How do you pick a nursing home?

[Seaholly]

For those who have loved ones in nursing homes, how did you go about selecting the right one?

Mum is talking more about it being 'time' she went into a hospice (although none of the hospices round here will take people with dementia) and there are a few nursing homes that do dementia and end of life care.
I've definitely ruled one out, because she went there for a fortnight's respite care a couple of years ago and I really wish I had reported them to the CQC when she came out, but I suppose we just wanted to get her home and forget about it and there was an element of not really knowing how much of what mum said and did was delirium and how much was genuine neglect. However, there are a few 'definites'.

* Mum has a pre-entry home visit where both she and I said that although there hadn't been a formal diagnosis via Memory Clinic, her GP had said she did appear to have some form of dementia. However, as it was only weeks after losing her husband and we were still getting to grips with everything too, we hadn't pushed her to go.
* Mum and I also also explained she had Age-related Macular Degeneration and as Mum was having one of her lucid days, she was able to actually explain to the lady who did the assessment what she could and couldn't see.
* I clearly told the assessor that Mum liked to wear her proper shoes and socks at all times during the day, as it gave her more confidence standing and walking (in the days when she could walk a bit)
* I clearly said Mum liked to have her tissues and talking clock with her at all times.
* The one thing Mum was really looking forward to was a proper hot bath in a bath tub and this was promised!

Just prior to Mum going home, I had a bit of showdown with the Manager and asked to look through her file and found the following:
'visual impairment - none'
'cogniative impairment - none'

Each day, when we visited, we found Mum left sitting utterly confused, with a cold cup of weak tea left out of reach and depending on the day, stocking feet; tissues missing; clock missing; zimmer frame missing ('we don't know where it is' said the carer I asked - before I pointed out it was in the other room, with Mum's name and room number on, which I had written on in Sharpie marker on Day 1! "How do you know that one is hers?" I was asked!!!

One evening, I visited a bit later in the evening and Mum said she wanted to go to bed, so I assisted the 2 carers and her urine was as dark as I've ever seen it and stank to high heaven. I asked if she had an infection, or was dehydrated, "oh, I don't know" was the reply.

She never had a bath. She never joined in any activities and every time I queried something, I was treated as though I was a nuisance and the staff seemed more concerned about defending themselves and making excuses than Mum's welfare. Even her GP, who was a regular visitor to the care home said, "what have they done to her?!"

Mum went in able to feed herself, use a normal cup and hold a conversation. She came out thinking she was living where she lived as a child and being wrapped in a big PVC bib, spoon fed and drinking through a straw. I do understand PWD can go backwards for a few weeks at first...now...but that wasn't explained to me back then!

This place has 5 star reviews on the care home UK site, but some really scary ones on the facebook page and locally, it's reputation is really like Marmite - it's either 'wonderful' or 'absolutely terrible'.

I know Mum could go somewhere for respite for a week or two weeks, but if she went downhill and got really confused, we'd be none the wiser. I've seen other local nursing homes on facebook and some that have amazing reviews post pictures of residents surrounded by streamers, buntings, cakes etc., with captions about celebrations, parties and activities and in all honesty, the residents look either confused or bored senseless. If I saw a picture of Mum like that it would break my heart as all of us at home try so hard to tailor everything just to her and find activities that suit her and she will enjoy but only when she's up for them.

So, how do you choose a nursing home? To look at the website and reviews and even the CQC report of the place she went in for respite, you'd think it was absolutely wonderful! I'm starting to feel like every home I investigate 'talks the talk' .....

 

[Sarasa]

Hi @Seaholly, I sometimes think that care homes are like schools. A school that is a brilliant fit for one child would be a disaster for another. It sounds like the care home your mum went into for respite was a disaster for her, though that is no excuse for not having the correct details about her cognitive impairment and macular degeneration.
It is so difficult at the moment, as not only can you not visit homes to get a feel as to what they are really like, but also if your mum did go into one she would have to self-isolate to some degree for a couple of week which rules out a quick respite visit.
I think I'd phone up and talk things through with the homes you are interested in and see if you can get a feel. I'm afraid I take CQC reports with a pinch of salt I've been through too many OFSTEDs one way or another, and knowing that some schools are better at putting on a 'show' that others makes me suspect that care homes are the same. I wouldn't dismiss reports out of hand but I would like to form my own opinion.

 

[karaokePete]

In the hope that it might help you @Seaholly, I've put a link to a sit that gives details and reviews for many Care Homes around the UK. I can't vouch for the reviews, although I've been in a couple local to me and the picture given seems reasonable for those.

Care Homes & Nursing Homes UK – Care Home Reviews & Nursing Home Reviews

Guide to over 17,500 care homes, nursing homes and residential homes providing care in the UK, also the leading UK review site for care homes and nursing homes.

www.carehome.co.uk

 

[lemonbalm]

Hello @Seaholly
Just to mention that the link @karaokePete has given also has some very useful information at the bottom of the main page about how to pick a care-home, what to ask and so on.

