How to choose a care home

How to choose a care home

Finding the best care home: a step-by-step guide for self-funders

Whilst the idea of finding a care home may seem daunting, it's like anything else - much easier when you have a plan. Whatever your situation, if you are looking for care, our detailed guide will set you on the right path.

First of all, some useful facts:

How is care regulated in England?

The Care Quality Commission (CQC) is the body that regulates the care industry. All practising care homes have to be CQC registered, and are regularly inspected by the CQC, so their website is useful for finding reports on any care homes you decide to shortlist. You can access the CQC website here


How many care homes are there?

Before you start to identify potential care homes, you need to know how to start narrowing the field. There are over 13,000 care homes in the UK with around 700 in the county of Kent alone, so it's a good idea to be clear on the 'must haves' before you start a detailed search or you could waste time, and risk becoming despondent.

1. Preparation

As is often the case, thorough preparation helps ensure everything rolls out smoothly and logically.

Preparation
Preparation

1. Is there a Lasting Power of Attorney in place?

          If there is no LPA, then do try to put one in place so that close family are able to act for you if necessary. You’ll need to talk to a solicitor specialising in family law as it is a legal document. You will find more on this in the section headed 'Legal Advice' or by calling the Law and Life advice line on 0800 999 4437.

          2. What medical conditions do we need to consider – now and in the future?

            Your family will need to know about any existing medical condition/s and the long-term prognosis so that you can all plan your on-going care needs effectively. That may mean a joint consultation with your GP so that you are all clear on the current situation and the future prognosis – and so that the GP has a record of who to speak to at any point.

            You will swiftly discover that there are many different categories of care home provision (see 3. below). It is therefore important to look at those that can cater for your likely long-term needs and not just for now. If you have a degenerative condition, your needs will change. 

            3. How many different types of Residential Care Home are there?



            a. Daily care without nursing care

            b. Daily care with nursing care

            c. Dementia care

              Note: care homes in this category vary according to the type and level of dementia care they can provide so it is important to be familiar with the main types of dementia and how they are likely to progress.

              d. Respite care

              e. Challenging behaviour

                There are also care homes which are tailored to the needs of specific groups, eg:

                f. Religious foundation (ie: Christian, Muslim, Jewish)

                g. Sexual orientation

                h. Arts-biased (Musicians, Artists, Dramatists)

                4. How much money do I have and how long will it last?


                  Anyone with assets in excess of £23,250 will have to fund their own care. This means if you are a home-owner, you will be a self-funder as your home is an asset.

                  Residential care for self-funders typically costs from £750 - £1200 per week – but can be more for homes that are more like 5* hotels – or where 24-hour one-on-one support is required.

                  Knowing how much money will be available, how to release funds, and how long it will last, is vital before you start the search for a care home. It may at first look as though the sums won’t add up, but rest assured there are various financial management schemes available geared specifically to the ongoing release of funds to cover long-term care needs.

                  We advise that you contact a registered Independent Financial Advisor, someone who has the SOLLA accreditation (Society of Later Life Advisors). They will be able to provide initial guidance and tailored advice should you need it. 

                  You can find more useful information in the section headed Funding Care on this site, or call our chosen partner, Care Funding Guidance on 0800 055 6225 who will be able to advise you.

                  5. Where does the care home need to be?

                    If you and your family have never discussed the possibility that you may one day live in a care home, there may be a lot of ground to cover quite quickly. It’s not unusual to be opposed to the idea initially, and to want to stay in your own home.

                    It’s important to be realistic about location and environment. Someone who has enjoyed the silence of the countryside may not want to move to the centre of a busy town, but equally, it should be easy for family and friends to visit.


                    What other questions should I ask myself before I get started?


                    Once you have identified where the care home needs to be (+/- 5 miles), the maximum amount it can cost and any medical conditions that you need to bear in mind, try and identify what else will help you to refine your search quickly. The following list should cover most things you need to be thinking about:

