Alzheimer's Society

In the UK, 700,000 people have dementia, and residential care provides a home for one-third of these individuals. Good quality care that preserves dignity, treats people with respect and promotes independence improves the lives of care home residents with dementia. Selecting a care home that offers this environment is, therefore, very important and it can be a difficult decision. This factsheet 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 activities such as washing, dressing and eating. In some homes that are registered to provide personal care, staff will have had specialist 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 not be a mental health nurse).

Dual-registered homes no longer exist, but some homes that are registered for nursing care will accept people with personal care needs who may need nursing care in the future.

The type of home required will depend on the general health and needs of the individual.

How do I go about choosing a care home?

Arrangements for care may be made through the local authority, or independently. Either way, it is a good idea to visit a number of homes before making a final choice. 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 factsheet.

If you are looking for a home on behalf of the person with dementia, you may want to visit once on your own and then, if you think it suitable, visit again with the person with dementia. 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.

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'.

(See also Factsheet 451, What standards of care can people expect from a care home?)

The local authority cannot necessarily dictate which home someone should move in to. If the person with dementia has mental capacity, they must be in agreement about the home it is suggesting. If they do not have mental capacity, then the local authority must liaise with the person's guardian, lasting power of attorney (LPA) for personal welfare or someone who is closely involved with the person (see Factsheet 459, Mental Capacity Act 2005 and Factsheet 472, Enduring power of attorney and lasting powers of attorney). If there is no guardian, LPA for personal welfare or carer involved, the person has the right to an independent mental capacity advocate (see Factsheet 459, as above).

If the person liaising with the local authority does not agree about the home suggested, they should raise their concerns with the social worker, and make a formal complaint if necessary.

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 are suitable for people with dementia. A professional such as a doctor or social worker, or a voluntary organisation such as a local branch of Alzheimer's Society or Age Concern, may be able to give advice on which homes may be suitable for someone with dementia. You can also contact the Alzheimer's Society Dementia Helpline for a list.

How should I approach the home?

Phone 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, but the following suggestions may be useful. In addition, the Society's booklet 838, Putting Care Right, has questions to ask when visiting a care home.

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, and that individuals are treated with dignity and respect:

• Do staff speak to residents in a way the residents like?
• 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 - and if so, can you see any examples of this?

Location

However pleasant the home itself may be, ask yourself:

• Will it be easy for visitors to get to the home?
• Are there facilities such as shops, a pub or a park within walking distance, for residents who enjoy going out?
• Is there much noise from traffic, or anything else?

Access

If the person with dementia is likely to need equipment or adaptations:

• Are the corridors and toilets wide enough for a walking frame or wheelchair?
• Are there suitably adapted toilets and baths?
• Are there ramps or a lift?

Bedrooms

• Can residents can have a single room?
• Are residents encouraged to bring in some of their own furniture and possessions?
• Are the bedrooms are bright and pleasant?
• Can residents go to their rooms when they wish to be alone?
• Can residents keep pets in their rooms, or in other areas of the home?
• Do staff respect people's 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

• Are chairs are arranged in groups to encourage talking, rather than placed in a circle around 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

• Are special diets are catered for, and are residents' likes and dislikes taken into account?
• Is a choice of food offered at mealtimes?
• Can residents eat in their rooms, or eat at different times, 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

• What happens if residents are unwell or need medication?
• Which doctor or doctors can residents see?
• Does the home have access to other services, such as community mental health teams, chiropodists and dentists?
• 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 there quiet areas where relatives can spend time with residents?
• Are visitors encouraged to take residents out, or join them for a meal?
• Are children made to feel at home?
• Is information readily shared with families, and are they supported to become involved in the life of the home - for example, is there a relatives group?

Activities

Residents should be stimulated without feeling stressed:

• Does the home provide personalised activities that are suitable and engaging for residents with dementia?
• 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 be addressed, 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 who you can talk to about your own worries concerning 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 (see 'Useful organisations') 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.

