A Guide to Choosing a Good Care Home

Before I start I would like to take this opportunity to introduce myself. I am a registered nurse by profession and I have worked in a variety of different settings, but predominately in care homes for the elderly. I have been an agency nurse and have also worked for the NHS.

 Despite my experience as a nurse in a number of different care homes I do not consider myself in any way an expert. The idea of compiling a guide came to me a while ago after I began to notice the disparities between my experience in working at certain homes, and the description they give on their websites.

 Another reason for writing this is that other guides I have read — although they do ask certain questions regarding the suitability of a home — exclude many of the queries that I would make in a similar position. An example of this is that people are often told to check whether a home has en suite bathrooms and a telephone in every room. Homes that provide all of these facilities and more, do not necessarily provide what I would describe as an adequate level of care. The physical infrastructure should not be regarded as being indicative of a good home.

 I would like to say that I wholeheartedly support both carers and nurses (after all I was and am both), who do a very difficult job in often less than ideal circumstances. I hope that the readers of this guide do not see it as an attack on these professions. If anything the guide should serve to highlight how difficult the work can be.

Choosing the right care home is a difficult and daunting prospect. Often the person needing the additional support that a care home can offer will have been unwell for a long period of time, and this will inevitably have put a strain on their family and friends who have tried to provide them with the additional support they require. Because of this, when the time comes to make this important decision and choose a home, the person’s family and friends are already under considerable pressure.

What should someone look for in a care home? Choosing a care home is not the simple and easy process it may appear to be. It is for this reason that I decided to write this guide, to try and help people in making such an important decision.

Unfortunately care homes these days often seem to be synonymous with abuse and falling standards. This is a great shame, as during my time as both a carer and a nurse I have seen some excellent examples of care provided to residents.

As professional carers we are often privy to information and insights that other people are not, and I feel that we should do our best to make them aware of this information if it may benefit them. Information is an important aspect of good decision making, and we carers need to provide as much information as possible.

Most people understand and accept that the National Health Service is under tremendous pressure, and that much needs to be done to retain this valuable institution. As a health care professional I find it frustrating that the alternatives to the NHS, such as care provided by private companies, organisations, and charities do not meet the standard of care that they claim to provide. This is detrimental to everyone involved, and particularly the residents who deserve the best possible level of care.

Examples of this failure are care homes I have worked in that are chronically understaffed, with resulting low morale, and have enormous difficulty recruiting new staff. Yet they do little to address these pressing issues, instead spending millions of pounds on unnecessary refurbishments and extensions.  

 Some care homes continue to take on new clients in circumstances like the above, while making little or no attempt to address the situation.

I will now give you my ideas of what to look for when choosing a suitable home.


What Shift Patterns Does the Home Have?

The reason I have included this question is that many of the homes I have worked in only have two shift patterns, usually 8a.m.-8p.m. and 8p.m.-8a.m. The problem with this is obviously that staff have to work twelve hour shifts. Long days are exhausting in any job, but particularly so in health care, which involves looking after vulnerable people with complex needs. In my experience this can lead to provision of an inadequate level of care.

This may also be detrimental to the clients in the handover of information from one shift to another. This is the crucial time when the team finishing one shift hands over important information to the staff that are about to start. When there are only two shift patterns there is no overlap and handovers are often hasty and less efficient. Having more than two shifts allows staff members to fully concentrate on the information being handed over to them, without having to worry about who is actually looking after the residents.


Ask if You Can Attend a Relatives Meeting Prior to Making a Decision

Many care homes regularly have what is known as Relatives Meetings. This is where relatives and friends of residents can meet at a scheduled time to discuss anything to do with the home, including concerns with any of the staff members (usually but not always the manager). This enables relatives and friends to obtain a holistic view of the home by speaking with other people in a similar position. The meetings might contain complaints, but it is worth putting these into perspective to get an overall view of the home. I can't think of any reason why a good care home would object to this, with the exception of confidentiality issues and they might well jump at the opportunity if the relatives of a resident are pleased with the level of care their loved one is receiving.

