For some time I have been thinking about writing this. I receive many calls a week from people looking for care homes. The majority of times these people know very little and ask me to start at the beginning about the care system. With this in mind and based on future social care reforms taking place in October 2023 (at the time of writing this) I thought this would be useful. It is fair to say that rarely do people plan to move into care homes, it is generally not the sort of thing the we discuss with our loved ones, or consider for ourselves. So… if you are looking for residential care / considering it for your loved ones this may help. This is my personal opinion on how to look for a care home. (This focuses on choosing care for older loved ones rather than those with learning disabilities or complex health needs)
The decision to consider residential care for a loved one is often filled with apprehension and at times, guilt. It is a difficult decision and if possible see as many homes as possible. Remember to put the person who is moving into residential care at the heart of the decision – choose homes that will suit them rather than what you may like. Without stating the obvious, the care is the most important thing. Fancy wallpapers / gyms / cinema rooms….are unlikely to improve quality of life. The care and the staff who work in the homes are the most important thing to consider.
1. How to choose then….
Without stating the obvious, involve your loved one with the decision. If they do not have capacity to make the decision, then a Power of Attorney for Health and Welfare should be in place. If it is not then arranging a placement for someone who does not have capacity is much more tricky and the Local Authority / adult social care team and other healthcare professionals will need to be involved.
Make a list of how the person likes to live or used to like to live;
- Urban or rural
- Pets?
- Homely environment or more “hotel” like. I aim to make our home feel like a home, all who live and work together I regard as my family. Not all homes are the same, and home like environment do not necessarily suit everyone.
- Lots of people around or quiet spaces for alone time?
- Brand new fixtures and fittings and matching crockery (yes, people do ask….)
- Dementia Home or not? If people in the home are living with dementia it is important that any residents who do not have dementia are aware that they are living in a home with residents who live with dementia. I strongly recommend that if your loved one lives with dementia you look for a home that specialises in caring for those living with dementia. Some residential homes will cope with dementia symptoms to a certain level, but may not cope with all aspects of how dementia can progress in an individual.
Unless you are going to visit more than once a week please do not rule out homes based on ease of visiting for the occasional visitors. If your loved one moves into residential care, unless you plan to visit very regularly the most important people are going to be those doing the care rather than whether the journey to visit for the grandchildren four times a year takes one hour or three……. The important thing is the home suits your loved one, prioritise that above your travel time.
Some new build homes will often advertise “cinemas” “gyms” “beauty areas”. Ask yourself whether these areas will really be of use to your loved one? An easily accessible garden, a staff member who will do chair based activities and a hairdresser who visits once a week may be more appropriate than purpose built areas which may be used for marketing… and are likely to considerably increase the cost. Choose a home based on what your loved one would like NOT on what is important to you.
Super duper en-suites, Wi-Fi access may be important to you, but if your loved one lives with dementia realistically they may not be using the internet and an en-suite forever.
Make sure you meet the staff. I am the owner of a care home, I think about my residents, staff and the home 24/7, I have access to the realtime care records 24/7,I cover shifts, but I am not there every day, make sure you speak to people who are actually caring, not just the person who is doing the “marketing”. I ensure that anyone who visits our home meets the staff on shift. Ask about staffing levels, speak to the staff, ask about the amount of agency staff. Continuity of staff will be important to ensure your loved one gets to know those who care for them. Make sure you see the residents – if you are shown empty rooms that should raise alarm bells, what is being hidden?
But a word of caution, care homes are under immense infection control regulations, depending on Covid rates at the time, visits may not be possible. In this case, ask to see videos or have a zoom video call.
2. Care Home or Nursing Home?
Residential Care can be provided in either care homes or nursing homes. The CQC (Care Quality Commission) that regulates all healthcare providers will register a residential care provider as a “Care Home” or “Nursing Home”. Nursing homes must have registered nurses on site 24/7. Care Homes do not have registered nurses on site at all times. Nursing homes can therefore provide care for those with complex medical needs.
However, when it comes to Dementia, care homes or nursing homes may be considered.
Dementia Care is often provided within Care Homes. Previously called “EMI – Elderly Mentally Infirm” this is not a description which is used nowadays (this meant the home specialised in the care of those living with dementia) and as such it is hard to differentiate homes that specialise in the care of those living with dementia. Some care homes will not be able to provide care for those living with moderate / advanced dementia symptoms, some may not be able to care for those with significant mobility issues (requiring hoisting to get out of bed for example).
