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Paying for social care (older people)

Choosing a care home

This page covers:
• Where to find information and how to get started
• Things to consider, like type of care, location and cost
• How good care can mean different things to different people

Choosing a care home is often a once in a lifetime decision. Although some people had helped family members with looking at care homes before, most said they didn’t know where to start. If the need for full-time care is quite sudden, it can be really difficult to choose the right place in a hurry. People said that they wished they had thought about it sooner, or even looked at what was available locally before they needed to move to residential care, especially as care homes often have waiting lists. Many people asked friends and colleagues for recommendations of local residential care homes.

 

Beverley asked friends if they could recommend a care home locally.

Beverley asked friends if they could recommend a care home locally.

Age at interview: 68
Sex: Female
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I asked around of various friends, and the friend who's the private carer, and she recommended two places in [City]. She said there's the, a nursing home in [Town], which is supposed to be very good. And we'd also thought about that for my father-in-law, because his, he was a mason, and if you're a mason you get into that one and it's very good. And then, she also mentioned [care home]. I've heard of [care home] before, and my partner, who's self-employed builder has worked there, and a few years ago… And he came home, and he said, "We should put our names down, it's really nice, we've got to live somewhere in our old age." I thought well, if, you know. And it does, and they do, and they are lovely, so helpful when you contact them and everything. It's just the waiting list. But because, I'm really glad I have put my father's name down, because although he hasn't asked for any help like that yet, and I haven't even told him, to be honest, but if he does say, I think it's time, then at least, you know, he's on the list now.

Where to start

People told us that the internet was a good place to find information about care homes. Some people used the Age UK or Alzheimer’s Society websites which provide information about what to look for and also have useful checklists. The Care Quality Commission (CQC) website reports on the facilities and quality of care homes. Some people said they found the CQC website useful but stressed that it is important to go and look round the care homes if you can.

 

Rosemary got information from various sources, including colleagues, online and a care home open day.

Rosemary got information from various sources, including colleagues, online and a care home open day.

Age at interview: 65
Sex: Female
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Well again I spoke to people that I knew, colleagues and people who had been through the process or who had got parents or partners or whatever in care. So I talked to people and got sort of recommendations or, oh don’t touch that place with a bargepole type thing, you know. But so I got that sort of anecdotal stuff. Again use, I used sort of my sort of professional links to talk to people who I knew provided support of this kind; things like the things you can find for yourself on the internet, the checklists of what to look for when you go into a care home, you know and, to be honest, they’re helpful, I’m sure, and they’re readily available and they do mention one or two things that you might not think of yourself, but pretty much what was on the list is common sense and I would; but it is useful to have somebody else saying, have, you know, just, just think about these things. So I sort of had that in the back of my mind and then I basically drew up a sort of list; I researched obviously CQC reports so I knew what, you know, other peo, what they had said about the homes, chucked some out and came up with a list of, I don’t know, a dozen, I suppose and I suppose I must have gone to about a dozen, sometimes on my own, sometimes with somebody else; if it went to a second visit or a third visit I would take somebody, a friend or my mother or somebody with another pair of eyes and I suppose I eventually drew up a shortlist of three or four and went in obviously, went several times to them. I spent a bit of time in each of them, I just sort of sat and; it’s, it’s amazing what you pick up by sitting in, you know, reception or a lounge or whatever and just watching what goes on. Ironically I wasn’t able to do that with the care home that Graham eventually moved into, because it was brand new and so the best that I could do would be to go and talk to the manager who’d been appointed with the nurse, because they provide nursing care, this particular care home. I went to an open days that they had, I visited it. So I did the best I could but what appealed to me was the fact that it was a uniquely specialist dementia care home and I thought well that was probably, I would hope, give, you know, the best quality of care that we could afford.

Some people said they were given a list of providers from their local council adult social care department. However, they said that they were disappointed not to be given more guidance on which care homes were suitable. Tracey said she felt ‘really alone’ looking for a home for her parents who were living with dementia. Some people found the discharge teams at the hospital were supportive or signposted services that could help them find a care home to suit their needs.

 

Margaret had help looking for a care home when her husband was discharged from hospital.

Margaret had help looking for a care home when her husband was discharged from hospital.

