care homes 101

As this place is the font of all knowledge…

My mum has got to the stage, at 86, that she wants to consider a residential care home. We’re visiting 2 on Thursday, but I have now idea what I should be asking for other than; do they have space, how much and ratio of staff to patient (resident?)

she will be self funding until she reaches the limit at which the council will kick in. How does the funding work once this point is reached?

any advice or experiences from those that have gone through this would be greatly appreciated.

Unless there’s an absolute need for her to be in one then she’s better off at home for as long as possible. Some people who go into care can see their mental state diminish quickly. Care homes are very expensive. Is there an option of her staying at home and having carers coming in to her to assist x times a day?

If no option then look at the CQC reports, speak to other residents when you’re there, speak to family members if see any visiting, ask about the activities etc…last thing you want is her sat in front of tv in the lounge all day.

CQC or Care Inspectorate reports are published and should be your first place to look. Advice above is spot on, what do they do other than care? Do they employ activities coordinator, do they have a regular programme of different things to do? I worked at regional management level in care homes and I would suggest you trust your instinct and your nose. If a care home smells, it’s not well run. If it smells, walk away.  You can usually tell and feel within 5 mins if a place is run with care, as well as for providing for care.

My mom was 88 when she went from sheltered accommodation into a care home. She suffered a seizure and had been diagnosed with dementia. Upside is the care home is lovely (brand new and only 5 miles away) with fantastic staff and facilities. In the first year she definitely enjoyed things like the little cinema and hair salon, but as she’s gone down hill she’s pretty much bed ridden now. So the “value’ of paying more isn’t worth it, but I wouldn’t move her because it’s about the only certainty she has left.

On that note, she went through all her savings until she hit the limit. It doesn’t take long, the “cheapest” care homes in Herefordshire are £900-£1100 per week and most are more. I don’t know how it works elsewhere but we had to get someone from the council assigned who did an assessment and made a recommendation of how what care she needed and how much the council would fund.

I’m not going to get into on here all the ins and out of that, but it was a stressful and worrying time for all (well not my mum who was fading fast mentally). We ended up with the best outcome that the council funded all the care (after her pension etc), but it was quite a ride to get there. Council to be fair were excellent when we could finally get a case worker. If you want to know more, feel free to drop me a msg.

In terms of staying out of the home, our mum was feeling more and more isolated as she was worried about going out etc, so even if she’d been able to stay, she was ready to go. And that from a very independent woman.

Oh and what frank says- we visited six I think and a few just felt ‘wrong’- just places I wouldn’t want to put anyones parent never mind my own! What swayed it for us was the fact that we really liked the feel of it, the facilities but also that it was close. So – especially when she was more with it – we’d go quite a few times a week. That definitely made a massive difference and I was glad to be able to do it even tho it’s bloody painful…

Staff told us that some people had never had a visitor. That just seems horrible. We used to take one of the dogs as well and all the old people loved them!

Unless there’s an absolute need for her to be in one then she’s better off at home for as long as possible. Some people who go into care can see their mental state diminish quickly

We did the carers coming in each day for my parents and it was expensive (about £1100 pcm for one hour twice a day) and not a particularly good service – the carers never did the full hour and there was little continuity of staff.

My father ended up in a home, straight from hospital after a fall and never came out. It was a nice home but it was a bit pot-luck tbh.

After my father died my mother eventually ended up in a care home. She wasn’t housebound but had poor mobility and had a couple of falls. There’s little point in me recommending it as it’s in Lisbon (but I would recommend it as it’s about a quarter of the cost, very nice, well staffed and warm). However it has been good for her, the social interaction and regular care has really improved her mental and physical health.

I have been and am going through this at the moment with my father

As Houns says, does she really need to be in a home? She is far better off in her own home for as long as possible.

My dad has talked about it but always comes back to wanting to be in his own place, with his own garden and stuff around him. His friends can pop round whenever, he gets decent food via occado etc etc. He has 2 hours care a day, roughly. It costs about 35 an hour and currently has 2 care companies spread over a week.

