Looking for new care home and already feeling despondent...

[looviloo]

I've starting looking for a new, more suitable care home for dad. Oh my. I remember now why I hated looking round them three years ago when he first moved into care.

Today's tour was a local dementia unit... older building with some character, lovely staff (met a few), with busy and quiet areas and wonderful outside space. But... the smell... such an overpowering smell of urine . It was everywhere.

It totally put me off, despite the positives. Do people living/working there just get used to it?

Some of the residents in dad's current home are incontinent but I've NEVER smelt urine there! On the odd occasion a resident has been whisked away for 'changing' but it's done quickly and discreetly and I would never have known if I wasn't such a frequent visitor. All I ever smell is the home cooked food, which always makes me hungry!

I've only looked at two homes so far (the first was more like a hotel and I have reservations about it) and then this one. I had high hopes for both of them but now realise it might be a long haul...

 

[highland girl]

I've starting looking for a new, more suitable care home for dad. Oh my. I remember now why I hated looking round them three years ago when he first moved into care.

Today's tour was a local dementia unit... older building with some character, lovely staff (met a few), with busy and quiet areas and wonderful outside space. But... the smell... such an overpowering smell of urine . It was everywhere.

It totally put me off, despite the positives. Do people living/working there just get used to it?

Some of the residents in dad's current home are incontinent but I've NEVER smelt urine there! On the odd occasion a resident has been whisked away for 'changing' but it's done quickly and discreetly and I would never have known if I wasn't such a frequent visitor. All I ever smell is the home cooked food, which always makes me hungry!

I've only looked at two homes so far (the first was more like a hotel and I have reservations about it) and then this one. I had high hopes for both of them but now realise it might be a long haul...

Sounds exactly like my visits to two yesterday, some good points made in the discussion in partners forum, think it’s in the one named respite. Xxx

 

[canary]

Trust your instincts.
You might have to look at several before you find the right one and the one that turns out to be right might surprise you. The one mum ended up in was one that I had decided that I wasnt even going to look at because I just knew it wouldnt be right! Actually it was and she was happy there.

 

[looviloo]

Sounds exactly like my visits to two yesterday, some good points made in the discussion in partners forum, think it’s in the one named respite. Xxx

Thanks, I've just taken a look at the thread . Sounds like we've had very similar experiences. I guess that's why I've posted this thread... should I overlook the 'smell' and concentrate on how lovely the staff are? Am I being too picky? Actually, it worries me that such a strong smell exists because maybe it indicates a lack of cleanliness. And doesn't urine smell stronger when people don't drink enough? I won't cross the home off the list, but I would want to visit again at a different time of day.

Trust your instincts.
You might have to look at several before you find the right one and the one that turns out to be right might surprise you. The one mum ended up in was one that I had decided that I wasnt even going to look at because I just knew it wouldnt be right! Actually it was and she was happy there.

Yes, I suppose it's just dawned on me that I might have to look at quite a few. Three years ago, when I first looked, it was residential homes. But now I'm looking for more specialist care and it probably needs even more effort than before.

Ack, I can still 'smell' today's care home. I feel pretty bad about it...

 

[canary]

My recommendations would be

• No nasty smells. The occasional whiff is OK and mums care home did smell of disinfectant, but I could accept that!
• Friendly homely atmosphere - this is much more important that 5 star decor
• Good cheerful staff. The caring is the most important thing.
  
• Ask the manager what sort of behaviour they would not tolerate. Unfortunately, many care homes, even the ones that say that they specialise in dementia care, will not tolerate usual dementia symptoms like wandering at night, incontinence or any sort of aggression.
• Dont worry about large gardens and nice views. Mum very seldom went into her room (she was usually in the lounge) and when she was, she didnt care about the view. Her room overlooked the car park and she actually enjoyed watching everyone come and go. I really would not have believed that before she moved there.
• Home cooked food is nice as it usually means that they can adapt to residents needs
• Dont worry that many of the residents are much further along the dementia journey than your dad. If the care home will look after them right up to the end this is to be expected; if they all seem to be about your dads level then this probably means that fairly soon your dad would be asked to leave.

 

[looviloo]

That's a brilliant checklist, canary, thank you so much. I'm going to print this out as a reminder. Each point rings true to me too, and you're right about the decor... yesterday's care home was straight out of a brochure but there was no atmosphere.

