What standards of care can people expect from a care home?

Two-thirds of care home residents in the UK have some form of dementia, so the primary task of the care home sector is to provide dementia care. This factsheet describes the kind of care that someone with dementia should expect from a care home, and explains what action can be taken if problems arise.

The provision of excellent care can make a huge difference to the quality of life of a person with dementia. Many care homes already provide a stimulating atmosphere that provides quality of life for people in all stages of dementia, and we should all have much higher expectations of the quality of life that can be experienced by people with dementia in care homes.

Recognising high-quality care

Person-centred care

A good care home will follow the principles of person-centred care. This approach aims to see the person with dementia as an individual, rather than focusing on their illness or on abilities they may have lost. Instead of treating the person as a collection of symptoms and behaviours to be controlled, person-centred care considers the whole person, taking into account each individual's unique qualities, abilities, interests, preferences and needs. Person-centred care also means treating residents with dementia with dignity and respect.

Care homes that follow the philosophy of person-centred care aim to bring out the best in the people with dementia who live there. Each home has its own written philosophy, or mission statement, based on this concept. This should influence every aspect of the life of the home, and makes it possible to measure how well the home is living up to its standards at any time.

It is important that you ask managers quite specific questions in relation to their philosophy to get a real sense of whether they are putting the vision into practice. A good way of finding out about a manager's understanding of dementia, for example, might be to ask what approach they would take if a resident continually asked to go home or wanted their mother. A 'good' answer would be one which recognises the emotional needs of insecurity and loss and an attempt to respond to these needs.

Respecting the individual

Each person with dementia living in a care home should have his or her own individual care plan. The care plan should summarise how staff can encourage and maintain the unique strengths of the person with dementia while meeting his or her needs for support. This plan should be reviewed at regular intervals.

Staff at all levels should have received training in how to care for people with dementia. This will enable them to understand the difficulties in communication that a person with dementia may face, and to help them express their wishes and needs.

Personal dignity and privacy should be respected at all times. Individual cultural or religious beliefs should also be taken into account. For example, staff should address the person with dementia in whichever way the person prefers, whether by their first name or more formally. However advanced the state of the person's dementia, the person should be treated as an adult and with courtesy at all times.

People with dementia have the right to expect those caring for them to try to understand how they feel and to make time to offer support rather than ignoring or humouring them. Staff should sit and chat to residents while they are helping them with physical tasks such as washing and dressing. One member of staff should have particular responsibility for the care of each person with dementia. This staff member should have a clear idea of that person's life history, routines and interests.

For more information, see the Factsheet 524, Understanding and respecting the person with dementia, and Factsheet 500, Communicating.

The right to choose

People don't lose their right to take part in decisions about their lives just because they have dementia, or because they have moved into a care home. They should be included in plans and decisions about their care, and helped and supported to make choices. Whether it is choosing food, clothes or activities, their likes and dislikes should be fully taken into account. If the person with dementia can do particular things for themselves, they should be encouraged to continue to do so.

The Mental Capacity Act, which came into effect during 2007, says that all adults have the right to make decisions for themselves unless it can be shown that they are unable to make them, and that everyone should be given appropriate help and support to make a decision. Any actions or decisions taken on behalf of someone who does not have the capacity to make decisions for themselves must be in their best interests. The Mental Capacity Act should underpin everything that health and social care professionals do when working with a person with dementia. (See Factsheet 460, Mental Capacity Act 2005.)

A meaningful life

Care staff should show a sensitive approach to helping people with dementia maintain a good level of personal care and ensuring that they get enough to eat and drink.

Whilst many care homes will have some structured group activities during the week which may or may not be of interest, this should not be the whole picture. The starting point for leading a meaningful life will be ensuring that a person's preferred activities are integrated into the care plan. This might include details of favourite radio or television channels, where and when a person likes to go out, whether they like an alcoholic drink in the evening etc.

You may want to ask about the activities programme in the home, but it is also important to ask specific questions in relation to the person who is going to be living in the home, for example 'I like to do my shopping in Marks and Spencers - can I continue to do this?' or 'my father is a keen cricket fan, what are the ways in which he could be helped to keep up this interest if he lived here?' The answers to these questions will give you a good indicator of the home manager's willingness to respond to individual needs.

The care team should create opportunities for residents to spend time together and get to know each other through a wide variety of social opportunities.

People with dementia should also be encouraged to maintain relationships with people outside the care home. Just because a person has entered a care environment, this should not mean the end of many of the familiar routines which have helped shape the person's day.

The physical environment

The environment of the home should be as comfortable and homely as possible. A smart hotel-style environment might impress a visitor initially, but remember that it is going to be a place to live. People with dementia often need to have things to stimulate their interest and so an overly tidy environment is not helpful. A home with pictures and objects on tables, and with opportunities for residents to do household tasks such as dusting or folding towels, will give you an indication that residents are welcome to get involved in the community of the home.