Age at interview: 79
Sex: Female
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Specialists in the major hospital discharge schemes. So this lady came to me and I have looked it up, they obviously still function, and her job was to help me she, because the hospital were saying, “He’s got to go home.” And I realised that he was taking up a bed that he didn’t need. So she was, it, that was very good because she asked me, you know, “Whereabouts do you want to go? What, you know, how far are you prepared to tra, you know, travel?” All this sort of thing. And so she phoned round homes, well it was only four in the end in the area that I wanted to, you know, I felt was within an easy distance [a] I could drive there in the car but if, for any reason, I couldn’t use the car I could get a bus there because, you know, I felt I wanted to visit him every day, so. And then she took me round to the, she made appointments, and so that made it very, very easy for me, that was very helpful, and she was very helpful. But in the hospital they weren’t particularly helpful, the social workers but she was that was very helpful and she gave me some fact sheets and so really I only saw four places so it, I, which wasn’t that good, but three of the others just weren’t at all suitable, I didn’t think, or I, because it was going to be such a sudden, and he wasn’t going to see it, but then because of how he was I don’t think he would have accepted going to see anywhere, whereas because he was in hospital [sighs] I suppose he’d, I think he realised he wanted to get out [laughs].

 

Tracey looked online but says it’s best to visit the homes in person.

Tracey looked online but says it’s best to visit the homes in person.

Age at interview: 59
Sex: Female
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I looked at CQC, which completely it just gave places marks; and some of the places I’d been, their marks didn’t match to what I thought; so I didn’t have much confidence in the CQC at all. Yeah, then, that was then. And all the places I looked up there wasn’t, they only showed the, all the homes and the places I looked up only showed the best bits, they didn’t show any particular case studies, they were just showing, all the ones I could find were only just showing a little bit about them, what their facilities were and what they could do, but there was no like sort of Trip Advisor no clients’ feelings or anything, which to me is just like a sales pitch. So not much info at all really, no, no. The only way to do it was to look at them [pause 2 seconds], go and physically look around them, and the more you look at the more you learn...

 

...and, you know, and then you obviously go, you don’t make an appointment, you just go, obviously all the time, but then if everybody’s doing that they haven’t got time to look after the, who’s in there do they? But I, we did find with this new one, the new one that we found for dad that they had a sales person showing people round, who didn’t discuss prices or anything, just showing the facilities, and it was like looking round a new, it was like looking round a show home.

Was it empty then, because it was so new?

No it wasn’t, they only had a few people in, but they didn’t have anybody in the basement where dad was going to be, and I didn’t know that he was going to be down there. So I only was shown round the nice rooms, which is a sales pitch isn’t it?

 

Jacky pointed out that the ratings on CQC are not just about the standard of care.

Jacky pointed out that the ratings on CQC are not just about the standard of care.

Age at interview: 65
Sex: Female
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I started with a list that I was directed to online when I rang [name of county] Social Services, then I looked at the Care Quality Commission reviews actually that is a bit misleading, and I already, I already knew this I think from experience of the residential home where my mum and dad were, because the problem is, and it’s, it’s a bit like, it’s the equivalent of Ofsted for schools really, it’s, it can be, if you just look at the headline as to whether it’s good, in need of improvement or whatever then it can be misleading, because if you automatically rule out anything that says in need of improvement you’re really restricting your choice, and sometimes it can be something which is not really to do with quality of care. So the one they had here was in need of improvement but one of the reasons had been because it’s an old Victorian house the laundry is in the basement and they, they weren’t happy with the basement area of the laundry. If you looked at the, I can’t remember what they are now but there’s five different criteria and to me the most important one is the quality of care. Because, yes, OK, there could, it could be that this laundry being in the basement, and there was some damp in the basement, could increase a risk of infection, I do see that, but to me that’s different from a care home being rated in need of improvement because it’s not got good on the quality of care, because that’s what affects your relative.

Residential and nursing care homes

Care homes provide care for people 24 hours a day. There are different levels of care home, for example, a residential care home can only provide social care but does not cover nursing needs. Margaret’s husband lives in a residential home that specialises in dementia care but it is not a nursing home. If he needs nursing care in the future he would have to move to a new home. This may affect the cost of care or the way it is funded, see more about NHS funding in What is continuing healthcare (CHC)?