Great point too about asking what the home can not tolerate. I had the feeling yesterday that the residents were 'cherry picked'; very quiet, not a zimmer frame in sight (although they may have been hoisted into a seat). No interaction between them and the carers. I didn't like that. And no-one obviously worse than dad, which worried me and I realise why now, after reading your last point.

I must also remember that it's not ME I'm choosing the home for! Dad had respite in the early days, in a home that I considered just about 'ok' at the time. I'm now thinking I should go back there to take another look. I see things differently now.

 

[canary]

Oops, sorry I said your mum rather than your dad. I was thinking about my mum.
Ive edited it now

 

[mumsgone]

choosing care home/nursing home is as hard as choosing your childs first school. My advice would be not to make appointment and arrive unannounced and see how receptive they are ! Chat to other residents. My dad was in a home which was not cosmetically perfect but all residents were treated like family. Sadly that one closed when owner retired and it would have cost too much to get it up to spec. He is now in a home that is well run but lacks the real cosiness of the first but he is as happy as he can be xx

 

[Elle3]

I think we all seem to have similar experiences when looking at care homes, mine were so similar to yours. Some I had great expectations for but then I was so disappointed when I viewed them. I to visited a couple that just smelt, I even went back to one at a different time just to see if it was a one off, but it was just the same. I tended to look at the other residents to see what they were like, to see if they looked relaxed and well cared for and how the staff interacted with them.

I think you just know when you find the right one, that's what happened to me on both occasions, unfortunately the first one didn't work out as I or them didn't expect dad to be as challenging, that was a big learning curve. But then I was better informed when looking for the second home, I knew what the triggers were, ie I had to avoid rooms/bathrooms that had mirrors (my dad doesn't recognise himself so he thinks it's an old man spying on him) his care home had already thought of that, so didn't have any, only a portable mirror they could bring and take away if needed. I looked for windows that had good locks on them and doors he couldn't easily open and escape from. This home has coded fire doors which only open with the code or when the alarm goes off and it has secure perimeter fencing too. I looked for quiet areas and a nice lounge area that didn't have chairs just situated around the edges. I also looked for a better ratio of staff to residents and I checked regarding behaviour to see what they would and would not tolerate and how they dealt with the challenging residents. They talked to me about strategies they used and I've seen them work. It makes such a difference when they are much better trained and I haven't smelt anything bad at all when I visit, residents who have mishaps (like my dad) are cleaned and changed very quickly and dirty clothes are instantly removed for washing.

Just keep looking, I'm sure you will find something soon.

Elle x

 

[Kevinl]

It's about matching the person's needs to what the home provides.
Anything like a cinema room, spa, extensive grounds are nice but my wife can't use any of them so what's the point? Everything costs money so all the useless fancy bits use up money that could be used for the most important thing of all, plenty of staff.
Today we had 5 carers, one CHAPS nurse and 2 SRN/RGN nurses, 3 domestic staff (cleaners) as well as the kitchen staff, maintenance staff and office staff which we share with the other unit so we had 10 staff for the unit and as share of the rest. The wage bill must be astronomical.
Despite the fact the place is regularly redecorated it doesn't take long for them to get damaged again by all the wheelchairs and food trolleys plus the residents throwing drinks and soup around.
The smell of wee is an issue but my wife is often the cause of it and if I go in the morning it is worse as overnight soiled clothes and bedding is left in the sluice and many of the rooms smell a bit which wafts through the place, by mid morning when the cleaning staff have tidied it all up and started mopping it gets better and stays Ok until the next morning.
I often wonder what people think when they get shown round, if you'd been shown round when I was visiting today one woman decided to take her trousers off and resist all efforts by the staff to get them back on, another has a UTI and was swearing her head off at everyone she saw, one of the men ripped a set of curtains down...just another day in EMI nursing.
My wife was shouting a bit and the spitting on the floor lady was doing just that, I'm sure it must put people off but it's EMI for challenging people so it's going to be like that.
As I was about to leave my wife wee'd enough to fill a size 10 pad (the biggest the home uses) soak the chair and leave a puddle on the floor but there were plenty of staff around so it was dealt with in minutes. Three people aske me if I wanted a cup of tea and as usual there was loads of food left over so I had a cheeseburger and chips too because I could eat that while I fed my wife the other option which was soup followed by lasagne.
As has been said you need to look at the number of staff, the way they interact with the residents and each other everything else is just cosmetic.
K

 

[looviloo]

Thanks everyone, I'm too tired to respond individually but I do read and appreciate all the comments. I hope I haven't offended anyone in talking about the urine smell - I've only been to a few nursing homes over the past few years and 2 or 3 of them have had a pronounced smell. But today's was the worst. I do understand it can't always be avoided, and have wondered if I'm just expecting too much. Yes, the staff themselves are the most important factor... dad's current home is well run and the carers are really lovely, interacting with the residents and always with a smile. I'm sad dad will have to leave, but at least he has enjoyed three years there.