There are some numbers to crunch around the cost of care at home vs cost of care home. There’s also the issue of organising food/cleaning/maintenance etc but its all doable. I manage everything online

He did get placed in a home after a spate in hospital, to recover after a stroke. He utterly hated it and walked out after 4 days – it’s full of nutters and people in a right state he said! In reality it was an ok ish home, in his village.

There’s some cold facts to think about – life expectancy in a home is circa 3-4 years iirc. There will need to be a decision made about possessions, furniture, all that kind of stuff that is utterly ghastly to think about. Is it easy to get to for her friends etc etc

I worked in care homes a fair bit

Use your nose.  Any stink of wee then its a crap home.  Look at patients footwear – its one thing that gets missed – a good home they will have clean footwear on. any home without a waiting list is probably poor

Staff ratios are set by regulation.  Very few homes will be over or under minimums  ask about agency usage tho to see how much of a recruitment issue they have

the key thing to the quality of the home is the manager.  So interview the manager.

the key thing to the quality of the home is the manager

Working in the industry, this is the primary reason for a home being good/bad/indifferent

General information here: Paying for your own social care (self-funding) – Social care and support guide – NHS (www.nhs.uk)

Unless she has significant wealth, paying for your own care is very expensive (easily +£1000 per week) and a good home is going to want to know that you have the funding in place for your whole stay. Local Authority rates are not commercially viable for most operators, so they dont want you to run out of funding after a few months.

Depends on her reasons for wanting to go into a Care Home?
(as our ex-director said “nobody aspires to go into a Care Home”)

If she is in Eastbourne I can recommend where my mum is.

So many stories I could tell but when my mum first went in she couldn’t move. We arrived unannounced and it said do not disturb on her door. We waited outside and while doing so we could hear the lovely Irish nurse singing to my mum while she was feeding her.

Everyone in that home goes above and beyond.

 will be self funding until she reaches the limit at which the council will kick in. How does the funding work once this point is reached?

important you’re aware that once your mum is at financial threshold the local authority will assess her needs. If they assess that she doesn’t have 24hr care needs they won’t fund. You’ve said that your mums 86 and would like to move into a care home, LA funding is based on need and not choice. As others have said, far better to remain at home for as long as possible and that’s what the LA will encourage.

We managed to keep MIL at home as long as possible with four care visits and a family member most days (she had limited movement and could just about shuffle to the commode or wheel chair). That was until illness landed her in hospital and then mobility deteriorated futher and she wasn’t able to get herself out of a chair and needed hoisting. That meant a nursing home.

MIL didn’t really want to go but there was no way she could stay. We put a charge on the house with the local authority and used the house against care costs until she eventually passed away about 3 to 4 years later.

If they assess that she doesn’t have 24hr care needs they won’t fund. You’ve said that your mums 86 and would like to move into a care home, LA funding is based on need and not choice. As others have said, far better to remain at home for as long as possible and that’s what the LA will encourage.

thats not really how it works around here.  Once care costs at home get to more than a care home fees as paid by the LA then its off to a home for you.  £500 a week ish)  It doesn’t have to be 24 hour care needs tho home care will not cover any night time care usually – so you will be left alone for 12 hours at least overnight.

If two carers are needed for a home visit it gets expensive real quick

I would suggest getting social work involved now so she is on their books

Something similar happened in my family. My parents health had been deteriorating in a number of different ways since before the pandemic. The key thing being that my mum’s physical health was relatively good but her mental health was not alzheimers was the main issue for mum. My dad’s mental health was good but physically he was deteriorating quickly due to asbestosis. Fortunately we had obtained both welfare and financial guardianship, we could see that my dad was no longer able to look after himself never mind anyone else ,care at home just did’nt have the staff so my mum went to a home we had reasonable confidence in, but my dad died in hospital less than 48 hrs later.

