a good care home guide

by Audrey Thompson

a good care home guide | help and info | personal stories

Finding a care home for a relative is usually a last resort after months and often years of caring for that person. It can be a very traumatic time, raising a whole host of emotions in all concerned, including guilt, grief, feelings of abandonment, stress and relief.

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If at all possible, you should give yourselves plenty of time to find a suitable home to avoid being pressurised into making a last-minute decision. Vital information needs to be sought and questions asked – and properly answered – to improve your chances of making the right choice.

what kind of care home?

First on the list is to decide what kind of care home is needed. What you choose will usually depend on the cost of the home and the frailty of the likely resident.

• Private residential homes are run for profit by private organisations and individual proprietors.
• Voluntary-sector homes are non-profit-making and run by registered charities.
• Small residential homes care for three or fewer people and must register with the local authority's registration and inspection unit.
• Social services departments run local authority residential homes.
• Most nursing homes are run by private organisations and proprietors, though some are run by the voluntary sector.

how to find a home

A list of all registered private and voluntary residential homes in the area is available from your council or your local Commission for Social Care Inspection (CSCI) office. The CSCI regulates and inspects all care homes and inspection reports can be found on their website or obtained by contacting their helpline (see help and info for details). These reports set out what the home does well, and what needs to improve.

Other sources that you can investigate to find a care home can be obtained from:

• local Age Concern organisations (see help and info for the national organisation)
• the community health council or Citizens Advice Bureau (check your local telephone directory for contact details)
• specific charities for the elderly or infirm (see help and info for the contact details of several organisations).

If you can, it's also always wise to get recommendations from friends and others whose judgement you trust.

what makes a good care home?

Most people would agree that quality of life is everything. Even if a resident of a care home has a serious condition such as dementia, Parkinson's disease or a stroke, they should still expect the best quality of life possible. And what is a good 'quality of life' in these circumstances? A situation in which residents are given the same respect, privacy, care and comfort that they would have if they were still living in their own home.

All good care homes depend on the quality of the management. A sensitive, experienced and qualified manager generally ensures a well-run home. A high ratio of qualified to unqualified staff is also a big bonus.

Central to good care are adequate numbers of staff who can take the time to talk to residents and build up a rapport. A good home does not rely on over-stretched care staff to do everything. Instead, it employs extra staff to clean and run residents' activities.

A home should be clean and comfortable, though not necessarily plush. It should also meet the minimum standards set out by the government.

what to check out

Les Bright, deputy chief executive of the charity Counsel and Care (see help and info), believes that, in choosing a care home, people should trust their instincts but also investigate.

location Just like buying a house, you should first consider its location and ask yourself: would I want to live there?

smells 'If you do nothing else, take a sniff around the place,' says Les Bright. How a home smells can tell you a lot about its cleanliness, whether residents are left to sit in their own mess and, therefore, whether the home is under-staffed.

toilets and bathrooms Are they clean? Are there handrails for the frail? Do they have alarm buttons for those who get into trouble?

check out everything Are you allowed to check all the facilities? Or are staff steering you away from some areas? Insist on seeing everything, says Mr Bright.

visit the home It is vital to visit a home by appointment and, whenever possible, unannounced. If staff are hostile when you simply turn up, this should set alarm bells ringing. Spend a whole day at the home, particularly during meal times, and sample the food yourself. Is there enough to eat and has it been served hot? If there is room, try to stay overnight at least once. Does the place feel institutional or homely?

activities and gardens Find out if the home has activities, what they are and whether they are regularly scheduled. Make a surprise visit on the day an activity is due to take place – does it? Does the home have a garden and is it used? Again, visit on more than one occasion and at different times to check this. It is not unknown for gardens to be used or activities laid on only for the benefit of relatives' scheduled visits. Fun and interesting activities can make all the difference for residents of homes, rather than being left to vegetate for hours at a time in front of a TV.

heating Check the heating and the times when it is supposed to come on. Do residents sit around all day in lots of woolly jumpers or even overcoats and gloves?

'All these things may seem obvious,' says Mr Bright. 'But they can get overlooked when people are confronting their feelings about placing a mum or dad or a husband or wife in a home.'

questions to ask

• Are residents encouraged to continue to be independent and to make as many choices about their lives as possible?
• Can residents bring personal possessions?
• Do residents have the choice of a single room with en suite facilities?
• Do residents get up and go to bed when they choose? If not, why not?
• What outings and activities are residents offered?
• Are visits made to the home by hairdressers and other people who can help improve residents sense of well-being, such as reflexologists and masseurs?
• Can residents have their own GPs?
• Are residents free to see visitors when and where they choose?
• Can visitors stay overnight?
• What facilities are there for couples?
• What food do they get to eat? And do residents choose when and where they eat?
• Can residents use the telephone in private for incoming and outgoing calls?
• Can the home meet the residents' communication needs?
• Are residents still able to maintain their hobbies, religions and social life?

a suitable home

Taking time to choose the right care home paid off for Sue Adams' family.

'My mother-in-law could be quite a difficult person. Also she wasn't very outgoing and we thought it would be hard to find a home that suited her,' she says. 'But the staff in her care home never got cross with her. They were always courteous, friendly and discreet. We had our own front door keys and could come and go as we wished.

'The care staff formed a relationship with her and were genuinely affectionate, buying her birthday and Christmas presents,' Ms Adams continues. 'They invited her to things but understood if she didn't want to join in. In short they allowed her to be an individual.'

Ms Adams also praises the standards of care. When her mother-in-law had entered the home, she had been very frail, but during her stay, her health improved.

As acting chief executive of the Relatives and Residents Association (see help and info), Ms Adams comes into contact with many families and residents with good things to say about care homes.

'The media gives a distorted picture. There are over half a million people in care homes and only a fraction of these have a bad experience,' she says.

(July 2001)

Read on for some personal stories, told from different perspectives, about choosing a care home for a loved one. Or follow this link for details of relevant organisations, websites and reading.