Residential homes

[Hedonism]

I'll try to be brief....

My stepfather has dementia. He needs someone with him 24/7. If he lived alone he would be way past the state of being able to cope living independently with carers popping in. DM is exhausted but reluctant to consider residential care.

Can anyone tell me what a day in a care home might actually look like? DM has visions of him sat in his room on his own all day feeling sad and lonely (he's resistant to organised fun so would not be joining in with chair yoga etc, unless with a lot of cajoling). I said that the staff would be there to make sure he was ok, and keep him occupied and happy.... But maybe I'm looking at it through rose tinted specs?

Obviously the next step is to go and visit some homes and see for ourselves, but I wondered if anyone on here had any insights they could share?

@Hedonism sympathy with you but really sensible of you to be looking at the next move. Very personal choice looking at care/nursing homes - not all the flashy boutique type ones are as good as they ought to be. Visit some varied ones in your area and you will get a feel for what is what. Another word of advice is not all homes can actually just cater for anyone and you may find that a home you really like will do and assessment of your SF and perhaps not be able to offer him what he needs. This happened with us. It might be helpful if he has a medical contact to find out what kind of care they recommend. Google EMI care and EMD care. Some homes do not offer either/both. https://carelearning.org.uk/blog/settings/what-is-emi-care/

The home my elderly is in have lots going on, outings, live music, arts and crafts, garden picnics, exercise classes etc

Unfortunately her dementia is so advanced that she does stay in her room most days and not participate, but she is safer there than at home - she is well cared for and for me that's the most important factor.

Mum went into residential care at 95 - she was still sharp as a tack but most residents did have dementia.

I think there is still a perception that care homes are like the workhouse, whereas the can be more like being at a nice hotel or (in mum’s case) like being on a cruise!

The day was a whirlwind of activity if you wanted to join in, and if you didn’t there were plenty of quiet spaces to sit but see the action going on without joining in. Obviously she had a TV in her room, and the door was always open to visitors. I took her out a couple of times a week at times to suit her and me.

We visited before hand, and found the best thing was asking to visit at lunchtime - the one we chose invited us to lunch. The ambience of the dining room, the food and the attitude to a glass of wine with dinner swung it for her.

The best dementia care home round here mostly has council-funded residents and is nothing to look at, but the quality of care and range of activities is excellent.

Think about what your dad enjoys (food? Peace and quiet? His TV programmes on an endless loop) and what he needs (24/7 awareness/staff on hand? Help with eating? Falls prevention?) and focus on that, not on the decor.

@kenidorm same at most homes we looked at. Lots of activity options, almost timetabled - which is what our DF homes is like. The co ordinater is lovely. Reality is in some homes they want everyone in the main areas so they are safe not in their rooms risking falls. Another reality is if your relative would not have joined in before being ill it is unlikely they will change. As mentioned - safe and well cared for are my priorities as well and they definitely tick those boxes. Also we had to fill in a really detailed life story for our Dad which they really read and make sure staff know his likes and dislikes etc. For example if the football is on TV they will make sure he gets to watch it.

I’m sorry OP it’s a tough situation. It really depends on the person and the home they are in. One of my grandparents was in a care home until they sadly passed away a few years ago and their home was brilliant in that they had a big open plan living area which residents were encouraged to go to, lots of people playing dominos, watching TV, chatting etc every time I went to visit I could see this, but my granda just never went and joined in. They also did different activities like yoga, took them out to aqua aerobics once a week for people who wanted to, had a team of therapy dogs come in once a week, had bingo on once a week etc but again, my granda never joined in as he just didn’t want to. But then that’s how he always was in life, he was never really one for organised fun or socialising he was always a man who kept himself to himself and spent most of his time in the house, in his armchair watching TV, so he just continued to do that at the home.

It’s unrealistic to think the staff are there to keep him occupied and happy, they’ll be there to keep him well & look after him. The staff at my granda’s home were amazing but there isn’t enough of them or the time for them to be sitting in rooms with people who don’t want to come and join in. For my granda this was fine, he preferred it and loved being left alone as he always had been in his life, he just wanted his TV and his armchair, they came with his meals and to help him toilet/bathe and of course always asked if he wanted to join in but when he said no that’s that.

My other grandparent is now in the same boat as my granda has Alzheimers, it’s really quite advanced now sadly and my gran is his carer. He is also past the point of being able to live independently or even just with carers popping in a few times a day, she is exhausted trying to do everything for him but the same as your mum she knows that life in a care home (for people who don’t want to be involved in things) does mean sitting alone in a room on his own with the exception of people providing him with meals/bathing etc.

It’s a very personal decision and a hard one.

