Nursing home verses residential home end of life care

[Totallybannanas]

My 80 year old dad has stage 4 oesophagus terminal cancer, I think he only has a few weeks maybe months to live. He is currently in a hospice and we have been advised to look at some home. I've found a few lovely care homes that do palliative care and end of life, but they obviously do not have a nursery on site. Finding a decent nursing home with a nurse onsite is very difficult. My dad is mobile but this cancer has aged him. He's a lot slower and not so good on his feet. He is also struggling psychologically and just wants to die. He has become incontinent and needs help with showering and dressing. He is forever ringing the bell for anti anxiety medication and he's anxious and worked up. He's just a totally different person and has become demanding and sometimes rude 😔. I don't think he will be happy anywhere, but I know wherever he goes will be where he will die and I'm so worried about getting it wrong.

The hospice will usually advise on which homes their patients typically go to.

I worked in an area where there were very few nursing homes and mainly residential. We were very clear who needed nursing - and those patients almost all went to the same home.

His care should be funded by Fast track CHC and CHC will also have an clear idea of which homes they will contract with and which they won't.

Thank you, to be honest I'm not getting alot of advice on which homes as they say they have to be impartial. Alot of the homes are more dementia specialist homes. I'm just worried that once he is a nursing home, if his care is not being managed properly eg. pain relief etc we won't have any outside help and he will be stuck there.

For any home, look up their CQC registration and most recent inspection. They are all online. You can ask local social services and health services for advice/ guidance. Care for people with dementia is specialist. A change of personality is a common occurrence as is forgetting who their relatives are. Hospices are for definite end of life care and usually require medical agreement. They can be very good. It's not easy. The Alzheimer's society is a good resource, it's not just for Alzheimer's, they advise on all forms of dementia. Also, they often run support groups, which can be very helpful. Most of all, look after yourself.xx

I would say nursing for sure. I have worked in various residential and nursing homes for 10 years. If you dad is in pain and requires controlled drugs, in a residential home it can be hours before the district nurses can come out and give it and in my experience they’re very reluctant to give, I’ve made numerous complaints about them refusing to give to someone in paid. In a nursing home, there’s always someone who can administer the medication when needed.

Sorry to hear that @Totallybannanas my experience is that it really varies from hospice to hospice - some are very chill and don't even mention discharge planning until 2 weeks have gone, some are mentioning it on day 1.

However even if they are insisting on being impartial, they should be telling you whether your dad needs nursing or residential or you are wasting your time. Most of the time for hospice patients it's nursing, unless there is some local variation.

Ignore the bits on the registration of the care homes that says they do palliative or end of life. The key difference is nursing or not nursing.

I’d echo what @andanotherproblem says…
my relative was a long term resident in a fabulous residential home, they'd been there from 92ish - end of life at 99yrs. The home assured me they could manage, and as they’d been so happy there I thought it best not to move them.
But the reality of being dependant on district nurses for pain relief was awful, they were so reluctant to administer anything, took hours and hours to turn up, and sometimes didn’t turn up at all. When I complained, one said “but these drugs are addictive” honestly, is that a concern when you’re dying.
Find somewhere with staff that can administer the good drugs is my advice! Good luck.