7. Things to think about when visiting care homes
Spend some time looking around 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.
First impressions are often an important clue as 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?
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 around?
- Are they encouraged to do as much for themselves as they can - and if so, can you see any examples of this?
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 park or a pub within walking distance, for residents who enjoy going out?
- Is there much noise from traffic, or anything else?
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?
- Can residents have a single room?
- Are residents encouraged to bring in some of their own furniture and possessions?
- Are the bedrooms 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?
- Is there somewhere for visitors to sit in the room?
- Is there adequate storage space?
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?
- Are chairs arranged in groups to encourage socialising, 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?
- Are special diets catered for, and are residents' likes and dislikes taken into account?
- Is a choice of food offered at mealtimes? Can you see the current menu?
- 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?
- What happens if residents are unwell or need medication?
- Which doctors can residents see?
- Does the home have access to other services, such as community mental health teams, chiropodists, opticians and dentists?
- Can a relative stay overnight if a resident is unwell?
- What happens if residents need help with taking medication?
- Are changes in medication discussed with the family carers?
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?
- Can visitors make a drink for themselves and the resident?
- Are children made to feel at home?
- Is information readily shared with families? How is this done?
- Are families supported to become involved in the life of the home - for example, is there a relatives group?
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?
Security and safety
- What safety and security measures are in place to keep residents safe?
- What measures are taken to reduce the risk of falls?
- What call systems are in place if the person needs help?
End of life care
- What options are available for end of life care?
- What support or care is given to family or other carers?
If the person with dementia comes from a different background or culture from most other residents, you might enquire about how their needs could be 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?
- Do staff speak the resident's language?
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?
- How do they learn 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? How can they be contacted?
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 before a resident moves into the home?
- Does each resident have a care plan? How regularly are their needs reviewed?
- Is the family carer consulted about the care plan and about any proposed changes to it?
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.