My priority now is a higher staff ratio, and somewhere I think dad might settle, so as similar to his current home as I can find but with the amenities he now needs. It might be too much to ask but I'll just keep looking! Thankfully I have some time, because the current home can still care for him a while longer (unless he takes another downturn).

Dad is becoming more and more restricted these days, sitting mostly in the lounge and having a snooze. He likes sitting with his back to a wall, so an open lounge with a big circle of chairs is no good. He can't chat with other residents because his speech is almost zero, making interaction with carers even more important. And he's less and less interested anyway. I have another couple of places in mind to see, and next week the social care worker is going to see dad so I'm hoping she'll have suggestions too. I'm finding it stressful but we'll get through it .

 

[kindred]

Thanks, I've just taken a look at the thread . Sounds like we've had very similar experiences. I guess that's why I've posted this thread... should I overlook the 'smell' and concentrate on how lovely the staff are? Am I being too picky? Actually, it worries me that such a strong smell exists because maybe it indicates a lack of cleanliness. And doesn't urine smell stronger when people don't drink enough? I won't cross the home off the list, but I would want to visit again at a different time of day.



Yes, I suppose it's just dawned on me that I might have to look at quite a few. Three years ago, when I first looked, it was residential homes. But now I'm looking for more specialist care and it probably needs even more effort than before.

Ack, I can still 'smell' today's care home. I feel pretty bad about it...

This smell would affect you too badly, I think. I do understand. At OH home, there are smells now and then but they have this under control by mid-morning with their constant cleaning and disinfecting and I would say that smell management is vital. I think a little smell sometimes is normal because it is dementia we are dealing with, but not such as it haunts you afterwards or clings to your hair and clothes. Smell does affect us badly. (or well if it's a lovely smell). My beloved OH peed on a certain spot on the carpet the minute my back was turned, and left a stain and smell that the most dedicated surgical cleaning could not remove. I feared for the floorboards, but nice man in carpet shop (who deals with this every week, he says), came, cut out the affected patch so I could treat the (not affected floorboards) before I had a new carpet put down. Oh, without that smell, I feel so much better. It was really upsetting me, the smell. So I do understand and honour your point of view. I think it is so valuable to post about nitty gritty stuff like this, thank you.

 

[kindred]

It's about matching the person's needs to what the home provides.
Anything like a cinema room, spa, extensive grounds are nice but my wife can't use any of them so what's the point? Everything costs money so all the useless fancy bits use up money that could be used for the most important thing of all, plenty of staff.
Today we had 5 carers, one CHAPS nurse and 2 SRN/RGN nurses, 3 domestic staff (cleaners) as well as the kitchen staff, maintenance staff and office staff which we share with the other unit so we had 10 staff for the unit and as share of the rest. The wage bill must be astronomical.
Despite the fact the place is regularly redecorated it doesn't take long for them to get damaged again by all the wheelchairs and food trolleys plus the residents throwing drinks and soup around.
The smell of wee is an issue but my wife is often the cause of it and if I go in the morning it is worse as overnight soiled clothes and bedding is left in the sluice and many of the rooms smell a bit which wafts through the place, by mid morning when the cleaning staff have tidied it all up and started mopping it gets better and stays Ok until the next morning.
I often wonder what people think when they get shown round, if you'd been shown round when I was visiting today one woman decided to take her trousers off and resist all efforts by the staff to get them back on, another has a UTI and was swearing her head off at everyone she saw, one of the men ripped a set of curtains down...just another day in EMI nursing.
My wife was shouting a bit and the spitting on the floor lady was doing just that, I'm sure it must put people off but it's EMI for challenging people so it's going to be like that.
As I was about to leave my wife wee'd enough to fill a size 10 pad (the biggest the home uses) soak the chair and leave a puddle on the floor but there were plenty of staff around so it was dealt with in minutes. Three people aske me if I wanted a cup of tea and as usual there was loads of food left over so I had a cheeseburger and chips too because I could eat that while I fed my wife the other option which was soup followed by lasagne.
As has been said you need to look at the number of staff, the way they interact with the residents and each other everything else is just cosmetic.
K

Thank you for this post, greatly appreciated. You are telling it like it is, but with hope and compassion. Thank you. Kindred.

