Choosing a care home

Most people say that they would rather stay at home than ever go into a care home. That’s understandable.  You spend your whole life building a comfortable space that is full of memories, in a place you like to be.  Why would you want to leave?

Unfortunately, however, a time may come when you are not able to look after yourself and it’s no longer practical for someone, even a care company, to look after you for 24 hours a day in your own home. This may be because the amount of care that you need is too great. It could be that the design of your home makes it impractical for people to look after you.

A positive reason for going to stay in a care home is that this is a place where you will have good companionship and be looked after in an environment that offers you stimulation or peace according to your wish on any day.

For some more affluent people, going to stay in a care home is a lifestyle choice. It means that they no longer have to worry about shopping, cooking, laundry, or cleaning, and they can live as if they are in a hotel. This is of course expensive and so for most people their move to a care home is something that happens towards the end of life when every other option has been exhausted.  Some people have to fund it themselves and others have care paid for by the local authority or even the NHS.

The publicity around care homes is often negative. This is more to do with news values than the overall state of care homes in this country. When something bad happens in any industry everyone wants to know all about it and it attracts attention.  But when a neighbourhood care home is going along quietly providing friendly and cheerful care for local people, it’s not really the sort of thing that makes the news.

Truly with care homes, no news is good news. A comfortable care home is the reward for a life well lived, both for the resident, and for their family and friends, who can sleep at night knowing that their loved one is cared for.   It might be that the resident is having a particularly difficult time, distressed, and anxious as part of their dementia symptoms.  Care homes do a very difficult job looking after people who sometimes are so unwell that no one else is able to take on the job of caring for them. But you still have to try to get the best one.

Choosing a care home is one of the most emotionally difficult and expensive decisions that anyone will ever make. It might be that the decision has to be made quickly for one parent on the death of the other, while the family is still grieving and dealing with practical issues of a funeral and executry. It can be a sudden requirement when a person has been in hospital and needs to leave but is unable to go home. It can coincide with the need to sell the family home with all the emotional turmoil that can be involved in disposing of a lifetime worth of precious objects that no one now seems to want or need.

The work involved is significant, and the process is usually exhausting for everyone involved.  This is why talking about it long before it is needed is a good idea.  Even though everyone is hoping that a care home never becomes necessary, it still helps to have a scenario plan about who will do what, and when and how it will be paid for if the worst happens.

A wide range of unfamiliar issues have to be addressed simultaneously, so that’s where any planning is helpful.  If you talk about these things years in advance and ask for views early enough, you can take into account the previously expressed opinions of the person who is going to live in the home.  Sometimes a failure to think about a hypothetical situation gives rise to problems that could have been avoided. So, what do you need to think about?

Here are six important factors, in no particular order.

1   Alternatives

It might seem odd to start with this.  Going to a care home solves some problems and offers the benefits of communal living, such as reduced cost, and increased social opportunities.  But could you get good care and peace of mind in other ways? It’s possible to delay or prevent the need for care home care by considering care at homeshared housing, housing with support or multigenerational living.

2   Finances

How will it be paid for?  The financial picture is complex but based on the premise that people must pay for care home care if they can afford it.  A financial assessment will take into account both the value of any property, such as the person’s home, and also any money they have.

For some residents, the NHS will pay for the care.  For people who have no resources, the state will step in to pay.  If you have your own money, what you get is choice.  When the council is paying for care, their offering may not be enough to place you in a home that you prefer.  Relatives can top up what the local authority allows.

Some people try to avoid paying for care so that they can leave a legacy for their children, but this is something to think about decades in advance, and there are risks that you might break the rules and have to pay back to the authorities.  Seeing an independent financial adviser and a solicitor who specialises in caring for older people is a smart move at the earliest opportunity.

3   Location

If a care home is a long way from where loved ones live, it reduces the chance of people dropping in for a visit. There is a dilemma when families and friends are dispersed – do you pick a place near one key person who will do the majority of visits, or near where you used to live to maintain a social circle, or try to pick somewhere in the middle, that disadvantages everyone equally.

Being on a bus route or having good parking might not seem immediately important but it makes a big difference.  The cost of care homes varies hugely across the country, and the amount that different local authorities will contribute also differs.

4   Facilities

It is standard now for a resident to have an ensuite room.  This sometimes only means a room with a toilet and washbasin, but ideally there would also be a shower, for privacy and dignity.  A room on the ground floor might have direct access to a garden or courtyard, and on upper floors access to a balcony is important. You expect the resident to be able to personalise their room.  A comfortable chair and space for visitors to have private time with the resident is essential.

Many homes include hairdressing facilities, and luxuries like a café, a cinema room, or even a pool and a gym.  They can be elegant like a hotel, or basic, but in every case, they should be quiet, without constant alarms ringing, and clean without any lingering bad odours.

The most important facility is the staff.  They should be able to demonstrate that they’ve had dementia specific education and training, not just awareness.  Their behaviour towards visitors and residents alike is crucial and their skills can make up for any defects in décor.

5   Reputation

Care homes now have websites with information about what they offer and often with testimonials.  Anyone can check what the regulators have said about a care home on their inspection reports.  There is also a sort of Trip Advisor site for care homes that you can read.

The most reliable element is what local people say about the home.  Ask at the local club or church.  Check with neighbours.  Visit yourself and if that’s impossible get a reliable friend to visit.  Use a checklist to make sure you’ve asked about all the right things.  The person who is in charge is a crucial factor, and if there has been a recent change or if there is a lot of turnover of the senior roles, it’s a signal to be cautious.

6   What else might you think about?

If the building and the people look fine, what can you expect in terms of services:

  • Food – will they respect the residents’ cultural preferences including vegetarianism, or other religious requirements such as halal?
  • Laundry and clothing maintenance – who does the personal clothing laundry?
  • Outings and entertainment – are these included in the price, and will your resident always be encouraged to take part?
  • Worship or other religious observance – does a faith leader come in or can the person be taken out to church or other faith meeting?
  • Hairdressing and other grooming – how often and how much, and can you take the person back to their own hairdresser?
  • Chiropody, physiotherapy, opticians and related paramedical needs – what care plans are there for that?
  • Pharmacy – is there a regular medication review?
  • Doctor/hospital visits – how are these managed, eg is there a dedicated GP or do you use the one you have?
  • Dentistry – is there regular care and dental check-up?
  • Arrangements for the end of life – can the resident stay there until the end, or might they be moved on if they become more dependent?

If you are a carer, you can only do your best.  If you are a person who might one day need care, start thinking about it now, and give as much help as you can to those coming behind who might have to make these decisions for you.  And remember that in the end, most of us never need to go to a care home. But don’t rely on crossed fingers.

Professor June Andrews


Professor June Andrews

Professor Andrews is a dementia specialist and former adviser to the Dementia Trust. After a long career in the NHS, academia and government, June now works as a consultant to Sedaca Ltd, making life better for people affected by dementia. She is the author of Dementia the One Stop Guide.

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