                    Choosing a care home - considerations 

                    • What do I enjoy doing when I’m at home?
                    • Do I get fearful about anything when I’m alone?
                    • What do I hope will be the main benefit of living in a care home?
                    • Do I have any reservations about moving into a care home?
                    • Are we just looking for me – or my partner too?
                    • If so, do we want a double room? And a double bed?
                    • Do I prefer an open and airy living environment or one that’s more cosy?
                    • Would I prefer modern or traditional styling in the main?
                    • Do I like things to be very tidy – or a bit cluttered?
                    • Would I be happy with my room being upstairs or downstairs?
                    • Do I need a lift or a stair lift?
                    • Is an en-suite bathroom essential?
                    • Do I enjoy a bath, or prefer to shower?
                    • Are there any favourite pieces of furniture I’d like to take with me?
                    • When do I like to eat?
                    • What’s my favourite meal – breakfast, lunch, tea, dinner?
                    • Will I miss preparing my own meals?
                    • Do I enjoy a glass of wine?
                    • What do I hope the people looking after me will be like?
                    • Do I like to watch TV/listen to music in bed?
                    • What types of programmes do I particularly enjoy?
                    • Do I watch a lot of films?
                    • Do I like being outdoors?
                    • Will I miss gardening?
                    • Do I do any particular type of exercise regularly?
                    • What hobbies would I like to be able to continue?
                    • How often do I like to have my hair done?
                    • What other activities do I enjoy now?
                    • How much do I socialise?
                    • Have I typically been the life and soul of the party?
                    • Do I want a bit of independence – to go into town occasionally?
                    • What clothes do I like to wear?
                    • Do I want to take my pet/s into the home with me?

                      2. Building the 'long' short list

                      When you start to use the Autumna directory search facility to find a care home, you'll be taken effortlessly through a series of questions to identify your needs and wishes.

                      Making a long short list
                      Start the list

                      From the information you give, Autumna will find an initial ‘long’ shortlist of potential care homes for you to look at. You’ll be able to review detailed information on each, comparing one with the other from the comfort of your own home, and then make direct contact with any that look promising.

                      Alternatively, you can speak to Chosen with Care who, for a very reasonable fee, can take this part of the search away from you altogether. 

                      If you find yourself feeling confused or overwhelmed, call the Chosen With Care Advice Line initially and find out how they can help: 01892 300 530.

                      Reducing the long list

                      You should be able to eliminate some of your early options from the long list fairly quickly by doing a like-for-like comparison of each whilst also checking on a map to see precisely where they are located.

                      Narrowing the choice
                      Narrowing the choice

                      Once you have done this, it’s a good idea to call those you are left with – it’s all part of the securing a vital ‘First Impression’.

                      What do you want to find out when you make the call?

                      • How quickly the phone is answered
                      • If there is a voicemail, how it sounds and what promise it makes to the caller
                      • How the call is answered, eg:

                       ‘Good morning, this is the Sea View care home and I am Karen White, the Manager; how can I help you?’

                      • Level of background noise from the care home
                      • How instantly welcome you are made to feel
                      • Whether the person you speak to is able to help you with your enquiry – and if not, if they can put you through to the right person
                      • Whether they seem efficient and well-organised
                      • Howinterested they are in you
                      • How willing they are to patiently listen to you and answer the questions you have
                      • Whether the questions they ask you are designed to determine whether they can meet your needs
                      • Whether the information provided on the website is correct – particularly cost and availability
                      • How you feel at the end of the call

                      The second 'first impression'

                      The only way to confirm or challenge the opinion you’ve already formed is to pay a visit. It's the ideal opportunity search for any missing pieces to the jigsaw and get answers to any specific questions you may have.

                      The second first impression
                      Look again... and closer

                      It’s important that someone goes with you – ideally a close friend or relative who knows you well. Not only are two sets of eyes better than one, but you'll be able to discuss the pros and cons of each home with them afterwards.

                      A word of warning: avoid the temptation to visit too many care homes on one day – as with viewing houses on Rightmove or choosing a holiday cottage on Booking.com, they’ll all start to merge into one after a while.

                      Ask if you can take photographs – it should be fine if you don’t include residents in the pictures. Over and above anything else, you need to be able to identify with ‘how it feels here’ and you won’t do that if you cram too much into the day.

                      Tips for a Care Home Visit:

                      1. Don’t make an appointment

                        Turn up unannounced, but at a reasonable time, ie: between breakfast and dinner, ideally 10.30am – 4.30pm.

                        2. Weekday or weekend?

                          Bear in mind that Monday – Friday runs like a working week; weekends are slightly more relaxed and the Care Home Manager may not be there. However, you will probably have the opportunity to meet more visitors which can be very useful.

                          3. On arrival, what do you find?

                          • How clear is the sign-posting?
                          • Is it easy to park?
                          • Are you able to park near to the main entrance?
                          • Is the front area well maintained and tidy?
                          • Are there clear entry instructions?