What Are the Staffing Levels Like?

An organisation called the Safe Staffing Alliance recommends that there should never be more than eight patients to one nurse on an acute ward. In my experience, this is a very optimistic figure, and it is ironic that of all the places I have worked it is the NHS homes that have come closest to achieving this ratio. There are no recommendations for staffing levels in care homes. The closer a home is to achieving this ratio the better.

It is an extremely daunting experience for a nurse to arrive at a care home for the first time, only to be handed the medicine keys and be informed that you are the only nurse for the whole day in charge of the welfare of up to 70 residents. Although the recommendations of the Safe Staffing Alliance are not mandatory, I would certainly raise this issue with any prospective home to see if they are aware of it, and if they have any plans on implementing it if it is not already being adhered to.


How Often does the Care Home use Agency Staff?

Regular staff know a lot of valuable information; probably a lot more than they are aware of. This includes such things as a resident’s routine, their likes and dislikes, what they like to eat, and when they like to go to bed. This type of information may seem trivial, but in fact it is vital for the proper running of a home.

When a number of different people work in a home they cannot be familiar with the residents, and they are in need of constant explanation. This can impact on the running of the home if it needs to be done too often. Care homes should really only make use of an agency as a last resort, and you should be concerned if they are used on a frequent basis. This is the type of information that could be found out through attending relatives meetings.


Does the Home Manager Have Any Clinical Experience?

Every care home should have an individual on the staff who is what is known as a ’Clinical Lead.’ Even so, it is the manager who will be making the day to day decisions affecting the running of the home. Thus it is very important that the manager also has some clinical experience. The definition of this is, “relating to the observation and treatment of actual patients rather than theoretical or laboratory studies.” In simple terms this refers to an individual who is (or was) a registered nurse or doctor. If in doubt you can always ask the manager directly. Alternatively you can check this by going to the websites for the General Medical Council (which lists all practising doctors), or the Nursing Midwifery Council (which lists all practising nurses).


Look At the Latest CQC Report

The Care Quality Commission (CQC) is a body of The Department of Health which regulates and inspects Health and Social Care services in England. This report is often found on the websites of care homes, and grades the home on a number of different areas, such as treating people with respect, staffing levels etc. This report can be deceptive, because the CQC will only be able to obtain a broad overview of a particular home and will not always get the full picture. There are numerous examples of care homes that have been given glowing reports, only to be found later to give shocking care to its residents. Other homes have been given a low rating yet have provided excellent care.


What Is the Staff Turnover Like?

Again this is another question which can be raised at a relatives meeting. If the relatives or friends of a resident confirm that there is a high turnover, and agency staff are used on an alarmingly frequent basis, you have to ask why this is so.

Another thing to look out for is ads for the home reappearing in the ‘Vacancies’ section on the Internet, or in a local paper. Ads that appear week after week, month after month, for the same care home often indicate difficulty in recruiting staff, and again it is worth asking why?


What training is Available for Carers?

Carers in England receive no formal training for this demanding role. Although it is not mandatory, it is worth asking a potential care home if they provide any assistance for their carers to complete a course in Health and Social Care.

A home that provides opportunities for their staff to progress in this way is likely to be one that also provides good care.


Be Wary of Care Homes that Have Extravagant Claims

 I would always be wary of homes that promise such services as “all care is tailored specifically to an individual’s needs”, or that meal times are "always a unique experience” (what exactly makes for a “unique experience” at meal times?)

Although such optimism is commendable and should always be aimed for it is rarely realistic, and often sounds like the utilisation of buzz words and phrases coined by people who have never actually worked in care.

I have to be honest I have worked in care homes with far less enthusiastic descriptions attached to them which have offered far better care than the ones that do.

I hope that you have found this guide useful. If you have any questions please contact me on the following email address.