The decision to move into a care home is one that you should consider carefully, it is different to living at home, however when you feel the time is right, you need to know what to look for.
You may well feel that this decision is appropriate if you have lost a partner, become less mobile, experienced ill health, begun to feel lonely, depressed or isolated.
The care home you choose should improve your quality of life, so take your time and follow our check list where ever you go: –
Visit when it suits you, there should never be a need to make an appointment if it is during the working day, out of those hours it is correct to make an appointment.
Ask to look right round as this lets you see the quality of all rooms and will very likely let you see staff at work.
Ask to see the week’s menu, the activities list, the bathrooms and shower rooms, and how the laundry operates to be sure you get your clothes back!
Listen to the staff talking to the residents, would you be comfortable if that were you?
Speak to the Registered Manager to find out what the fees are, if a Top Up is required how much will it be, when are the fees due to rise again, what are the extras you will need to pay for?
Don’t feel awkward about making one or more return visits and put your name down if you like the look of the place.
The law says that where the local authority is funding accommodation, it must allow a person entering residential care to choose which care home they would prefer, within reason.
Social services must first agree the home is suitable for your needs and it would not cost more than you would normally pay for a home that would meet those needs.
Local authority help with the cost of residential care is means-tested. You are free to make your own arrangements? If you can afford the long-term cost. However, it is worth asking the local authority for a financial assessment, because it might pay some or all of your care costs.
If you choose a care home that costs more than the local authority usually expects to pay for a person with your needs, you may still be able to live in the care home if a relative or friend is willing and able to pay the difference between what the local authority pays and the amount the care home charges – this is known as a “top-up” fee. It is important to realise that the local authority will means test the fee they pay for you, so it is unlikely that you will have money to pay the top up as you will be expected to sell any property dispose of any assets and declare any savings.
Deprivation of capital and notional capital. The local authority will also look at your capital, such as savings and property. Currently, local authorities won’t contribute to the cost of your care if you have more than £23,250 in savings and property (known as “capital”). From April 2020, this threshold will rise alongside the introduction of the cap on care costs, so more people will be eligible for help sooner.
Support is means-tested, which means the local authority will carry out a financial assessment to work out what you can afford to contribute towards the cost of your care.
If you have more than this capital limit because of the value of your home, but you have a low income, the local authority may allow you to defer payment while you arrange to sell your home.
If the local authority thinks someone has deliberately got rid of capital to get financial assistance, it will treat that person as if they still had that capital. This could apply if you:
spent money on a non-essential or luxury item
gave money away
gave away property or a share of property
The local authority will look at the reason why the money has been spent. Repaying a debt, for example, may justify your action, but it will depend on the individual circumstances.
The timing of the expenditure or disposal of capital is also important. If you didn’t know you needed care or you were likely to need care in the immediate future, the less likely it is that the local authority will view it as deliberate deprivation of capital.
If the local authority decides there has been deliberate deprivation of capital, you will be treated as if you still had the capital. This is known as notional capital. Notional capital is treated as gradually reducing over time to a point where you qualify for full help.
You can use the local authority complaints system to dispute a decision. If you disagree with the local authority’s assessment of your needs or your finances, you can take steps to challenge the decision.
Contact your local authority to discuss how to do this. If the situation is complicated – for example, around deprivation of capital – it may be best to get specialist legal advice.
if you are receiving local authority support with the cost of your care and you need to live in a certain place to receive that care, such as a care home, you have the right to choose where you live (choice of accommodation).
The local authority must ensure you have at least one choice that is affordable from the amount identified in your personal budget, and ideally more than one. Some local authorities will have a list of preferred providers that they will usually recommend.
If you do not like the provider suggested, or you or the person you care for has a particular service in mind, you can ask the local authority to arrange it.
The local authority has a duty to explain this right of choice to you. This free choice is subject to conditions:
the preferred accommodation must be available
the preferred accommodation must be suitable to meet your assessed needs
it will not cost more than the amount set out in your personal budget
the provider is willing to enter into a contract
You may choose a care home that is more expensive than the amount set out in your personal budget. If you do, a third party such as a relative or friend must be willing and able to pay the difference in cost for the likely duration of your stay. This is known as a “top-up” payment.
