Advice on choosing a care home

[poisonedbypen]

We are currently finding a care (nursing) home for my father. He has dementia & some nursing needs. I am compiling a list of questions to ask when I visit, does anyone have any advice on what to ask?
Also, I have been told the cost of this care home (from £1200) - is this at the top end (home counties)?

Ask if they do end of life care. Some homes will and it allows them to stay in familiar surroundings. Others won't and will insist they are transported to hospital. My grandmother was able to stay in her home and it made a huge difference to her and the family.

No that's sounds about average. I'm sorry you're in this position. It's never easy. I hope he adjusts well. Keep visiting and be patient.

Thank you. He has been in hospital for a long time (seems to have got stuck in the system) and it's not doing him any good at all, so I'm hoping he improves. He really wants to go home but it's just not feasible. If he improves a little it might become a possibility. He has gone downhill so quickly :(. Good point about end of life care, thank you.

Take a look around. Ask to see an empty bedroom. Ask to use a loo and check for smells.

Ask how many staff they have on overnight, how many staff vacancies they currently have, and what turnover is like. Ask to see a copy of their most recent report.

What times are mealtimes, how many staff do they have helping residents who need support to eat, what are the menus like?

What's going on during the day? Do they have an activities coordinator, who visits (library, vicar, hair dresser, podiatrist, local brownies, whoever)?

Is there a garden, and if do are any of the residents actually using it?

Listen to the tone of the staff when talking to other residents. Are they kind? Go with gut feeling.

We recently had to do this for a rellie. Had a choice of three places. One looked fab, each resident had their own large private suite, the home has a garden and keeps chickens and Guinea pigs, residents are encouraged to help grow veg etc. But there were incredibly loud radios blaring in every public area all the time.

A second, brand new, state of the art, ultra modern, excellent reputation. But talking to residents they hated the food.

So went for the third. Nothing special as far as the building is concerned. Smaller rooms, shared bathrooms. But a manager who goes above and beyond. Sherry served before Sunday lunch and for residents birthdays. Smaller; it's home not a Home.

Hope you find somewhere decent where you can know he is being well cared for.

Echo Natty's thoughts. Don't be seduced by decor- it is the way staff behave that makes all the difference.
Good luck

Have a look for people like your dad - age, sociability, mobility etc and see what they can access. For instance, my mum isn't very verbal, is rather antisocial, is in her early 70's, and can shuffle round short distances with crutches. So for her, actvities with war time songs/reminiscence is totally inappropriate. She doesn't want to sit with other people - but would love a garden she could access - very shallow ramp with a non slip surface, not steps or a steep ramp intended for a carer to push a wheelchair down. The garden would need to be totally secure, have scope for feeling like you wander and have lots of suitable height seating.
So you can see that what might seem great on the surface (I've seen homes with lovely gardens that aren't secure!)
Depending on your dads nursing needs, ask specifically about their experience in managing these if they progress. What happens if he needed an airflow mattress etc

Find out where the call alarm bell is. Is it noisy, a klaxon? Is it near the room you are going for? That works only if your rellie is deaf.

Find out where the laundry is. Is it below your room? If so it will be hot.

Is your neighbour or a neighbour noisy and shouty, esp all through the night?

What is the carer/resident ratio?

What is the latest CQC review? Often it can be months before they go public with it, the CQC often will sit on it.

Get a friend to put in a FoI request to the CQC for number of residents admitted to hospital with dehydration over a given period. If you do it yourself, you're singling yourself out.

Are there regular Relatives' meetings?

Google care home and local press for scare stories.

Is it easy to get to, any pubs or parks nearby? For yourself frankly as well as your relative.

Don't go with testimony from those who have residents who are with it, they are often treated better than those with dementia who might get covertly fast-tracked to the morgue via dehydration by the care home to save both the Council and NHS money. Allegedly.

If they boast about how they have most rooms filled, that's no boast. It just means they're v good at recruiting customers, not hard in itself with the crisis in adult social care. There's no shortage of contenders, and it could mean they're as good at filling coffins than filling rooms.

£1,200 is very much the going rate for Home Counties.

