Questions to ask at care home visit.

[ChaliceinWonderland]

Very focused on asking the right questions, for elderly relative.
Armed with QCC guidance , any information anyone can suggest please?

I think it’s a bit individual tbh.

For my mum, I asked myself -— was the manager happy to talk to me? How can I contact the manager or nursing staff day to day? Did they ask me about Lasting Power of Attorney?

Did I like the general vibe of the home? Does it smell? Are there serried ranks of residents sat in front of inappropriate telly because of low staff numbers/poor training? What are the staff doing? Do they look unhappy/rushed off their feet? How are they managing distress? What’s the view from the bed or the chair in the room?

Ime, good management and leadership are the key. Are the manager(s) friendly and approachable? Are they accessible to family members? Do they know the residents and their staff? How do the staff respond to the managers? Are the staff happy? If the staff are happy (they won't be if management is poor), they do a good job of caring for the residents.
It's not.so much about the asking right questions as being observant.

Ask to see a bedroom. If the place is full then even better, whilst you don’t want to disturb residents, you do want to check they are not leaving people in bed rather than getting them up.

What activities do they do, how do they make sure everyone has an opportunity to join in?

Are they open to visitors at any time? (Is there something they’re hiding).

Ask what their daily food budget is- you may be shocked!

I'd list their current needs and ask how they meet them.
Is it a residential home, if so ask when district nurses visit , is there senior carers
If it's a nursing home ask for registered nurse ratio to residents
What's included in the price, what's the notice period
How are fees paid
Can they keep current GP
What is the admission process, does relative and family get involved in initial assessments and care plans
How often are care plans updated

Is the relative happy to go to a carehome, do they have capacity, are they able to visit the chosen home

You cannot go into a residents bedroom without their or their representatives permission. Some people will need to stay in bed, not everyone is able or safe to be up, you van ask to see a empty room, and the communal areas.

Look at the appearance of the residents.
Activies and the food.

They all talk a good talk as ultimately they want to keep their beds filled.

Ask if you'll be able to just drop in to visit, or will you have to make an appointment.
I cleaned for a short time in a care home that was truly awful (since been closed down) and they would only get residents washed and dressed if they were having a visit.

Look at the appearance of the residents.

That. My mum was in a BUPA home. I lived a distance away so I'd generally get there late morning. I'd often get there too find dried porridge or cereal on her face, that no-one had bothered to wipe off. She was always proud about her appearance so she'd have been mortified. Likewise she'd have been horrified to know that she had long chin hairs that no-one cared enough to remove for her.

My MIL was in a council run care home, and always looked clean, fresh, and nicely dressed. If they needed to buy replacement things for her (again, both I and my sister in law lived a long distance away) they'd always choose things really carefully in her favourite colours, or to go with her other clothes.

Staff ratios and turnover. Use of agency staff.

Sample weekly menu and activities list. How often do these change? Are there trips out?

Arrangements for attending hospital appointments. Transport, accompanying staff.

Do residents eat in their rooms, a communal dining room, or a choice of both - and if the last one do they encourage one or the other. My dad's place had lots of small dining rooms, for about 10 resident each, which worked better than a single big hall - and between meals each was used as a little social hub for that group of rooms. Staff sat in there to do there paperwork so there was always someone around to chat to or ask for help.

Are there multiple lounge areas with different activities, and some quiet ones?

Outdoor/different floor access - free range, staff controlled, or reliant on residents memorising a code?

Do GPs, nurses, physios, opticians, dentists, chiropodists etc visit regularly or only on request. If regular, how frequent?

Extra charges? For example some places supply basic toiletries free, some supply but charge extra, some expect you to.supply everything yourself. Hairdressing and feet I think are always extra. Sometimes laundry is.

Not questions, but observations.

Smell?

Bells or a silent call system? (Silent makes for much calmer atmosphere.) How long is it taking calls to be answered?

Can you see things going on and residents engaging with them? Are the staff moving around the home hurrying from one place to another or stopping to chat to residents, or at least saying a few words as they pass?

Are there plenty of easy-read signs, with pictures as well as words, to help residents find their way around?

How recognisable is each door - all the same with a room number, or does it have a name and photo on it? Some places have an info board or photo mk page outside each room to give them prompts for chatting to residents and remind them of likes and dislikes, particular needs, and that the resident is a person with previous life.

At my mum's care home, the residents chairs were just arranged around the edge of the 'lounge'. So the residents were basically just sat there in a huge circle just staring at each other.

At my MIL's they were scattered around informally and the area felt so much more relaxed and social, with carers passing through and chatting informally to their residents.

Brilliant questions thankyou all

Ask what their policy is around end of life care. Some homes will ask residents to leave if they become too difficult, need too much care. Mum was in a fab place - the owner held her hand when distressed, and made sure she was around when she passed.
Extras - when we were looking, horrified at some of the paid for extras (bath etc).
Most important - how does it feel to you? If it feels clinical and uncaring to you - it will be worse for your parent.

