Selecting a care home

Selecting a care home is a very important decision, and there are many issues that you will need to consider in order to find the right place. This sheet explains what to look for when choosing a care home.

Are there different types of care home?

Yes. Some care homes are registered to provide personal care, which means they will provide help with washing, dressing, eating etc. In some homes registered to provide personal care, staff will have had special training in dementia care. Other homes are registered to provide nursing care, which means they have a qualified nurse on duty 24 hours a day (although the nurse may well not be a mental health nurse). Dual registered homes no longer exist but homes registered for nursing care may accept people with personal care needs who may need nursing care in the future. The type of home required will depend on the person with dementia's general health and needs.

How do I go about choosing a care home?

It is a good idea to visit a number of homes before making a final choice. This applies whether the arrangements for care are being made through the local authority or whether you are making them independently. The local authority cannot dictate which home a person should move into - the person with dementia's carers must be in agreement. Make sure you spend enough time at the home to get a good idea of what it is like, and bear in mind the points in this information sheet.

Before making a final decision you may want to look at a recent inspection report for the home. These often give a lot of detail on how the home operates. You could ask the home itself to let you see a copy or you could contact the Commission for Social Care Inspection (CSCI) (see Useful organisations, below).

Once you have found a home that you like it may be a good idea to visit again with the person with dementia, if they haven't already visited it. You can then see what their reactions are and how they might settle in. You may be able to arrange a trial period - many homes require these anyway, and they can be very useful. Discuss this with the home.

How can I find suitable homes in my area?

Lists of local care homes and inspection reports are available from the CSCI. However, not all care homes offer places to people with dementia. A professional such as a doctor or social worker, or a
voluntary organisation such as a local Alzheimer's Society or Age Concern group, may be able to give advice on which homes may be suitable for someone with dementia. You can also contact the
Alzheimer's Helpline for a list.

How should I approach the home?

You should telephone or write to a number of homes and ask about the level of care provided for people with dementia, the fees and the waiting list. Many homes will send out a glossy brochure - but these can sometimes give a misleading impression. It is important to visit several homes that seem promising.

What should I look for in a care home?

Spend some time looking round and talking to the person in charge, as well as other staff and residents. Don't be afraid to ask questions. It may help to take a checklist of things you want to find out. You will have your own views on what is important for you but the following are some suggestions.

First impressions

First impressions are often an important clue to how a home is run. For example:

Are you greeted in a friendly way when you arrive?
Is the atmosphere homely and welcoming?
Is it clean and pleasantly decorated and furnished?
Are there any unpleasant smells?

Residents

The best indication of a good home is that the residents appear happy and responsive.

Are residents involved in activities or chatting?
Are they properly dressed and well groomed?
Do they seem alert and interested?
Do they talk to you as you walk round?
Are they encouraged to do as much for themselves as they can? Can you see any examples of this?

Location

However pleasant the home, you may also need to consider whether:

It will be easy for visitors to get to the home
There are shops, a pub or a park, for example, within walking distance for residents who enjoy going out
There is much noise from traffic or anything else.

Access

If the person with dementia needs or is likely to need equipment or adaptations you may want to check whether:

The corridors and toilets are wide enough for a walking frame or wheelchair
There are suitably adapted toilets and baths
There are ramps or a lift.

Bedrooms

You may want to find out whether the person with dementia can have a single room and whether:

Residents are encouraged to bring in some of their own furniture and possessions
The bedrooms are bright and pleasant
Residents can go to their rooms when they wish to be alone
Residents are able to keep pets in their room or in other areas of the home
Staff respect the right to privacy and knock on bedroom doors.

Toilets

Getting to the toilet in time can sometimes be a problem as dementia progresses.

Are there enough toilets within easy reach of the bedrooms and living areas?
Are staff trained to spot the signs when someone needs to go to the toilet?
Are staff cheerful and tactful about helping residents use the toilet and changing them if they are incontinent?

Living areas

Look to see whether chairs are arranged in groups to encourage talking rather than placed in a circle round the outside of the room.

Is there a TV or radio left on when no one is watching or listening?
Is there more than one room where residents can sit or where they can be quiet or see visitors?
Are there smoking and non-smoking areas?
Is there a garden where residents can walk safely?

Meals

You may need to ask whether special diets are catered for and whether residents' likes and dislikes are taken into account.

Is a choice of food offered at mealtimes?
Can residents eat in their room or eat at a different time if they prefer?
Are there facilities for making snacks if a resident feels peckish?
Are staff trained to sensitively help people eat their food, if necessary?

Health

You will want to know what happens if residents are unwell or need medication.

Which doctor or doctors can residents see?
Can a relative stay overnight if a resident is unwell?
What happens if residents need help in taking medication?
Are changes in medication discussed with the family carers?

