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Care homes

There are many types of residential care homes available. These include permanent care homes for older people, homes for younger adults with disabilities and homes for children. They may be privately owned or run by the voluntary sector or local authorities. You may want to consider in detail the many options for residential care before you make a decision.

Older people

Find care homes and domiciliary care services near you

Care homes for older people may provide personal care or nursing care. A care home which is registered to provide personal care (see the section on care home regulation, below) will offer support, ensuring that basic personal needs, such as meals, bathing, going to the toilet and medication, are taken care of. In some homes more able residents have greater independence and take care of many of their own needs.

Some residents may need medical care and some care homes are registered to provide this. These are often referred to as nursing homes. Some homes specialise in certain types of disability, for example, dementia.

Adults aged 18-65

There are also residential care homes that provide care and support for younger adults with, for example, severe physical disabilities, learning disabilities, acquired brain injury, progressive neurological conditions or mental health problems. Care can be provided for adults with more than one condition and some homes have expertise in providing care for adults with alcohol or drug dependency. These homes offer permanent residence or provide care for a temporary period until the adult is able to live independently or move to a different type of accommodation.

Children and adolescents

Some homes specialise in providing residential care for children. This could be for a variety of reasons, including physical or learning disabilities or emotional problems.

Residential special schools focus on education and provide teaching on site. Children in traditional children's homes are normally educated outside the home in an educational or training facility.

In some cases, care homes for children offer "transition" support for young people until they reach their early 20s.

Choosing between residential care and independent living

Social services normally encourage the younger adults they assess for support to be as independent as their circumstances allow. The care plan for adults with disabilities will consider what independent tasks they can carry out and how they can be helped to achieve more. Even if adults have very severe disabilities their needs are reviewed from time to time to check whether residential care or a very high level of support is still appropriate.

Supported living may be an option for younger adults. This allows people to live independently in the community but with basic support. The support offered includes help with setting up a home and managing finances, and assistance with cleaning and shopping.

For older people there are various alternatives to residential care. These include sheltered housing and extra care housing schemes, which offer independence with an increased level of care and support.

For many people there is also the choice of living independently at home with community care support.

Choice of accommodation

The law says that where the local authority is funding accommodation it must allow the person entering residential care to choose which care home they would prefer. Social services must first agree that the home is suitable for the person’s needs and that it would not cost more than they would normally pay for a home that would meet those needs. If the person chooses to go into a more expensive home, a relative or friend may be able to "top up" the difference in cost. For more information see funding for residential care.

Choosing a care home

There are residential care homes available for people of all ages and types of disability (see above for information about types of care home), but choosing which one is most suitable for the person you're looking after can be complicated.

The first thing to do in most cases is to get an assessment from social services for the person you're looking after. This will make clear whether or not they need residential care, and what other options might be available. Social services will be able to give you and the person you're looking after information about residential care homes, and they may be able to assist with finding a suitable home.

Even if the person you're looking after is unlikely to be eligible for financial help with residential care home fees, it could still be worth involving social services. The assessment and information they provide are likely to be very helpful in making decisions about care.

You and the person you're looking after will need to make choices that depend on your individual circumstances and needs. It could be useful to consider the following:

  • The location of a care home. This will be more relevant for some people than others. Would the person you're looking after prefer to be near family and friends? Are there shops, leisure or educational facilities in the area? Is the area noisy?
  • Will the care home meet specific religious, ethnic or cultural needs? Will the correct diet be provided? Will the person’s language be spoken? Will there be opportunities to participate in religious activities?
  • Is the care home you're looking at focused on the individual needs of residents and concerned to provide for those needs? Or do they insist that residents adapt to a particular routine?
  • What contacts with the community does the care home have? What arrangements are there for visitors? Can residents come and go as they please, as far as it is safe to do so? Are staff able to help residents to go out? Are outings arranged?
  • What involvement would you have in the care home? How would you communicate with staff? Are there any support groups or regular meetings?
  • If safety and security are issues for the person you're looking after, what arrangements or supervision can the care home provide?
  • When you are choosing accommodation it may be a lifelong decision, so you may want to consider planning for end of life care.

Inspection reports

Care homes for adults are regulated by the Care Quality Commission (CQC) and care homes for children are regulated by Ofsted.

If you and the person you're looking after are considering a particular residential care home, check the most recent inspection report to see how well the care home is doing and if there is anything of concern.

Reports can be downloaded from the CQC and Ofsted websites.

To find a care home

In addition to the information you can get from social services, there are various other means of finding out about care homes that would be suitable for the person you're looking after.

You can contact a voluntary organisation with expertise in the particular disability of the person you're looking after. Useful organisations include Independent Age, for older people, Mencap, for people with a learning disability, the National Autistic Society, for people with autism, Leonard Cheshire Disability, for people with a physical disability and Mind, for people with a mental health problem.

