A recent investigation by Which? magazine is another worrying indictment of some care homes. Undercover reporters found residents in some care homes inadequately fed, under-stimulated and, in one extreme case, potentially abused by a member of staff. The consumer champion sent undercover actors posing as residents into four care homes in England.
While the reporters noted some examples of good practice, areas of care in all four homes “left a lot to be desired”. For example, food in two of the care homes was described as unappetising and inadequate and in one home, sub-standard portion sizes and inadequate calories or protein were also found – and one researcher reported a half stone (7lbs) weight loss in a single week.
In three homes, reporters noted that residents sometimes had to wait for 16 or 17 hours between dinner and breakfast without food. In one, it was reported that lunch was served at 11.30 a.m despite breakfast having been served at 10.00 a.m.
Lack of activity was noted in all four homes. In one, residents constantly said they were bored, and in another, not one of the advertised daily activities actually took place. Lack of stimulation is linked to a range of health problems, and can leave residents restless and agitated, or withdrawn and depressed.
Even basic health and safety, from damp and dirty facilities, to exposed wires and a blocked fire escape were recorded in two of the homes.
In the most extreme case, one researcher witnessed a resident being dragged by a carer towards the toilet by one arm, while another resident was repeatedly pushed down into their chair by the head and shoulders when trying to stand up.
Which? reported this to the regulator, the Care Quality Commission (CQC). Admissions to the home were suspended immediately. (The best course of action is now being considered for current residents).
Care for older people doesn’t have to be like this. Sanctuary Care owned Ashley House, Hampshire, was recommended to Which? by NAPA (The National Association for Providers of Activities) for its range of engaging and stimulating activities. As well as providing a range of activities, staff are encouraged to spend time talking to residents throughout the day.
At Many Happy Returns , we know a bit about this, because the group has bought a large number of our Chatterbox reminiscence conversation trigger cards from us.
As Which? so rightly points out, the difficulty for families is that when visiting a care home “it's easy to be wowed by the glossy brochure, tasty sample menus and timetable of stimulating activities. It’s harder to know whether they represent the real conditions in the home, and whether it’s right for your relative”.
Helpfully, the magazine offers tips and questions picked up from the investigation and experts, to make sure people can choose the right care home. I thought them excellent and here they are:
Treat it like you would choosing any other home – visit at different times of the day, unannounced if you can. For example, could you visit at a meal time as well as seeing a menu?
Are meal times relaxed and social, with residents offered a choice and the right level of support? Are fresh fruit and veg on offer?
Look at the activity programme, but look around you, too. Activity is about the everyday things as well as events – is there a buzz in the home and are staff chatting with residents, rather than with each other, as they help with care tasks?
Is there plenty to do – for example suitable music, and dolls and memorabilia for people with dementia? Bear in mind that an active home may not be neat and tidy.
Ask specific questions that reflect your relative's needs – for example ‘will someone be able to take mum to Marks & Spencer once a month as she likes shopping there?’
As you look around you, notice how other people are treated. Are distressed people helped with sensitivity and skill? Do withdrawn people get forgotten? Most importantly, are people treated as individuals?
Would the home’s physical environment suit your relative? For example, will a quieter person have areas to sit and escape?
Are hotel-style homes comfortable as well as smart? Would a sterile bathroom without any colour or comfort frighten a nervous bather? Is there anywhere for an active person with dementia to walk? Ideally this would be on the ground floor with safe and independent access to an enclosed garden.
Chat to other residents and get their views on what they think of the home and the way it’s run.
If you're not happy with a relative's existing care, talk to the home manager or get advice from the relevant regulator – all the UK regulators make inspection reports available to the public.
A very good list to get you going, but here are some further suggestions, based on personal and working experience…
Understand what the home’s attitude is to you decorating your loved one’s room in the way that they would like, or filling it with treasured possessions, or furniture. Good homes will encourage you to make your loved one's room as much 'like home' as possible.
Ask what mandatory training the staff receive. Ask what incentives the staff receive to improve their skills beyond this, if any. Good homes encourage their staff to keep learning and training and REAL Communication workshops are a great place to start – but of course, I would say that wouldn't I?...
Listen for laughter – not the staff, but residents. Staff are often friends and humour is an essential part of a happy home - but in some homes it is the staff who are partying – on their own.
Ask to see residents’ pictorial life history books (if they have them). Good homes recognise that they cannot care for people well if they don't know about them or their history – and this is especially important for residents who have dementia. In addition, life history books provide a wonderful way for families to connect with loved ones when meaningful communication can be so challenging.
Ask what the home’s attitude is to Psychotropic drugs. Poor homes keep residents dis-engaged – and therefore under control – through the use of drugs, for their own convenience.
Ask how many of the day, and as importantly, night staff have dementia training and how many staff are 'on the floor' at any time.
Find out about whether residents are left in their rooms to sleep in peace, or wakened regularly throughout the night. Good home staff check their residents quietly with the use of a torch, if they bother them at all.
Note where Zimmer frames or walking sticks are in relation to the residents seated in the lounge and whether residents are 'trapped' in their chairs because they cannot leave them unaided. Good homes encourage people's ambulation and movement.
Ask how many people, if any, have to be hoisted during the day and why – and then if you can, watch one – and note with how much dignity this is performed. (Then join my campaign to get these horrible bits of kit better designed!)
Ask if fresh water is available and easy to access in all rooms. Good homes understand the link between hydration and mental health.
Breathe in and smell... and note how sweet the it is. No home should smell – and the good ones don't.
Note whether the dining room looks appealing as a place to eat – ask yourself, would you want to eat there yourself? Are there fresh flowers on the tables? Does the home run a 'silver service' waiting system? Good homes understand the importance of eating for pleasure for older people.
Ask whether the residents can get up when they want to in the morning. Good homes encourage residents to continue to do what they always did at home, as far as possible.
Listen to any music being piped and note whether it is for the residents – or for the staff. Ask if the home has a 'quiet room'.
Find out about the laundry and how carefully clothes are cared for; whether residents' clothes labelled discreetly with name tapes or marked crudely with felt-tip markers. Good homes ensure that residents' appearance is good and recognise that this can also affect the way they are respected and cared for.
Ask how often the hairdresser comes in and if you are there when hairdressing is taking place, note how much or how little conversation there is between the hairdresser and the resident.
Note whether the bathrooms are decorated in an appealing way, with pictures and other decorative items, or are merely stores for bathroom equipment.
Ask what policies the home has regarding end of life and how many staff have received end of life care training. Good homes encourage families to avoid sending loved ones into hospital at the end of their lives.
Ask the manager if he/she runs a 'My Home Life' home and if so, how this affects people's lives in the home, whether working, living, visiting, or dying. Good homes are often My Home Life homes, supporting the initiative to improve care homes through best practice.
Ask how the manager would define Quality of Life for the residents. The answer may be very revealing.
And finally, if you really like the home – ask if you can help!
Sources: PIR Care Management Magazines; Which? Car Homes Investigation