                          4. In Reception, what do you see?

                          • How tidy is it?
                          • Is it welcoming?
                          • What can you smell?
                          • What are the décor, flooring and furnishings like?
                          • How is it lit?
                          • Is it noticeably clean and fresh?
                          • Are their flowers?
                          • Is it JUST a Reception area, or does it double up as something else?
                          • Can you see beyond Reception – and if so – what do you see?
                          • Who is in the Reception area when you arrive?
                          • Who greets you and how?
                          • What happens when you say you would like to look around/talk to someone but don’t have an appointment?

                          5. On the tour, what do you notice?

                          • Were you invited to have a tour?
                          • Were you asked what you wanted to see?
                          • Did you feel the tour was thorough?
                          • Were you happy with the answers to the questions you asked?
                          • Did you feel that residents’ privacy was respected during the tour, eg:
                            • gentle knock on the door
                            • asking the resident’s permission to let you see their room
                            • introducing you to the residents
                            • encouraging you to speak to them

                            What should you ask about? Checklist.

                            A. Staff

                            1. Who manages the care home on a daily basis?
                            2. When is the manager on duty and who deputises when they are absent?
                            3. How many staff are there in total?
                            4. How many management staff, carers and ancillary staff?
                            5. What is the ratio of staff to residents? (Note: this will vary depending on the type of care provided)
                            6. Will there be profiles available of the staff who will be caring for me/my relative?
                            7. What are the staff retention figures?
                            8. Is the care home fully staffed currently?
                            9. What is the absence rate?
                            10. What is the shift pattern?
                            11. How many staff are available during the night?
                            12. Are there any medical staff on call during the night?

                            B. Residents’ Rooms

                            1. How many floors are there in the care home?
                            2. Can I specify floor and type of room?
                            3. Are all rooms the same size with the same facilities?
                            4. Are there any double rooms or suites?
                            5. Do any rooms have a kitchenette?
                            6. Are there any apartments within the care home/complex?
                            7. What is the view like from the bedroom window?
                            8. Do the windows have safety catches – how far do they open?
                            9. Does every room have en-suite shower and/or bath facilities?
                            10. Does every room have a telephone point?
                            11. Is there wi-fi throughout the care home?
                            12. Does each room have a television?
                            13. Is there fitted furniture in each room, or…
                            14. Can a resident bring their own furniture if they wish?
                            15. Are there bedside lamps and an overhead light?
                            16. Are all furnishing fabrics flame retardant?

                            C. Communal Areas

                            1. How many lounges are there?
                            2. Is there a ‘quiet lounge’ without a television?
                            3. Is there a library/reading and writing area?
                            4. What facilities are there for activities – art room, exercise room etc.?
                            5. Is there a hairdressing/barber facility in the care home?
                            6. Are there any treatment rooms – eg: for massage, beauty treatments?
                            7. How many wheelchair-accessible downstairs toilets are there within easy walking distance of the communal lounges?
                            8. Is there an area where teas and coffees are available all day?
                            9. Are there dedicated areas for smokers/vapers?

                            D. Food



                            1. Is all food prepared using fresh ingredients? Is it… cooked on the premises, delivered ready to eat or supplied frozen, for thawing and re-heating?
                            2. Do you cater for special diets – Vegetarian, Vegan, Kosher?
                            3. Do you cater for individuals with specific nutrition needs?
                            4. What times are meals served?
                            5. Is there a dedicated dining room?
                            6. What range of refreshments are available outside normal meal times?
                            7. Can residents eat in their rooms if they prefer?
                            8. Can residents order in their own food or can visitors bring food in?
                            9. Are there the facilities for residents to prepare their own drinks and snacks?
                            10. Does the care home cater for residents’ guests/visitors?

                            E. Activities


                            1. What activities are available to residents?
                            2. Is there a full time Activities Manager?
                            3. Is there an activities programme in place?
                            4. Does the home lean towards particular types of activity – eg: art; ceramics, etc
                            5. Do residents play board/card games?
                            6. Can residents choose what they want to do?
                            7. Are there any outdoor activities in the care home gardens/grounds?
                            8. Are any external trips organised – to exhibitions, musicals, plays etc.?
                            9. Do people come in to give talks and demonstrations?
                            10. Are there any clubs run at the care home that non-residents participate in?
                            11. Are books available – is there a reading area?
                            12. Are newspapers delivered?

                            F. Outdoor Space

                            1. Does the care home have a garden – and is it visible and accessible from the communal rooms?
                            2. Is there a kitchen garden?
                            3. Is there any other outside space for residents?
                            4. Who maintains the garden – are residents encouraged to take part if they want to?

