Residential verses Nursing Home?

[frogleap]

I've been tasked with finding a care home for my elderly relative.
They will be self-funding (at least for a few years).
They are frail and have a diagnosis of dementia (need prompting for everything but very amiable).

My sister seems to think we need to find a home which is a nursing home as well as a care home.

I'm not sure why and it cuts down a lot of choice of homes as most seem to be care home only (obviously I'm only looking at homes which take elderly and dementia residents).

Can someone please explain why I should only consider ones with nursing as well?
My relative has no other health issues.

If you anticipate future deterioration from a medical perspective and want to reduce the disruption caused by having to find a new home and move your relative when they may be even more frail/infirm, a dual registered residential and nursing home may be a preferred option.

With dementia they will continue to deteriorate and may eventually go off their feet, their nutritional intake may decline and their skin may deteriorate which may lead to needing nursing care. Unless they pass away from something else before they need nursing care it's likely that they'll require nursing at some point so this will minimise disruption for your family member.

you need to speak to the homes. It will depend on her specific needs and their ability to meet them.

my gran was in a residential home, but eventually her dementia worsened to the point they couldn’t care for her adequately. It wasn’t so much physical and actual nursing care, it was the level of supervision and staffing needed to manage.

residential is fine while they are relatively independent. But you need to think long term and as pp says, would it be easy to move her?

i’d go and see as many as you can and ask what they can provide, considering if she worsens and how a move might work.

one big question I’d ask is how they manage end of life care. My mum has had a DNR in place for years, she’s healthy and fit, simply doesn’t want CPR. I’d want somewhere that is able to provide pain relief and palliative meds, and doesn’t ship off to a hospital at the slightest concern.

She may need nursing care eventually, there again she may not. Even if she's in a dual registered home she would still need to move within the home should she need nursing care. Personally I'd be giving more consideration to the activities programme and how convenient it is for visiting.

You could ask your sister what her concerns are because it is important that you are a team with this.

My parents both went into a home that had residents requiring various levels of care. My Mum went directly into the Nursing level but Dad was initially Residential but moved to Nursing as he got more frail. Having to move to a new home at that point would have been terrible for us all, but especially for him.
My Mum had Alzheimer's. It's a disorder which often develops into more physical problems requiring a higher level of care unfortunately. Obviously some peoplecwith dementia stay in goid physical health, but many don't, so you would be well advised to consider the possibility that your relative may need nursing care in the future, especially if they are already frail. If you are looking at residential only then I would ask a lot of questions about what their maximum care provision is, what kind of things might precipitate a need to move your relative and how that would be managed etc. Keeping a familiar environment is important for people with dementia and unfamiliar people and places can worsen their confusion considerably so if you can minimise changes it's preferable.

One reason would be that if they go into a residential home and then require nursing care at some point down the line (a time line which is difficult to predict) then your relative would have to move from the residential home as it's likely they would assess as not being able to meet her needs. If you are prepared for this then it's fine to look at just residential homes, just do be aware that this could happen especially if your relative needs a higher ratio of carers or needs to be hoisted at all times, or requires regular injections etc in the future

residential homes may not have the staff ratio suitable for looking after someone whose dementia gets worse and some people with dementia start wandering so need to be somewhere secure when this happens.

my dad was in a residential home but as his dementia deteriorated he started wandering at night and got as far as running a scalding hot bath and was about to get in just as he was discovered by the one and only night staff. We had to move him to a home which specialised in dementia care and which was secure as even though his mind was going he was still physically fit and could walk quite fast.

Even if you are self funders your relative is still entitled to a care act assessment which would determine their level of need.

If nursing care is the appropriate level of need then the NHS pay a contribution towards the weekly fee and a nursing assessment will also be completed.

But basically residential care is for people who need an eye keeping on them 24 hours a day but don't have specialist needs such as hoisting, dressings, pressure care, challenging behaviours etc. They wod be nursing needs.

Some residential homes specialise in dementia; as indeed do some nursing homes.

All you can do is look around for homes that seem good to you - and ask each of them what happens when someone deteriorates.

Haven't read all replies, but in general a care home doesn't have to have qualified nurses on duty at all times, and hence don't provide nursing care.

If your relative is in a care home, and their needs increase, they'll need to be moved to somewhere that offers nursing care which is disruptive

Thanks everyone.
There seems so many more residential care homes than nursing homes so I assume most people don't end up actually needing a nursing home.

All the homes I spoke to say patients are allowed to die there (I'm paraphrasing!) so don't necessarily need to be moved when they inevitably deteriorate.
They call in NHS Drs and nurses who will diagnose ailments and dress wounds etc.

Both grannies went into residential care (dementia, weight loss due to not eating, inability to manage at home). Mum went on to nursing care when her breathing deteriorated and she came out of hospital with oxygen "to see how she got on". I don't know if they would have been that breezy about it if they'd know she would have needed to move as a result. After seven months in the residential home she still couldn't find the toilet or knew that she had a bed there so the disruption of a move to the nursing home was small. It's not as if she had to find her way around all over again. The staff had known her and what she liked and that was the big thing that was disrupted by the move.

If I had to make the decision all over again I'd still go with the residential placement first because it was a lovely place, the food was good, the staff were pleasant and I could walk there. Yes, mum had to move but by that point I doubt that she noticed that anything had changed.

Close is good because as time went on my visits with both of them shrank to about ten minutes after which they were itching to get back to the lounge. I felt better about that when it was a ten minute round trip, less so when it's close to an hour.

We chose a home that had a residential wing and a nursing wing, to save the need to move if the need for nursing care arose. As it did, my grandmother did need to switch to nursing care.

If this is an option, really consider it.

It's worth remembering that some people live at home till the end of their lives with district nurses etc. going in. This also happens in residential homes, most of which do their very best to keep people to the end.

It sounds like residents are often physically moved within the home even if the home is both residential and nursing?

It's hard because the home I think would be best for the relative at present is not a nursing home - the one that is nursing also is more expensive and much larger and feels more institutional - which is not what I feel my relative would benefit from initially as they make the adjustment from living at home alone (as they currently are) it feels so strange to move them to communal living as it is!