Visitors

You will want to make sure that there is good communication between relatives and the home and that phone calls and visits are encouraged.

Are visitors welcomed at any time?
Are visitors encouraged to take residents out or join them for a meal?
Are children made to feel at home?

Activities

Residents should be stimulated without feeling stressed.

Are there opportunities for residents to help staff with small tasks if they wish?
Are activities available each day or are residents left to sit in front of the TV?
Are trips and outings organised and special events celebrated?
Are residents encouraged to take exercise?
Are residents able to choose and listen to a variety of music when they feel like it?

Cultural differences

If the person with dementia comes from a different background or culture from most other residents you will want to make sure that their needs are catered for in a sensitive way.

Are staff interested in learning about the person's background and culture?
Do staff show a respect for differences that might involve diet, clothing, hygiene practices or religious observances, for example?
Do staff find out how residents wish to beaddressed and how they prefer to relate to other people?

Staff

It is important to note whether staff seem friendly and caring towards residents and whether they treat residents with respect.

Do they have any training and experience in dementia care?
Do they make time to sit and chat to residents or talk to them while they are helping them with physical tasks such as washing and dressing?
Do they know about residents' backgrounds, habits and interests?
Will the person with dementia have a member of staff particularly responsible for their care?
Is there a member of staff you can talk to about your own worries about the person with dementia?

Manager/head of home

A manager who is caring as well as efficient can make all the difference to a home.

Does the manager have a friendly manner with staff and residents?
Do they answer your questions openly and seem to understand your concerns?
Do they have a knowledge of dementia and can they deal with difficulties that may arise in an understanding way?
Is there a full assessment at home before a resident is admitted?
Does each resident have a care plan and are their needs regularly reviewed?
Is the family carer consulted about the care plan and about any proposed changes to it?

Contract

If the home is being arranged through the local authority the local authority will have a contract with the home. You may want to see a copy.

If you are arranging a home independently make sure you have a contract with the home or a statement in writing. Get advice from a solicitor or citizens advice bureau before signing any agreement. You need to be clear about:

What is included in the weekly fee, what may be charged as 'extras' and how much notice is given if fees are raised
What kind of care and what services residents can expect
What happens if a resident's condition deteriorates - can they remain in the home and if not how are alternative arrangements made?
How much notice has to be given on either side.

Useful organisations

Age Concern

For advice and information call freephoneL 0808 808 6060 (9.30am-5pm).

For free factsheets call freephone: 0800 00 99 66 every day 7am-7pm or write to:

Mail Order Department
Age Concern
Freepost SWB 30375
Ashburton
Devon TQ13 7ZZ

Factsheets are also available on the website: http://www.ace.org.uk/

Citizens advice bureaux (CAB)

Your local CAB can offer you information and advice in confidence or point you in the right direction. To find your nearest CAB look in the telephone book or ask at your local library. Opening times vary so check first.

Commission for Social Care Inspection

33 Greycoat Street
London SW1P 2QF

Telephone: 020 7979 2000
Fax: 020 7979 2111
Email: enquiries@csci.gsi.gov.uk
Website: http://www.csci.org.uk/

Counsel and Care

Phone the information line on 0845 300 7585 (weekdays 10am-12pm and 2pm-4pm). All calls are charged at the local rate.

For helpful free factsheets send a stamped self addressed envelope to:

Advice Department
Counsel and Care
Twyman House
16 Bonny Street
London NW1 9PG

Website: http://www.counselandcare.org.uk/

Counsel and Care produces two useful guides to care homes: The complete care home guide and The brief care home guide.

Elderly Accommodation Counsel

The Elderly Accommodation Counsel provides information on sheltered housing, retirement developments, residential care homes and nursing homes.

Phone the advice line on 020 7820 1343, Monday to Friday 9am-5pm, or contact:

Elderly Accommodation Counsel
3rd Floor
89 Albert Embankment
London SE1 7TP

Telephone: 020 7820 1343
Email: enquiries@e-a-c.demon.co.uk
Website: http://www.housingcare.org/

Grace Consulting

Grace Consulting offers independent expert advice on housing and care options available.

Phone freephone: 0800 137 669 for advice, or contact:

Grace Consulting
Orchard House
Albury
Guildford GU5 9AG

Website: http://www.graceconsulting.co.uk/

Help the Aged

For advice and information call freephone 0808 800 6565 (weekdays 9am-4pm) or write to:

Help the Aged
207-221 Pentonville Road
London N1 9UZ

Free leaflets are available. Leaflets are also available
on the web: http://www.helptheaged.org.uk/

Relatives and Residents Association

Telephone for advice on 020 7359 8136 (weekdays 9.30am-5pm) or write to:

Relatives and Residents Association
24 The Ivories
6-18 Northampton Street
London N1 2HY

Email: info@relres.org
Website: http://www.relres.org/

Alzheimer's Society