 

Margaret had to choose a care home for her husband in a hurry when he was being discharged from hospital.

Margaret had to choose a care home for her husband in a hurry when he was being discharged from hospital.

Age at interview: 79
Sex: Female
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As I say, but my, my regret is that, although I’d been thinking about the future and Joe to go into care I didn’t want it to happen really I felt I ought to be able to manage myself but, you know, I couldn’t and that was recognising that I couldn’t manage was quite a big step for me and [sighs] I wish I had started looking at homes and thinking about it before it suddenly happened; that would be my, the main, you know, the main thing that I would, I would say, from my experience to, to do more research before you’re suddenly, you know, don’t think it’s not going to [laughs] suddenly things are going to change and you’re presented with the problem of getting full-time care in a, in a care home.

Getting the right level of care can be difficult. Jennifer said that she didn’t want to lose her independence but needed access to flexible care as her needs changed. Some people thought it was helpful to be in a place that could provide whatever care is needed to the end of life.

 

Sarah thought the care home with nursing helped her parents stay out of hospital.

Sarah thought the care home with nursing helped her parents stay out of hospital.

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While they were there, my mum’s still, there I wasn’t, you know, they certainly, they as far as I was aware they never had another UTI, well my mum hasn’t; my dad, just over the last few months of his life he did seem to have some problems but the nursing staff, you know, they did manage it and he was comfortable sort of to the end. But yeah, I do think that obviously having that care there and the nursing staff, their experience made them a lot more comfortable probably and, yeah, were able to sort of look after them and give them what they needed to sort of, you know; I suppose they need somebody, they needed somebody there the whole time to make sure they were drinking and they were, you know, I mean my mum had been on a fluid chart and all that kind of thing. So yeah, they needed that sort of expertise and support, definitely, which they got there, and which we didn’t, we couldn’t provide in quite the same way, I don’t think, at home; well it got to that stage anyway.

Location

When choosing a care home, people thought location was very important. They looked for a home where friends and family could easily visit.

 

Hannah and her sister and brother considered different options for the location of their mum’s care home.

Hannah and her sister and brother considered different options for the location of their mum’s care home.

Age at interview: 53
Sex: Female
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So that really was a difficult decision a lot of to and froing in the family as to where she would actually reside, as to whether it should be a home in her town that she had spent the majority of her married life in or whether she should be somewhere where, which was equidistant from the rest of us but in the end it was agreed that she would be in a home that was close to me as I was the primary carer for her; so we then looked for homes that were close to where I lived. That, then my brother and I then went and walked around various homes and ended up settling on the care home that she ended up residing in.

 

June found a home nearby so that she and her daughter could visit everyday.

June found a home nearby so that she and her daughter could visit everyday.

Age at interview: 72
Sex: Female
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Yeah, because mainly because it was close to me and close to my daughter and I thought that was as important as anything that we could see him every day. And so we had a look round; they didn’t have any vacancies at the time but you know, I said we were self-funders, and they’re quite keen to have self-funders and [laughs] and she did explain, because the rooms varied quite a lot and she said, of course when a vacancy arose he’d have to go into whatever room there was, but some of them were small and pokey without, without a bathroom and toilet and some were bigger and airier with the bathroom and toilet and there was no distinction between self-funding and council funding which she said she didn’t, she didn’t really think was right, but anyway, but if John went in and he went into a small pokey room then they would move him round when one became available in another room. So told me the costs and we knew we would get funded nursing care, which was, it’s about 150 a week, I think, something like that. So, he, a place became available about ten days/two weeks later, so he was transferred by ambulance to [Residential home] Nursing Home.

Although location was important, there were many other factors that people considered.

 

Deryck decided on a home further away for his mum because she would get more for her money.

Deryck decided on a home further away for his mum because she would get more for her money.

Age at interview: 71
Sex: Male
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Because she was in [County B] and we live in [County A] and we had to think about how we maintained contact with her, and it was pretty obvious that it was going to be a lot easier if we moved her to [County A]. So I investigated the cost of care in [County A] around here against the cost of care in [County B]; and this is another case of being a postcode lottery. You get more for your pound in [County B] than you do in [County A]. So having made that discovery the decision of where she was to be was easy; she needed the best care she could afford and we would travel and that’s the way it always was. So we discussed with [County B] finance department how this was all going to happen and because she had a property, although they didn’t take any financial interest in that, their decision was that they would obviously take all of, all of her income, her pensions, etc, but if she was going to go into care and have any choice of where she was going to go she would need to self-fund and that meant selling her place; and the figure that they needed was enough capital to support her for three years.

