Selecting a Care Home

(Nursing or Residential Home Care)

Unfortunately, in many cases, the decision to enter some form of residential or nursing home care is taken after a serious illness or accident has meant that the ability to cope at home is reduced. These decisions are therefore made at a time of immense stress and heartache and can seem quite daunting. All of us realise how hard it is to decide to enter a nursing or residential home. These days however it must be realised that more people are entering care homes on a temporary basis, to convalesce and recuperate following accident or illness and to be rehabilitated home again.

Often family and friends are informed by professionals such as Doctors, Nurses or Social Workers that their relation has under gone a multi disciplinary assessment of their condition and their ability to care for themselves. This is to determine whether they need to be cared for within a nursing or residential home and if so what sort of home it should be, or whether they can manage at home with the help of a home care service. Once the assessment has been made, and if necessary a financial review been undertaken by Social Services as to who will pay for the care to be received, it will be time to look for the right Home for your loved one.

If you or your relative are funding the care to be received privately you should approach a selection of Homes, a list and copies of inspection reports can be obtained through the Care Quality Commission (tel: 0845 015 0120 / 0191 233 3323 e-mail: enquries@cqc.org.uk website: www.cqc.org.uk

Care Quality Commission

On 1^st April 2009 the Commission for Social Care Inspection was replaced by the Care Quality Commission. This new commission brings together the independent regulation of health, mental health and adult social care for the first time.

Before April 1^st this work was carried out by three different organisations, the Healthcare Commission, the Mental Health Act and the Commission for Social Care Inspection.

The aim of the CQC is to ensure better care for everyone whether this care is provided by the NHS, local Authorities, private companies or voluntary organisations.

To find out more about them, go to their website at www.cqc.org.uk

Local Authorities, through their social service departments, take responsibility for the greater proportion of placements in care homes around the country, paying a weekly sum on behalf of the resident towards the cost of the care provided. Most care homes accept clients funded through private means or through social services. The vast majority of homes require “top-up” of the fees paid by social services towards the care of their residents. This is because the fees payable by local authorities have not kept pace with the retail price index nor wage inflation. It is now widely recognised by the government and the care home industry that fee levels paid by the state are not sufficient to provide high standards of care.

It must be noted that where residential or nursing care is arranged without the input of a multi- disciplinary assessment and where at some later stage the cost of that care will need to be met in part or wholly by the local authority they will only fund appropriate placements (those residents being cared for in a Home that meets their needs).

Once your relative has been informed by the professionals involved in their care what the appropriate setting for them is you will need to choose the Home. In brief, a nursing home has a qualified nurse on duty 24 hours a day supervising the care provided and being professionally responsible for the patients in his/her care. Nursing homes are staffed to a higher level than residential homes to meet the healthcare needs of a more highly dependant client group. A residential home provides social care and does not have a nurse supervising the care provided (although many residential home owners are themselves nurses). All care homes are registered by the Care Quality Commission (CQC).

Once you've decided that residential or nursing home care is the appropriate care for your loved one you, need to know how to choose the appropriate Home.

Where do I start?

Evaluate the Home with a personal visit.
Include as many family members as possible when visiting the Home.
If your relative is able, he/she should visit the Home with you.
Assign one family member to handle all the necessary arrangements financial or others.

What Should I Look For When I Visit?

Is the Home registered with the CQC. All Homes will be pleased to show you their certificate of registration, how many residents are they registered to care for, and what type of care can they provide.
Ask to see the Home’s Inspection Reports. All Homes are inspected is carried annually and CQC have the right to an announced visit. which takes about a day and where all the policies and procedures of the Home are inspected as well as the standards of care observed. Then at least one unannounced visit is carried annually to ensure that the Home is operating correctly and within the terms of its registration. CQC have the right to visit more often where deemed necessary, and in nursing homes there is always one night time visit. Ask to see all the Reports, and where areas have been highlighted as being a problem ask to see what action has been taken to remedy the problem.
Note the Home’s overall appearance. Is it clean and pleasant? Is it homely? Are you looking for a hotel like environment or a homely environment?
Note whether the Home smells pleasant – there should be no overwhelming smell of urine for example.
The environment should be safe. Lack of handrails, proper bathing safety equipment and hoists can be indicative of a problem. A good home will ensure the safety of both residents and staff by having the appropriate equipment.
Are the staff responsive to the residents’ needs? Take note of how long call buttons go unanswered or meal trays go uncollected.

What Medical Services Are Available?

Can the Home provide the specific care your loved one needs?
Does the Home have a good relationship with local GPs’ who will visit the Home on a regular basis?
Does the Home allow the choice of a Doctor?

How Is The Food At The Home?

Meals should be served on time.
Food should be available at all times of day, as the resident wishes.
Are alternatives available?
Can the Home provide specialist diets?
Food should be attractive and served at the appropriate temperature.
Ask to see the kitchen and speak to the Catering Manager/Cook.
Where can residents’ eat their meals?
Do they have the opportunity to eat in their rooms if they wish?
Staff should be readily available for residents who need assistance with feeding.

What About The Rooms?

Find out what furnishings are provided.
Find out what furnishings can be brought in.
Do you require a single or double room? Having company in a room can be reassuring to someone who is chronically sick. Do ensure that double rooms offer privacy.
Does the room offer a private bathroom or toilet and wash-basin?
Can you or your relation use a bathroom unaided? If you need assistance can you still use the private facilities within the room?
How many bathrooms are there? What facilities for assisted bathing are there? Bath hoists/chairs etc? Is there a separate shower facility?

What About The Residents?

Are all residents treated with dignity and respect by all the staff all the time?
Do the residents look well cared for? Are you able to meet some and talk about their experiences within the Home?
Are visits made regularly by a chiropodist, dentist, physiotherapist or other health workers?
On occasions restraints may be necessary for the safety and protection of the resident, but this should only be used after full discussion and agreement with the family and social workers involved in the care.
Observe what residents are wearing, is it appropriate to the room temperature and the season, and are they wearing their own clothes.

Are There Activities and Other Amenities For My Relation?

Activities should interest the majority of the residents. Ask to see the activity calendar.
Do residents have to take part in activities – can they opt out if they wish?
Find out if religious services are available.
Are hairdresser or barber services available?
Is there a resident's committee, where residents can express their opinions?
If phones are not available in each room, are telephones available somewhere that residents can use privately?
Is there an activity or social organiser?

Other Considerations

There should be no restriction on relatives and close friends visiting.
Are there facilities for relatives to stay with their relation in the Home if they wish?
May your relation visit outside of the Home for a few hours or overnight?
Does the Home allow smoking? Are there designated smoking areas?

If you have questions about your relatives rights, contact the Care Quality Commission (CQC) who have a responsibility for the quality of life and care of residents within Homes.

Organisations such as Age Concern, the Citizens Advice Bureau or this organisation can also assist with advice. When selecting a Home, ask the Home Manager or Matron as many questions as possible. It is often helpful to make a list prior to your visit. If possible, it's helpful to talk to one or two of the residents. Before making your final selection, visit the Home again to see how it operates at another time. Finding the right place for your relation is very important. Do not be pressured into making a quick decision. The Choice is YOURS.

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