What to consider when choosing a care home

If you need to find a care home for your loved one you might be feeling daunted and confused by the choice. Knowing the basic information, can help you make the right decision

Could this be you?

Your loved one can’t live at home anymore and you know it makes sense for them to move into a care home but:
• You’re confused about which sort of home they’ll need
• How can you trust what they say in their brochures?
• What if you make the wrong choice?

Choosing somewhere for your loved one to live is a massive responsibility – it’s no surprise many carers feel overwhelmed. But with the right information and support you should find it a bit easier.

Types of care homes

Residential care homes
These are staffed with carers who can offer personal care such as washing, dressing and eating, staff might also be trained in dementia care, but not in nursing.

Nursing care homes/EMI
These have to have a qualified nurse on duty 24 hours a day. The term EMI (it stands for Elderly Mentally Infirm) is still sometimes used to describe nursing homes for people with dementia but it is generally considered an outdated term. These days, EMI usually refers to people who have later stage dementia or very complex needs.

But: Some residential care homes have EMI units which can be useful for people with dementia. It’s often reassuring to know that if their condition progresses, the care home will be able to accommodate any extra needs or nursing requirements, rather than the person with dementia having to move again to a different home.

How do you know which type of home to choose?

The good news is you don’t have to make this decision yourself. Every person living with dementia is unique and many have other needs or medical conditions to take into consideration, too, so before you start looking at homes, your loved one needs to be assessed by a nurse who will decide whether they need nursing care or residential care.

The assessment should happen in your own home. It’s quite detailed and often takes several visits to complete but it will help decide which choice would be best.

Did you know? If you’re told that nursing care is most appropriate for your loved one, they should be entitled to a contribution from the NHS towards their nursing care. This is called Registered Nursing Care Contribution.

Visiting care homes

Once you’ve established the type of care home you’re looking for, get a list of potential homes in your area from the Care Quality Commission.

Tip: Read the home’s most recent inspection report too – it should be available online.

Tip: Treat each visit as if you’re looking for a new home and choosing a good school for your children – at the same time. After all, you aren’t only looking for the perfect building and location, but for warm, caring staff to look after someone you love and who may, in many respects, be as vulnerable as a child.

Tip: If you feel nervous, make a list of questions you might want to ask (we’ve listed a few below but you can probably think of plenty others) and take a good friend with you for moral support.
It’s probably best not to take the person with dementia to an initial visit, just in case the home itself is disappointing and puts them off the idea of moving completely.

Four questions to ask yourself

Is it homely?
A care home that looks like a posh hotel might impress you – but you aren’t the one who will be living there! So ask yourself what the person with dementia would think of it. If the furnishings are shiny, new and modern, will they really feel at home? Or would they prefer a place that reminds them more of their own home now?

How does it smell?
There’s no reason for a care home to have an unpleasant smell. Even if residents are incontinent, good quality care should be able to address any odour problems. If you can smell a home cooked meal, or cake baking on the other hand, that’s a good sign…

What are the residents doing?
Is there plenty going on? Organised activities can be a great source of stimulation and a way for people with dementia to socialise. But watch out for other activities as well. For example, if you see a resident dusting or folding clothes that’s a sign they’ve been given a meaningful activity which gives them a sense of purpose.

Tip: Don’t be put off if a few residents seem to be dozing in a chair – an afternoon nap may be part of their care plan.

How are residents dressed?
Do they seem dishevelled, or nicely dressed? Are they clean shaven, does their hair look tidy or unkempt? Are their fingernails clean and trimmed? These are all indications that the people who live in the care home are treated with dignity and respect. Don't be afraid to ask how often residents receive a bath or shower.

Six questions to ask the manager/staff

1. How do they get to know new residents?
The more detailed their answer, the more likely it is that they are genuinely interested in giving person-centred care. You could test this further by asking, for example, if your loved one can be escorted to church every Sunday to practise their faith or if the fact that they enjoy a sherry every evening before dinner will be written into their care plan.

2. What would they do if a resident keeps asking to go home?
If their answer is thoughtful and includes references to looking ‘beyond’ what they’re saying and helping them to feel calm, there’s a good change they really understand person-centred care.

3. Can residents go into the garden whenever they want?
Some care homes have beautiful gardens but residents are only allowed outside if there are enough staff to escort them.

4. What is their policy on anti-psychotic medication use?
Sometimes they are prescribed less to calm residents and more because there aren't enough staff members and they use them to make life easier.

5. Can they bring their own furniture and a pet if they have one?
Some care homes do allow pets, but not all and most will try their best to accommodate some personal furniture to make your loved one feel really at home.

6. Can we decorate their bedroom?
Some homes will allow you to this and it could really help someone with dementia to settle, especially if you can find a wallpaper or paint colour they’re really familiar with (perhaps one they have in their own home).

Like what you see?

• Take the person with dementia to see the home and ask any other friends or relatives, whose opinion you’d value, to visit, too.
• Drop in again – this time unannounced and at a different time of day if possible. Staff should still welcome you if they have nothing to hide.
• Take advice before signing any contract with the home. You don’t have to pay, you could just take it to your local Citizen’s Advice Bureau and ask them to look over it.