Good and bad care homes

All care homes vary in their quality, and it can be hard to know what qualities to look for when choosing a home. A good care home will probably do the following:

  • Offer new residents and their families or carers a guide (in a variety of accessible formats) describing what they can expect while they’re living there. Ideally, residents of the home would have helped to produce the guide.
  • Have a majority of staff who've worked there for a long time. They know the residents well, and are friendly, supportive and respectful.
  • Involve residents, carers and their families in decision making, perhaps through regular meetings with staff.
  • Support residents in doing things for themselves and maximising their independence, including keeping contact with the outside community.
  • Offer a choice of tasty and nutritious food, which residents may have helped to prepare.
  • Take into account the needs and wishes of all residents, and provide a variety of leisure and social activities.
  • Be in a clean, bright and hygienic environment that's been adapted appropriately for residents, with single bedrooms available. A good environment encourages residents to personalise their room.
  • Have staff who respect residents’ privacy and knock before they enter someone’s room.
  • Be staffed by well-trained people, for example, nurses trained in dementia care.
  • Respect residents’ modesty and make sure that they look respectable, while recognising residents’ choice about what they wear.
  • Be accredited under the Gold Standards Framework for end of life care.

A bad care home might do the following:

  • Have a code of practice and a set of aims, but doesn’t make them a priority.
  • Offers little opportunity to listen to residents, with most decisions made by staff.
  • Have residents’ care plans that are out of date, and don’t reflect their needs accurately. This means that some residents aren't getting the support they need with their healthcare and personal care.
  • Give residents little privacy. Staff often enter residents’ rooms without knocking, and they talk about residents within earshot of other people.
  • Have staff who don’t make an effort to interact with residents, and leave them sitting in front of the TV all day.
  • Be in a poorly maintained building, with rooms that all look the same and have little choice in furnishings.
  • Need cleaning, with shared bathrooms that aren't cleaned regularly.
  • Deny residents their independence, for example, by not allowing someone to feed themselves because it takes too long.

Rights of care home residents

The Care Quality Commission (CQC) is the regulator of health and social care in England, whether it’s provided by the NHS, local authorities, private companies or voluntary organisations.

Under existing rules, independent healthcare and adult social services should be registered with the CQC. NHS providers, such as hospitals and ambulance services, must also be registered. Registration of organisations reassures the public when they receive a care service or treatment. It also enables the CQC to check that organisations are continuing to meet CQC standards.

The standards set out the quality of care and facilities that you should expect from a care provider. As a resident in a care home, you should expect:

  • The right to be treated politely and with dignity.
  • The right to privacy for yourself, and your relatives and friends when they visit.
  • The right to deal with your own finances and spend your money how you choose.
  • The right to eat food that's prepared in line with your faith, and to worship when and where you want to.
  • The right to choose the food that you eat, and to be given the time and space to relax and enjoy your meal.
  • The right to choose when you get up in the mornings and go to bed at night.
  • The right to complain if you're unhappy with your care.

Standards for care homes are outlined on the CQC website.

These standards are not enforceable by law, but the CQC can enforce fines, public warnings or close or suspend a service if they believe that people’s basic right’s or safety are at risk. Organisations that are closed or suspended are given the chance to meet the safety requirements and resume their service.

Abuse and neglect in care homes

Physical and sexual assault, fraud and theft are crimes. If you believe that there has been criminal abuse or neglect, contact the police. Dial 999 if there is an emergency involving physical or sexual abuse. Write down what happened, including details of anyone who was present. Keep any evidence and do not tamper with it or clean it.

What is abuse?

There are many different forms of abuse. Some, such as physical injuries, can be easy to spot. Others are much more difficult. Abuse could, for example, include failing to provide enough soap so that someone cannot keep themselves clean.

The charity Action on Elder Abuse defines abuse as "a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person".

The person you care about may not be able or willing to talk about any problems, perhaps because they cannot communicate or due to embarrassment or intimidation. Take time to look for signs of neglect. Abuse may not be the cause of the problem, but investigate what has happened if you have any concerns.

What abusers do

Abusers will try to create dependency in their victim to manipulate them.

People often find it difficult to accept that a family member is being abused. It's easy to believe everything is OK, even if something feels wrong. Abusers often rely on this to allow them to continue their actions. Having suspicions is OK, and knowing how to deal with the situation will allow you to help the person being abused.

Pay attention to the person you care for. They may be trying to tell you what's happening or showing subtle signs of mistreatment. Let the person know that they're not alone.

Physical abuse

This could be happening if the person you care for has unexplained or untreated injuries, such as cuts, bruises or broken bones or signs that they have been restrained. They may have other signs, such as soiled clothing or bedding, or skin problems including bed sores, ulcers or damaged skin. Other signs can be less obvious, such as dehydration, malnourishment or weight loss. There may also be unexplained differences in the dosage of their medication.

