Not all care homes are the same – spending some time considering your options will help you choose a good one.
Moving into a care home will always involve some degree of upheaval. But thinking about what you or an elderly relative wants or needs – and what’s available – before a move is necessary, will help make going into a home a positive choice, and not a decision made under pressure.
Use this guide to explore the options.
Which type of Home?
First of all you need to decide which type of home might be best.
Residential Care Homes
These are for people who find it hard to manage alone and need help with “personal care” – washing, bathing, dressing and going to the toilet.
Some, but not all, residential care homes can cope with people who are incontinent. And, although they will provide help for residents who fall ill, they can’t usually give long term, full nursing care.
Residential care homes are run either by local authority social services departments, individuals or companies on a commercial basis or voluntary groups.
These are for people who also need skilled nursing care, and cannot be cared for in the community by their GP or district nurses. Qualified nursing staff are available 24 hours a day.
There are some health authority (NHS) nursing homes, but most are run privately or by voluntary organisations.
Some homes can offer both types of care. The main advantage of these is that you won’t have to move if your nursing needs increase. However, it’s important to find out how the home defines “nursing care” as this may mean paying a higher fee.
Homes of all types vary in what they offer and it is important to be clear about what level of care is included in the fees, how they could increase and what services may be extra.
Where to start..
If you – or a relative – need residential or nursing care, first think carefully about how much money you have and what you can afford. If you can pay your fees yourself to begin with, but can’t be sure how long your money will last, it’s sensible to get your local social services department to carry out an assessment of your (or your relative’s) needs first.
This is because if you need help with the fees later on, the local authority can do so only if it has assessed you, or your relative, as needing residential or nursing care.
Although you may be able to get reassessed, it’s better to get it done sooner rather than later. And by contacting the local authority before you move, you can get an idea of how much financial help you could get which could affect your choice of care home.
If you’re in hospital and need continuing medical care which the hospital cannot provide, the Area Health Authority can arrange placement in a nursing home.
You will not be charged fees while you remain a patient of the NHS (though any benefits and state pension will be affected after a time).
If you fall outside this category, you should not be discharged from hospital into a home before a full assessment of needs has been carried out and the financial implications thoroughly considered.
- For a list of residential care homes, contact the local authority social services department (for both local authority-run homes and registered private and voluntary homes)
- For nursing homes, contact the Area Health Authority Registration Officer for Nursing Homes.
- For more information, contact the local Community Health Council.
- You can then contact the homes directly yourself.
Moving into a residential care or nursing home can be stressful.
Use our checks to make the change easier.
- Most care homes have brochures which give details about the facilities, number of rooms and scale of fees, as well as outlining the home’s aims and objectives.
- Ask if there is a waiting list and how long the average waiting time is. Some offer a trial stay of a month or so. But don’t rely on brochures alone – visit the home and see if the residents seem happy and well cared for.
- Talk to the person in charge, staff and residents and, if possible, residents’ relatives for their views on the home.
Care Home Checklist
When you go to visit a home prepare yourself with a list of things to check, starting with:
- The location – See if it’s convenient for shops and transport .
- The fees – Make sure you’re clear about the fees, and what they include.
- Find out whether you get a care plan giving details of the sort of care you will get.
- Ask about extra charges for example, care if you fall ill, chiropody, physiotherapy, incontinence pads or sheets, and toiletries.
- Ask whether there is insurance for your possessions, or whether you have to arrange your own cover.
- Ask how often fees can be raised.
- Ask about what happens if you become ill.
- Find out which GPs attend the home and whether you can keep your own GP.
- Check what arrangements are if you go into hospital or on holiday.
- Also check what happens if a resident dies – how long fees have to go on being paid and what arrangements are made for funerals.
Check first that the home has a written contract with residents. If the local authority arranges a place for you, it will have a contract with the home. Any contract should cover fees, facilities, services and level of care provided and the complaints procedure.
See whether it covers reasons you could be asked to leave – for example, because your health has deteriorated and the home can no longer provide suitable care.
Check how much notice you have to give if you want to leave.
You may want to get advice from a Citizens Advice Bureau or solicitor before signing a contract.
Ask about staffing levels
How many staff there are on duty during the day and night?
What is the ratio of staff to residents overall?
Find out whether staff are trained to deal with particular conditions, dementia for example.
See how staff treat residents, and if they’re pleasant and respectful.
- Look around the buildings and grounds and see if they’re well maintained and cared for
- Inside, make sure the home looks and smells clean
- See if there is good access for wheelchairs etc., look for difficult steps and check whether there’s a lift.
- A garden or area for sitting outside is important, make sure it’s easy to get to.
- Check how much privacy you will have. If you’ll have to share a room, find out whether you have a say about who you share with.
- If there are commodes in shared rooms make sure there are screens or curtains around them.
- Ask about emergency arrangements – see if each room has an alarm within easy reach.
- Some homes give you more freedom than others. Ask how much of your own furniture ad possessions you can bring with you and whether the room can be decorated to personal taste.
- Check also the home’s policy on keeping pets.
- Find out how many communal rooms there are, and what they are used for (for example, whether there are separate rooms for television, sitting, reading and dining).
- Find out if (or where) smoking is allowed
- Look at toilets and bathrooms to see if they are equipped with handles and helpful aids.
Organisation of the Home
Some homes have a more structured routine than others.
- Find out if you can get up and go to bed, and have a bath or shower, when you want.
- Find out also how flexible the home is about menus and mealtimes.
- Ask to see a sample menu.
- Ask if they cater for the individual’s dietary needs.
- Check on visitors arrangements. See if visitors can stay for a meal or overnight.
Some homes organise leisure activities or shopping trips.
- Find out what sort of activities are offered and how much say you have in what is organised..
Other Downloadable Fact Sheets available from this website:
Thanks to the Scottish Huntington’s Association for permission to reprint this fact sheet
An excellent resource for Care Home advice is at the