What Makes the Best Care Nursing Home? Discussed by Bristol Care Homes
Care homes provide personal care and accommodation for people who need extra support in their daily lives and this can include a wide range of support; personal care with eating, washing, dressing, going to the toilet or taking medication. If your loved one is finding it difficult to manage at home on their own and they are feeling lonely and isolated then a Care Home may be the best option for them. Choosing a care home for a relative can be daunting as well as complicated and our article What Makes the Best Care Home will help you understand what you should be looking for, the questions you should ask, considerations and much more when you are making this huge decision.
All care homes offer personal care and accommodation and there are also specialist types of care home that offer additional services for residents with greater care or medical needs. Care homes can be run by private companies, local councils or voluntary organisations and are regulated by the Quality Care Commission (CQC) who is the independent regulator of health and social care in England.
Types of Care and Nursing Homes
A care home provides help with personal care, such as washing, dressing, taking medication and going to the toilet. They may also offer social activities such as day trips or outings.
A nursing home provides personal care as well as assistance from qualified nurses if it is needed. They are also sometimes called care homes with nursing.
A care home offering specialist dementia care has a team of carers who understand dementia and have the skills and experience to ensure the people they are looking after feel comfortable and safe.
Dual-registered care homes look after residents who need both personal and nursing care and often someone who just needs personal care will move into one of these types of care home so they don’t have to move if they later need nursing care.
Is a Care Home the Best Option?
If you’ve never experienced it before then its often a daunting and difficult process to know where to start when looking for a care home for your loved one. There are lots of considerations to think about and we would always advise that if possible you involve your relative with all, or some of the decisions and this way they won’t feel you have taken over their life and made this life-changing decision for them.
In some cases staying at home is the better option for them and there are some things that you can do that will make this easier for them and you, including:
- Adapting their home to make certain activities easier for them
- Getting some care at-home support to help them with things that are becoming difficult. This can be on a regular or ad hoc basis
- Moving into sheltered housing where there is an on-site warden to help if they need it and this enables them to live their life independently, just with a bit more support as well as more social interaction with other residents
You can ask your local council to arrange a care needs assessment and this will assess their day to day needs to see what support can be provided.
Moving into a care home is often the right choice for people and if you find the right one then it can be a positive and life-changing experience for anyone who is struggling on their own and feeling isolated and lonely.
How to Find the Best Care Home
Finding the best care home for your loved one the first time round will ensure they are happy, contented and that they won’t need to move again which often causes stress, upset and upheaval for them.
Ask for recommendations from friends, family and your local community as personal recommendations are often the best way to find the best care home for your loved one. You can use local online chats and Facebook pages to ask for recommendations.
You can also, search for care homes via CareHomeAdvisor.
Care Home Advisor is a website that you can use to search for care homes in your area and find out how they are rated by the Care Quality Commission, NHS Choices, Your Care Rating, Food Standards Agency and the Health and Safety Executive.
Care Home Advisor is a website for anyone thinking of entering a care home or looking for one for a friend or relative. It helps you to understand quickly and clearly who the best care providers are so you can make an informed judgement and decision when you start your search. The website only covers nursing and residential nursing homes for older people (over 65), including dementia care homes. Entry into a home can often be a result of an emergency with the decision needing to be made quickly, so having access to the right facts, all in one place and from independent resources can give you essential and informed advice.
Care Home Advisor
Independent – They are owned by LaingBuisson, the healthcare market intelligence provider that supplies the Office for National Statistics with data on the independent healthcare market. The important part is they are not aligned with any care home provider, they don’t allow advertising by any care home provider on their home page and are endorsed by organisations such as Age UK, Saga and Ipsos MORI who run Your Care Rating.
Impartial – They don’t use TripAdvisor type rankings. They use data from LaingBuisson, the Care Quality Commission, NHS Choices, Your Care Rating, Food Standards Agency and Health & Safety Executive. They do this because judging the quality of care is not as straightforward as judging the quality of a restaurant or hotel and is a complex and emotional process so it focuses on objective and moderated facts and the views of experts in care.
Real-time – Their website is linked directly to the underlying databases so if anything changes the website updates itself immediately ensuring you always have the latest and most accurate view on any care home.
