Visiting a care home

DISC Oxford Dementia Centre Institute of Public Care Roosevelt Drive Oxford OX3 7XR Tel: 0845 120 4048 www.disc.org.uk email: info@disc.org.uk Home

This fact sheet offers help to carers when visiting a care home for the first time. It focuses on how to select care homes to visit, how to make contact, what the key things you want to look for are, and provides a checklist of questions to ask and things to look for whilst there. You may also find the following fact sheets helpful: · The process of choosing a care home · How will the cost of a care home be paid for? What is a care home? ‘Care home’ is a general term used to describe an establishment that offers care, and sometimes nursing, twenty-four hours a day, seven days a week, to a person who lives on the premises. Care home is the new name for residential care. ‘Care home with nursing’ is the new name for nursing home. The old terms (residential care and nursing home) are often still used. Sheltered and Extra Care Housing In addition to care homes, there is, where available, sheltered housing and extra care housing. These also offer accommodation (although the person is a tenant with full tenancy rights as compared to a resident who pays a fee) but normally they offer less care and supervision than a care home. However, some extra care, or very sheltered housing schemes differ little from care homes in the actual amount of care and support they provide. How to find what care homes are available Each care home should be inspected by, and registered with, the Commission for Social Care Inspection (previously National Care Standards Commission). The CSCI visit every registered home twice a year, and write an inspection report after the visit. You can ask the CSCI for a list of all the care homes in your area or a copy of the most recent inspection report of any home. If you have access to the internet you can visit their website www.csci.org.uk. Alternatively telephone the CSCI order line on: 0870 2407535 to have inspection reports sent to you. If you ask for more than 10 reports they will charge you a set fee of £5.00 per copy.

Some care homes have a specialist registration with CSCI because they have shown that they have staff with some level of training in the care of people with dementia. These homes were previously called Elderly Mentally Ill Infirm Homes (EMI). Homes with this registration can be care homes either with or without nursing care.

Your local authority social services will provide a list of all registered care homes within their jurisdiction. Other organisations such as Alzheimer’s Society may be able to provide you with helpful advice about homes in a particular area.

Deciding which homes to visit

A number of factors might affect which homes you think could be appropriate and therefore visit. For example, some care homes will not accept people with dementia.

· Distance – Is the location of the Home easy for you to get to? If you want to visit regularly, is the home on a regular bus route? Are there buses at weekends? If you are driving, is there somewhere convenient to park?

· Behaviour – The person you care for may wander, or shout and become very loud or aggressive, some homes specialise in looking after someone with dementia.

· Lifestyle – The person you care for may need lots of activities or may need none at all, so the social programme and outings may be an important consideration.

As dementia progresses, people usually need more care and support than they need now. Ask the care homes you visit if they can cope with people whose dementia is more advanced, otherwise the person you care for may have to move later on. Some homes are able to provide residential and nursing home care (they are called dual registered homes) which would be an important consideration if you want the care home to be a home for the rest of the person’s life. We would also suggest not making all visits formal; you want to see what life is like there at different times of the day and when visits are not expected. Just pop in unannounced, if this is a problem to the home, why?

What do care homes charge?

The first question to ask is one about cost unless you are sure that you or your relative is going to be financing all of the costs of the placement yourselves. Some care homes only take people who are self-financing. Others take a mixture of people who are paying for themselves and others who are being paid for solely by the local authority. Some homes are entirely for people funded by the local authority. It is not helpful going to visit somewhere where the costs are greater than you or the local authority is willing to pay.

Your local authority has a standard amount that they will pay for a placement. Find out how much this is. They will also have a list of preferred accommodation where they and the care home have agreed to a fixed amount that will be paid for a placement - obtain a copy of the “preferred accommodation” homes.

See our fact sheet on: How will the cost of a care home placement be paid for? And: The process of going into a care home.

Not all care home charges are covered in the set fee eg, chiropody, hairdressing or outings may cost extra. Other kinds of financial questions you might want to ask may include:

· Price and payment – How much will the home cost a month/a year?

· Is the home on the list of social services preferred accommodation?

· Ask for a copy of a draft contract - check it carefully, preferably with legal advice.

· Are there outings?

· Can a prospective resident go into the home for a month’s trial?

· What happens if your relative is very unhappy and wishes to move? Do residents have to give a month’s notice?

· Each home should produce a statement setting out its aims and objectives, the range of facilities and services it offers to residents and the terms and conditions on which it does so. Ask for a copy of this document.

Preparing for the visit

It’s not always easy to think of all the questions you might want to ask on a visit. Consequently, we have prepared a checklist of questions you may want to use or adapt.

