Any advice for finding a care home for elderly mother.

[Tolkienista]

My mother is 95 and until she had a fall five months ago was living independently at home, shopping daily, very fit and active.
Two hospital stays later, she's still at home has carers in twice a day and between her four children we've been doing our best to support her with daily visits........cooking, shopping, cleaning etc. Mobility is her biggest issue. She has to live downstairs because the bathroom is upstairs and she uses a commode.

Over the last few weeks we've noticed a gradual decline in her health & more dependence on us, she has a heart condition too (atrial fibrillation)
We collectively feel the time has come to move up a level with care and consider moving her into a care home.

Where do we begin?
She is a self funder with her care company, owns her home (has over £23K in savings) so is this the same starting point with care homes £23K?

It's a constant worry, but after 5 months of us doing everything possible to keep her at home, we just feel it's time to move on, her home is just not suitable for a 95 yr old with decreasing mobility and a weakening heart.

Have a detailed think about what you think residential care will give her that she can't get at home, and/or what you are worried about happening if she carries on at home and/or what you think she is missing out on.

You might find the perfect residential home. But it may be that extra-care sheltered housing works better for her (there are quite a few of these being built now so they are still shiny and up to date), or more frequent carers, or a live in carer, or moving to a more suitable home.

Costs vary by room (some homes have a range from bedroom with shared bathroom to fancy suites) and by the amount of care needed. You won't get an accurate cost until you've identified a room and they've done an assessment but be prepared for £1000-£2000/week depending on location/swankiness/care needs.

If you start to visit some you will be able to compare and feel which is right for your mother. As someone else mentioned think about where is best for her to be depending on who will visit most, but maybe you are all close. My dad was in an independent home with just 22 residents and many long term staff and no agency staff. They really got to know all residents and their families which meant they could talk to them about their families.
We have a lot of chain homes being built on new developments around us but they are very large and advertise hair salons, cinema rooms etc. I don't think many older residents have the concentration to watch whole films. A nice cosy lounge with TV or music was far more homely. Do check what activities they arrange too but be prepared that at that wonderful age she may not be up to very many activities for very long. Simple quizzes sitting in the lounge always went down well and visitors could join in too! You often get the feeling it is right as soon as you walk in.

If she doesnt have dementia keep her at home by having more care visits.

Our LA will only fund residential care if someone's not coping with 4 care visits a day.

You dont want her to self fund then that run out then the LA to say they won't pay!

She really isn't at the care home stage.

My mum was in a miserable place (Bupa) my MIL was on a wonderful one (council-run, but she was self funding).

The differences? The staff at the BUPA one didn't acknowledge us when we visited, and we never saw them show any warmth to my mum. MIL's carers greeted us warmly, and even wanted to feed me every time, as they knew it was a more than 2.5 hour journey for me to get there. And they spoke to my MIL with such warmth and affection. Even when her dementia was advanced, they'd talk to her as if she could understand everything, sharing their family news, etc. And it wasn't performative for our visit, because we'd see them come on shift and greet and chat to other residents (all with dementia) in the same way.

The BUPA one was dark and dingy, the council one modern and full of natural light.

The BUPA one had a rapid turnover of staff, the council one had carers who'd been there for many years and who loved their job, and knew every resident and their families.

I'd arrive to find my mum in dirty clothes and with dried on food on her face. My MIL would be carefully dressed in beautifully laundered toning colours, and when they needed to buy anything for her, they'd buy it on the colours they knew she liked.

Never write off council run care homes.

Where are you based?
I work in a small, charity run care home and it's just lovely - lots of long term staff, amazing food and a generally lovely environment, also currently only 1 resident with dementia so I'm not entirely sure where a pp was coming from.
Def visit a few and get a general feel for them and their staff, you know your Mum best so will have a better idea of what type of place will suit her best.

She's a very sociable person, loves catching up with friends and relatives having a laugh and getting all the gossip.
She's not a "joiner in" of social activities, so I guess that wouldn't be important, but I think she'd be happy in the communal lounge chatting to others.

Based in the west midlands.
We definitely intend to visit and as you say.......get a feel.
I guess it's a gut instinct .

Really good advice and clearly written from the heart. That is so relatable the way you've outlined her experience in real terms. Thank you.

At ours, it was in the contract that if they developed raging dementia that you understood you’d have to find somewhere else…In practice the place was full of delightfully dotty old ladies who probably couldn’t have reliably told you what year it was but there was no shouting or screaming or other distressing dementia symptoms.

Thank you for your advice and experience.
She's 95 and won't be entering a care home to be taking up new hobbies, well I don't think she will.
I've visited a new care home and it was like walking into a five star hotel, beautiful sofas in the entrance hall, sumptuous carpets, grand table lamps........none of it was anything to do with the care residents were receiving.

Does she have enough money to self fund for a long time? Have you looked into how expensive it is? You don’t want to move her into a home and then run out of money. If she hasn’t been assessed by social services as needing full time care then they won’t fund it and she would have to leave the home. Usually SS would try all preventative services first such as aids/adaptations and additional care calls before a care home would even be considered

Don't dismiss your DM not joining in activities, people can change when they move into a care home and you might be surprised about how she adapts to her new home.