Visiting a Care Home
You should visit a Care Home before you make any commitment and our advice would be to visit a few to start with and then any you like, visit them several times, even spending a day or an afternoon there. There are important things you should check before you visit any care home:
- Ensure the care home provides the level of care your loved one needs now or could need in the future
- Check if the care home currently has any vacancies and if not ask them how long their waiting list is. If there is a waiting list this is often a good sign and shows it is a sought after, care home, however, this does depend on how urgently you need it
- Read the care home’s brochure and have a thorough look at their website before you arrange a visit, this will help you think of the questions you will need to ask
- Call and speak to the home, this will give you a good first impression and an opportunity to ask any questions you may have before you decide if you want to visit them
- Read the most recent inspection report for the home. You can ask the home for it and look for it on the CQC website
The Quality Care Commission (CQC) is the independent regulator of health and social care in England. Their purpose is to make sure health and social care services provide people with safe, effective, compassionate and high-quality care by monitoring, inspecting and regulating health and social care services, encouraging care services to improve. They publish what they find which includes care home ratings to help people choose their care service provider. You can read our Care Quality Commission FAQ’s here.
If you can, always take time to find the right home for your loved one. Visit a couple in your area and have a look around their different social areas and bedrooms, talk to the residents if you can as well as the staff as this will tell you a lot. Before you go you should make a list of questions to make sure you find out everything you need to when you are there. It’s easy to forget things when you are there and preparing beforehand will help you make a well-informed decision. A good and professional care home will want you to spend time with them and will want to ensure you are comfortable with what and how they do things, and if not then this probably isn’t the right care home for your loved one.
First Impressions are really important when you first visit a care home.
- Look to see that the building and gardens are well maintained and if not then this probably isn’t a good sign
- Check there is an easily accessible garden
- Think about how the home felt when you first walked in, did it feel welcoming and inviting
- Is the home in a nice location with good surroundings and local to family members and friends to visit
- Staff welcoming and talking to you when you are walking visiting is a good sign and observe how they interact with the residents
- Take note of the cleanliness of the home and if it smells fresh in all of the areas and rooms
- Is the temperature in the home comfortable in both the social areas and residents rooms
- Look to see how the home and rooms are decorated and if it feels fresh and well maintained
Care Home Staff
Care home staff will often give you a true reflection and insight into the home, they will have a huge influence on the atmosphere of the home, how the residents feel as well as the level of personal care and support the residents receive.
- Welcoming, friendly and interested staff are positive in a care home. Think about how they interacted with you and your loved one when you visited
- Observe how they interact with other residents when you are walking around and how well do they know each of them
- Find out how the staffs shift patterns work and if there is always a manager and or senior member of staff in the home 24 hours a day
- Find out what their ratio of staff to residents is during the day, night and weekends
- Ask if residents can choose if they have a female or male carer
- Ask what training the staff go through, how often and who with. Ask them what training they receive and how regularly. Find out what minimum qualifications and experience the staff and caring team have
- Ask if all carers are trained in caring for residents with dementia, if not, how many and how do their shift patterns work if dementia care is critical to you
- Ask for the care homes staff retention rates and the average staff tenure as this is an indication of how happy staff are working there and will reflect on the care the residents receive and the atmosphere
Meeting Individual Care Needs
Everyone will have different care needs, some will need more than others and peoples care needs change so it is important to find out everything you can about this.
- How do they assess each resident’s individual care needs and situation before they offer them a place
- Does each resident have a named carer who oversees their care
- How does the home interact and what are their processes with the residents and families when decisions need to be made about their care
- Are there other residents in the home with the same level and type of care needs
- Can the care home adapt and increase their care if their needs change
- Do the toilet and washing facilities suit their needs and are there accessible toilets available in all parts of the home which are easy to find and get to
- Can residents be helped to the toilet if needed during the day and at night
- Are there suitable and enough handrails around the home in the social areas, bedrooms and bathrooms, this can also include raised toilet seats and mobility aids
- Are the corridors wide with enough space for wheelchair access
- Are there wheelchairs available if they are needed
- Are there links with a specific GP for residents and how does that work if they need to see a doctor
- What processes are in place and who decides if a resident needs to see a doctor
- What processes are in place to inform ‘family’ if a resident is unwell
- What other health care staff visit the care home and how often (opticians and chiropodists)
- Are residents accompanied to any regular doctor and hospital visits and how do they get there, also ask if there is an additional charge for this
- What care does the home specialise in and what processes are put in place for anyone with specific sensory impairments or needs if this applies to you
- How does the care home settle a resident in when they first move in with them and check how they are doing throughout their time with them
- Does the home offer support for end-of-life care
Care Home Food & Snacks
Food is an important part of most peoples lives and healthy, well-prepared meals are important in most peoples happiness.
