However, most people who need full time care are told they have to pay for their own care, and many people find that they are assessed first by their local authority – to look at their financial means.
This is the wrong way round.
Choosing a care home for an elderly relative is one of the most difficult things to do. There are many things to consider, and one of the most vital is the degree to which your elderly relative will remain engaged with life whilst there.
We’ve all seen the stereotypical pictures of elderly people in care sitting all day with little or no stimulation. It is perhaps no wonder that in those situations they become even more withdrawn and disengaged.
Care guidelines state that people should be involved in their own care planning, where possible, and be able to exercise choice in their lives. If we take food as an example for a moment, choosing from a menu is all very well, but if the fixed choices are institutional and uninspiring, or simply not what someone would normally choose, then mealtimes – a vital positive element in a day – are no longer enjoyable.
In the same way, if the choices for day-to-day activities and daily routines are already prescribed, there’s limited opportunity for real engagement. That’s perhaps why so many elderly people describe life in a care home as being ‘like a prison’.
Studies show that having a greater sense of purpose leads to more sustained cognitive function in elderly people. This would suggest that it’s far better all round to have elderly people, where possible, involved not simply in choosing from a menu of care and activity options, but actually creating those options in the first place – and in so doing strengthening their sense of value and purpose.
This will more than likely manifest itself in stronger health and wellbeing.
You can’t really know for sure what a care home will be like until you’re living there, but there are careful questions you can ask to get a better feel for how things will be.
Explore more tips about choosing a care home.
There are increasing calls from various stakeholders in elderly care for a greater recognition of dementia as a serious disease and terminal illness. Dementia is very much a hidden disease as far as care services are concerned, especially when compared with diseases like cancer.
Acute hospitals are supposed to have an older people’s mental health liaison team in place to ensure that people with dementia – arguably the most vulnerable people in our society – are discharged into the most appropriate care.
What’s alarming, however, is that most people with dementia, whether receiving day-to-day care in their own homes or in a care home, end up in the hands of carers who may just have an NVQ but no other relevant qualifications or skills relating to the needs of people in their care. They often have no specific experience of dementia and no specialist training.
A recent Care Quality Commission report highlights that in 25% of care homes surveyed, staff were unsure about the health needs and care requirements of the people in their care. If a sick child were placed in the care of someone who was unqualified to look after it, there would be uproar. And yet it seems ‘OK’ for this to happen to elderly people with a serious brain disease.
If you’re currently looking for a care home place for a relative with dementia, do your homework. Obtaining a list of care homes in your area providing EMI (Elderly Mentally Infirm) care is fairly straightforward, but actually choosing the home can be harder.
If the care home you’re visiting has a special Elderly Mentally Infirm Unit (EMI), always ask to see it. It may be a separate EMI unit that is kept locked. Although keeping people safe is important, EMI residents still need fresh air, sunlight, access to the garden and other stimuli. In some homes EMI residents never go outside that locked unit.
There are some good care homes though, and it’s vital to ask the manager specific questions to get a good idea of their approach to people with dementia. These 3 critical questions will get you off to a good start:
1. How much knowledge do the carers and nurses have about dementia and its associated challenges?
The home may say that it has other residents with dementia, but this doesn’t necessarily mean the residents’ needs are well understood. Ask open questions such as, “What specific training do you give your carers in looking after someone with dementia?” or “What do carers do differently when they’re with someone with dementia?” The answers will indicate more fully how much they really understand the disease. If the answer is simply that the staff are ‘fully trained’, keep asking questions. How exactly does the care home educate its staff about dementia? It’s also worth asking whether the home invites any specialist dementia nurses in to help train staff in dementia.
2. What patterns and designs are on the carpets and curtains?
This might sound like an odd question, but people with dementia or mental confusion can find some bold patterns or certain prints disorientating and sometimes frightening. It can also worsen the severity of hallucinations. The same applies to lighting where certain shadows are cast. A good care home will be aware of this. The Alzheimer’s Society has an interesting web page about patterns and lighting for people with dementia.
3. How much do residents get involved in the day-to-day operation of the home?
For example, if your relative likes gardening, what opportunities are there for them to make important decisions about maintaining the garden? Generally speaking, the more involved residents are, the greater their sense of purpose and value will be, the more they will engage with activities (instead of being passive recipients). This often manifests itself in stronger mental health and wellbeing.
Be persistent with your questions about dementia at any care home, and don’t be pressured into making a quick decision. Then, once you’re satisfied that the home can provide proper care, ask for a trial period to start with.
If your relative is in a Southern Cross care home, you may be concerned about who’ll be taking over the home, now that the Darlington-based Southern Cross group has collapsed.