Checklist

Topic	Questions
Do staff in the home appear to have an understanding of the needs of people with dementia? Communication Care plans Keyworkers	Do you see staff engaging in one to one conversations with residents other than when performing care tasks? If a resident was upset or agitated did staff ignore them or take time to talk to them, distract them or offer some form of reassurance? How many staff have received some special training in the care of people with dementia? Do you feel that staff respond to residents positively and give the impression that they respect them and enjoy being with them? Do staff seem to be patient and attentive when people have difficulty in communicating with them? Is there a written care plan for each resident? Does the plan cover people’s preferences and choices? Does the plan cover how someone communicates? Does it describe a person's strengths, abilities and interests when a care plan is written? Does the plan clearly identify that people will be supported to do as much as they can for themselves? How will people’s past experiences and background be used to help find out about their care and support needs and does it say how these needs will be met? Will a key worker be allocated? (A keyworker will have special responsibility for ensuring that a care plan is carried out, and that all other staff are aware of what the plan says). Does this keyworker change regularly? Do you feel that the importance of the past is understood?
Indications of care may be interpreted through the appearance of residents	Do residents look well cared for? What are their clothes and general appearance like? Is their hair cut and washed, are their nails cut and clean? Are people dressed uniformly or do you feel that their dress reflects what they would choose? (You may not feel that this matters as long as the dress is appropriate and clean). Did you notice if someone looked uncomfortable and if so, whether staff responded to help them?
Indications of care may be interpreted through the appearance of the accommodation	Is there a balance between cleanliness and homeliness? Is there a sense of pride in how the place looks? Would you like to sit in the lounge? Is it bright, warm and inviting? Are there magazines and newspapers? Does the home smell badly, for example of urine, or does it smell fresh and pleasant? Do the furniture, colour schemes and signs within the home help people to find their way around, and to locate their own room? Can people personalise their rooms, bring their own furniture if this is appropriate? Can people clearly recognise their own rooms? Does the home appear too noisy or quiet?
Indications of care may be interpreted through the design of the accommodation Mobility and access around the home	Is there a separate lounge and dining room so the television is not always dominant if people want to talk? What is the ratio of single rooms to shared rooms? Is the person you care for going to be able to use communal areas or are they going to be room bound? Is there access to a garden that is safe for people to walk in? Is there a lift? Is there evidence that people in the home have individualised equipment to enable them to take part in activities and/or maximises their mobility?
The best care homes manage personal and intimate care with a sense of pride and dignity Privacy and dignity Medical care	How close do you think a person needs to be to a bathroom/toilet? Is there an en-suite toilet or bathroom? How often can residents have a bath or shower? Are the beds made up with clean linen? Would you like to climb into that bed? Are people encouraged to wash and dress themselves with as little or as much support as they need? Were doors left open when people were washing or dressing? What arrangements does the home make for ongoing dental care? Did you see toothpaste in people’s bathrooms and other personal care products? Does the home have its own doctor and how often do they visit?
Quality of life Food and diet Activities, exercise and social events	Do the other people in the home appear alert, bright, happy and well cared for? Will the person you care for be able to mix with the other people in the home? If a resident is willing to chat to you, you could ask them what they most like about where they live. If there is something they could change what would it be? Would you want there to be smoking allowed or not allowed? What are the policies on staff smoking? Are snacks and drinks offered regularly? (Sometimes people with dementia forget to eat and drink). Is the amount people eat and drink monitored? Are people weighed regularly? Are special diets catered for eg, soft diets for people with swallowing difficulties? Are there finger foods for people who cannot use cutlery? What time of day is the last meal served? What would a typical day in the home look like? Do volunteers come in and visit? Are relatives invited to take part in activities? Was everyone stuck in front of the television or sitting in their own rooms in isolation?
Staffing and a commitment to high quality care Working as a team	Does there appear to be enough staff? How long did you have to wait before someone came to welcome you? What is the ratio of staff to residents? Are the staff permanent or temporary? Is the atmosphere cheerful? How are people in the home and their relatives informed of day-to-day developments and changes?
The process of moving in	Is the person with dementia supported when they move into the home and how will they be helped to settle in? Will the person with dementia be involved in decisions about the admission? Is contact between the staff, the service user and family offered before the admission? Do you feel staff would provide positive support and assistance to family and friends of the person with dementia and help them cope with the admission? Do you feel a new resident will be welcomed and given extra support?
Links with the wider community Visits from, or to, religious leaders, eg, vicar Visits from other community groups or members Visits by relatives and carers Relatives’ Support	Are visits allowed at all times? Can well behaved pets (for example a dog) be taken in? Are people given an opportunity to attend a place of worship inside or outside the home? Can people opt out of religious events? Does the home encourage outside agencies to come in, eg, ‘Pat the dog’ schemes, volunteer visitors? Is there a private place to visit with my relative or will that always be in their bedroom? If I want to make a cup of tea when visiting how easy or difficult will that be? If I wanted to cook some food or have a meal in privacy can that be done? Can I telephone and speak to my relative in private? Is there an active relative’s/carer’s group?

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While the information contained in this fact sheet is believed to be correct, DISC does not accept liability for any error/s it may contain.