Obviously ask alm the questions about end of life care / cqc, etc as above, but the biggest thing is the feel of the place.

My gran is in a home (alzheimers) and we looked around a few. Some were all singing all dancing brand new amazingness, but my 87 year old gran doesn't care about new tvs in bedrooms, or hi tech facilities.
She wants cups of tea on demand, comfy furniture and friendly staff.

The home we chose was a little bit old fashioned (which of course gran loves) and is basically like an 'old persons' house. Lots of comfy armchairs, fruit bowls, biscuit tins on the living room shelf etc. The staff are lovely, they always have old music on (and all residents know the words still), and its just like a big family home.
Residents are encouraged to use and work in the large garden, my gran regularly flicks a duster round (obviously they have cleaners but my gran thinks she's at home, and part of that is dusting. It keeps her happy).

Don't be seduced by all mod cons, etc. Think about how your relative lives and what will make them happy.

For reference my gran's home is £500 a week, she's been there 6 years, and the staff have assured us they will keep her to the very end.

Turn up and ask for a show around. When you are looking around look for availability of fluids. I'd also be asking about staff turnover. Anything over 35% is above the industry norm. If you can look for a home that doesn't rely on agency nurses.

I'd personally prefer one run by a large provider of care homes, but it's personal choice. I'd be reassured that there is an area support team/operations manager with overall responsibility above the manager.

Look for evidence that there lots of activities and trips. Do they have a minibus? Is it used?

Did this over a year ago for dad.

Definitely the feel of the place. Ask about what if scenarios - what would trigger them to tell you they couldn't care for him anymore etc. I was very put off by one that kept saying " we are not a nursing home" many times. But will they cope with incontinence , needing help with meals , what level of mobility etc and yes end of life care. I will be forever great full they keep dad for end of life and despite my anxieties , at no point did they feel they couldn't cope ( he went off fast though and became chair / bed bound quickly which effectively lessened his supervision issues I guess).

Ask about staff turnover. We had few very young carers. Most had been there ages and were Middle Aged.

Don't be seduced by activities etc yes if they are ones your relative will like that's great but actually dad became unable to take part much quite quickly. Music was good though - singing or sometimes having performers in was good but art/ bingo etc he couldn't do.

Depending on how old your father is and how he's funded I'd find out if they have any soc services residents. If he's self funding and the money runs out you want to know if you'll need to move him or not. It might be a consideration.

We paid 650 or so a week. Midlands. That sounds like nursing home rates to me

Thank you all. We are turning up this morning, unannounced. It's so hard, it's not what he wants but we have no choice :(

How did it go?

Sorry, only just seen this! It was nice, although I don't think he's ready for the dementia section yet. He has a very high risk of falls & I'm not convinced they could cope with him. I'm going to see some others for comparison.

See lots. the more you see the better Youll understand what your df wants and wants.

Excellent advice above.

Drop in for lunch unannounced.

Ask what proportion of the residents have dementia/are at the same stage as your dad.

Ask what's extra - eg do they pay extra for outings?

Mum pays £1050 in a Sunrise for a room with a shared bathroom and she has no care needs. £1200 sounds about average for your dads needs.

If they are a high falls risk check the have an alarm May next the bed at night so they know when he is getting up and moving.

Check if there is a dedicated staff member on duty in the day room during the day to assist the residents. Some do and some just have staff going in and out.

Mat not may!

Some care homes don't want you turning up at lunch specifically, they say that it's intrusive for residents eating, also there won't be someone to show you around.

If you're dad had falls you may be asked about bed rails if he's the sort who tries to get up in the night. That will leads to a DOLS conversation about Depravation of Liberties, which never sounds great frankly. Tbh I am not really sure if the whole DOLS thing is sinister or not.

How much dementia does you Dad have? Can you still get him to give you Power of Attorney in Health and Welfare and Finance? If so, do not delay, do it now. I cannot say anything more important than that. Otherwise, once he's lost it, you will not even be able to see his medical notes, let alone access any other information.

I would ring first and do the 'official' tour at an arranged time, then follow up a few days later unannounced - but not during meal times or too early/late in the day.
Did this for my mum in June and it's hard but the benefits outweigh the drawbacks.

good luck!