Finding a Good Care Home

 and keeping it that way, a detailed guide.

Before going any further, ask yourselves: do you really need residential care?

  • Residential care is expensive - it can cost £1,500 a week, or  more.

  • It means a loss of independence and usually trusting a commercial organisation to care for a very vulnerable individual. 

  • Aside from the potential theft, abuse, neglect and being forced into communal living with strangers, there are alternatives which do not involve being incarcerated without parole in a pricey, profit-driven prison.

 

Is OLM against residential care? On the whole, yes. With direct experience of private sector homes, demanding fees of between £900 and £1,400 a week, we would not recommend any of them. 

If there were any alternative, we would strongly suggest taking it.  

A CATALOGUE OF SHAME

  • We have seen a culture of neglect and untrustworthiness and covering up, where profits were put before older people and demoralised carers had little impact.  

 

  • We have seen over-worked staff who were unable to cope.

 

  • We have some who were untrained, uncaring, unprofessional and on their mobiles.

 

  • We have seen residents neglected, manhandled, ignored, mocked, desperate for a drink and calling out for help.

  • We have seen older people'S health decline in terms  over very short periods.

  • And we heard ridiculous excuses as to why a poor old person was dressed for summer on a cold winter's day or why staff hadn't noticed someone was unconscious...or seriously ill. 

 

  • We have been told lies, seen shocking behaviour and had belongings stolen.

  • We have seen genuinely unpleasant 'care'. 

 

This is not opinion. Figures provided by the UK Government's regulator, the CQC, show that six years after the inspection scheme was introduced, (2 February 2020) just 416 care homes for older people out of 10,792 inspected are rated 'Outstanding'.

There are care homes that provide decent care. But many older people are currently paying top dollar for substandard care. Money really isn't everything. It is the quality of the manager and the staff that really counts. See below and our Top Ten Tips

 

   Some older people really need 24-hour care, but there are a lot of people in homes who do not need to be there. They may be lonely, isolated, in need of social care or who have no one to speak for them. Many of these problems can be addressed without  going into care.

OK.  You think you need a care home.

WHERE TO BEGIN - First things first

Virtually every home and every care company has fancy marketing materials, promising a wonderful life and happy final years. Don’t believe any of it. The glossier the materials, the less believable. But, before you even get into these preposterous claims, you need to consider what sort of residential home you are actually looking for:

  • Nursing home – do you need nursing care, rather than residential care?

  1. Residents tend to be more frail and unwell than in a care home,

  2. It will, probably, be more expensive – because you are paying for a higher level of care, whether you get it or not,

  3. Many residents may be permanently in bed. Is that what you want or need?

  4. Do you want somewhere more lively?

  5. But, thinking of the future, do you want somewhere that has a nursing wing?

  • Dementia home – do you want a home specialising in dementia care...or not?

  1. You do not want a dementia specialist place, if you haven’t got dementia,

  2. If you do want a dementia home, does it cater for all types and degrees of dementia or will you feel as though you’re in One Flew Over the Cuckoo’s Nest?

  • Residential or Care Home – do you just want to be looked after?

  1. Do you actually need a care home or would you prefer sheltered housing or extra care?

  2. How much care will you need, will more care be available for nursing or dementia, if you need it later?

  3. How much will this cost?

LOCATING POSSIBLE HOMES - Runners and Riders

Once you know what sort of home you are looking for, you need to consider where to look – near you or a sibling, near the older person's home? - and then follow our 10 Top Tips to identify a short list of possibles.

   You should go to see at least three homes – preferably more – and visit each ‘runner’ several times before making a decision.  You are putting a lot of trust in these people, and probably spending a lot of money, you need to make sure it is going to be good and worth it – otherwise you will be looking again very soon or possibly even worse.

  • Start with the homes rated ‘Outstanding’ by the CQC. You may not find one particularly close by, but it would be worth visiting the closest one to your target area. Start your search here.

  • If you can’t find anything among these, then try this link here, which will take you to all the ‘Good’ care homes. There are nearly 8,000, so you should be able to find several.

 

  • There are some 200 homes that you really do not want to go near. They have all been judged to be ‘Inadequate’ by the CQC and should not be under consideration. Avoid these here.

 

 

ASKING THE RIGHT QUESTIONS - It's war but not as we know it

You can use the CQC's website filters to find the sort of homes you are looking for - dementia, over 65s etc. Once you have your shortlist:

  • Set aside a day to make initial visits and go in a group of at least two, if possible. Don’t go alone

  • You can make appointments in advance. Or, during office hours, you can just turn up - which is good for a first look

  • Try to talk to people ‘off tour’ – residents/families/staff.

  • Look carefully at the residents – what are they doing, how do they appear? Are they dirty or unkempt?

  • Check notice boards for evidence of activities.

  • What are the staff doing? Are they rushing around? Are they engaging with residents?

  • What is the food like, try to make sure you visit at a meal time?

  • Will they be able to cater for your relative’s particular needs/interests/Faith?

  • Do any residents have Local Authority ‘safeguarding’ orders in place? A very worrying sign, suggesting the care home is not looking after people properly.

  • There are many other questions you should consider listed in 10 Top Tips.  

