Viewing a care home for respite care. What questions do I ask?

[OrdinaryMoment]

As title, but I’m completely new to this.

I (72F) have been caring for my husband (79M) who has mid stage vascular dementia, for two and a half years now since his formal diagnosis, but he was dependent on me for some time before that due to other health problems (prostate cancer). A stroke two years ago left him double incontinent and he also has severe mobility challenges due to a back problem.

i manage his care day to day, but I’m exhausted and he has finally agreed to go into a care home for a couple of weeks so I can take a break. I have drawn up a short list of suitable places locally and am going to visit one next week which looks perfect.

Can anyone advise on what I should be looking for, what questions to ask or any red flags I need to be aware of. This is a first time for me so all advice gratefully received. I am taking a level headed friend with me as a second pair of eyes. Thank you in advance.

Look for a nursing home rather than a care home. They will have nurses on hand 24/7. I have just moved my elderly father with vascular dementia from a care home to a nursing home with dementia unit. The difference in the level of care and input he receives is marked.

Ask about staffing retention. If they have a high turnover, something is wrong. If most staff have been there for years, that's usually a good sign. Food - is it cooked from scratch or from catering suppliers? Do they assist with feeding?

Think about how you look after him and base your questions on that. Write them and the answers down so you don't forget.

Ask if they have availability. I found somewhere lovely, but they had no spaces. On the upside, they put us on the waiting list and when my father needed to be moved, he was right at the top of the list after six months.

I found the Alzheimer's website a good resource but it is difficult to navigate and AgeUK have some helpful guides too. https://www.ageuk.org.uk/services/information-advice/guides-and-factsheets/#home I also checked the CQC reports and used https://www.carehome.co.uk/ and https://lottie.org/

Don't forget to ask around too, it's useful to hear what other people say about homes. It's a lot of work, but so important to get it right. When you go away, you want to feel totally at ease and not worry about whether they are being properly cared for.

@unsync has given you some good pointers. I just wanted to add that it’s not just about you finding somewhere you like, it’s about them being able to manage their residents. They will have to assess your DH to determine if they can meet his needs - so don’t pin your hopes on a place you think is perfect because they may not be able to accept him.
My stepfather spent 2 years in a care home. If I had chosen one myself, it certainly wouldn’t have been that one but he ended up having a wonderful couple of years there. Appearances can be deceptive!

When DMIL moved to a Care Home itwas a bit different as we were in the midst of the first lockdown. We did read the reports but alao yhe google reviews which were all really good. As a PP, try not to go on appearances. Her Care Home coukd probably best be described as shabby but the staff were all great and she settled very quickly.

If it’s Care Homes that you’re looking at, ask what happens when they need Nursing Care. Some Care Homes will have a Nursing Wing or floor. In others it will necessitate a move for your DH to somewhere more suitable.

Do ask about staff retention as PP suggested.

DFIL was in a Nursing Home with very high turnover and mainly staffed with agency staff. It was awful. Lots of buzzers going off for long periods of time and not being answered, smells of wee and poo as you walked through but he had cognition and for some reason wanted to be in that particular one

A different relative of mine is somewhere completely different. Lots of activities, food cooked on site, open visiting, high staff retention and smells clean as you walk through.

It depends how his dementia manifests or how he might react to the unfamiliar setting. Some care homes say they cater for dementia but really they mean "people who sit quietly being confused" not people who wander about, shout, resist care, try to escape, take and hide things. If he has any challenging behaviour at all ask how they would manage it. Are staff all trained in dementia, are there MH qualified nurses on site all times?

Also how do they stop belongings getting lost? Are other residents doors locked from outside? My mum has done much better in a small specialist dementia unit than a big care home which wasn't safe for her.

I do agree with that.

If he has back problems, does he need a hoist or could need one in the future?

With his incontinence, it is worth discussing their rate of changes - we found initially that my mum was not changed frequently enough and had to make a bit of fuss, but we got it sorted quite easily - more about letting them know how frequently pants need changing so they’re aware than about fighting the system.

Thank you for all the replies. Some excellent advice here, and I’m making a list of things to ask.

To answer a couple of points, he’s very calm, well mannered and even tempered normally: doesn’t get agitated or aggressive, thank goodness, so that’s not a worry. His mobility restrictions mean he needs walking aids but can generally get into and out of bed ok, and can sit/stand ok if his chair has arms to help him. He does need to sit in the shower, however.

His continence issues are the main concern as he seems to be completely unaware when he’s wet (or worse!) and has to be constantly reminded to check things and change if needed.

Thank you again.

Woukd he be willing to let the staff change him? I agree with adking fkr tge rate of change

Sorry about the typos

I inspect care homes and you get a definite 'feel' very quickly.

• does it smell
• are the staff looking harassed or do they smile
• observe interactions
• ask to see lunch and sit quietly and watch interactions
• call buzzers. Are they ringing wildly
• ask if you can talk to other relatives
• do they follow any researched model of dementia care eg Teepa Snow and are staff trained beyond a basic level
• is the staff team stable or is there huge reliance on agency or foreign workers
• is the management structure stable
• read their report from the regulators. It's a shame as Wales inspect every 18 months max but England can be up to 5 or 6 years!!!!

Don't make an appointment, just go. You want to see how they work when not on 'best behaviour'.

Are there signs that the carers go above and beyond? When my Nana had to go in a home (not dementia) one of the staff got a nail kit for Xmas and spent her spare time doing residents' nails. Some of the carers came to my Nana's funeral.

How do they keep residents safe? My grandmother had dementia, previously she had worked in a nursing home so she would try to get in the kitchen, or give orders. The carers would just say 'thank you' and guide her back to a chair or her room.

Look at the realities of the situation. My grandmother lost a lot of weight before she got tot he home, partly because the carers who came in would ask what she wanted to eat and she would say, "Oh just a sandwich". At the time I was teaching 'health and social care' and the right thing to do is ask for the resident / service user what they want.

Once in the care home the carers would say, "time for dinner, we have roast chicken today or a beef casserole which would you like? The home did have vegetarian, halal and could make sandwiches or toast but the first option was always the hot meal. Grandma put on a bit of weight there.

Ask the carers how long they have worked there. The longer the better.

Very good advice here.
Speak with other relatives, are they happy with the care?,
Read the "visitors book ' comments ,check the dates;are relatives encouraged to write comments??
No better recommendation than a care home resident or relative telling you about their experience.

Ask how many trained and untrained staff are on duty during day and night.

When I was looking at care homes, one had 1 nurse on the floor during the day, one nurse covering both floors at night, 5 carers for 30 dementia residents during the day, only 1 on the dementia floor at night (with 2 runners covering both floors, so 60 residents in total) which wasn’t enough as far as I was concerned.

The other home, which was the one I chose, had a trained nurse on the dementia floor day and night, 6 carers on the floor during the day and 4 at night (for 30 residents).