All homes will have an activity programme, but if he's not a joiner he's not a joiner and they won't make him. But look for a good range of different types of activity - if he won't do chair yoga, might he enjoy a film evening, board games, gardening or a 'pub' quiz? The vast majority of residents will be women, so some homes have a very stereotypically 'female' activity programme; the better ones are more mixed. The home my dad was in had a specific 'gentleman's club' once a week - not a lot of planned activities but board games and drinks on offer, a quiz, and just a change for the few men from different wings to get together and chat.

Also look for a range of social spaces, where even if he's not really joining in he can be around other people. My dad's place had small dining room/lounges for each corridor (about 10 residents) rather than 1 big dining hall. There were sofas, and drinks and snacks that residents could help themselves to and just hang out between meals. The staff for that area would do their paperwork in that room, so there was always somebody about. There was also a conservatory with a few small pets, a sitting area with TV and fireplace in reception (so again always staff around), a garden with benches, a main snacks and drinks area done up like a 50s diner, and a quiet sensory lounge as well as the main activity rooms. So everyone could choose a level of sociability. If people chose to stay in their room the staff would have a little chat when they brought meals and pills, and stick a head round the door every hour or so to say hello and offer tea.

My mum went into a cafe home when she was 94. She was admitted from hospital during Covid and because of lockdowns and Covid outbreaks, we didn't really have a say where she went. But the home was wonderful in all respects. It was like a 5* hotel, and she had brand new furniture, brand new TV with Netflix, her own wet room, and a daily laundry service which even included ironing. There were organised activities every morning, afternoon, and evening, an on site hairdressing salon, and a restaurant on each floor with a completely personalised menu for those who wanted it. There was also a coffee lounge with feee coffee and snacks for all residents and their guests, and a free bar with draught beer, wine, and soft drinks. But most importantly the staff were absolutely wonderful and were true caters in every sense of the word. My mum's dementia progressed very quickly and she didn't want to be involved in most of the activities, and she spent most of her time in her room. The carers visited her every hour and spent time with her, and I felt that they really got to know her well. We were very fortunate to have been allocated this care home, but I had previously visited a couple of other homes and I think they would have offered an excellent standard of care and activities too.

Thank you to everyone for taking the time to write such helpful responses.

If people chose to stay in their room the staff would have a little chat when they brought meals and pills, and stick a head round the door every hour or so to say hello and offer tea.

This is what I was imagining, rather than the idea that he'd have 1:1 attention all of the time! Just that they would be able to make suggestions periodically, and see if he wanted to go for a walk, or pop to the communal coffee area etc, and that someone would notice if he was upset or in distress. I think my mum has it in her head that he would be left alone until he emerged from his room - and that he might not think to do that.

I guess it is all very individual to the home and to the resident.

@Hedonism glad you got some responses that help. I do think there are perceptions from TV, MSM and or experience that frightens people about being in a home. For sure if you simply have no other option that is hard, but for some it could provide some comfort after a struggle and the experience is positive. One thing I would add is that there will be good and bad staff in all places - that is human nature but on the whole the home our DF is in has staff who have worked there for over 20 years and really care about their residents and us as family, always giving us updates and also checking in on how we are. Another thing at the home we are involved in the ‘timetable’ if you like is really varied and changes regularly. Fridays are marked with a regular sort of take away lunch and an entertainer usually a singer in the afternoon. Love it or loathe it you can see residents tapping their fingers or feet when certain tracks come on. It is such a personal thing but I also found the managers a good barometer of the way the place was run. One place we liked the look off it was very much run by a business type person in a business suit. The one we are using is managed and run by a Matron who maybe it sways me to be more confident dresses in a Matron uniform and knows all the staff by name - and there are a lot of staff due to agency staff. As ever hope you get a good outcome.

In addition to what others have already said - if he was in a home close by, then your DM would be able to visit him as often as she liked. My DF has advanced dementia, and my DM was utterly opposed to him going into a nursing home, but with his total loss of mobility having him at home with carers visits was a nightmare - she had to find this out the hard way as insisted he come home from hospital when it was obviously going to be a disaster.

Now he's in home she visits almost every day, and my aunt and uncle also visit every week or so as well.

My FIL was in one. Family said he would not like organized fun and also gave a long list of his dietary likes and dislikes.

The reality was that he had dementia and the home were experts in managing dementia. As a result of his dementia his dietary preferences had changed (he would regularly tuck into food he supposedly didn't like) and he was also easily cajoled into activities which he then enjoyed.

My father’s home know a lot about him, including what mood he woke up in this morning.

No time for long conversations but snatches of small talk with every interaction.

when he was mobile, he stayed in his room most of the time, but most days took a walk the length of the home and back, and was greeted by any staff he met. He has always taken all his meals in his bedroom.

Some of the activities are a bit wacky - he has been visited by ducklings and llamas. DS’s dog has always been welcomed.