Cost of care

People told us it is important to ask about the weekly cost of care homes as there is no point in spending time looking round if it is not affordable. Care fees can vary greatly across different parts of the country. People also found that things like furnishings affected the cost of a room but said it was more important to think about the way the carers interact with residents than ‘five star hotel quality surroundings’.

 

Jacky looked at care home fees first but says it’s crucial the home has a good feeling.

Jacky looked at care home fees first but says it’s crucial the home has a good feeling.

Age at interview: 65
Sex: Female
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So I, I emailed maybe, maybe about; some I looked at the fees or I rang them up and found the fees were so expensive I just thought well that’s just ridiculous. There was one which was 1,500 a week, for example so I didn’t even write to them when I’d done that. Then I wrote to them; some I just didn’t get replies from so I thought well that’s not a good sign is it [laughs] the ones I didn’t get replies from. I only got replies from three so I went to, I went to those three. And I think it’s difficult to justify because a lot of it’s a gut feeling when you, because I’d been visiting in care homes where they were and because I’d been in a care home situation a lot, visiting, then I think I would pick up on things that maybe somebody who’s never been in one before, it’s difficult, because you’re more tuned into it and you just, when you’re there you just notice what’s going on around you and you’re just like watching how they interact with people that are there and things like that, and I just had, and it was a very convenient location, the price was, well the other one was the same price actually, the two I was comparing were the same price, and I just had a better feeling about it.

So yes, I was very conscious about keeping costs down, which you, which you feel horrible because, because you see lovely rooms which are a £1,000 a week and you think well yes, I’d like mum to have that room, but you just know financially you can’t sustain it.

As well as paying for care, the fees paid to care homes cover the room, meals and utilities such as heating and electricity. However, people said they were disappointed to find they had to pay for extras such as hairdressing also some families said they had to take some of the laundry home.

 

Bella explains about the extras on top of the cost of a care home.

Bella explains about the extras on top of the cost of a care home.

Age at interview: 69
Sex: Female
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I think another thing that people need to be aware of when they're self-funding is that, yes, you will get your board and lodging, but things like hairdressers, chiropodists, dentists, opticians, you will all have to find those. And that is just something you need to factor in. You know, it is going to add to the expense.

Many care homes run activities for residents which are included in the fees. Some places also run special outings which have to be paid for.

 

Jennifer lives in a care village where there are lots of extra activities on offer.

Jennifer lives in a care village where there are lots of extra activities on offer.

Age at interview: 74
Sex: Female
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So if people want to go to the shops; we have outings to the local shops every day, Monday to Friday, with our minibus; you have to book for them but they’re free, if you want to go shopping, to different places all the time, you know, morning or afternoon. I don’t go shopping because I can’t cope with the shops, but that’s a facility that people need to know about, and that is free. We do have outings, some of which are free and some of which we have to pay for, it depends what they are. If we go to the theatre or a concert, and they arrange that every now and again; they try and do something every month, you know, two or three things that; we have to pay for the concert but we might not have to pay for the transport, we might have to, it depends. And then we have a lot of activities here many of which are free; I mean we have a croquet lawn, we have a bowls lawn, we have a clubs, you know, which, but they’re run by residents, a lot of them, you know, Scrabble and What Shall We Have and Rummikub and; I run a couple of groups and they’re all free.

What is good care?

Good care can mean different things to different people. One of the important things people told us about care homes is whether the residents are given choices in their daily routine.

 

Rosemary says that personalisation and choice are central to good care.

Rosemary says that personalisation and choice are central to good care.

Age at interview: 65
Sex: Female
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But, as I say, I think it should be better than just physical care, it should be, “is this right for them, how can we make the quality of life as in, as the best it can be for this particular individual?” You know, it’s all those stuff that we hear about: personalised care planning, and it seems to me the system’s under so much pressure that that is what tends to go. So I would say to somebody, look out for them, ask questions about how you cater for each person to be an individual, how you make sure that, you know, your idea of an entertainment is not fifteen people sitting round in a room either asleep or sort of in a very, you know, desultory way hitting a balloon backwards and forwards, you know, and thinking that that’s an activity.