Spaces should be clearly signed and laid out to minimise any of the confusion or distress that people with dementia may sometimes feel. Residents should also be able to spend meaningful time outdoors. Residents with dementia who don't live on the ground floor might not have easy access to the outside, which is not ideal. Regular exercise, fresh air and natural light are important for a person's well-being.

Staying in touch

There should always be a member of staff available to talk to friends or relatives of the person with dementia about any worries they have. Staff, in turn, should be supported at all times by the care home manager, who should see relatives and close friends as allies in their attempt to offer the highest level of care possible.

What should I do if things go wrong?

Not every care home will live up to every aspect of person-centred care all the time. Staff may adopt a patronising or degrading attitude, and in some homes, people with dementia may even be vulnerable to physical or psychological abuse or general neglect.

In these situations, the person with dementia may not be willing or able to complain - either because it is difficult for them to 'make a fuss' or because they are afraid of being victimised.

Relatives or friends of the person with dementia may have general or specific concerns about the level of care provided. Any home that is doing its best to provide good quality care has nothing to fear from a complaint. Instead, it should see it as a positive opportunity to improve.

Voicing concern

Anyone who wants to raise a concern should initially hold a private meeting with the care home manager or another senior member of staff, letting them know that they have a serious matter to report. A constructive suggestion for how things could be improved may help prevent a repetition of the problem. If the outcome of this meeting is not satisfactory, the person should ask for a copy of the home's complaints procedure and then decide whether or not to register a formal complaint.

All care homes must be legally registered. This means that they must have a simple, clear and accessible complaints procedure. The procedure should set out the stages and timescales for the process. Complaints should be dealt with promptly and effectively, within a maximum of 28 days. A good complaints process will not only investigate what happened on a particular occasion but will also identify weaknesses in the overall processes of care and make sure that the same situations or mistakes do not keep occurring. The home should keep a record of all complaints, which should include details of investigations and any action taken.

If you have been throught the care home's complaints procedure and have not come to a resolution, you can take the complaint to the Local Government Ombudsman (see 'Useful organisations'). From October 2010, the Local Government Ombudsman can provide an independent complaints review service for people who are funding their own care, as well as people whose care is paid for by the local authority.

For details of Alzheimer's Society services in your area, visit alzheimers.org.uk/localinfo
For information about a wide range of dementia-related topics, visit alzheimers.org.uk/factsheets

Useful organisations

Action on Elder Abuse

Astral House
PO Box 60001
Streatham SW16 9BY
T 0808 808 8141 (helpline)
E enquiries@elderabuse.org.uk
W www.elderabuse.org.uk

Alzheimer's Society

Devon House
58 St Katharine's Way
London E1W 1LB
T 020 7423 3500
   0845 3000 336 (helpline)
E info@alzheimers.org.uk
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.

Care and Social Services Inspectorate Wales (CSSIW)

Cathays Park
Cardiff CF10 3NQ
T 01443 848450
E cssiw@wales.gsi.gov.uk
W www.cssiw.org.uk

Supports the improvement of care, early years and social services in Wales by raising standards, improving the quality of services, promoting best practice, and through regulation, inspection and development.

Care Quality Commission

National Correspondence
Citygate
Gallowgate
Newcastle upon Tyne NE1 4WH
T 03000 616161
E enquiries@cqc.org.uk
W www.cqc.org.uk

Regulates, inspects and reviews all adult social care services in the public, private and voluntary sectors in England. Formerly the Commission for Social Care Inspection (CSCI).

Local Government Ombudsman

PO Box 4771
Coventry  CV4 0EH
T 0300 061 0614
E advice@lgo.org.uk
W www.lgo.org.uk

Independent organisation that investigates complaints about councils and care providers and looks for a resolution.

NAPA (National Association for Providers of Activities for Older People)

Bondway Commercial Centre
Unit 5.12, 5th Floor
71 Bondway
London SW8 1SQ
T 020 7078 9375
E info@napa-activities.co.uk
W napa-activities.co.uk

Promotes the importance of activity, particularly in care homes. Provides regular newsletters and guides to encourage good practice in this area. 

Further reading

Alzheimer's Society (2008) 'Home from home: a report highlighting opportunities for improving standards of dementia care in care homes'. London: Alzheimer's Society.

Counsel and Care (2007) Your care home - is it up to standard?. London: Counsel and Care.
Department for Constitutional Affairs (2007) Making decisions: a guide for family, friends and other unpaid carers. London: Department for Constitutional Affairs.

Sheard, D (2007) Being, an approach to life and dementia. London: Alzheimer's Society and Dementia Care Matters.

NAPA (2010) Activity at the heart of care - A guide for residents and A guide for relatives and friends. London: NAPA.

Factsheet 451

Last updated: November 2010
Last reviewed: November 2010
Next review due: November 2012

Reviewed by: Sally Knocker, Director of Communications, NAPA