Research conducted over twelve+ years suggests that while the factors considered during the process are pretty consistent, the end-decision made is a highly subjective one. What appeals to one will not necessarily appeal to another.
In this article we share the advice of care seekers and providers to help you make the right choice for you and your loved one.
The care inspectorate’s role it is to register and monitor residential and nursing care providers, essentially to make sure they maintain specific national minimum standards. All homes will be inspected within six months of opening or ownership change and periodically thereafter. “Key inspections” are un-announced and a report is produced and published online at the relevant inspectorate’s website for England, Wales and Scotland. For the Channel Islands and the Isle of Man, contact the relevant Government offices.
We recommend strongly that you review not only the most recent care inspectorates report for the homes you’re considering, but potentially also the historical ones too. At the time of writing not all homes listed on our site have links to the relevant reports, but we aim to provide this as soon as possible.
The location of the care home is hugely important and you’d be surprised how many people get this wrong.
Some like to be near shops, amenities and transport, while others want to be surrounded by rolling hills and picture-postcard scenery. If you’ve always lived in a large city, moving to the countryside will mean a big adjustment. Is this a two week respite break or a permanent move?
In this age where families can be geographically dispersed, it may be necessary to take a balanced view on location between the visiting frequency and mobility of the residents’ circle of family and friends. If you've lived in a certain area for a long time, moving away from familiarity and friends may be more of a wrench that the family will appreciate.
While some may have a car, others may be dependant on public transport. Plenty of parking spaces would be handy for drivers, while those who use public transport would like the home to be near a well connected bus stop or train station.
Not all care homes can accommodate all residents’ needs. Not all homes can accommodate residents with dementia or Parkinsons disease for example. This should be identifiable by the services they are registered for, but may require a more detailed conversation with the home to check. The standard list of registration categories are:
- Old age (PC)
- Dementia care (DE)
- Physical disability, under 65 years old (PD)
- Sensory impairment (SI)
- Learning disability (LD)
- Mental health (MD)
- Alcohol dependency (A)
- Drug dependency (D)
Everyone is entitled to an assessment by their local social services department and it can surface needs you weren’t aware of or entitlement to benefits in some cases. Involving social services can slow the process down considerably, however.
Regardless of any assessment carried out already by social workers or NHS staff, most care homes will also conduct their own assessment often in the person’s current home to ensure they can accommodate the needs of the prospective resident.
It sounds like common sense, but look closely at all the costs. The fees of care homes range widely depending on factors like location and the ‘assessed needs’ of the individual. Fees for nursing care are much higher than residential care. Some homes charge a base fee rate, but then hairdressing, laundry, incontinence pads and chiropody [for example] are charged as extras. For other homes it’s ‘all-in’. Fees increase over time too, so make sure you understand whether they increase on a yearly basis and if so, by how much.
Some homes offer different payment options, ask what they can offer, and from that consider whether what they offer can work for you.
Consider the likelihood of entitlement to any benefits either from the local council or under NHS Continuing Healthcare (if the potential resident is being discharged from hospital, but the hospital are saying they can’t go home, ask the hospital).
Our finance section covers this at a high level, but if the residents’ savings and asset levels suggest you’re likely to be largely self-funding, it might be worth consulting a financial advisor or support brokers who specialise in long-term care. It could save you £ thousands!
DO visit the homes
Definitely DO visit the homes you are evaluating and do evaluate a number of homes. Every care seeker and provider we have spoken to said that choosing a care home is not like choosing somewhere for a two week holiday, you really are choosing a home. Each home has its individual “feel” and what “feels right” for one, may not be right for another.
It’s not always necessary (or desirable) to schedule a visit, in many cases popping in un-announced will give you a clearer picture of what the reality of living in that home is like than if you had ‘booked a viewing’.
Consider the potential residents lifestyle and wishes
While conditions like dementia affects peoples thinking, reasoning and memory, their feelings remain intact. A move from an independent lifestyle in their own home to residential or nursing care is likely to be upsetting and they may try to resist the move. Talk to them about their anxieties and try to find ways to address them.