Some care homes will have separate “wings” for those living with dementia, other homes will have all residents in the same areas and will not segregate based on level of need.
When considering a home, remember this is likely to be your / your loved ones last home. Find out what level of need the home would not be able to cope with. Go into specifics about this – you do not want to find out that a home is unable to support your loved one one / two / three years in the future.
3. Funding!
If an individual has savings or assets over £23K then, at the current time, they will have to fund their own residential care. If an individual has a home then this is considered within the £23K limit (although not if they have a spouse who is still living in the home. Continuing Healthcare (“CHC”) is sometimes provided for those with very complex needs who require nursing care and this is fully funded by the NHS, However, the thresholds for eligibility for CHC are very very high – advanced Alzheimer’s does not normally meet the thresholds.
However as of October 2023 the rules change! At the time of writing a Local Authority will contribute to part of care costs if someone has assets under £100K AND there will be a lifetime limit on care costs of £83K. But this is just the cost of care – not accommodation / food / utilities. As an example, if an individual is paying for residential care of £1000 per week, probably around £600 of that will be the cost of care, so the £83K lifetime limit would apply to care costs, not the full weekly fee.
BUT… no fees will be paid / costs of care considered unless the Local Authority is aware of your / your loved one’s needs and have essentially confirmed that they require a residential placement.
If you are looking for care, or you have a loved one in a residential setting at the current time who is self funded it is essential that you ensure the Local Authority are aware of them.
In terms of costs, there can be huge variety in costs. I do not believe that cost equals quality of care…..
4. CQC Ratings / Reviews / Open Days
CQC reviews should always be read, they will give an overview of the home. BUT… do not get too hung up on the ratings. I have personally visited homes with “Outstanding” ratings that I would never consider recommending, and I have also visited homes that are “Requires Improvements” that I would recommend. Inspectors have a very difficult job to do, and see a snap shot of a home at a moment in time, some of the big chains of care homes have people who solely focus on how to get brilliant CQC ratings,…. Read reports in full and decide whether you share the same concerns or whether a report is perhaps “too good to be true”.
Reviews can also be “created” and unlike trip advisor / trust pilot generally negative reviews are not as widely accessed or provided. So take all reviews with a pinch of salt.
If a home has an open day it means they are desperate to fill beds. This is not necessarily a bad thing, but it should raise some questions, generally there is a shortage of care home spaces, a home with lots of vacancies may not be a good thing. If you go to an open day, make sure you speak to people who actually do the caring, not a marketing / front of house team.
5. Respite or short stay?
I get tens of calls a week about respite stay, particularly in the summer. This is something we rarely offer, respite stays are in high demand and there are not many available, particularly for those living with dementia. It take a few weeks for a home to get to know the resident and for the resident to get to know a home, respite stays can often be unsettling and should be considered carefully.
BUT… I always say to new residents and their families to view a move as a respite stay – if they don’t like us, then there is no lengthy notice period, ensure that this is in place with any new home.
For someone living with dementia who may have some awareness of a move, but not their level of need, I suggest that any placement is initially communicated this way to the individual.
6. Start Early
The amount of times we receive calls when people say “what do you mean you have no rooms”. I have even had one person turn up outside our door because “Well I thought seeing you in person may mean you find us a room”. Understandably people often do not start looking for care homes until they are desperate, and then they may not have many homes to choose from.
Particularly if a loved one has dementia and you think they may need care in the future, please start looking now and start speaking to lots of homes..
7. And finally
Expect to be “interviewed”. Not only do I want to learn about the resident, I want to learn about the family and visitors. Whenever a new resident moves in there is always a period of adjustment for the resident, but also for their families. We expect lots of calls, and we are on hand to guide you and support you through the transition. However, sadly this can often at times mean that a well meaning loved one can be somewhat demanding, and sadly this can often be directed at more junior members of staff. My residents and staff are my family and as such I want to ensure they are happy, safe, loved and respected. Any good Manager / Owner will also be interviewing you to ensure that you will fit with the home.
Get to understand the structure of the home, ask who is onsite at all times. Is the Owner available at all times, do they know what is happening?. Does the Registered Manager spend most of their time on the floor with the residents – not hidden in an office?. In my opinion I feel that anyone managing and owning a home should be involved and hands on, and you should be able to contact them direct.
I hope that this helps, remember to put your loved one and their needs at the centre of this decision.