                            G. Medical and Wellbeing Services

                            1. Is there a GP assigned to the care home and all its residents?
                            2. If so, does that person visit regularly as a matter of course, or just when called?
                            3. Can a new resident retain their existing GP if they are still living within the relevant catchment area?
                            4. Does the home arrange for dentists, opticians and chiropodists to visit regularly?
                            5. Are there hair dressing facilities for men and women within the care home?
                            6. Are there any therapy rooms for beauty and medical treatments, eg: massage, manicure, pedicure?
                            7. Can residents continue to visit the therapists they have always used if they prefer?

                            H. Safe Mobility

                            1. Are there hand rails near doorways, steps, stairs, along corridors, in toilets?
                            2. Is there at least one lift that will accommodate two wheelchairs at once?
                            3. Is there a stairlift in operation?
                            4. Do all the toilets – including any visitor facilities – provide for wheelchair access?
                            5. What are the floor coverings throughout the building (trip hazards?)
                            6. Can wheelchairs go everywhere, including outside?
                            7. Can residents bring their own mobility vehicle? If so, will it be maintained?
                            8. What safety provisions are outside to protect residents with compromised mobility?
                            9. Is the garden/outside space safe and accessible for residents with dementia?
                            10. Is there direct access from the garden to the drive and parking areas?

                            I. Security

                            1. Is there a burglar alarm fitted to the care home?
                            2. Are there window locks?
                            3. Is there CCTV in the common areas and the grounds?
                            4. Is a resident’s room accessible by anyone passing by – or just staff?
                            5. Is there someone secure for residents to store valuables, including paperwork?

                            J. Language, Religion, Culture

                            1. What languages are spoken fluently in the care home by care home staff?
                            2. What languages are spoken amongst residents and their families?
                            3. How are different religious beliefs catered for in the care home?
                            4. What efforts are made to ensure people of varying cultural backgrounds all feel respected and included?

                            K. Guests

                            1. Can guests visit at any time?
                            2. Can residents invite family and friends for lunch/supper? Weekdays? Weekends?
                            3. Are there any events that are open to family and friends?
                            4. Can relatives get involved helping with activities and events?
                            5. Can guests stay overnight (if they have a long way to travel)?

                            L. Fees

                            1. What are the weekly fees for the type of care I need?
                            2. Is payment made on a monthly basis by standing order?
                            3. What items/services are ‘extras’ and is there a price list for those?
                            4. How and when are extras invoiced?
                            5. Do I need to pay a deposit in addition to the first month’s fees?
                            6. When is the initial deposit returned?
                            7. What notice period do you require of a resident who is moving elsewhere?

                            M. Availability

                            1. What is the room availability and is there a waiting list?
                            2. How far ahead can I put my name on the waiting list?
                            3. Will I have to pay a deposit at that point?
                            4. Would I have to take a room as soon as it becomes available?

                            N. Legalities

                            The care home is obliged to provide a brochure which should clearly set out the following:

                            • Its aims and objectives
                            • The facilities offered
                            • The terms and conditions of residents’ contracts of occupancy

                            After your visit, reflect and then review

                            If you let your heart rule your head from the very beginning then you may be prepared to overlook things that are very important to you. However, once you are confident that the care home has everything you need, ask yourself: '... can I imagine myself living there?'

                            Review and reflect
                            Does it FEEL right?

                            Once you have ticked off everything on your check list, reflect, and ask yourself:

                            • Did the person showing me round seem proud of the care home? 
                            • Did he/she seem popular with staff and residents? 
                            • Were other staff welcoming and willing to talk?  
                            • Was I encouraged to talk to other people?
                            • Were staff actively involved and engaged with residents – above just ‘doing the job’? 
                            • Was there a cheerful, lively atmosphere in the public rooms? Were people talking, sitting together, doing things together? 
                            • How was the furniture arranged – sociable clusters, chairs lined up around the wall? Was the TV on?  Was I aware of flowers or other decorations around? Were there any visitors? 
                            • Did I see enough of the care home and its grounds to give me a clear picture of the environment and facilities?
                            • Do I think I could be happy there?

                            Make sure you satisfy yourself that the reality matches the marketing message.

                            And before you sign any agreement:

                            • Read and understand the contract
                            • Let your solicitor know what you are intending to do
                            • Speak to your financial adviser

                            "This may seem an immense amount to think about – but the decision you will be making, whether for yourself or a loved one, is one of the most important you will ever make. It's about ensuring that life can be lived and enjoyed, in the best possible environment – and surely everyone should be able to do that?"