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How much should we expect from a care home? - Carers UK Forum

How much should we expect from a care home?

Share your ideas about the practical side of caring.
61 posts
My father (83) moved into a residential care home last July. He has middle stage dementia, is an alcoholic and needs a frame to walk more than a few steps.

On the whole, we've been really pleased with the care home, the staff are nice and Dad always says they look after him well, but there are some ongoing issues which are bothering me. I don't know if I'm being unreasonable in my expectations and I'm unsure what standard of care we should expect, so I thought I'd canvass some opinions from other members.

Ongoing Issues
  • His wallet (including cash) keeps ending up in the wash. A minor annoyance in some ways, and most of the cash turns up eventually, but surely it's not that hard to empty his pockets before putting them in the laundry?
    Hand nails were not cut for weeks on end and were filthy. I've done them myself a couple of times but surely this is something they should be doing? I've flagged this up quite recently and said I know the staff are very busy but ideally I'd like them done weekly, after his bath.
    He's always in his room when I visit, usually just lying on the bed, looking bored. I'm concerned they're taking the easy way out by not drawing him into the activities in the day room.
    His TV is never on when I visit. I know he can't operate the remote control himself, but as he's spending so much time in his room I wish they'd at least leave it on the BBC news channel to take the edge off his boredom.
    He's losing weight and not eating many proper meals. Dad has a fixed idea that dinner should be eaten at 7pm, and has never eaten a hot meal at lunchtime. This was discussed before he entered the home, and the owner advised me that although most of the residents eat their main meal at lunchtime, Dad could have his in the evening. However, it transpires that the chef only works lunchtime and no proper cooking takes place in the evenings. So, the carers just heat up his meal in the microwave, but truth be told the meals don't look very appetising, the microwave is filthy and they don't bother to cover the plate when they reheat the meals.
Maybe he's also losing weight as they've reduced his beer intake, so he's having less calories. When he lived at home he subsisted mainly on tea and biscuits, plus 4 cans of strong beer a day and whatever I could get him to eat (mostly soup, sometimes a curry). Now they are just giving him 1 or 2 cans each evening, and trying to increase his food intake, but it's just not working.

I've told them I'd rather he has a 3rd can each night, if only to add some calories, but I'm not sure they'll listen. (We buy his beer and have it delivered.) I don't know how much to push all of this stuff - am I being unreasonable to want these things sorted?

The food issues bother me most. For instance, this evening they warmed up a meal of liver and bacon, with veg and mashed potato, all covered in gravy. Dad doesn't like gravy much anyway, and the veg was all mushy - it all looked a bit of a mess so I'm not surprised he barely touched it. They bought his pudding out at the same time - apple crumble and custard, but by the time he'd had some dinner the pudding was cold. So, I went off to reheat it, thinking - why don't they bring the pudding once he's finished his dinner? His pudding must be cold every night! I took it off to the microwave myself, which is when I found the filthy microwave.

I feel I need to have a meeting with the care home manager, but I wonder if I'm just expecting too much? What do you think?
Hmm, how much does this place cost? Is he self-paying, or is the council paying?

I could say glibly and utterly unhelpfully, well, you get what you pay for and you don't get what you don't pay for, but the real issue is: is your dad getting value for money? ie, is all the fees paid for him actually going to his care, or are they going into the profit margins of the owners, and are the owners driving around in a Ferrari on your dad's fees, while hiring far too few staff and then paying them a pittance....

On the other hand, if his fees are going where they should be, and they are 'only' paying for what he is currently paying for, then I suppose he's not going to get more out of the place than that??

But, how does one know which is which?!

On the food front - I'm going to a bit 'harsh' here, but although your dad doesn't like lunch, he likes dinner in the evenings, from a health point of view isn't it better he eats properly at least once a day, and if that means 'giving in' and saying 'lunch is the main meal' then that would be better than what is happening now? It could be that if he isn't given much of a dinner in the evening, only what the other residents have, that his hunger cues will kick in (I appreciate alcohol screws those up anyway) and he'll be ready for a good meal at lunchtime after all? If the place employs a chef etc, you might as well get the value of that!

