Choosing a care home needs careful consideration. Nicky Cave explains what clients should be looking for when making their decision
Advising on long term care (LTC) is not just about addressing financial issues. It is also about adding value. This can be provided by having knowledge about the care sector as a whole as well as being able to give clients useful information to help them make the correct decision about their future care.
Choosing the right care home is a key aspect of this decision making process, and there are a number of factors clients need to consider when making this choice.
Choice of home
Apart from ensuring the client's actual care needs are met and that the care home is properly registered, deciding on the location of the home is a good starting point. The client may want to stay near their current home and community or they may be happy to move to a seaside town or be near relatives in a different part of the country. It is also worth taking into account whether it is easy for their friends and relatives to visit.
The accommodation itself also needs to be right for your client. Will they have to share a bedroom and what does the room overlook? Your client may want an ensuite bathroom and may wish to bring personal belongings such as certain furniture, a television or even a pet into the home. It may be important for them to have their own telephone with a separate number so that they can communicate with friends and family at any time.
The general facilities, catering and the home's staff should also be considered. Are there communal sitting rooms, both with and without a television, and is there a separate dining room? Can meals be eaten in the resident's room and could a visitor join them for a meal occasionally or be offered refreshments? Having a choice of meals with varied, good quality ingredients may also be important to your client.
The overall decor of the home, access to a garden and the provision of onsite services such as hairdressing, chiropody and activities are all key factors. It may also be important for your client to be able to get out and about regularly, so proximity to a bus stop or the provision of a home's own transport, will also be necessary.
Key factors
Another important factor to consider is the staff employed by the home. They should appear clean, tidy, cheerful and respectful and there should be an adequate number of staff on duty at all times. It is also worth noting what qualifications the staff have and what ongoing training is provided for them.
One of the key factors when deciding on a home is often the level of fees and how much your client can afford to pay. They need to be sure of what is included in the weekly rate, as certain medical needs and toiletries may have to be paid for in addition. It would also be prudent to enquire how often the fees are likely to increase, by how much, and when reviews are likely to take place.
Naturally the issue of paying for care is the adviser's area of expertise and they will be able to advise the client on what State benefits are available to them and how best to meet the fees. But, in the cases where there is a chance that the capital could run out, the client needs to know whether the home would continue to accommodate them in the event of that happening, given that the home will usually receive a lower weekly rate for a State funded individual. If this proves to be the case, the home may insist on a 'third-party' top-up from the client's family so it is worth knowing whether the family would be in a financial position to pay this.
Finally, the overall feel of the home is probably the most relevant factor. Asking questions like whether the client would be happy to live within the home's regime, or if they can choose when they get up and go to bed each day, for example, is hugely important. Can visitors come at any time and see the resident in their own room? Are there any rules regarding alcohol consumption or are there designated smoking areas in the home?
Every client will have different needs, and these areas are just a few of the elements to consider. The client may have many more in addition to these and therefore it is important they visit several homes to compare them and establish where their particular needs will be best met.
Disappointment
Taking a pre-prepared checklist along on a visit and covering some of the key points and concerns would be a good way of ensuring all the requirements are addressed. Finding out in advance whether there is a waiting list may avoid disappointment if the client decides on a home that has no current vacancies.
Most clients will certainly be able to tell a lot from a first visit and the first impressions made should certainly influence their overall opinion of the home. Even the attitude of the person taking the client's first telephone enquiry can give them an impression of the service provided.
To further compare the homes visited, inspection reports can be found on www.csci.org.uk and there are also a number of websites providing lists of homes, often with a link to the home's own website. One of the better sites is www.bettercaring.co.uk which gives a summary of the home's facilities, size and fee levels and allows searches by postcode or proximity to a specific town as well as by name of a specific home. Information is also given about the average cost of homes across the country.
Personal view
If the home being considered is local to where the client currently lives, they should seek the view of their own GP, social worker or friends who may have knowledge of the home's reputation. A personal view, as long as this is based on experience, can often be as good a way as any to make a decision.
Before making any final decision, it would be advisable for the client to go into the home on a trial basis for a few weeks and ensure they request the terms and conditions of residence and read them thoroughly.
Care homes do differ greatly, the main distinction simply being between those that provide 24-hour nursing care - nursing homes - and those that do not - residential homes.
The type of care provided in a residential home can vary significantly. A small proportion may simply provide cooked meals and companionship for residents with negligible care needs, whereas most will provide personal care for more dependent residents, such as help with washing, dressing and bathing.
Nursing homes tend to be more expensive than residential homes as they offer nursing care in addition to personal care.
Across all types of homes the level of service will vary, particularly in terms of the leisure activities that are run. Many homes will offer activities but it would be worth checking, perhaps with current residents, that they are provided regularly and as advertised. Being part of a group of homes does not necessarily mean that services will be provided in equal spirit in each of the group's homes; much will depend upon the manager on site. Naturally the staffing levels of each home will affect the services across the board.
All these factors will have an effect on the fees charged by the home. A home that has recently been refurbished, offers single occupancy rooms with ensuite bathrooms, a good menu and relaxed rules will be justified in charging a higher fee than one in need of a facelift that only offers shared rooms and separate bathrooms. The brand name and reputation of a particular group of homes may also warrant a higher fee level. Naturally there will be regional price variations; where housing is more expensive, it will follow that fees are higher too.
Funding
As for the future of the cost of care, it is likely this will continue to increase year on year. The rate of inflation alone, together with the impact of staff pay rises, increased regulation within homes and staff training would support this view. While the Government continues to provide insufficient funding for those who are funded in homes by Social Services contracts, the private fees tend to balance the books and so we are unlikely to see anything other than an upward trend in the foreseeable future.
Advisers therefore have a real responsibility to help people understand the financial implications of needing long term care.
Nicky Cave is head of the Millfield Care Partnership
COVER notes
• Location, accommodation and available facilities are important factors to consider when choosing a care home.
• Understanding what the care home cost includes is imperative in case medical and toiletries requirements have to be paid for in addition.
• It is important to visit several care homes to compare and contrast in order to find one suited to the client's needs.