Your local Alzheimer's Society branch will always be willing to talk to you and offer advice and information to support your needs.

For more information, Dementia Catalogue, our specialist dementia information resource, is available on the website at alzheimers.org.uk/dementiacatalogue

Useful organisations

Age Concern England

Freepost SWB 30375
Ashburton
Devon TQ13 7ZZ
T 0800 00 99 66 (free helpline every day 8am-7pm)
E use the enquiry form on the website (see below)
W www.ace.org.uk

Provides advice and information for older people in England.

Age Concern Cymru

Ty John Pathy
13-14 Neptune Court
Vanguard Way
Cardiff CF24 5PJ
T 02920 413 555
E enquiries@accymru.org.uk
W www.accymru.org.uk

Provides advice and information for older people in Wales.

Alzheimer's Society

Devon House
58 St Katharine's Way
London E1W 1JX
T 020 7423 3500
   0845 300 0336 (helpline open 8.30am-6.30pm weekdays)
E info@alzheimers.org.uk (general information)
   helpline@alzheimer.org.uk (helpline)
W alzheimers.org.uk

The UK's leading care and research charity for people with dementia and those who care for them. The helpline provides information, support, guidance and referrals to other appropriate organisations.

Citizens Advice Bureau (CAB)

Various locations
W www.citizensadvice.org.uk
     www.adviceguide.org.uk

Your local CAB can provide information and advice in confidence or point you in the right direction. To find your nearest CAB look in the phone book, ask at your local library or look on the citizens advice website (above). Opening times vary.

Commission for Social Care Inspection (CSCI)

33 Greycoat Street
London SW1P 2QF
T 0845 015 0120 (helpline, charged at national rate)
   0191 233 3323 (helpline, charged at local rate)
E enquiries@csci.gsi.gov.uk
W www.csci.org.uk

Regulates, inspects and reviews all adult social care services in the public, private and voluntary sectors in England. Note that the CSCI is expected to be superseded by the Care Quality Commission in 2009.

Counsel and Care

Twyman House
16 Bonny Street
London NW1 9PG
T 0845 300 7585 (advice line, weekdays 10am-4pm except Wednesdays 10am-1pm)
E  advice@counselandcare.org.uk
W www.counselandcare.org.uk

Provides advice, information and financial support for older people, their families and carers, including useful guides to choosing a care home.

Elderly Accommodation Counsel

3rd Floor
89 Albert Embankment
London SE1 7TP

T 020 7820 1343 (helpline, Monday to Friday)
E enquiries@e-a-c.demon.co.uk
W www.eac.org.uk
    www.housingcare.org

Charity that aims to help older people make informed choices about meeting their housing and care needs.

Grace Consulting

Orchard House
Albury
Guildford GU5 9AG
T 0800 137669 (freephone)
E enquiries@graceconsulting.co.uk
W www.graceconsulting.co.uk

Consultancy offering independent expert advice on housing and care options.

Help the Aged (England)

207-221 Pentonville Road
London N1 9UZ
T 020 7278 1114
   0808 800 6565 (seniorline freephone, weekdays 9am-4pm)
E info@helptheaged.org.uk
W www.helptheaged.org.uk

Provides advice and reliable information for older people and their carers.

Help the Aged (Wales)

12 Cathedral Road
Cardiff CF11 9LJ
T 02920 346 550
E infocymru@helptheaged.org.uk
W www.helptheaged.org.uk

Relatives and Residents Association

24 The Ivories
6-18 Northampton Street
London N1 2HY
T 020 7359 8148
   020 7359 8136 (advice line, weekdays 9.30am - 4.30pm)
E info@relres.org
W www.relres.org

Advises relatives and close friends of people in care homes on a range of topics, from how to get an assessment to what to do when problems occur in a home.

Factsheet 476

Last updated: July 2008
Last reviewed: July 2008

Reviewed by: Louise Lakey, Senior Policy Officer, Alzheimer's Society