Get the feel/vibe.

i’m happy thus far (7months in) with the home the person I care for (EPiCF) is in.

no smell
stable staff
community feel at meals. Staff eat with residents - manager, her deputy and admin team
residents from all areas except the severe dementia unit free range - garden which is well set up with accessible garden furniture, several lounges, quiet seating areas.
people stop and chat - residents, visitors and staff
staff not on phone
very clean
laundry doesn’t kill knitwear
loads of activities to cover all tastes and open to suggestions.
trips out.

food a bit contentious at present just moved from locally prepared by a chef to pre-prepared (appetito). It’s not going that well. Apparently caters for different textured diets better but my person doesn’t have those needs and is part of a vocal group organising a revolt due to poor portion size, unidentifiable soup and repetitive menus. (moral: you can’t look after a load of articulate educated albeit elderly/cognitively declining professionals and not have some dissent argument). I’m quite enjoying watching them make a fuss but I’m awkward squad myself!

I asked about whether there were residents she’d be able to have a good chat with. That was a huge decider for me as in some cases the answer was ‘no’.

Look at the place with your elderly persons needs in mind - a lovely garden is no use if they can't access it without help, or it isn't secure (if they have dementia). If they like to wander, is the home set up to allow this and offer them opportunities to rest/ do things along their path. If they use a mobility device, would they be able to get to and from their room independently.
Are activities age appropriate? There's still a lot of 40's sing a longs going when some residents are more Beatles and Stones. Do the actvities on the list actually happen?
Also, how could progression happen in that home? Is there a dementia unit there, or what if they had more intense nursing needs

My mum spent some respite time in a home which really didn't look great from the outside, but it was set up so thoughtfully inside and she loved the courtyard garden (totally enclosed, viewable on 3 sides) which had tools invitingly in the raised beds to mess about with and even a bus stop. She liked to wander, but they had little stations along the corridors with a chair, water dispenser and something like a fish tank or laundry basket (clean towels to fold) to give an opportunity to stop

Also interested in this so thank you for starting the thread.

That is brilliant idea about the towels to fold. I would love that for myself.

Staff to resident ratio but mostly I went in the feel of the place. Were the staff smiling, did the residents look content, was their hair clean and so on. I looked in a few bedrooms in all the 11 care/nursing homes I viewed.

Staff ratios, the general feel of the home when you visit, attitude and approachability of matron/manager, carers and other staff (I work in the office and am always introduced when people come round if I’m there, as are kitchen, laundry, housekeeping staff etc). Any limits on visiting? We welcome visitors at any time, as people have their own limitations on when they can come to visit their relatives/friends.
food - what’s the menu like and policy on dietary preferences etc.
activities - what sorts of things are organised, and how do they try to include everyone (including 1 to 1’s if a resident isn’t interested in ‘joining in’)
how do the residents appear, and what noises/chat do you pick up in general while you are visiting.

I’d also recommend reading reviews from family and residents. DMIL went in the cheapest local Care Home avd we read OIt’s of reviews before her moving to their. They were all the same, the place looks shabby but the care is amazing. This was very much our experience.

Another elderly relative had just been in one, they were adamant that is the one they wanted and had cognition, to be honest the dead plants outside the entrance should have told us everything we needed to know.

Lots of agency staff. Buzzers going off all of the time. Smell of wee as you walked through. High staff turnover. You get the idea.

What makes your relative happy - food? Wine? Activities? Socalising? Peace and quiet? Check how the home delivers on these.

Things I like about mum’s home:
It’s immaculately clean with no smell at all (either wee or sickly air freshener). Low turnover of staff; they all know me and my name and can instantly tell me where she is and what she’s been doing when I come in. They have an assigned local GP who does a weekly review of residents and who will respond to requests promptly. They have a policy where every resident is accompanied to any medical appointment and if they are admitted to hospital then one of the carers from the home will visit them every day to check on them and advocate if neccesary. Family visiting can be at any time over 24 hours if you want. They offer me a drink when I’m there and any food if they’re feeding people (people are always eating even outside mealtimes). Food is home cooked on site. Mum always looks “put together”, rather than the random clothes chosen by a toddler approach she had before she went in; face is free from chin hair and old porridge, she’s got her hair brushed, teeth in and wearing her glasses. I’ve got access to her care record online. They have a minibar in the corner of a lounge. They do outings weekly and rotate which residents go, matching them up to their interests (bingo, theatre, local NT place etc). There’s a small secure garden. They also do end of life care and wanted to have the conversation with me about her preferences as soon as she moved in.

Things that may put someone off the place:
it does look slightly shabby in places, mainly the back corridors - it’s a converted Victorian mansion and some of the adaptations and fire doors need a lick of paint where they’ve been bashed by the wheelchairs. All the rooms are fresh and clean but there are no en-suite bathrooms. But given mum can’t get herself to the loo it doesn’t really matter to us - she does have a sink in the room.

So on balance, not one of the ultra modern homes that looks like a hotel, but it’s a cosy place with excellent care, and the good care was what I wanted over fancy facilities she’d pay for but never use.

Definitely check that they will be able to go on looking after your relative if they develop dementia, or get significantly worse. Also check that they will offer end of life care.

The last thing you want to do is have to find somewhere else and move them. My Mum's care home looked after her until she died, at times she was very resistant to being cared for, and it was invaluable to know she was being looked after by people who had known her in better times.