The group has, until now, been the largest UK care home operator, running 752 care homes with 31,000 residents. However, the care homes themselves are now being reclaimed by landlords and the running of the homes transferred to new operators.
This process should be complete by the end of October 2011. However, not all homes have secured new operators, which raises the question what will happen to the residents of those particular homes once Southern Cross ceases trading.
This article in The Guardian newspaper lists the different Southern Cross care homes and outlines what’s happening with each one.
Southern Cross has 97 care homes in Scotland, 34 in Wales, 25 in Northern Ireland and just under 600 in England. The biggest landlord, NHP, will run 249 homes as a joint venture with Court Cavendish.
London & Regional, the second biggest landlord with 90 homes, will assign the running of the homes in the north of England to Orchard Care Homes and to Minster in the south east of England. Loyd’s Property is another landlord with 54 homes, but as yet without an operator.
250 homes will be transferred back to landlords who are also operators, including to Four Seasons. However, those homes for which an operator can’t be found may end up closing, leaving families and elderly residents facing uncertainty and painful upheaval.
If you have a relative in a Southern Cross care home, you may decide to move them somewhere new. It can be a difficult process – and it’s often hard to know whether the new care home really will provide good care for as long as your relative needs it. Our practical guide, How To Choose A Care Home, gives you some vital questions to ask a care home manager before you make a decision.
When you’re weighing up different care homes, how do you know which is best?
There are lots of issues to consider – and lots of questions you need to ask the manager and staff.
One aspect to consider is mobility. Staying mobile can be difficult in a care home. So make sure you ask these three vital questions before you make any decisions:
The less obvious questions are always the best. You’ll find lots more of them – about all sorts of topics – in our guide, How To Choose A Care Home. It covers the key questions most people don’t ask – but should!
Current media reports show that Southern Cross Healthcare, which runs 750 care homes right across the UK, is facing serious financial difficulties. If a solution can’t be found, over 30,000 elderly people may have to be rehomed. It’s a distressing situation for all.
Finding a care home can be difficult – and it’s hard to know if you’re making the right choice. It’s vital to ask good questions when you visit, especially about the financial stability of any care home company, how they operate and the morale of the staff.
Bear in mind that the size of a home, the corporate brand name and any official inspection reports don’t necessarily reflect the quality of care or the day-to-day life that people actually experience in the home. Bigger is not always better, and well-known brand names don’t necessarily provide better care. That’s why it’s vital to visit the home in person – preferably more than once and at different times of the day. It’s also a very good idea to ask people you know in the local area whether they know someone who is resident in a particular care home – and then to ask that person’s family for their views and feedback on the home.
You can gauge a lot from phoning a care home. Do they have time to answer the phone? Is it answered by someone who knows what they’re talking about? Is there a lot of background noise? What questions do they ask you? This is just as important as what you ask them. Do they offer to send you their brochure? How professional do they sound?
A good manager will have a very positive effect on his/her staff, and that also filters down into the care given to residents. A defensive manager, on the other hand, may have something to hide – even if it’s their own lack of experience. An overly confident manager may not listen to new ideas or complaints. Again, it comes down to your own judgment and instinct. Does the manager also own the home? If not, how long has he/she been in post? What’s his/her background?
Today there are a relatively small number of large companies who own the majority of care homes in the UK. Is the company financially stable? Are they likely to invest in upgrading the home as and when it needs it? Are they committed to providing care for the long term? It’s heartbreaking to hear of care homes closing and residents having to be split up and sent elsewhere. Find out as much as you can in advance.
Agency carers and nurses are not based at the care home. Instead, they’re a bit like office temps – they go to whichever home needs them on the day, and so they may not know you or be familiar with your needs. The greater the percentage of permanent staff at a care home the better it will be for you.
What are their specific qualifications? And what about the qualifications held by the other care staff? What’s the staff/resident ratio during the night? What about the ‘after lunch slot’ when staff are taking their own lunch break? And how long has the longest-serving member of staff been at the home?
This could be contents insurance for your possessions, accident insurance, public liability insurance and/or professional indemnity insurance. Does this include insurance to allow staff to help people walk and exercise, etc. If not, and if you’re not very mobile (or you have an accident), the care team is unlikely to help you keep your joints supple and mobile and you may have to pay for regular physiotherapy.
It’s the less obvious questions that give you a better idea of what the home will really be like. Read more here about going into a care home.
And remember, just because you have some savings or a property doesn’t necessarily mean you have to pay for care – no matter what the care home, Social Services or the NHS may have told you.