The TV thing is a pain in the neck, as I do wish the manufacturers would invent a TV that had simple remotes, ideally one you could set up to 'favourite chanel's, that just had a single 'change' button on them, and the elderly person could hit it round and round until their current best channel came up. Right now, as I type, I know I have to go downstairs and change the channel for Granny, as she is staring at Channel 4 which did have somethign on she likes (Frasier) and now doesn't.....but she won't or can't change it.

Sorry not to bemore helpful, not having any experience of care homes. But I shall be reading the replies from those who do with great interest, as, who knows, one day I may be in your position.

Good luck! Jenny.
Jenny,

It's costing £625 a week. So, not top rate by any means, but he's self funding. I'll be applying for funding quite soon when his savings drop below the threshold.

The home is privately owned by a very likeable Asian man, who told me that part of the reason he went into the business was because he was shocked at how badly elderly people are treated in the UK. He bought an old house and extended it radically and has been having ongoing work done, such as adding en suite facilities to more bedrooms. He doesn't drive a flashy car, he says he's not making a huge profit yet, he's ploughing money back into the place.

The carers have a warm, friendly attitude and on the whole the place seems clean, so maybe I shouldn't worry too much about a grubby microwave. I don't think they're paid much as I was told that if I wanted one to accompany him to hospital appointments they'd charge £7.50 an hour. Part of me understands why if they found a couple of tenners in a pile of washing they'd be tempted to keep it.

Yes, ideally he should enjoy freshly cooked meals each lunch time but they've been coaxing him for months to eat lunch but he is so stubborn I just don't think it will happen. I don't want to nit pick, but although I only visit once or twice a week, on every visit I discover more issues. I saw his care plan briefly, but wasn't given a copy. I think I will ask for a copy and go through it in detail with the manager, to get a few things added. Most of what I'm concerned about wouldn't take a huge amount of time or effort.

I'm considering supplying his food and asking them for a discount. Sounds drastic I know, and shouldn't be necessary, but he's going downhill as he's effectively being served what, to him, looks like leftover slops as he's never liked "pappy"/mushy food. The only meals I've seen him enjoy there are bowls of soup (tinned) with bread - nothing special but more appealing to him than leftovers. I gave them a list of his likes/dislikes when he moved in, but they don't seem to have taken any notice of it and I think I need to get this sorted. He doesn't have a lot going for him and I just want him to have palatable food and enough beer to keep him happy, plus someone putting his TV onto a suitable channel. I don't think that's asking too much.

PS (5.20pm): Just had a visit to the home and meeting with the manager. Had quite a helpful chat and am hopeful things will improve a bit. I mentioned that Dad hasn't seen a dentist for years and his breath smelt a bit stale yesterday (though he'd just woken from a nap so may be nothing). They can arrange for a dentist to visit the care home but it has to be done by referral through the GP and takes ages, so I'm going to take him for a check up myself asap, just in case.

I've asked for a copy of his care plan - I want to get some things added in. Dad really has nobody else to speak up when things go wrong, so I need to pin them down on a few issues.
Hello She Wolf Image

I had issues with food when Mum was in her care home - like your Dad my Mum was used to and preferred her 'main' meal in the evening too. But serving it at lunchtime seems to be usual in care homes, probably because the kitchen staff go off duty once 'tea' has been served (in Mum's case about 5.30pm when the residents got a sandwich and a piece of cake). I used to make sure that she had a small tin of biscuits in her room in case she got 'peckish' during the night - the staff on duty were always willing to make her a cup of tea in the middle of the night if she wanted one to go with them Image The few times I was there at lunchtime I did notice that the quality and quantity of the food served did vary depending on who was on duty in the kitchen ! Mum never did have a big appetite and with the dementia lost 'interest' in food anyway so it was more a case of coaxing her to eat enough - although she could ALWAYS manage a pudding or cake !