- How are meals prepared, are they prepared onsite or are they brought in by outside caterers
- Are there meal planners for the days ahead
- Can the residents choose what they have for each main meal
- Do residents eat together, or can they eat in their rooms if they want to
- Are the main meals at set times
- Ask if you can see sample menus
- How often do the menu’s change
- Are there snacks available during the day or at night and how are these provided
- Can the home meet any dietary requirements that you need them to
- Are the residents and visitors able to make their own drinks (hot and cold)
- Are the residents able to store their own food in their room
Social Activities at a Care Home
Social activities are vital for a happy and relaxed care home where there are both opportunities to take part in different activities as well as relax and have your own space.
- What social activities are available for the residents on the premises (music or singing, reminiscence groups, exercise classes, gardening, celebrations for special occasions, visits from entertainers, and outings to shops, entertainment venues or places of worship)
- Are they encouraged to stay active and do as much as they can for themselves
- How are the activities co-ordinated
- When you visit try to ensure you go at a time when activities are going on and you will see if residents seem happy and occupied
- Find out what social areas there are in the care home, how is the furniture arranged. Chairs around the edges of a room often mean that residents aren’t able to socialise as well and are also not able to socialise in small groups which can be key to them forming good friendships
- Are the staff sat with residents talking to them, or do they all seem to be rushing about doing jobs
- Think how would you feel socialising in the care home
- Do they have any pets in the care home or can residents and their families bring them in
- Are there lots of resources for the residents, books, magazines, games, TV’s, phones and computers etc
- Does the home have a hairdresser come to them regularly
- Do the rooms all have a TV, a DVD, a phone and internet access where the residents can relax in their own space when they want to
- Are the rooms spacious and well decorated with a homely feel, rather than a sterile hospital feel
Visitors are extremely important for residents in care homes to feel they aren’t isolated from their family, friends and the outside world.
- Do they have specific visiting times and days and is there a restriction to the number of visitors that can come to the care home
- Do visitors have to tell the care home when they are visiting
- Can visitors stay overnight
- Are children welcome
- Where can residents spend time with their visitors (inside and outside)
- Can visitors visit at mealtimes and are they able to have meals with residents
- What security systems does the care home have
- Is there an emergency call button in each residents room, in the main bathrooms and around the social areas of the home
- Does the home have good signage to show where everything is to help residents
- Are residents able to choose their own routine or does everyone have to get up and go to bed at the same time
- Can residents choose what they wear each day or is help available if they need it
- What belongings can residents bring to the home
- How is personal money handled in the home
- Does each bedroom have its own secure storage
- Does each bedroom have its own bathroom and what is in each bathroom (bath, shower, basin, toilet with any adaptions)
- Is the home mixed with both female and male residents
- Are families encouraged to be part of, and involved in the life of the home and how
Always ensure you are very clear about a care homes contract, what is included, excluded and you are comfortable with it before you make any commitments.
- Ask them to give you a summary of their contract terms and also ask for a copy
- Is there an option for residents to stay as a trial
- What does the care home do to support a resident settling in and what happens if they are unhappy after a certain amount of time
- What insurance does the care home have and does it cover residents personal belongings
- If a resident is taken to hospital and has to stay for a while how long is their room kept for them
- What notice period is required to notify them if a resident is leaving and how does this compare to other care homes
Care Charges & Fees
Ensure you are clear about the charges, when they are paid, how much and who will be paying for them before you make any commitment and sign a contract with them.
- What does the care home charge
- How are the charges calculated, collected and when
- Are there any requirements for deposits or advance payments, what are these, how much and are they refundable at any time
- Will fees increase each year and what notice is given to advise you of these
- How are NHS-funded nursing care payments accounted for in the fee structure
- Are there any extra services or items that are not included in the basic fees
Paying for Residential Care
Paying for residential care is expensive and there is some help available to meet the cost if it is needed. The care system can be complicated and difficult to find your way through but your care home should be able to help you with this so you know who you will need to contact.
If you are eligible for funding support your local council could pay some or most of the fees. The council will carry out a care needs assessment and if it is decided care is needed in a care home setting they will carry out a financial assessment to work out whether you qualify for help with the cost. This will look at both income and capital. They will do a means test that takes into account the value of a property if there is one, as well as income and savings.
Care home fees vary depending on their location, the care home itself and your loved ones own personal financial circumstances. Costs can average around £600 a week and over £800 a week for a place in a nursing home.
Your local authority council will calculate the cost of the residential care and how much needs to be contributed from personal finances always leaving £24.90 per week which is the Personal Expenses Allowance. The figure they give you must be realistic and allow access to an appropriate and good local care home.
If the care needs are primarily health-based the NHS can contribute towards the cost of the care and if you are eligible for NHS continuing healthcare then sometimes the care home placement will be free.
How can finances and property affect ‘care or nursing home’ fees?
