Viewing Care Home - Questions to Ask?

Share information, support and advice on all aspects of caring.
Hi All,

We are visiting nursing home with MIL tomorrow. She will be totally overwhelmed and probably not know what to ask, and its a whole new experience for us too. Anyone suggest things we need to know/ask about? I have already jotted down a couple of things, but would welcome any comments from those who have been through this to prompt us. Mum wants to know whether she can take her own furniture (depends on size of room offered I guess) and if there is a hairdressing service (she has her own mobile one at home and she could probably still visit if home don't have one). I am sure there are much more serious and pertinent questions we should be asking, so any suggestions welcome.

Thanks
One of the things you need to check out is if the home also offer nursing care - some homes are only suitable long term for those who are reasonably mobile and if your MiL's needs increase to the point where she does need nursing care then you wouldn't want to be having to move her at a later date.

When you do visit take a moment to register if there are any 'unpleasant' smells (i.e. urine !); try to engage some of the other residents and visiting family in conversation to get their views on the home and staff. Is the home clean and well maintained ? What is the ratio of staff to resident - especially at night time. What activities/entertainment do they offer ?

You can download this useful guide from the Age UK website
http://www.ageuk.org.uk/Documents/EN-GB ... ?dtrk=true
Have you drawn up a short list for mum, visited the homes concerned first?
I used to have a job which involved helping elderly people to find a care home. It's so much easier than you would think. Just ask yourself if you would be happy there, if you were in mum's situation?
As Susie says, make sure it is somewhere which also has a nursing section, so that mum will never have to move again.
I take it dementia is not in the picture from what you say?

If it is, however, then the care home will want to assess your MIL in some way. For example, at the home my MIL moved into we went to visit 'for tea' (I'd already visited on my own and liked it a lot - see below), the care manager ushered us into the lounge, and tea was 'served'. She 'chatted away' with MIL (having kicked me under the table not to answer for her!!!! :) )(which I'd got very used to doing!). Afterwards she took me aside and said 'She's got substantial dementia - she can't tell me the names of her sons, etc, BUT she has retained good social skills. I deliberately, for example, offered her the teacup with the handle turned aside, and she automatically turned it the right way and drank from it nicely and put it back on the saucer correctly'....(those 'social skills' are still with her, several years later, even though she is now almost totally non-verbal)

If dementia IS in the picture then one question you will need to ask is whether the home is 'secure'.

The home I mentioned above wasn't - the front door could be opened from the inside, and residents could, if they wanted, come and go. (It was rural, but they could get to the lane down the drive if they were really 'driven'....and my MIL was!)

Dementia can bring on 'wandering'....either random, they simply 'wander off' or, in the case of my MIL they were trying to 'escape'. They knew they didn't want to be in the home, they wanted to 'get home' (ie, to me, sigh)..

Because the home wasn't officially a 'secure' home, she had to leave - they were constantly heading her away from the front door, and once she managed to get out and had to be brought back in, including she was hitting out at the staff member who had taken her arm (my MIL is very strong willed!!!!!)

So, that's a grim question, but an essential one, if dementia is in the frame - is the home secure or is there a secure unit? (My MIL was moved to another home, with a secure unit - the lift had a code, as did all the doors - no escape....awful, but necessary)(ironically, she is now non-mobile, and so can go into the much nicer non-secure unit - hurrah!).

If your MIL does not have dementia, then I would be wary of choosing a home, however nice, where there are any/a lot of resdients with dementia. After all, who would want to be surrounded by people with dementia? That said, I know that some of the residents without dementia were very 'caring' of my MIL, which was nice (for my MIL). But I doubt I would want, if old and infirm physically, to be surrounded by people I could not really communicate with in any way.

Whether or not dementia is in the frame, I would say that discussing what entertainment is on hand is vital. The non-secure home had a very active programme, partly by the staff and partly by volunteers (eg, from the local chapel), so when you went in after lunch there was always 'something going on'.

However, the evenigns could be dull dull dull. They eat 'tea' early (so the kitchen staff can go home!) and then there is just TV really, or for those without dementia, a lounge to chat in (play board games etc) - there is little staff interaction other than cups of tea and biscuits etc.

Both my MIL's homes had a hair salon, and this was a firm favourite, so definitely worth checking.

The non-secure home had glorious countryside views right out to the coast - I used to praise them every time I visited, BUT, to my MIL with dementia, they were completely irrelevant. She was oblivious to it!

Re furniture - both the homes encourage 'own furniture', though usually only chair/little tables/knick nacks - not the bed itself (which might need to be high sided etc etc). ALL personal items have to be labelled!! One of a pair of lamps went missing for a while. (Clothes ALL have to be labelled!). They tend not to encourage jewellery, expensive things, re loss (or even theft - often just by those with dementia 'wandering in' I suppose, hopefully not staff!).