So perhaps have a look at, have, go in on an afternoon when they’re doing their activities? [Laughs].

Go in and not be; yeah that’s a very, that’s a very good point. Don’t just go in, walk round the rooms and the bathrooms and say, oh this looks nice and clean, oh they’re, nice cottage pie they’re having tonight, all of which are important, of course, but actually go in and spend time, you know, spend an afternoon there. Go back in the evening, go back at night, see what happens then; I would always say that to somebody, because the staffing is almost inevitably lower, with justification, but, you know go in and look at night. Go in at mealtimes, go in first thing in the morning when, you know, is everybody being made to get up at eight o’clock in the morning in, or by eight o’clock in order to fit in with the staff shifts, you know, or are people, if they say, actually no I think I’m going to have a duvet day today. Are they able to do that? They should be able to; that’s what personal preference is about. So I think you need to put quite a lot of time into it, yeah, and then ask about the systems and processes behind all of that that enables that to happen. and I do think gut instinct has quite a lot to do with it; I think there’s a practical checklist, there’s all those questions, there’s the scrutiny but I think, you know, trust your judgement, I would say and sniff [laughter] but actually, again, that is not, I don’t think in the pla-, from my experience, as much of an issue as people say it is; it can be but, you know, in general. But just how are people, how are the staff interacting with people, you know, is it with kindness, is it with individual attention and support you know, are people, I don’t mean that people are fashion plates but are they well-dressed, you know, appropriately dressed, do they look as if some care has been put into making sure that they’re wearing the things that they want to wear and, you know that there’s evidence of choice being provided, all of that stuff; and you can only do that by sitting and watching, yeah, I don’t think it’s something you go in and you go and see one place and you make a decision in half an hour, no.

For people living with dementia, there may be restrictions on their movement in and out of the home, for their own safety. It is important that the care home is inspected to make sure that their procedures are appropriate. These checks are called ‘Deprivation of Liberty Safeguards’ (DoLS). Although this can be worrying for families, it is an extra check on the suitability of the care provided.

 

Although it was hard, Hannah was reassured by the DoLS inspection.

Although it was hard, Hannah was reassured by the DoLS inspection.

Age at interview: 53
Sex: Female
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There’s, another aspect as well is one of the things that mum didn’t have in her first care home, well it wasn’t done straightaway, which [county] are hot on, is deprivation of liberty. So this is called a DoLS report for short and it’s where a social care worker goes and visits the individual in the home to look at the circumstances, because those homes will prevent your loved one from being able to leave the premises and therefore there has to be an Order in place. Again that’s quite hard when you’re reading those reports because they have to set out explicitly the circumstances as to why their liberty’s been deprived; but they’re also a good source because they will go round and look at the home and decide as to whether they think they’re getting good care.

Special care at the end of life is also a consideration. Although few people talked about this, those that did found it a comfort to know that there was a plan for end of life for their loved one.

 

Hannah found it helpful to ask about end of life care when looking for a care home for her mum.

Hannah found it helpful to ask about end of life care when looking for a care home for her mum.

Age at interview: 53
Sex: Female
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I think it’s really hard to find a good care home and you’re very much dependent on the people CQC reports and actually this home, I actually spoke to a lady who’s sister had been residing in it for the last five years. So we did a lot more due diligence on the home, having had a previous understandings as to what happened previously. My sister-in-law’s actually got nursing background and she was very good actually asking.

My sister-in-law was very good at asking end of life care, which is something that actually my brother and I wouldn’t have thought to ask but was really pleased that she did, because having seen that, having seen so many people pass away, end of life care is paramount to me because I wouldn’t want mum to be on her own if, for any reason, I couldn’t be there so.

So that was something that your sister-in-law actually thought about in advance and it…?

Yes, yeah, yeah.

Yeah, it was helpful, those conversations?

And she asked those questions and we didn’t know she was going to ask those questions but I’m really pleased she did because they give you actually a good feel of the home as to how they, how they treat the individual.

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