 

 

 

 

BEFORE COMMITTING TO A HOME - If in doubt, don't

 

  • If you find a home you like, ask for a trial stay of, say, two weeks. That should be long enough to find out if it suits your relative and if the home lives up to its boasts. During this time, visit frequently to see how it is going and also to let staff know there is a local family presence. It is amazing how the thought of a relative hoving into view, improves care.

  • Everything is negotiable and care home fees are no different. Before committing yourself to a home, find out how much they charge and what that covers? Will they come to you for cash each time your relative goes on an outing or needs a bar of soap? They will ask you to pay as much as they think you can afford – so look poor.

  • You want to see the room your relative will be living in. If you don’t like it, don’t agree to it on the basis that a nicer one may come up soon. Once they’re in, they probably won’t move. It needs to be accessible and pleasant but, hopefully, they won’t be spending too much time in it, so don’t obsess about the curtains.

  • Once you have decided on a home, you need to make sure that all the belongings your relative is taking with them are labelled. Everything – even the socks. Buy printed name tapes and, if possible, sew them in firmly with a sewing machine. This is the best way to make sure they will come back from the laundry. Make a list of everything and give a copy to the home – in case anything goes missing and you want to recover the cost.

  • Do not send in any clothes that are not washable at high temperature. Staff are unlikely to have much time to sort out the clothes and will put everything into large, industrial-scale washing machines, guaranteed to ruin delicates and woollens. My late father’s sports jacket went through a boil wash and ended up small enough for the dog .

  • Do not take anything of value into a care home. Vases, money, jewellery, nick nacks, even silver photo frames can go missing. I once took in a vase of daffodils. Vase and flowers were never seen again, although a carer said: 'Was it Royal Doulton? Like something off the Antiques Roadshow? Yes, I replied. 'Never seen it,' he told me. 

  • Make the room look as nice as you can. Put pictures up, bring in furniture or a television, if necessary, obviously not expensive stuff. This is going to be home and you want your relative to be as happy and comfortable as possible.

ONCE IN A HOME - Making the right start

Although the anxiety levels will reduce considerably, thinking that your relative is in a safe place, you cannot sit back when they are in a care home.

Once you have chosen a home, you need to draw up a Care Plan along with the key worker or lead carer. This is a very important document. It will determine – or should – the care your relative receives. Everything from how they want to be addressed to how many times a week they should shower ought to be in the care plan, along with their medical history and a potted life story.

  It needs to be updated regularly – at least once every month or six weeks - and you will want to be present when this happens. It will also state preferences in terms of eating, illness, resuscitation and even death and funeral arrangements.

 

In addition to checking on the care plan, it is advisable to check on other aspects of your relative’s life when you visit:

  • Look at any records. Usually, there will be a file in their room showing the care they have received. Are staff following the care plan? When is your relative getting up/going to bed? Some care homes hustle residents off to bed after supper and leave them in bed until noon. What are they eating/drinking/doing and how many baths/showers are they taking? The care record should tell you. But, sadly, some are works of total fiction. I was once with my father in his room when his care record claimed he was eating in the dining room. It had already been completed for the whole day. 

  • Spend time in the lounge with them, if this is where they usually sit, and maybe stay for a meal time. Also, make sure you look in their room

  • Listen to your relative. Are they happy? It may take a little while to settle in or they may be generally stressed anyway, but it may be that this is not the right place. We remember hearing one woman pleading with her daughter to take her out of a nursing home. She was in totally the wrong place. Although she could do the crossword and enjoyed a chat, most of the other residents had advanced dementia and the poor woman spent her days trying to engage other people's visitors in conversation.

  • Are the residents properly dressed? Are they distressed/dirty/unkempt or even bruised? Ask for explanations and be insistent

  • Attend family meetings – it’s a good way to meet other families. You can keep an eye on each other’s parents and if there are any concerns, you will get to hear

  • Talk to staff and make an effort to be friendly. They do a hard job and it doesn’t cost anything to be nice. Not many people bother to chat and you could help your relative.

  • Take your relative out, if possible – even if it means hiring a wheelchair taxi. Being indoors all the time is miserable

  • If your relative is unwell, you want to be notified straightaway and, if possible, attend medical appointments. You cannot rely on care staff to represent them as you would

  • When you visit, if you think your relative is unwell, notify staff straightaway and do not be put off. Ask for a doctor – and follow it up. Insist. Call an ambulance if necessary

.

  • Do not be afraid to raise concerns with staff and s speak to the manager if you have serious concerns. No one else will raise concerns if you do not.

 

 

BUT IF THINGS GO WRONG – If you’re really not happy - Move your relative.

 

If you fear they are the subject of neglect or abuse of any sort, move them immediately.

Do not wait for things to get better. They won’t.

Click here to go to Complaining about Care

© 2017 by OlderLivingMatters   All text and original photos subject to copyright                    email 

OlderLivingMatters is a journalistic website offering information, guidance and advice based on experience of life today for older people. It is designed to be a friendly hand in difficulties and to highlight the problems of older people and their families. As with any friend, it is not perfect and will not have all the answers all of the time. Everyone’s situation is different and this needs to be taken this into account if you take action. Please be aware that you use the information and advice on this website at your own risk and it is not responsible or liable if things go wrong.