Looking for a care home

[VentingDaughter]

My mother has reached the point where she can't stay in her home and will need to go into a care home. I understand that she qualifies for some help from the NHS but not full nursing costs as her needs could be met by someone at healthcare assistant level, which I would agree with. She's currently in what is officially a rehab placement in a hospital but is showing no signs of rehabilitating, and obviously can't stay there. She's 94, can only walk a few steps, and is catheterised;
her sight is poor and although I don't think she's officially diagnosed with dementia she's definitely gone downhill in that respect since going into hospital. She also has what is almost certainly bladder cancer, but at the moment that is not likely to be terminal and she isn't being treated for it. She owns the flat so will need to self-fund.

The immediate problem is actually finding somewhere. She's not someone who will want to get involved in activities and social get-togethers, so I guess the priority is somewhere comfortable where she will be properly looked after and feel cared for and have as good a quality of life as is possible. Could I ask for tips on what to look out for when looking at care homes?

Also, just in case, can anyone recommend somewhere? Roughly anywhere reasonably accessible from London or Bristol would be good.

might be worth having a look at wymondley care home (in between hitchin and letchworth garden city- both have train stations with links to london). all the best x

Ask about visiting hours as a good home should be open for visits at any time rather than when they are on show

I work in care homes and have done for my entire adult life.
I always advise people to look around care homes at the weekend, there will be little to no management in and you will get a more honest feel for what the home is like.
The carehome.co.uk website is good, like tripadvisor for care homes, always read the CQC report but take it with a pinch of salt (they're all available online).
Look for staff who seem happy and are friendly when you visit,
Residents who seem well looked after (ladies with make up on, gents who've been shaved etc)
Ask about their activity provision (although she may not get involved she may value one to one time)
Look for homes with the Gold Standards Framework accreditation (this indicates good end of life care)
No decent home will have visiting hours.

If you need advise or support please feel free to message me

My parents have been living in a Sunrise home for the past 6 months and I can't praise it enough. I realise that a lot depends on individual staff, but if the home my parents have been in is anything to go by, their recruitment/training is good. I think they have homes all over the country.

My dad has recently passed; my mum is still there. She has Alzheimer's with gradual deterioration and the activities have been brilliant for her. They do a lot of activities involving music, including people coming in from outside to perform or to lead sessions with the residents. I have seen a big improvement in mums demeanour since she has been there. I wish they had moved into the home earlier, but my mum was always one for not wanting to join in organised activities and had previously said she didn't want to go into a home.

The other thing which makes me happy is to see mum dressed in her nice clothes again. Mum always took a lot of care in her appearance but in recent years at home had lost the ability to look after herself in this way.

hi OP

I had to look at care homes in the past. What I found was that several of the homes in the area didn't have any online presence. The big ones with all the facilities had a presence, but the small quiet places were places we found by asking around, so I would definitely do that.

does the hospital have a list, or maybe Adult Social Services? It sounds as if your mum needs to be quiet and comfortable and the possibility of a smaller home that doesn't have a website is even more likely.

My mum is a sunrise one (well Gracewell, but they were bought by sunrise). She is clean and content in a nice environment, none of which were the case when she was at home. She has Alzheimer’s. You just need to visit a lot: and agree with pp to go at the weekend. But a lot will depend on your mum’s nursing needs.

Social Services should be able to provide you with a list and practical support even if you are self funding.

I will add to savingmysanity's really good list by saying have a look at the quality and choice of food available (I.e make sure it's not mash, mushy peas and mince every night - unless that's her thing!)

Also, try and see past glossy interiors. As a social worker I've visited all types of care homes and sometimes some of the ones that are a little shabby round the edges can still provide outstanding care.

Don't place too much store in CQC reports, homes can change very quickly under new managers, or staff changes, or resident changes.

Ask social services to assess. They will help you establish what is right type of home you need- residential or nursing home. Also, they'll check if she has over or under threshold savings/assets - if someone owns a property but has otherwise less than £23,500 they can apply for 12 week property disregard funding - so basically adult services where her property is assess her, fund and arrange care home for first 12 weeks.

Even if you are self funding/full cost you can still ask social services to assess and make arrangements, but pay them , as they negotiate for you. (The issue with Sunrise is that it is notoriously pricey for what it is, it might just be our area. )

I think you'd be better to ask her social services in her current LA area (where her flat is) for assessment and list of care homes. She might have other options than just care home . You've given such a large area, but it means she's less likely to bump into friends she grew up with or have visitors. Look up her LA website they will have links to lists of care homes for searches, for after assessment.

There's a company along that corridor you mention that assist (free to you but charge the home) to find suitable care home for self funders, they negotiate for you to get right home and better price. I'll see if I can find a leaflet or weblink, as I've seen leaflets given out down here (south of M4)

I can recommend the Porthaven group. My mum was in one, they were great, the nursing care was outstanding. She actually put on weight, loved the company and I can’t describe the relief I felt, knowing she was safe and looked after.

hatgirl is right that care in home can change if cqc assessed a long while ago and manager changed.

But CQC reports are a good measure regardless - as rarely do all the staff team change too. It shouldn't replace your views of home (with list above) when you visit but I'd read it as well.