The NHS has a duty to provide fully-funded NHS Continuing Healthcare (covering 100% of care home fees) for elderly people who are in full-time care primarily for health needs. Read more about going into a care home.
Going into a care home can be one of the most difficult transitions anyone has to make. It can also be traumatic for the whole family. In addition, it’s often hard to know how the care system works or what to do first.
Many people also find that their NHS and local authority are less than proactive in providing accurate guidance and advice.
In addition, when you consider the risk of care homes going out of business, the whole decision can be daunting. The recent news about Southern Cross Healthcare’s financial difficulties, potentially affecting over 30,000 care home residents, highlights once again how vulnerable elderly people can be.
Finding the right care home can be a tricky business. That’s why, when you’re looking for one, it’s vital to do your research – and to find out as much as you can about what it’s really like to live in any given home.
By law, adult health and social care providers such as care homes, must ensure they meet essential quality and safety standards. Official care quality guidelines also state that care planning should build in measures to prevent health and welfare problem occurring.
The Care Quality Commission carries out regular inspections of care homes, but these inspections are generally ‘regulatory. It means they check on the ‘processes’ in place in a care home such as record keeping, medicine storage, window safety and food handling.
Unfortunately, these official inspections don’t always reflect the day-to-day standards of care, humanity and health that elderly residents actually experience.
For example, there are ‘rules’ about food handling and food hygiene but, astonishingly, no clear guidelines about the level of beneficial nutrients in care home food.
Pressure sores are also, sadly, a common problem for care home residents, as are malnutrition and dehydration. And yet, with proper training for staff, these dangerous situations would be much less likely to develop in the first place.
So remember, it’s vital to do your research before you sign a care home contract. To help you, we’ve produced a practical guide, How To Choose A Care Home. It shows you where to start, what to do, what to ask and who to talk to. It’s packed with the less obvious questions to ask care home staff and management when you first visit – and it means you get a more in-depth impression of what the home will really be like and enables you to make a better decision. How To Choose A Care Home.
If you have health needs, when you first go into a care home you should be assessed by the NHS for NHS Continuing Healthcare funding.Elderly people in care homes who have health needs because of accident, illness or disability should be assessed for NHS Continuing Healthcare funding.
This should happen within the first three months of being in care – although ideally it should happen before you go into the care home, and certainly before you pay any care home fees.
NHS Continuing Healthcare Funding is provided by the NHS and covers 100% of your care fees.
If you haven’t been assessed for this, you can ask for an assessment. If you have been assessed, and it resulted in NHS Continuing Healthcare being denied, you can appeal. Read more about NHS Continuing Healthcare and Registered Nursing Care Contribution.
In addition, if you’re paying for your own care and you were means-tested when you went into care, the value of any property you own should have been disregarded for the first 12 weeks of your care.
How To Get The NHS To Pay For CareDid you know that the NHS is obliged to pay 100% of your care home fees if you need care primarily for health reasons? Just because you have savings doesn’t necessarily mean you have to pay…
Our NEW updated and easy-to-follow guide helps you cut through the confusion and claim what you’re entitled to. Read more…
Many emotions come to the fore. Sometimes you also have to feel your way through the process, as you’ve probably not had to do it before.
Contact your local council or Social Services department for a list of care homes in your area. There are different types of care homes providing different types of care services. These include:
Many care homes, whatever their type, also provide care for EMI residents. If that’s the case, it will be mentioned in the information provided by the home.
One vital question to ask when choosing a care home
Regardless of whether you’re paying care fees or not, it’s a good idea to take financial advice from an independent financial adviser. This will help you look more broadly at the options open to you – and ensure you protect your assets as much as possible. The earlier you can do this the better.
Choose an adviser who specialises in long term care planning AND who also understands the state benefits you’re entitled to, including NHS Continuing Healthcare.
Remember, if you need full time care for health needs, you do not necessarily have to pay for your own care! Read more about paying care fees.
This is a vital document! Read more about Lasting Powers of Attorney.
This is another vital document – and it’s crucial to keep it up to date. Find out more about making or updating your Will.
Ask the vital questions most people don’t ask – but should.
This 39-page practical guide shows you what to ask, when to ask it and how to make a better decision when you choose a care home. You’ll save time now – and avoid unnecessary care costs later.
It also gives you a helpful introduction to care fees and fully-funded NHS care. Read more…
“Your list of questions to ask a care home is fantastic.” Jim Blainey
Care To Be Different, The Copper Room, Deva City Office Park, Trinity Way, Salford, England, M3 7BG.
Care To Be Different is a trading name of Continuing Care Solutions Ltd, Registered no. 09939723.
All content on the Care To Be Different website is copyright Continuing Care Solutions Ltd.