So the main points for me is take action early.Have those awkward conversations  It is always tough and only gets tougher as time goes on especially when the roles are reversed and you find yourself explaining to your parents that sensitive decisions  such as where they can die are being taken out of their hands

Thanks all for your thought provoking responses.

This conversation with my mum has started after she’s had a number of falls recently as her leg has steadily become weaker through various complications of trapped nerves and remedies that unfortunately didn’t work to resolve.
She is now apprehensive about any real mobility, even with a zimmer frame, and so wants to be somewhere where there’ll be someone around if needs be.

As the point has been made a few times: stay in the house as long possible (she lives in an Alms house), and certainly agree that care home is not cheap, I think the first step is to arrange a Care Assessment from the local council. This will, I hope, provide some direction rather than a knee jerk reaction which is what it feels like at the moment.

for reference she lives in Suffolk in a small village (with a care home in which she visits a friend regularly) where she has been part of the community for decades… unfortunately I live in West Sussex.

Decent care homes will have a waiting list, however many will take a patient in for respite care, find a home you like and see if your Mum can go in for a week or two to see if it’s for her. If she is already helping out in the local care home I would seriously look into using a home where she is already known by other residents and has a relationship with staff. Will she be happier seeing you for 2 hrs a week or being around people she knows and has friendships with.

They can be scary for new residents as fully of strangers, staff they don’t know, unfortunately many of the residents will have dementia or Alzheimer’s but generally kept separate on different floors, they can be noisy, as someone mentioned on here check residents shoes, also check glasses are they wearing there own.

Check that you are not restricted on visiting times, ensures staff are acting as they should be at all times. All of the staff I encountered are really good but it is very hard work, long hours on minimum wage.

the key thing to the quality of the home is the manager.  So interview the manager.

This is good advice.

I’d also say it’s worth finding somewhere that’s easy and convenient to visit. Even though it’s hard to do, it makes a massive difference if you’re being visited on a daily basis in a care home, even if it’s only a brief pop in.

You will know when you visit, use your nose – literally – what can you smell? Use your ears – are the TV’s all on and very loud, worse still is there a horseshoe of chairs around a single loud TV. Use your eyes – is it clean, tidy and are the residents happy.  Talk to a resident if you can (with similar care needs to your parent). As above interview the manager.

We (my firm) also have developed a care readiness app – https://www.clearlines.co.uk/care-readiness-assessment/ it is in Beta at the moment and is free to use. It might be helpful.

Care assessment is a good step. Also you can maybe get an ot assessment on her house to see if small improvements can be made, a grab rail here, a ramp there etc.

My dad has a stair lift which it sounds like you wouldn’t need but for info for others he rents from a local company. He has an electric bed that raises and some special sitting stools for the kitchen.

He has a personal alarm necklace that is excellent, it has a fall sensor and you can talk through it to the alarm company. It has made a big difference knowing he can always contact someone, if he falls or knocks the pendant they speak to him to check he’s ok

I have power of attorney which is a must really.

Everything does take a while to set up but it’s worth it to be able to manage everything financially, talk to medical staff etc etc. I have cultivated good relationships with neighbours so there is a solid behind the scenes network of support looking out for him and also importantly helping me. I live a long way from him so quick visits aren’t possible.

Looking after elderly relatives can be incredibly stressful so remember to consider yourself in the equation, as well as your own family and relationships.

Looking after elderly relatives can be incredibly stressful so remember to consider yourself in the equation, as well as your own family and relationships.

this

Everyone has their limits.  These limits are different for everyone.  do what you can up to your limit and then stop and be content you have done your best.  Who cares if others do more or less.  If you go beyond your limits you WILL burn out and become resentful and angry.  Be clear about what your limits are.

Very much what tj says. I overdid it and suffered health wise, to the point of needing medication and some counseling.

It’s not the same as being a carer, you can’t walk away at the end of the session and forget about it. Looking after relatives has an omnipresent quality and its important to assert where your boundaries lie should you need too

My counselor described it as trying to find a balance between resentment and guilt!