If your local council carries out a care needs assessment and finds a care home place is needed, they will do a means test. This may take into account the value of a relatives property if it is owned, as well as income and savings.
A means test for social care looks at the capital (savings and property) and how this will affect any care fees:
- Over £23,250 – you must pay full fees (known as being self-funding)
- Between £14,250 and £23,250, – the local council will fund some of the care and you will make up the difference
- Less than £14,250 – this will be ignored and won’t be included in the means test and the local council will pay for the care. However, they will still take your eligible income into account
Feedback and Complaints
A caring care home, with the highest level of quality, will have a robust and clear feedback and complaints procedure that is well documented and communicated to residents, families and the staff as feedback is important to them to ensure changes are made when needed. A high standard of care home encourages feedback.
- How are the residents and families encouraged to give feedback, when and how often
- What is their complaint procedure and where is this documented
- Find out if the care home manager is accessible and approachable
- How are staff trained and how regularly on standard procedures for serious incidents, complaints or safeguarding concerns raised
Choosing the Best Care Home
As well as providing exceptional and personal care, a care home should feel relaxed, informal and comfortable. They should feel like a home and a happy place to be for every resident. When you have visited a few care homes you will start to get a feel for the one or ones you prefer and if you have asked the above questions you will have information to compare. Go back several times and also go back and visit without prior arrangement so you can see them in their true light. When you are near to making a decision arrange for your loved one to go in for an afternoon, a day and maybe overnight to see how they feel about it.
Moving into a care home is a life-changing experience and can often make people feel sad that they are leaving a home which has lots of happy memories and they will probably never have full independence ever again. It’s can be a difficult process for everyone so take time to plan how the change will happen.
Arrange for your loved one’s room to feel like their own space and retreat and ensure they have their home comforts in there, including photos, music, cushions, iPad, ornaments pillow, bedspread and so on. Remember they won’t have as much space as they used to so key things are really important. Some care homes allow you to take an armchair or your own bed so ask about this before the move happens.
Encourage them to mix with the other residents and the staff and visit them regularly so you can talk to them about how they are feeling and how it is going for them. Knowing any concerns early on are easier to resolve than if they drag on for a long time. Ask them lots of questions about their meals, how they are finding getting around, what social activities have been happening, and ask family and friends to visit so they don’t feel like they have been cut off from the outside world.
Encourage them to still do things for themselves and not become reliant on the carers, when you visit, sit outside with them or maybe take them out shopping or for a stroll and fresh air. Encourage them to maintain their routine if you think this will help them settle in. Talk to the staff to see how they feel it is going and if they have any concerns about them. Experienced staff in a care home will know the signs if someone is finding it hard when they first move in so your interaction with them is important.
Keep in contact via the phone in their room, get them a mobile phone and set them up with an email if they don’t already have one so they can stay in touch with family and friends, staying connected is important in the settling in stage and throughout their time in a care home.
Take in the toiletries that they love and any clothes they may need. It’s always a good idea to label clothes so they don’t get mixed up in the laundry but your care home will be able to advise you about this.
About Bristol Care Homes
Bristol Care Homes are an independently owned group of 4 high-quality care homes in Bristol. Our dedicated team provide quality and caring services every day and our founding vision is to provide excellence in all aspects of care for all our residents.
Our service leads the way in care home provision and this shows in our Care Quality Commission Ratings:
Glebe House – Outstanding Glebe House Care Home Bristol CQC
Beech House – Outstanding Beech House Care Home Bristol CQC
Field House – Good Field House Care Home Bristol CQC
Quarry House – Good Quarry House Care Home Bristol CQC
We are always looking to be innovative in our services and we offer many features which will help you or your loved one to maintain a high level of fulfilment in your life at each of our care homes. Many of our services are unique to Bristol Care Homes and all include:
- Beautiful gardens with plenty of greenery, trees and flowers
- Environmentally designed buildings with 24/7 air circulation always keeping the atmosphere fresh and airy
- Spacious rooms with increased ceiling height which gives the feel of openness
- Wide corridors for ease of access
- Television, DVD Player and direct line telephones in each room
- Internet access in residents rooms
- Customised top quality wheelchairs provided when needed
- High technology baths and walk-in showers
- Minibus services with a regular schedule of trips
- Regular maintenance and replacement cycles of new carpets and decoration
- Top Quality chefs producing tasty, varied and nutritious meals
- Programme of interesting and stimulating activities for all our residents
- Warm, friendly and caring staff who get to know each resident and take time with them every day to ensure they are happy and fulfilled
- Nurses on duty 24 hours a day, 365 days a year