 

[Seaholly]

Thank you for the links - unfortunately, it's the Carehome UK site that I would personally not trust at all again because on there, the place that we found was dreadful gets full marks time after time! I asked all the right questions before we booked mum in and the top and bottom is - they lied. It's as simple as that!
I actually went to visit beforehand and asked all the 'right' questions. I even picked her bedroom for her because it was a room I knew she would love. I was told she could choose to stay in her room and look at the view if she wanted to - which never happened. Instead, she was put in a small sitting room full of people she didn't know, all of whom were (at that time) much further along the progression of dementia than she was and ignored until it was toilet time, mealtime or bed-time. At those times, the best was to describe it was like an intensive farm - it just seemed to be a case of moving everyone from A to B as quickly as possible at the appointed time (I used to work on a big dairy farm and I'm sorry, but that is exactly what I was reminded of)

 

[Helly68]

@Seaholly - I would say, for many of the reasons you quote, choosing a care home is very difficult at the moment, especially when it isn't possible (or at least very limited) to visit.
I would say, when visiting is allowed, ask if you can visit. We were told (pre Covid) we could visit at any time, and that was in fact true. I would say that Sunday mornings can be an eye opener as the staffing tends to be most stretched at the weekend, but I think all homes struggle with staffing.
I would say, try to talk openly with the staff - even if by phone or Skype. We had a few challenges - staff forgetting things, things not being done - but as they got to know my Mum, they really did treat her as a person and it was rare that I had an issue with the standard of her care. If I did, I spoke to whoever was in charge - a lot easier when you can be there in person.
We asked a lot of questions, and one that I see here a lot, which I think is useful is "what behaviour or need would they NOT be able to accomodate"? This allows them to set out what is or isn't possible, though I accept what you say, if the home isn't honest, then that may not work.

 

[Jaded'n'faded]

You're right - it is a complete lottery. I agree with @Sarasa that care homes are like schools, and they evolve and change. The CQC report will only tell you so much and the latest reprt doesn't tell you whether the previous report was better or worse. When my kids were in school, the same was true of Ofsted reports. I would rather choose a school that was a previously bad one but was showing improvement than a previously good one that was going downhill. (Hope that makes sense.)

Then there are the care home staff. When things go wrong, it often results in a chnage of management - this happened 3 times in the 3 years mum was in a home. Each time there was a 'period of flux' while the new person settled in and tried to impose their desired methods on existing staff, which often resulted in more staff changes. And as everyone knows, there are good staff members and bad ones.

Obviously you are doing all the things you can do to check a place out, but bear in mind that a few staff changes can make a bad home good again or a good one poorer.

I'm sorry - just realised I have probably added to your concerns rather than helped! In the end, you can only do your best (which you clearly are doing) and keep your fingers crossed. And you can always move someone if it doesn't work out...

 

[Max68]

It is a very difficult decision and one thing I would say is in many cases I suspect, it doesn't matter how good a home is it will never be good enough for your relative. Certainly not my mum who still thinks she could look after herself at home!

I was quite lucky. I looked at several places, to start with. One was like a hotel, absolutely wonderful, I would have stayed there, but it was massive and as great as it was mum's room was second floor via lift of stairs, right at the end of a corridor, which I knew considering dementia is a progressive condition would make her very lonely. It was massively expensive as well, which wasn't a major issue, but they kept ringing and wanted a decision quickly, despite days earlier saying they had plenty of rooms. Scrubbed that one off.

Then there were others with walkways "through" rooms, so no privacy. One had a great reputation but as soon as my sister and I walked in we hated it. If you have ever seen Only Fools and Horses think The Villa Bella from The Jolly Boys Outing! I was half expecting Fenella Fielding from Carry on Screaming to pop out!

One other was very good but most of their staff were agency staff. No issue with that at all generally but in my thoughts that meant a regular change of staff means no lasting relationships could be made. I would like to see staff I can trust and if they are there one day but gone the next personally I do not see it as ideal.

Eventually with mum still in hospital a dementia nurse suggested a place and it was the same place mum's hairdresser had suggested as she was that homes hairdresser. My sister and I went to look and it was very relaxed. A bit dated and not at all flash but they had just refurbished a ground floor room that was right next door to the nurses office so staff would always be walking past. They had a large lounge, short corridors, conservatory and I have eaten there and the food is good. You could (pre covid) just turn up at any time for a visit, although ideally not meal times and that was a plus as I would be wary of a home that wouldn't allow you to just turn up at the door. Understandable at the moment of course. We accepted the room there and then.

The place and staff have been great. If mum has a fall or a medical concern they call, but don't overload you. It's never going to be home but I know I can trust them.

So in normal times my suggestion would be to visit as many as possible, although I understand that's not possible at the moment,. Read as many resident family reviews on websites and maybe have a word with a GP as GP's obviously visit care homes and go with the great advice others on here have suggested.