 

[love.dad.but..]

Adding to all the good points made so far and this is difficult to judge as it is tricky to anticipate how a pwd will decline...I tried to find a home that matched some important criteria for dad at that stage but also what factors may disappear or remain. Dad was a constant walker day and night so long corridors to satisfy that need and whilst encouragement to return to bed didn't work at entry stage...support during the night to let him settle wherever and refreshnents...this criteria was important right to end of life as he continued to be slow mobile. Access to a garden...the aesthetics of the garden not important although plants gave staff and me a communication tool but he always wanted to try doors and windows to leave so a secure outside space where he could walk and sit again satisfied that need. He couldn't verbalise clearly to ask for anything so he needed a bedroom with independent free access to his room...a few homes were with a bedroom only accessible by lift or gated stairs. These criteria remained important to his daily life in the 3 years dad was in his NH.I looked at 16 homes...I wasn't being fussy...some showed no interaction with residents...some not suitable for dad's stage ie say dementia but clearly only wanted early or non challenging. He was refused by 2 after day assessments as his compulsion to walk was viewed as challenging. There is a difference I felt between stale and fresh urine smell...with residents who are incontinent or as unfortunately dad was for a phase of peeing in inappropriate places it sometimes can't be helped but a good immediate response clean or deep cleaning regime should eliminate smells most of the time.

 

[looviloo]

This smell would affect you too badly, I think. I do understand.

Thank you kindred, I was worried I might upset people by highlighting this. A little smell would be fine, and of course accidents happen and can't be helped. Very happy to hear that your carpet problem could be solved... it must have been a relief. Washable flooring is obviously a must in nursing homes (it's something else on my checklist!).

I think a little smell sometimes is normal because it is dementia we are dealing with, but not such as it haunts you afterwards or clings to your hair and clothes.

Sadly the smell did linger despite only being there a short time, and I was still aware of the smell a few hours later. My daughter even commented on it.

Adding to all the good points made so far and this is difficult to judge as it is tricky to anticipate how a pwd will decline...

It IS so tricky. I'm glad to have the social worker involved and hope she will assess dad next week, and give me a better idea of the next step. I really don't want him to have to move again if possible since it's so stressful for all of us.

I looked at 16 homes...I wasn't being fussy...some showed no interaction with residents...some not suitable for dad's stage ie say dementia but clearly only wanted early or non challenging. He was refused by 2 after day assessments as his compulsion to walk was viewed as challenging.

Oh my gosh, 16 homes! I understand why you had to do this, since they are all so different even when they are offering similar services. It's impossible to know what they are really like without visiting.

I wouldn't describe my dad as challenging, but if a home is short staffed and dad gets it into his head to stand up from his seat and attempt to walk without supervision multiple times per day then it could be a big problem. So finding the right place for him is important.

 

[love.dad.but..]

My starting out high hopes and expectations gradually got worn down with disappointment and as I viewed some that frankly I wouldn't have placed a dog in. However I knew what was important for dad and as he declined and stuck with it. Gut instinct is a good measure. I knew within 5 minutes if a home wasn't suitable. Always arrived unannounced and didn't nind being kept waiting...you can pick up a lot from observing and listening. Crucial question...ask first what behaviour they wouldn't be able to cope with then follow up with an example of worst scenario your dad presebts atm and ask what strategies they would use. Gives insight into their proven experience and skill.

 

[emp]

Hi @looviloo a care home shouldn't have a constant smell of urine. If they do, it's a sign they aren't dealing with incontinence effectively. My advice for checking homes would be:

- turn up unannounced. If they want you to stick to an appointment time, they might be putting on a performance for you
- check the CQC reports online. Look for what sort of things, if any, they have been pulled up for and also how long ago the report was done. If the report was good, but it was done two years ago, you may need to be mindful that things may have changed
- ask other families with relatives there what they think
- visit at different times. The home may be very different at certain times of the day
- look at how the staff are with the residents. Are they busy concentrating on work tasks or are they sitting down with residents and spending time socialising with them?
- don't get hung up on decor. You might find a home that is visually stunning, but the care may not be there. Likewise, a home that might desperately need a lick of paint might have great staff who really care for the residents
- what sort of activity provision is there? Are residents sat around watching TV all the time or do staff engage with them?

