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.

Yes my mother is 95 and having spent close to 5 hours with her today, her mobility is literally tailing off at an alarming rate. Her home is no longer safe for her to negotiate.

My DM’s care home (an Abbeyfield, specialist and purpose built for dementia) took both self- and council funded residents - I’d guess maybe around 50/50. They all had exactly the same type of ensuite room, and enjoyed the same facilities. Of course the self funders subsidised the others, but we had no quarrel with that.

Good point.
I was just outlining what she's been like in her senior years.
Loves socialising, but not a participant in organised groups for the elderly.

This care home was made up of a row of big, old, houses. Lots of glamour and original archetictural features in the front with a more practical extension on the back. They only had a couple of the big sea view rooms with bay windows so they went for a chunky premium. Wasn't expected to live terribly long so it was thought better to spurge on the lovely view. Terms can vary wildly between care homes though so it's worth asking questions about what happens if xyz occurs. It is an emotive decision because you want your loved one to be safe and well cared for but you also need to consider practicalities.

My advice would be: the most expensive is not always the best, and although CQC reports are useful they don’t tell the full story. I went through all this with my mother. The nursing home she was in was very expensive: good food, fresh flowers, good quality furniture, sweet-smelling etc. - BUT we discovered too late that their ratio of staff to residents was not high enough. When my mother wanted to be helped to the toilet and rang her bell, she often had to wait ages for a carer to come, which she found very distressing.

I have since discovered that homes run by charities can be better as they often have volunteers who come in to chat to residents, make tea etc. and it takes some of the pressure off paid staff. Privately-owned homes need to make a profit and cutting down on staff to the minimum is a way of doing that.

Check if they have a daily activities programme. Some homes have an Activities Manager. Your mother might not be a joiner-in but might enjoy listening to live music or playing games like Scrabble or bingo.

See whether residents can choose to stay in their own room - at one home my mother was in temporarily, they just dumped everyone in the communal lounge in front of a blaring TV for the day, which she hated.

If possible, talk not just to residents but to their visiting families. The trouble with CQC inspections is that elderly residents usually don’t complain and inspectors just speak to a couple of visitors who happen to be there when they come. I was never spoken to by an inspector as I could only visit at weekends, but I could have told them a lot that they obviously never discovered, judging by their reports!

If your mother needs nursing care in the future, does the home have the capacity for that?

I hesitate to mention this point as I fear it makes me sound racist, but my mother 's hearing was not brilliant and she had great difficulty understanding a couple of the staff who were excellent carers but had strong foreign accents.

In the end, most of it boils down to the number and quality of staff. Low staff turnover is a good sign.

Good luck!

I first looked at the cqc ratings then visited about 10 different homes. The one I chose was a single owned one ie not part of a chain. The owner lived in Scotland but came over every month . He had given the matron carte Blanche to spend so much a month without running every thing via him. So for instance when it got very hot she was able to order a dozen fans etc.

it was not the smartest or most up to date home but the staff were fabulous. All of the nursing staff had been trained and certified by our local hospice in end of life care which is unusual so at the end of my mums life they were able to give her the palliative care she needed. If my mum started coughing in the morning they would listen to her chest and if they could hear a chest infection they would email the doctor who would authorise a prescription and my mum would be on antibiotics by the end of the day.
There is a very posh 5 star home near us that has a cinema and residents can have wine with their meal which us lovely but that same home queried the length of time it took one of their staff to feed someone who kept choking . It had been assessed that it took 30 minutes to feed this person. The matron said they didn't have time to do that. The assessor said " so what do you suggest then, the resident either doesn't eat and starves or eats quicker and chokes" Quite!
With my mum at the end of life in her home , it took however long it took .

Really interesting post and it makes so much sense not to be dazzled by the glamorous finish of the decor & to.look beyond to the caring side of things.

Thanks for your extensive post and so many good points to look out for.
I agree with everything you've said & going forward I hope that we are right in the place we have chosen to start her respite care tomorrow.
It's so much responsibility.

I'm glad you have found somewhere for respite. I do hope it works out well for her and all the family. Just one important point that I am not sure if anyone has mentioned but now she is going in for respite it is very useful to name her clothes. Although we were very happy with all the very caring staff and my dad was happy in his home it was surprising how the laundry would get mixed up even with only 3 men in the home!

Find out how morning and bedtimes work, especially with poor mobility.

One relative in her 90s went to one for intermediate care after a fall and they wanted her to poo in a pad and they'd change it, rather than help her onto the commode in the morning because they had limited time to get people up. She's never done that before (even in hospital she used a bedpan until she could get up, then used a commode or was pushed to a loo) and absolutely hated it.

If you didn't go to bed before the staff changeover it might take a while before you could go.

She said it was lovely during the day (nice food, activities, big gardens to sit and look at or be pushed into), but the getting up and going to bed really put her off. She's back at home with carers and family going in now and I think would refuse to go to another one, at least without asking a lot of questions first.

Another relative had dementia, so we had different criteria. Agree that low staff turnover is a good thing to look for.

If she has capacity, it's her decision to move.

If it's a mobility issue, I'd look at getting the occupational therapists and physios to have a look and see if they can help.

Definitely get more carer visits.

Also look for any extra care in the area as care can be more easily ramped up in that setting.

As @Straightouttachelmsford says, if she has capacity it is her decision. People take risks every day that we wouldn’t; walking alone in remote areas, wild swimming in icy water, riding powerful motorbikes etc. Just because she is 95, it doesn’t mean she can’t make her own decisions and take risks with which you and your siblings disagree. I get it. Supporting someone who wants to stay at home is hard. But I would suggest an OT visit, implementing suggested aids and adaptations, upping the care visits and a cleaner.

My mother's situation sounds very like yours, she lived independently until she had a fall when she was 97, after which the sheltered housing where she had been living for 10 years said they didn't have sufficient levels of care for her to return home when she left hospital. Mum wanted to go somewhere that was local where she lived, although it was very unlikely she would ever go home again. We used the CQC ratings as a guide to the various homes that were local and then visited the one that looked the most likely from the ratings. One important question that we didn't consider sufficiently before we chose was what would happen if a resident eventually needed nursing care; we didn't appreciate at all the difference between general care and nursing care and my mother deteriorated to the point where she needed nursing care very quickly, which couldn't really be offered by the home we chose. We managed to make it work for the few weeks before she died with the help of her very supportive GP and visiting district nurses but it's a complication that we should have given more thought to before we - and she - chose the home she went to.