CQC reports give you a thorough picture of the care home. A home with long standing problems may have repeated manager changes - care in a home (good or bad) is also about attitude of staff as well as the organisation, physical environment and manager.

Its a good idea to do a few visits at different times.
Check if people are up and comfortable in the evenings, if that is what they prefer, or if everyone is put straight into nightwear after their evening meal.
Do they have access to drinks during the day, tea/coffee and juices in between.
Is the tv on an appropriate channel, and is it turned down, or do they have nice relaxing music whilst they're eating?
Are there lots of different things to do - knitting, board games, reading, outings? (and is there a staff member to facilitate them with these things?)
Do they sit out when the weather is nice, if they want to?
Check out how the staff speak to the residents, and if toilets etc are cosy, warm and private.

Just thought of some more!
Are meal times leisurely, or rushed because of time constraints?
Are they allowed second helpings, as well as a good choice of alternatives?
Are there any pets allowed?
Do they have visiting services such as hairdresser, chiropodist?
Incidentally, the last home I worked in offered all of those good things as well as many more, despite the company not having a very good reputation.

It was simply because the manager and deputy were really lovely people and genuinely cared.

Thanks so much, everyone.

The reason we're thinking of looking further afield is that the area where my mother lives will be very expensive, and it will also make it easier for other relatives including my brother to visit. She doesn't have any friends locally - penalty of being in her 90s, I guess. She's been in sheltered accommodation where various activities were laid on and she has consistently refused to access them, which is why I suspect that it's pointless looking for a home with lots of activities.

I think effectively she's already been assessed by the hospital where she is and the social worker attached to it, though at a recent meeting I think they said they need to fill in the forms. Will Social Services help if you're looking at homes outside their area?

Yes. LAs place regularly the time outside our area for someone to move near family if that's all they have. Pick an area, not one that is "in-between" because she's most likely to get regular visitors from living 20-30 mins away from family members, less so when hour etc (as add on rush hour journey extra time it makes there and back hard after work).

Has she under 23,500 aside from her property? As if yes- you need to get her LA to assess and fund first 12 weeks as 12 wk property disregard if she is assessed as requiring residential care. Also if she lacks capacity and they do best interests, regardless of where she goes her LA retain duty to ensure she is appropriately placed under BID and to do the DOLs she'll need when there
(under ordinary residence)
Please ensure she gets a proper assessment and that they talk to you/ give you details about charging policy. Read it all.

Even if she is self funding you can ask the LA to make the arrangements (you still look at the homes), do the negotiations and you pay them a bit extra to manage it as a full cost person.

Outside their area, LA won't know the area, they'd be ringing that LA for advice, and will say you need to look and ask for list from new LA but they need to give you copy of her assessment that says what type of care home she needs and what her needs are. Hospitals will try to send you off on your own without that but people miss out what they might have been entitled to.

Dad is in a nursing home 2.5 miles away - it makes visiting far easier for me, and therefore much more likely to happen even when I have a busy week. So I would recommend putting on your list of things to look out for "proximity to the people who will visit her".

Your problem especially with your wide area of search, won't be "finding a home" as much as "eliminating homes until you have a manageable shortlist to visit".

This thread has a list of useful questions on it:
www.mumsnet.com/Talk/elderly_parents/3567652-Is-this-a-good-care-home

Slightly complicated situation re her finances: she certainly has under £23,000 apart from her property at the moment, but has more than that due from my father's estate which should come through at some point within the next few weeks.

What happens if/when money from the sale of the property doesn't come through within 12 weeks?

Find a home you can get to easily. Frequent visits from you will mean a lot. You will get to know the staff and be more in touch with what is going on.

Having seen the CQC reports of the homes my parents were in I wouldn't have too much confidence in their reports. Fine for compliance with regulations. Not so good on user experience.

Has she been assessed by nhs continuing care? If not call them and request an assessment - if her health needs mean she cannot live at home with 4 visits a day then they will fund a care home, and they will state whether it's residential or full nursing that's required. She sounds like nursing is needed btw.

Get funding sorted first, it takes time so getting the ball rolling is essential and put her flat on the market if she is needing to self fund.

Looking for a home you need to visit a few and get past the hotel type features and get a feeling of the staff attitude. Get a full quote including facility fees and extras. Try not to worry as much about the cqc rating as most have niggly things that caused their rating to be lower, just look into why they aren't good/excellent. It took me 3 months, we found several we liked but they assess the person being admitted and turned her down (dementia) plus the staff just didn't seem very caring at some places.

Ps we chose an independent home whose owner is on site for some of the time and has been in family for over 20 years, his mother managed the home but the current owner has employed a professional manager. They seem to care about their residents more than the other homes who would take severe dementia patients who saw them as atms (the fancy home wanted £450 a month for leisure activities despite the fact she doesn't know if it's day or night let alone playing bingo!)

re money, we were told we would need to show 2 years proof of funds and then would be invoiced monthly.

when you say there's money coming from an estate, are you waiting on probate? There are long delays at the probate office apparently.

I think she's been assessed at the hospital where she is currently. They say she needs lower level nursing care, i.e. the sort of care that could be done by a skilled health care assistant, which sounds right to me. They would fund the nursing element, but mostly the placement would have to be self funded.

Probate has gone through, we're waiting for the estate to be wound up and distributed, so in theory at least it shouldn't be long.