 

[Seaholly]

Don't worry - I'd rather have concerns than make another mistake like last time

The scary thing for me is that we were lied to and there is no other way of describing what they did. I had a meeting with the manager. I had a notebook with me so I could make sure I asked all my questions and I was very clear and specific about mum's needs and capabilities. I asked if I would be able to speak to some of the residents too and was directed to a lady who was sitting by herself and said, "this one is as good as it gets!" She, however, was fully mentally functioning but paralysed, so her needs were very different to mum's. We had the pre-entry home visit and everything was made clear to them there too. At that visit, the lady promised mum she'd have her 'proper' bath and be able to join in with the knitting group, even though she could no longer knit, she could just sit with them and chat about what they were making. When we took her stuff in and got her room ready, I chatted to the 2 carers who said they would be looking after her and they promised she'd have a proper bath - she didn't even have a shower

I brought in some old photos so people would see what mum was like back in the day and have something to chat about and they never came out of the envelope!

Shortly before her departure day, one carer ran up behind me and said, "I'm sorry, I never realised your mum was blind! Nobody said anything!" On the day we picked her up, I mentioned she'd lost the ability to eat and drink unaided while being there and one really smug lady said, "Oh, we gave her a cup with a straw to solve that!" I pointed out that she was given a cup with a straw only after I had complained that she was severely dehydrated and it was me who suggested that kind of cup!

I have learned that being 'qualified' or 'trained' in dementia care is fairly meaningless unless the person who has received the training has the natural empathy, observational skills and common sense to apply the training and also to have the ability to put themselves in the shoes of the family too, so they can explain in a timely and clear way what's going on.

 

[canary]

I asked if I would be able to speak to some of the residents too and was directed to a lady who was sitting by herself and said, "this one is as good as it gets!" She, however, was fully mentally functioning but paralysed, so her needs were very different to mum's.

This makes me think that the home your mum went into was a mixed dementia/non-dementia place. Did it say "people with dementia accepted", or something similar? The trouble with mixed places is that, as you say, people with dementia have very different needs. It is fine in the early stages of dementia, but the person with dementia will get to a stage where the home cannot meet them. Im guessing that the home wasnt even aware of that and when they said they could deal with anything, they were thinking of physical problems - and it certainly sounds like that is the sort of resident they were geared up to. It would also explain the high ratings.

Your mum is going to need a care home exclusively for people with dementia - often called an EMI unit. My mum went to a dementia home very similar to the one that @Max68 chose. A bit shabby and oldfashioned, but clean and geared up to people with dementia. Not only are the carers trained in dementia care, but they have lots more experience.

 

[Helly68]

Very much agree with @canary here, a dementia unit is something that is, sadly, nearly always needed. Staff can vary, even at "good" homes. I have to say that Mummy's home took everything she threw at them (literally sometimes) so there are caring homes out there who do a very difficult job to a high standard. There are also those who don't. I am not sure this is possible now, but maybe in the future, Mummy went to the home she lived in as a permanent resident as a "day care" session, two days a week, which we funded, to start with. We did this to bridge the transition process and also because she was refused a day care place by the council and my Dad was under a lot of stress trying to look after her. This meant that she got to know the staff and they her before dementia really took hold, and I think this was a good thing. Sadly though you would have to fund something like this as I very much doubt a council would.

 

[Frank24]

I think it is very hard indeed... and i am thinking pre covid.
Especially when you have had a bad experience and read the horror stories.
I like the carers at my mums home - and I feel like she is well cared for but a lot of teething problems in the early days.
I feel like its never perfect.

 

[Max68]

Nothing's ever perfect!! I find that there are things at mum's home that irritate my sister for instance but it's not a problem with me, and probably vice versa. All I know is that when I visit mum always looks clean and there is never any evidence of mistreatment and she never shies away from a carer in a frightened way and that's good enough for me. She says she hates it but then in the next breath it's nice there and that's the problem with dementia it's generally down to how you feel about the place because you relative in many cases can't give proper feedback.

 

[sunshine70]

I agree with Max68. We looked at a few care homes for my mum (Jan 2020) and saw ones like hotels, old and dated ones, some very small and some we didn't even want to stay to look round, but eventually chose one that felt 'right'. We visited without notice, I know this was pre covid, and they were happy to spend nearly two hours showing us around and then happily saw me again the next day with my18 year old son so he could see where his granny was going. Mum also says she hates it and the food is horrible, but in the next breath says what a lovely breakfast she had and "you can't fault the food". We had a meeting with the Manager last week, as mum's dementia has progressed, but as we sat there talking I felt that she 'knew' my mum. Guilt is always there but mum is settled and cared for.

 

[Max68]

Totally agree again with Sunshine70. The other thing I would also say is to see how you are addressed. At mum's home we are all on first name terms as mum is with the carers. It's always been first name terms since the start. Might sound obvious but a couple I looked at it was Mr this and Mrs that. Might be what some people like, but far too business like for me. Plus when we looked at mums room that day it was an afterthought for me to ask how much the room cost. Some places bring up finance pretty quickly, and whilst not cheap (what home is?!) mum has been there since 2019 and we pay the same for her care than we did at the start.