Where a person agrees to enter into a “top-up” payment, they will need to sign a written agreement with the local authority. This will set out what the costs are, how often they have to be paid, and what will happen if the person is no longer able to make the payment.
In some limited circumstances you can make this payment. This is if you enter into a deferred payment scheme, or you benefit from the value of your property being disregarded for the first 12 weeks of your care.
The restrictions on paying this additional cost yourself will be lifted from April 2020, when the point at which means-tested support for care costs is increased.
The local authority can never require you to pay a top-up payment and must ensure there is at least one choice available within the amount set in your personal budget. Any arrangements to pay a top-up must involve your local authority, and should not be directly between you and your provider (care home).
However, if their situation changes and you are no longer able to pay the top-up, the local authority may have no obligation to continue to fund the more expensive care home place and you may have to move out. It is worth thinking about this potentially difficult situation when deciding on care home options.
Get a very clear breakdown of the costs to be clear you can afford to make the move and be sure to find out what is included in the cost, what facilities you can expect and what happens if you have to go into hospital, do they keep your room for you?
If you are being assessed to move into a care home and you are seeking local authority funding, the value of your home will NOT be taken into account if a spouse, partner, or relative aged 60 or over is living there, BUT if none of these apply you will be expected to cover the costs.
Check to see if the fees are monthly or annual fees and are they paid in advance or arrears and how are you notified of increases in the fees and should it be necessary how is notice served.
Keeping in touch, we all depend on our phones and mobile phones nowadays so check to see if the home offers phone connections in your room and make sure you can get a mobile signal, if you use the internet, is there Wi-Fi and is it free and unlimited and if you do not use the internet, does the home have a computer you can access to Skype/FaceTime your friends and family? The home should make it clear if you need to pay for a TV license if you are over 75.
All homes should set out clearly the extra costs you may need to pay, whether your contents are insured and if there somewhere safe and secure where you can keep valuables, such as ID, credit cards, money and jewellery?
Ask what services visit the home including hairdressing and chiropody; ask about visits to the doctor, dentist, and optician etc. and if you can be accompanied on these visits and if there is transport to the local town for shopping or lunch out.
There is often an inevitability that we will experience further health needs as we age, check with the home if special care needs be met, even during the night? If your condition should worsen (for example, if you needed nursing care rather than just personal care), could the care home provide this? All good homes should regularly check residents weight, this helps monitor general health along with other observation, does the home you are considering do this?
When you move to a care home, it will be your home so consider the location: what the surrounding area is like, and is it easy for friends and family to reach by car or public transport? Visitors are normally welcome, but check what the arrangements are and if there are any restrictions including the number of visitors at any one time, as well as visiting children and pets. Some homes have accommodation for family and friends to stay. Just in the same way that you should check about you being able to go out, is the home kept secure back and front and what happens at night.
Very often rooms are different to each other and so have a look around, but make sure that all rooms have emergency call systems, that there is some where you can make a private phone call, that there is both an assisted bathroom and assisted shower facility. You should be able to bring some items of furniture with you and all rooms should be accessible by wheelchair even if you do not need one right now.
Usually at least one meal per day is cooked, ask to see the menu for the current week, if they can meet your personal dietary needs, if you can take your meals in your room and if meal times are flexible. When we have visited care homes around the country, we have noticed that plates are being returned without the meal being fully eaten, this is of real concern as it could be for many reason, including that the meal was unpalatable or you needed help to eat it and were not helped. Ask how they monitor meal times.
All too often resident’s lounges consist of a row of chairs along the wall, this prevents a group of people having a conversation, can the chairs be reorganised, is there an outdoor space or garden you can access, is there a communal lounge with or without TV, are there smoking and non-smoking areas, is there a private room other than bedrooms, where residents can meet guests and is there a residents committee or do they have residents meetings and what do they review?
When it comes to choosing between care homes we strongly recommend that you take a friend or relative with you as there is a lot to take in during a visit, and always go back to the one you like several times as that will give you more chance to take things in.
Local authorities have a responsibility to find a suitable home for anyone they have assessed as needing a care home place and, in theory, everyone should have a choice of care homes to pick from. In reality, though, the options open to you might be limited. If you are being funded by a local authority, you do have the freedom to change homes up to twelve weeks from moving into the first home.