At this risk of getting back on one of my hobby horses 🙂

Guilt is a negative emotion and really destructive particularly in this context.  Get it out of your mind.  You do what you can to the best of your abilities out of love and because you want to.  Do not feel guilty about reaching your limits and stopping there. Even if that limit is the once a month visit – if that is all you can do then you have done your best and no one can ask for more.

You must be content to be within in your limits.  Its hard but it is the only way

@tjagain

Thank you for these wise words. I’ll hold onto that advice as things inevitably get harder with my dad.

He has dementia and recently moved across the country to be closer to me and my sister, and his grandkids. We are trying to see him often to ensure he is settled and happy, alongside sorting out the mess of his finances, deputyship etc which he is oblivious to.

It really feels as though, if we weren’t seeing him, his mind would decline rapidly. There’s just not enough stimulation in the care home. But we’ve also got to stay within our own limits. Pretty sure that balancing act is going to get harder as time goes on.

Round here there are various supported living options which sound possibly more suitable than a full-on care home. Also massively cheaper.

FiL was lucky in that we found a very good local care home and he had the good sense to die suddenly and unexpectedly within 3 months.

Guilt is a negative emotion and really destructive particularly in this context.  Get it out of your mind.

Unfortunately this (no disrespect to TJ at all I agree – this is just a further warning) is very difficult to do. Visiting people in care homes long-term can cause quite a severe toll on one and it can lead to a lot of resentment, anger, guilt etc. It’s time consuming, seldom fun and depressing at times.

I was never upset by my dad who was in the home but my mother used to do my head in every time I took her to visit him. It really can all be a bit of a headfuck . I was double screwed as my dad died alone when I was working abroad and that took a lot of work to get past!!!

It is one of the areas in life where it is good to talk to people about even if you naturally bottle everything up.

totally fair enough Kilo.

Blimey this is all hard work isn’t it!

today I’ve started the process of getting a care assessment started but could take “weeks” for someone to come round!

we have decided on respite care for 28 days, which is the maximum amount of time my mum can be away from her alms house before it gets removed. Hopefully this will give her time to get her strength and confidence back to continue living independently. But today she was not in a great place!

i could write for ages about the challenges and the worries it brings, but if you know: you know!!

Well it’s a good start, well done for getting on with it

I keep a little notebook with everything ive done, dates of meetings, assessments etc. Phone numbers etc. Write down notes from conversation etc. In the first few months it was really useful as trying to remember names and departments was difficult. Its also a good way of parking all the worry.

Something i learnt quite quickly was that once you are in ‘the system’, go with it and let it run. Don’t try and buck it.

There are various charities that can help, I found that the British Red Cross were incredibly helpful sorting things out, giving advice and getting the right telephone number to speak to someone that would sort out a crisis situation.

My dad got a thing called a re-enablement package, basically physio/home visits/bit of care to basically get him back on his feet and restore confidence. It was good.

Good advice above RE: management and feel / smell / CQC

Not sure that Age UK has been mentioned ? Good source of information.

My mum (and Dad,) has dementia, it’s good to have a conversation about preferences for care, if it is not too late.

Look at nursing homes and care homes biases of the residents. Dementia residents can be more disruptive. MIL had stroke and aphasia, can’t talk, so gets frustrated / angry about stuff, but we don’t always get what the cause is. She expressed a preference for a nice care home but that was only available to self funders.

Cost needs to be factored in and you might want to understand if 3rd party top-ups are required when self funding stops.

Ride your bike it will keep you sane.

My mum is 65 miles away and can’t grasp how to use a phone.
I’ve bought her an echo show and normal echo.
As they are both on my account I first Drop In on the small one and ask if it’s ok to put the screen on. Sometimes the carer is there and says they are busy. Normally all is ok and I Drop In on the Show.
Sometimes mum mumbles so it’s a lot easier to have a conversation if I can see her.
She can also manage to ask it to play the bee gees.
This way she gets a visit everyday.