They DO encourage 'own TVs' (Unless they supply 'fixed' TVs, like in a hotel room - depends on the severity of the condition of the resident). They like residents to have their own TV mainly because it's the only one they will know how to use the remote control on!!!!!!! (which says more about the damn remote controls than about the elderly!).

As for food, the 'main meal' will nearly always be lunch, because they want to serve an early 'high tea' about 4-5, so the staff can go home. They may feel under pressure to serve 'balanced meals', eg, with a lot of vegetables (to pass the CQC tick marks!), which can be ironic since so many elderly 'wont eat greens' (my MIL just would not!). You may think differently, but personally I think if you reach your 80s and don't want greens any more, hell, you don't have to eat them!!!!! Most very elderly people just like 'sweet carbs' - puddings pudding puddings!!!! They don't need much 'fuel' as they don't do much. I say let them eat what they enjoy, and be done with it!

Sadly, I agree with Susie about the 'smell'. The secure unit did NOT 'smell fresh'....they were clearly doing their best (strong smell of disinfectant etc) but the grim truth is that double incontinence is on the hideous list of dementia symptoms, and there it is.The only 'blessing' is that they don't know about it. If my poor MIL had known she'd end up in nappies....horrible horrible horrible.

In the end, the overriding thing to want in a care home is NOT the physical surroundings maybe (at least, not for those with dementia, as they will cease to notice them at some point) but the attitude and kindness of the care workers. A 'five star home' is nothing without good staff.
Thanks for replies and advice.

It is a nursing home as being referred direct from hospital and there are only 2 suitable places in our immediate area which offer this. She has flatly refused to even consider visiting the other one so our options are limited. I have already read the last 2 CQC inspection reports and on paper it sounds great, no concerns, no smells, excellent care, plenty of staff and real home from home environment. Mum has no dementia issues, mind is very good for her age, just body giving up :(

As she is very resistant to going into care its going to be quite an emotional day anyway, and even if we are over the moon with the place, convincing her will be the hardest part.
Glad there is no dementia in the picture - that always helps!

I do understand why she hates the idea of moving into a care home - wouldn't we all hate it? However, needs must, as she is accepting, alb eit reluctantly.

Can you I wonder offer her what I did with my MIL when she first went into care, which was (her dementia wasn't too bad) to have her back to me for 'sleepovers'. I did it twice a week, but it could be done, say, over weekends etc.

Not necessarily every weekend, but enough to give her some 'home life' maybe? It may depend on your circumstances of course, and what has happened to her 'old home'.


I think if one could see care homes as something for 'weekly boarders' maybe, they are less scary??
The problem we have is she is adamant she wants to go home, and after being in hospital nearly 4 months now, giving the taster of home would be counter productive as would be showing her what she has lost and make her even more determined not to go into care. Her bungalow would need to be sold, or put on deferred payment with the council to cover her fees anyway.

We only have a tiny cottage, no room for bed downstairs and narrow doors which wouldn't accommodate mobile hoist or wheelchair. Would love to say we could take turns spending night with her at her place and have her home again, but its not really realistic as we both work and its only us nearby to be able to support her. Looked into overnight carers (who are few and far between here) and the nursing home would actually be cheaper!
Has she had her NHS Continuing Healthcare Assessment? If this was granted (a postcode lottery to some extent) all care would be totally free, either in her own home, or in a nursing home. At least get a checklist done before making any decisions.
Lesley Anne,

I would blame the doctor for not "allowing" her to go home. Could she be convinced to try the home for "convalescence"? That was the way I got my mum through the door and once there, avoided all mention of going home. In my mum's case, it was, in a sense, easier as she had dementia so "home" was the home she had about 60 years ago.

In addition to the useful checklist above, I would hang around the car park of the home around the main visiting time and ask relatives how they find the home. I got a lot of useful anecdotal evidence that way. Also, visit the homes at different times of the day without making an appointment may give you a feel. Some homes feel very different at weekends from weekdays for example.

I would also ask about end of life care. Some "posher" homes are very good at providing hairdressers and less good at caring for seriously ill people.

Good luck, a very emotional time for you. but ask away if you have questions, many of us have gone through the experience.

Anne x
Hi Lesley Anne
My husband is in a nursing home because of strokes and vascular dementia. When he went into the home he thought it was convalescence. Sadly he has forgotten our home now, and gave his address as his childhood home. He sometimes thinks he is in a hotel, sometimes a hospital, all sorts. I go along with it.
His needs were more important than what I and my family wanted. Maybe if you can think in those terms, NEEDS not WANTS, it will ease the journey. I won't pretend it's easy, because it's not. However,he is being cared for, something that is impossible for me to do. I love my husband very much, and miss the ' old him' dreadfully.
You are important too, please don't lose sight of that.
Hoping my take on the situation helps.