Consider the homes you look at in the context not only of their ‘assessed needs’, but also the way they like to live. One care seeker we spoke to chose a home near the sea with plenty of places on the flat within walking distance of the home because the prospective resident enjoys fresh air and daily walks.
Consider the homes not only in practical terms i.e. for ease of living, but also in terms of how comfortable, homely and ‘normal’ it will seem for the new resident. Ask the home if residents can retain some level of occupation in the home by carrying out small tasks throughout the day, such as helping to lay the tables or watering the plants.
If possible engage the resident in the viewing and selection process, take them with you. Listen to the feedback they give.
First impressions are important. How easy was it to park? Were you welcomed at the door? What is the entrance hall like? What are the lounges, dining and other shared areas like? What does it smell like? What does it feel like?
A number of the homes we visited recently had a lovely smell of lunch cooking when we arrived and residents relaxing in the foyer or lounges browsing newspapers and chatting. We also felt welcome when we arrived and a sense that this was a pleasant place to live.
Care home staff are key to residents happiness and wellbeing:
- Are there enough members of staff working, and do they look comfortably busy?
- Do they have time to spend with the residents individually?
- How do the residents and staff interact with each other?
- What training have the staff had and are they appropriately registered and CRB (Criminal Records Bureau) checked? Staff in dementia care homes should also have had specialist training.
- Canvas the views of other residents relatives
Care home staff should pay a reasonable amount of time with residents, especially interacting with them. Surveys have found that particularly people with dementia, are more happy and relaxed when care staff spend more than half their time interacting with them. Those that do not have so much time spent with them may become withdrawn and depressed.
Try to find out how long key staff have been there and assess for yourself how long they’re likely to stay.
Make sure you look at the residents rooms in the care home: are they shared or single rooms? Which do you prefer? Most purpose-built care homes now have single rooms with en-suite facilities, whereas some older homes may still have twin rooms.
The rooms you are shown should smell clean and fresh, be pleasantly decorated and furnished. Most care homes will let a resident personalise their room with photographs, and some will also allow people to bring in their own furniture, which can give the place a homely feeling. But this depends on space and the policy of the home, so it is best to check with each home while you’re evaluating.
You should check if the room is lockable and if not, is there a safe or lockable cabinet within the room or other facility where valuables can be kept? Do you need to obtain insurance for the potential residents valuables?
Diet is important regardless of age and most care homes will be able to offer residents a varied and nutritionally balanced diet of familiar dishes to residents taste. Food preferences and any allergies etc are normally discussed as part of the assessment process.
Do ask to sample the menu or join existing residents for a meal before deciding that a home is right for you or your loved one.
It’s widely acknowledged that a variety of regular activities and entertainment are key to the quality of care home life. Many care homes will have an activities co-ordinator who arranges events, outings, games, arts and crafts etc.
When you visit, you should see what the residents have been doing and ask to see photos of the events they’ve held and a schedule of what’s coming up. Also ask about any hobbies, pastimes and outside visits the care home undertakes, do the residents get involved in gardening or partake of regular exercise for example?
Look and see if it seems that residents are left watching TV for much of the day? Is there internet access available and is it wireless or from a single internet point?
If the prospective resident has dementia, enquire whether sessions like reminiscence are available or whether the home has a dementia sensory room and/or dementia sensory garden.
Independence and your say in the care home
Many care homes will run a resident’s committee and this can provide an excellent way of influencing how the care home is run. It can change how food is prepared, depending on the resident’s wishes, for example. Others will allow residents to have a direct say in the decision making, inviting them to sit in on management meetings.
The level of independence you’re given should also be considered when making your decision. Many homes will let relatives visit, in private and at any time you like; some will have relaxed arrangements for residents’ coming and going, giving them a level of independence that they may not have imagined possible prior to moving in.
Are residents free to wander around the home and go out when they want? Can residents get up and go to bed when they want? Can residents or a relative continue to look after the residents personal affairs i.e. money? Is the resident able to spend time alone if they wish? Can they retain their existing GP or do they have to sign up with the one attached to the home?
Arrange a trial stay
Once you have found a potential care home, try to set up a trial stay for your relative to see how they react to it and whether they like it and feel if they could settle there.
Some homes even allow relatives to stay over and eat at the home to evaluate the environment personally before making a decision.