB L69 9AZ

Telephone
Telephone helpline:
helpline: 0845
0845 010
302 9000
0203
www.hmrc.gov.uk
www.hmrc.gov.uk

Help
Help in
in the
the home
home and
and day-to-day
day-to-day living
living

ArjoHuntleigh UK and Ireland


Supplies patient handling and lifting equipment.
Supplies patient handling and lifting equipment.
St Catherines Street
St Catherines Street
Gloucester GL1 2SL
Gloucester GL1 2SL
Tel:
Tel: 08456
08456 114
114 114
114 D
www.arjohuntleigh.co.uk
www.arjohuntleigh.co.uk P
Disabled
Disabled Living
Living Foundation
Foundation (DLF)
(DLF) a
d
380/384 Harrow Road
380/384 Harrow Road i
London W9 2HU
London W9 2HU c
The DLF helps older and disabled people find
The DLF helps older and disabled people find e
equipment solutions that enable them to lead
equipment solutions that enable them to lead b
independent lives.
independent lives. p
Tel:
Tel: 0845
0845 130
130 9177
9177
(Helpline open 10am-4pm,Monday-Friday)
(Helpline open 10am-4pm,Monday-Friday) 1
www.dlf.org.uk 2
www.dlf.org.uk L
T
52
52 w

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Medesign Limited
Medesign supplies various health care aids.
Clock Tower Works
Railway Street, Southport
Merseyside PR8 5BB
Tel: 01704 542373
www.medesign.co.uk
Thrive
Thrive is a national charity that helps those
with a disability to enjoy gardening.
The Geoffrey Udall Centre
Beech Hill
Reading RG7 2AT
Tel: 0118 988 5688
www.thrive.org.uk

Your rights and the law

Disability Rights UK
Publishers of the Disability Rights Handbook, is
a leading authority on social security benefits for
disabled people. They provide regularly updated
information about benefits, tax credits and community
care. The Disability Rights Handbook is updated
each year. It contains information on social security
benefits, tax credits and related services for disabled
people and is available from the address below.

12 City Forum
250 City Road
London EC1V 8AF
Tel: 0845 026 4748
www.disabilityrightsuk.org 53
Equality Advisory
and Human Rights
and Commission
Support Services (EASS) J
Gives information and guidance on
Advisory service aimed at individulals who S
discrimination and human rights issues
need expert information, advice and support B
including disability. There are offices in
on discrimination and human rights issues U
and the applicable law.
Manchester, London, Cardiff and Glasgow. t
FREEPOST o
EnglandAdvisory
Equality Tel: 0845 604 6610
Support Service
Scotland
FPN 4431 Tel: 0845 604 5510 Y
Wales Tel:800
0845 604 8810 o
Tel: 0808 0082
www.equalityhumanrights.com
www.equalityadvisoryservice.com
Equality Commission for Northern Ireland
Equality Commission for Northern Ireland
Tel: 028 90 500
890 600
890
www.equalityni.org F
o
Advicenow

Web-based resource which provides links to
Web-based resource which provides links to
information an the law and your rights in England
information and the law and your rights in England
and Wales. It does not provide advice itself.
www.advicenow.org.uk F
a
Patients Association
The Patients Association provides information
The Patients Association provides information
and advice on access to health services,
complaints procedure and patients rights.
complaints procedure and patients rights.
O
PO Box 935
PO Box 935 b
Harrow
Harrow
Y
Middlesex HA1 3YJ
Middlesex HA1 3YJ
O
Tel:
Tel: 0845
0845 608
608 4455
4455 o
(Helpline open 9.30am-5pm)
(Helpline open 10am-4pm, Monday-Friday)
www.patients-association.com
www.patients-association.com

54
54

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Join the National Osteoporosis
Society today
Become a member and support the only
UK-wide charity dedicated to improving
the diagnosis, prevention and treatment
of osteoporosis.
You can join today, either call us or visit
our website:

01761 473 287


www.nos.org.uk
For more publications about
osteoporosis
0845 130 3076
info@nos.org.uk

For osteoporosis information


and support contact our Helpline:
0845 450 0230
nurses@nos.org.uk

Our publications are free of charge


but we would welcome a donation
You can support the work of the National
Osteoporosis Society by making a single
or regular donation:

01761 473 111


www.nos.org.uk
55
Other leaflets and factsheets
in this range:
Anorexia nervosa and osteoporosis
Anti-epileptic drugs and osteoporosis
Breast cancer treatments and osteoporosis
Clothing, body image and osteoporosis
Coeliac disease and osteoporosis
Complementary and alternative therapies
and osteoporosis
Complex regional pain syndrome and osteoporosis
The contraceptive injection (Depo Provera)
and osteoporosis
Drug treatments for osteoporosis
Exercise and osteoporosis
Glucocorticoids and osteoporosis
Further food facts and bone beyond calcium and
vitamin D
Healthy living for strong bones
Hip protectors and osteoporosis
Hormone therapy in men and women and osteoporosis
Hyperparathyroidism and osteoporosis
Osteoarthritis and osteoporosis
Osteogenesis imperfecta and osteoporosis
Osteoporosis in children
Percutaneous vertebroplasty and balloon
kyphoplasty and osteoporosis
Pregnancy and osteoporosis
Scans and tests and osteoporosis
Thyroid disease and osteoporosis
Transsexual people and osteoporosis
Vibration therapy and osteoporosis

0845 130 3076 (General Enquiries)


0845 450 0230 (Helpline)
www.nos.org.uk
Camerton, Bath BA2 0PJ

President: HRH The Duchess of Cornwall


National Osteoporosis Society is a registered charity no. 1102712 in England and Wales
and no. SC039755 in Scotland. Registered as a company limited by guarantee in England
and Wales no. 4995013
Last revised June 2013 NOS/00148

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