Hope this helps!

 

[Sirena]

There is never a smell of wee at my mother's care home - that would have been a deal breaker for me. The residents vary from mid to very late stage so there must be a lot of continence issues, but the only smells are food if you go close to meal times, and whatever cleaning agent they use.

Wee aside (!), it is one of the less expensive CHs in the area, decoratively it is slightly shabby but has a lovely welcoming atmosphere, the care is very good and the residents are treated as individuals. I feel very lucky to have found it, especially as I didn't have to look very hard - it turned out to the the first one I visited (I did subsequently visit others).

 

[Norfolk Cherry]

If anyone can recommend a care home for dementia in the Norwich..Norfolk/Suffolk area, please send me a message on the private conversation link. Thanks.

 

[looviloo]

My starting out high hopes and expectations gradually got worn down with disappointment and as I viewed some that frankly I wouldn't have placed a dog in. However I knew what was important for dad and as he declined and stuck with it. Gut instinct is a good measure. I knew within 5 minutes if a home wasn't suitable. Always arrived unannounced and didn't nind being kept waiting...you can pick up a lot from observing and listening. Crucial question...ask first what behaviour they wouldn't be able to cope with then follow up with an example of worst scenario your dad presebts atm and ask what strategies they would use. Gives insight into their proven experience and skill.

It can be massive disappoint when you visit, can't it? I'm going to make a list of questions for my next visit, because my mind goes blank once I get there! But I'm much better at observing this time around. Three years ago, when we first looked, I immediately knew that dad's current care home was the right place for him - it had the right 'feel', the people couldn't be more welcoming and helpful, and although it couldn't be described as a palace it was obviously well cared for. I trusted my gut and will do that again. Thank you!

Hi @looviloo a care home shouldn't have a constant smell of urine. If they do, it's a sign they aren't dealing with incontinence effectively. My advice for checking homes would be:

- turn up unannounced. If they want you to stick to an appointment time, they might be putting on a performance for you
- check the CQC reports online. Look for what sort of things, if any, they have been pulled up for and also how long ago the report was done. If the report was good, but it was done two years ago, you may need to be mindful that things may have changed
- ask other families with relatives there what they think
- visit at different times. The home may be very different at certain times of the day
- look at how the staff are with the residents. Are they busy concentrating on work tasks or are they sitting down with residents and spending time socialising with them?
- don't get hung up on decor. You might find a home that is visually stunning, but the care may not be there. Likewise, a home that might desperately need a lick of paint might have great staff who really care for the residents
- what sort of activity provision is there? Are residents sat around watching TV all the time or do staff engage with them?

Hope this helps!

A great set of points to remember, thank you! The next home I have in mind was inspected just a few months ago which is reassuring, but I've noticed quite few that have not been inspected for 3 or 4 years and a lot can happen in that time, as you say. I intend to go unannounced from now on, although if I'm travelling a long distance I may ring them before setting off. Activities are less important for dad these days but that's not to say he wouldn't enjoy activities going on around him. He will always need interaction with others, so I will be keeping a close eye on that kind of thing.

There is never a smell of wee at my mother's care home - that would have been a deal breaker for me. The residents vary from mid to very late stage so there must be a lot of continence issues, but the only smells are food if you go close to meal times, and whatever cleaning agent they use.

Wee aside (!), it is one of the less expensive CHs in the area, decoratively it is slightly shabby but has a lovely welcoming atmosphere, the care is very good and the residents are treated as individuals. I feel very lucky to have found it, especially as I didn't have to look very hard - it turned out to the the first one I visited (I did subsequently visit others).

Yes, a strong pervading smell is a deal breaker for me too. Such a shame that otherwise good homes can let this happen. Shabby on the other hand is not a problem! Maybe it's an indicator that more time is being spent on the resident's that worrying about a bit of paint?! Cleanliness is more important to my mind.

If anyone can recommend a care home for dementia in the Norwich..Norfolk/Suffolk area, please send me a message on the private conversation link. Thanks.

I hope someone can help you. Maybe start a new thread too, so everyone can see it? Good luck!