As a nurse who works in a care home I would say that the first vibes you get when you first visit is the best advice.
Do the carers look happy and have banter with the residents?
Don’t be taken in by the decor..beautiful flower arrangements etc doesn’t tell you anything about the care !!
Look at the companies finances ,ask to look in the kitchen,menu etc .
Ask the carers about how long they have worked there …happy carers =happy home!
You really need to be very enquiring to check out if the home is happy and not money grabbing!! Sorry if I am very cynical but it’s my experience that answers your questions.

I would look round a range. We found that for similar weekly rates the difference in quality could be massive.

A couple were like hospital wards with very cheap furniture and smelly shared toilets; for an extra £75-100 a week two homes are more like 5* hotels.

If your DM is likely to be fully self funding we found that for a slightly higher rate the couple of homes that didn't take council residents were much nicer because PIL wouldn't be subsidising anyone else, all of their money was spent on their own care.

But think how long the momey will last, because if you choose a home that doesn't take Council funded people, she'd have to move out when her money ran out.

Onve her savings are gone, then the rest will come from the sale of the house.

More than 1 lounge, so there can be a quiet one for reading or chatting, one for TV etc. My dad's second place had one done up as a 1950s diner, with help-yourself drinks and cakes, which was great.

Clear signage for residents to find their way around and a way for them to easily identify their own room (some have a personal photo montage, which also give staff a talking point to get to know them).

If it's divided into wings or floors, do the staff stay in one zone and get to know residents or rotate around? Do they use agency staff?

How easy is it to get from each room to the dining room, activity rooms, lounges etc? First place my dad was in had all social stuff downstairs, he was in a room upstairs so never went - there was a lift but the psychological barrier was too great (also only one lift, so when it broke he was stuck).

A small point, but music - if there's a singalong, or music playlist in a lounge, is it approriate eras for the ages of the residents or are they still stuck in the mindset that 'old people' = wartime and playing wall-to-wall Vera Lynn to people who grew up with rock and roll?.

Sorry if I've missed it - is she onboard about moving? Moving people out of their own homes at this age can be detrimental to their health so usually the home care visits are increased first to see whether that would help. Assistive technologies also can be put in like a lifeline alarm.

As she doesn't have dementia, it might be worth looking at extra care supported housing. Generally, carers in extra care are on site 24 hours but she would have her own flat so retain some independence. In our area they can usually deal with high physical care needs (eg; hoisting, catheter and stoma care and some memory loss but not full down dementia ie; wandering etc.). Rents are much lower than care home costs.

However, if she wants the full residential care home experience ie own room but communal meals, activities then start by looking at the CQC (care quality commission) reports for each home then visit.

I'm feeling gloomy about homes at the moment as we may try and move my mum from one to another. I see patients in them too, and there aren't many I like. Having said that, your mum sounds exactly the kind of person who might thrive in the right home.

The best one I've ever seen is the one my mother in law is in. I don't know what they pay the staff but they keep them a really decent length of time. I'd say the more that you see staff interacting with residents, the better the home. And by interaction, I mean that the staff adapt what they do and say to the resident - they don't just have a laugh/talk to other staff members over the heads of the resident. You can usually tell when they're acting it out for you as a visitor.

I can only say what we did twice - for FiL and later, for DM.

Made a list of any that seemed suitable, phoned them all. Discounted any that asked us to make an appt. just for an initial look around - any good home should be happy for you to do this - except at very busy times like mealtimes.

Visit them all (yes, it’s time consuming) and go on your gut feelings, and (from experience) try not to be influenced by smart ‘Homes and Gardens’ decor. All too often IMO it’s there to influence relatives who are choosing. Cosy and homely, even if a bit shabby round the edges, and cheerful, friendly staff, are IMO far more important.

One of the very worst we had experience of - an old aunt of dh was voluntarily there for a few weeks while her usual helper was away, was one of the most expensive, seafront views and very plush, but the staff were surly and miserable - she absolutely hated it there.

Somewhere that is convenient and pleasant for you to visit as well. My mothers nursing home was on the seafront which made walks out very pleasant.

@MereDintofPandiculation MIL is being funded from the sale of her house. The funds should last 6 or 7 years which hopefully will be OK. She's frail and 90. There are also some savings. I think OP's mother is 95.

Better that the money be spent on her living somewhere nice than be inherited by us.

We found that if you had funds to pay for a minimum 3 years privately they’d be willing to keep you on at council rates but you might have to move rooms. Relative had a nice big room, en-suite, with a sea view. There were much cheaper rooms round the back with shared facilities.

To someone who was largely confined to their room, particularly someone with cognitive impairment, that would be as bad as moving to a different home - especially as the larger homes tend to have teams of staff assigned to different areas, so she might not even be seeing the same faces.

Not all homes will keep people on.

My father went into a home at 96. He's coming up to his 102nd birthday with no sign of stopping. Going into a home can often mean an upturn in physical health - regular meals and snacks between meals, medicines on the dot does an awful lot.

Have you discussed this idea with her? If she has local friends she may have visited / heard about various local homes. Could you try increasing the number of daily carer visits and adding in a cleaner for support?