To find care homes in your area that have been approved by a national regulator such as the (for England) Care Quality Commission (CQC) www.cqc.org.uk click on Search whole website, choose Care Homes enter either the details of home you are looking at or the Town/Postcode and read the inspection reports, these are entirely unbiased and will give you a factual review. In Northern Ireland, search www.rqia.org.uk in Scotland search www.scswis.com and in Wales search www.cssiw.org.uk If a home is having problems the inspection will record such things as high staff turnover, and you may notice more frequent inspection intervals.
Another good reference for care homes without nursing is http://www.nhs.uk/Service-Search/Care-home-without-nursing/LocationSearch/1832 and for care homes with nursing refer to http://www.nhs.uk/Service-Search/Care-home-with-nursing/LocationSearch/1831
Check to see if the care home will meet your specific religious, ethnic, cultural or social needs? Will the correct diet be provided? Will the right language be spoken? Will there be opportunities to participate in religious activities? Do they allow pets?
A good care home will:
offer new residents and their families or carers a guide (in a variety of accessible formats) describing what they can expect while they’re living there
have staff who have worked there for a long time, know the residents well, and are friendly, supportive and respectful
employ well-trained staff, particularly where specialist care such as dementia nursing is required
involve residents, carers and their families in decision-making
support residents in doing things for themselves and maximising their independence
offer a choice of tasty and nutritious food, and provide a variety of leisure and social activities taking residents’ needs into account
be a clean, bright and hygienic environment that’s adapted appropriately for residents, with single bedrooms available
respect residents’ privacy, modesty, dignity and choices
An unsatisfactory care home might:
have a code of practice, but not adhere to it
fail to take into account residents’ needs and wishes, with most decisions made by staff
let residents’ care plans become out of date, or fail to reflect their needs accurately
have staff who enter residents’ rooms without knocking, and talk about residents within earshot of other people
deny residents their independence – for example, by not allowing someone to feed themselves because it “takes too long”
have staff who don’t make an effort to interact with residents and leave them sitting in front of the TV all day
be in a poorly maintained building, with rooms that all look the same and have little choice in furnishings
need cleaning, with shared bathrooms that aren’t cleaned regularly
Ask to see a copy of the contract before you make your final decision. Read it very carefully and ask a solicitor to explain any clauses that you don’t understand. If you are responsible for paying part or all of their fees, you may be asked to provide a guarantor. This will also happen if a relative has power of attorney for you; the care home will discuss the arrangements with you for paying the fees.
Before you decide on a particular home, it can be useful to make a second unannounced visit. You can see how the staff interact with the residents, how many people are around, and what activities are going on. Of course, this won’t always be practical or possible, but it’s worth doing if you can.
Moving into a care home is a huge emotional event, the surroundings will be unfamiliar and always a compromise to what you have been used to. You may well feel isolated and lonely, you need to think carefully about this and discuss it with family and friends. Because there are routines which are different to those you have now so you may well feel a loss of independence, although a good home should encourage you to be as independent as you can be.
This will probably be your home for the last years of your life, don’t be pressured, take your decisions with careful thought.
So if you used the check list above and chose one of Friary Care’s homes in Weymouth how would we match up to the checklist?
Well to start with we have a respite room, so why not come and stay with us for a couple of weeks?
We welcome people looking round at both our homes, don’t worry if it is a meal time, we are always happy to see people, the Registered Manager at Friary House is Shelly Sanders and at Kingsley Court it is Peter Fry, Peter owns both homes and Shelly and Peter have progressed from being carers themselves so they have a detailed knowledge of people’s needs.
If you choose to make your home with us, it is important to know that all our staff are on a continuous training programme, we are happy to share our records of this with you. We have residents at both homes that have progressive dementia as they reach their later years, if they wish to stay with us and that is what their family want as well, then we will work with you. We will be introducing enhanced training at Bournemouth University staring this year in dementia care.
Whilst we have set meal times, we are happy for people to ask for a variation on these if they wish and we are very happy to serve the meals in your room if that is what you prefer and if you are hungry through the night, the staff will happily make you toast and a drink.
So please come and see us, you will be very welcome, if we are the right place for you to call home then we will make the transition as easy as possible for you.