To be honest I think it's a case of you get what you pay for.
The home my nan was in was OK, it was clean, the staff nice enough, just too few of them.
There were activities if you wanted to join in. But the day to day reality was that they preferred all the residents to be in the lounge because it meant they needed a lower number of staff. There was nothing wrong with the lounge, bright and airy, nice armchairs but they didn't give you much option about using it.
Another issue was that residents would go wandering and some of my nans things went missing, it's possible of course that she was responsible for other people's things going missing.
The other main issue was that they didn't like people dying in residence so my nan was shipped off to hospital several times when she would have been more comfortable staying put.

My Dad sadly spent the last 4 weeks of his life in a nursing home when he was terminally ill and the honest answer was that he would have been getting as much care in a cardboard box at the side of the road.

Choose wisely, OP. Get personal recommendations, don't read online reviews as anyone can write them. And visit on several occasions at different times. People sat round in communal rooms with little or no staff is not a good sign, nor is them all sitting in their rooms staring into space or at a TV that no one has turned over for months.

Visit a few. I went to one last week for my stepdad Well, for 6 k a month I wasn't impressed. The sales manager smoked
The gardens were unkempt
The room wax dreary furniture old broken.
It wasn't appealing at all.
Shop around!
It's alot of money for potentially a long time....

This is the thing! I've noticed that he responds totally differently to strangers or care staff than he does to DM. My DM does not see this as it's usually when she is out of sight. Quite manipulative really, but I wonder if he even knows he's doing it.

Edited to add: By manipulative, I mean attention seeking. It sounded a bit harsh!

@SpanielPaws @Doubledded123 advice about shopping around and visiting is good - however I will caveat that with a caution. Because my parents, mother really, was determined to not find a home for my father even though his consultant and all medical staff said it was time a DoLs was imposed meaning we HAD to find one as his liberty had been deprived…..rightly so as she would not listen. By then we had 5 days to find a space and I called upward of 50 places - most couldn’t cater for EMI/EMD care required. Literally one home could and had a space. Thank fully it is near our mothers home and frankly they are doing a great job. He is eating and still alive nearly a year on from being told we had probably 4-6 weeks left.

@BlueLegume that sounds like a stressful time. It really echoes what I've been told by others though - that people most often go into homes when they hit crisis stage, and at that point you just have to take whatever place that suitable and has a space available.

My Granparents have had to go into care over the last w years it's been in and out on temporary respite with them now having found a permanent home. I am not going to lie some are really bad others better. You need to do research and speak to family of people staying there. I asked for recommendations on the local Facebook page. A typical day in my Nans is up at 8ish unless bedbound off for breakfast sit in front of the TV until cup of tea time dinner at 12 same in the afternoon teatime then bed. Lots of watching TV. Entertainment twice a week normally a quiz or a singer. This is so similar to their homelife and what it had become. It's not terrible it's not great. She lives for our visits so as close as possible with the best care is my advice.

To be honest I think it's a case of you get what you pay for. That’s not everyone’s experience. Too often an expensive home has facilities (restaurant, hairdresser, cinema) which the resident is no longer able to use. More important than physical facilities is the quality of the manager and the staff. You seem to have experienced a poor manager.

I don't think it's the case that you get what you pay for at all. Although I shared the wonderful experience yesterday that my mum had in an expensive care home, my mother in law ended her days in a comparatively cheap nursing home and she also had the most wonderful careers. My MIL was transferred there from hospital after two months of truly horrendous care as an inpatient, and the care home was wonderful. The building was quite scruffy, the furniture was a bit old and knackered, she didn't have an en suite, and the facilities were really basic. The cost was only 2/3 of what my mum had paid. But the staff couldn't have been kinder and were carers in the true sense of the word. They spoon fed her, they held her hand, they talked to her and listened to her, apart from changing her multiple times each day, washing and dressing her, and everything was done with kindness and compassion. Having seen the way my mother in law was treated and dehumanised in hospital, it restored my faith in human nature to see the lovely staff in the nursing home.

While luxurious surroundings, lots of activities and facilities might be important for many people, I think the attitude and compassion of the carers is far more important for vulnerable people, particularly those with dementia.

@Growlybear83

I think up to a point you are right, the quality of care is of course critical. My nan went into a home after a stroke, already diagnosed with Alzheimers but not so far gone. Her surroundings did matter to her at that point. Four years down the line when she had completely lost all her mental faculties she didn't have a clue where she was and none of that matters.

I actually feel cheerier reading this page- my FIL is 85 and although fit and well I'm aware that at some point he may need 'a bit more care' he is sociable and quite handsome too and by the sound of this if he is well enough might actually have some quality of life albeit different . ( social life sounds better than mine)

This is closest to my thoughts. Go for one with a visible manager and long serving well trained staff,
However, sometimes it’s the least worst option when your loved one needs to be cared by a team rather than one exhausted relative. There are some amazing care staff in every care home. Ideally, you want to a recent recommendation.