I got round the money issue by only leaving her a very small amount of loose change and a £5 note - there was nothing for her to buy there, but as long as she thought she had enough money for bus fare to 'get home' she was happy.

Yes, do have meeting with the home's Manager to go through the care plan. When I saw Mum's I found out that they had her down as a Type 2 Diabetic - she wasn't ! I doubt that they will agree to you supplying his food as this would mean more work for the kitchen staff to prepare a separate meal for him; and even if they did agree who’s to say that he would actually get it before it ended up in the kitchen’s general supply cupboard or was ‘appropriated’ by a member of staff ?
Susieq:
I got round the money issue by only leaving her a very small amount of loose change and a £5 note - there was nothing for her to buy there, but as long as she thought she had enough money for bus fare to 'get home' she was happy.
That would probably work for most people, but not for Dad at this stage. You see, he keeps demanding £200 cash, because his agenda is]http://www.carersuk.org/images/icon_eek.gif[/img] So, we've compromised by giving him £40 to keep in his wallet, which has gone missing twice. In the scheme of things losing £80 isn't a huge issue, but we don't have a bottomless pit of money and he'd never settle for a few pounds, so I'll just have to lie constantly and say I have no cash on me.

Sussex - thanks, I'll bear that in mind. At the moment it will be just a few tins of various nice quality soups, one or two microwave meals and maybe some crusty rolls now and again (he used to love crusty bread but with 90% of the residents having dentures they never buy it). I'll ask the care home to keep a detailed food diary so we know which things work best. Also, I will try to get his teeth checked next week and sort any teeth problems quickly. Before he lost his driving licence about 3 years ago he used to go for regular check ups but it's something that got overlooked with him lurching from one crisis to another at home.
Quickanswer - don't suppose you could give him counterfeit notes, could you? He might not know the differnce - plus it would really serve the thief right! (You might need to warn the police first, though!!!)
would he accept that his money is being kept in the office safe for safety ?
No Susie, he just wanted a wad of cash in his wallet, where he can see it.

Jenny - tempting idea and crossed my mind too! Image I was tempted to try to do some colour photocopying of notes at work (our machines do double sided copying) but the feeder mechanism can't accommodate such small paper sizes!

Every time he mentions cash now I explain he doesn't need it as the home is like the cruises he used to go on... a cashless society, all inclusive. That's OK, until he starts with "Oh, well can you just fetch me a bottle of whisky then?" Image If only the part of his brain that craves whisky would just die off, instead of the useful bits!
Like your dad, I too prefer to eat in the evening. I can't stomach breakfast, have a snack at dinner, and pile into tea.
It suited me well for years; now I've had to change and I've piled the pounds on. Different people have different needs. At over £600 a week I'd expect my main meal when I wanted it, and BBC too! Not a lot to ask for in the grand scheme of things. Especially given that the manager made a fuss about how awful old people are treated. He should put his money where his mouth is, and let your dad eat when he wants to. I'd hate to be deprived of my main meal if I were paying £600+... tea!
Sajehar,

I can see where you're coming from - where does all that money go? I've estimated that half if it goes on the wages bill, then there are loads of other overheads - gas, water, council tax, etc. The home probably has to pay for some kind of licence and the H&S regulations are a nightmare. There is probably a large mortgage and the ongoing building work/alterations must be costing a fortune, so I doubt the owner is making a large profit at this stage, but a few years down the line he might well do very nicely.

If you compare the costs to hotel prices, think about what it would cost you to stay in a hotel, full board, all year round, including laundry services. Then factor in having someone to assist with washing/bathing/dressing, with a staff/resident ratio of something like 1:4 and help on hand 24/7. I think you'd be hard pushed to find that sort of deal in England for much less. So, that's why I think the fee isn't extortionate, even though it seems a lot when you compare it to the cost of living in your own home. I just need to push the care home a bit to get the best I can for Dad, but it shouldn't mean drastic costs for them.
61 posts