Psychological abuse

Signs of psychological abuse, which can also be a crime, include confusion, reluctance to talk openly, implausible stories, unexplained fear or unusual behaviour such as sucking, biting or rocking. Some of these symptoms may indicate other conditions, such as dementia, so speak to a healthcare professional or get a second opinion if you’re concerned about this behaviour. The person may also be extremely withdrawn and non-communicative or unresponsive.

Financial abuse

Fraud and theft are crimes and should be reported to the police. Signs of financial abuse include unpaid bills, suspect signatures, sudden changes in bank account balance, additional names appearing on a bank account, changes to a person’s will, sudden transfer or disappearance of assets including jewellery, and lack of things that the person should be able to afford.

Sexual abuse

Sexual assault is a crime that should be reported to the police. If a person is being sexually abused, they may have unexplained bruising around their breasts or genital area, venereal disease or genital infections, vaginal or anal bleeding or torn, stained or bloody underclothing.

The person you've been caring for may have started a relationship with another person living at the home, so find out the facts before you make conclusions about care home staff.

Neglect

A person could be the victim of neglect if they live in unsanitary and unclean conditions, appear dirty, smell of urine or faeces, are wearing dirty or inadequate clothing, have rashes, sores or lice, have untreated medical conditions, or are not receiving proper amounts of medication.

Family abuse

In most cases, family abuse is not caused by the family member who provides most physical or emotional support, but by another member of the family.

For more information, read our page on Vulnerable adults.

Care home complaints

You or the person you're looking after may have a complaint about a residential care home. A complaint could be about the quality of care provided or the fees charged. There are a number of ways of making a complaint.

The care home’s complaints procedure

The law says that all care homes must have an appropriate complaints procedure, and you should consider complaining directly to the care home first of all. If you're worried about doing so, you can complain directly to the regulator responsible for all care homes instead.

Care home regulation

At present, the Care Quality Commission (CQC) is responsible for regulating care homes. Its role is to ensure that a care home complies with regulations and national minimum standards. The CQC is not a complaints agency so can't deal with, for example, the local authority’s failure to provide an appropriate placement in residential care.

Local authority complaints procedure

If the local authority is responsible for placing the person you're looking after in a care home or for creating a care plan for them then it is possible to use their statutory social services complaints system to make a complaint about the home.

If the local authority complaints procedure does not resolve the complaint, it may be possible to use other complaints methods, such as the Local Government Ombudsman (LGO).

If you do complain to the CQC or local authority, they should liaise with the care home to ensure that you receive a co-ordinated response.

Self funders

Self funders are people who pay for their own residential care costs. They can take their complaints to the LGO. If the self funder’s dispute is about the terms of the contract with the care home, they can get advice from the Office of Fair Trading.

Complaints about abuse or neglect

Some of the most serious complaints involve alleged physical or psychological abuse or neglect within the care home. If you believe this may have occurred, contact the local authority as quickly as possible. ‘Safeguarding adults teams’ in local authorities are responsible for responding to allegations whether or not the local authority has been involved in arranging residential care. The local authority will liaise with the police and the regulator if appropriate.

Closure of care homes

Proposals to close a care home can cause great distress to residents. Local authorities have guidance which sets out the detailed consultation process that should be followed. This is a complex area and it may be best to get specialist legal advice. You can find a solicitor with the appropriate expertise through the Law Society.

Help with transport costs

Transport costs can be significant if you're a carer. You may need to find out about transport costs for the person you look after, such as the cost of getting to and from hospital appointments. You may also need help with your own transport costs if you're on a low income. Help with travel costs can include hospital transport.

Hospital travel scheme

There is a scheme to help with travel costs to hospital for patients who are on certain benefits, including:

Patients are also eligible if their income is £15,050 or less and they get Child Tax Credit or Working Tax Credit with the disability element or severe disability element.

Under this scheme you can claim at the NHS hospital or clinic at the time of the appointment and payment will be made in cash.

NHS low income support scheme

If a patient doesn't receive any of the above benefits they may still be able to get help if they're on a low income. A claim for travel costs can be made on form HC1. This is available from your local Jobcentre Plus office or from the hospital.

Travel costs for carers

A carer’s travel costs can also be covered by this scheme if a doctor confirms that the person you look after needs someone to travel with them. If you're visiting someone in hospital and you get certain benefits, you may be able to get help with the travel expenses from the Social Fund, a scheme managed by the Department for Work and Pensions.

Other help with transport to and from hospital

Your area may have a community transport scheme. These schemes provide transport to and from hospitals, doctors' and dentists' surgeries, and opticians and chiropodists.

Help with travel elsewhere

Dial-A-Ride provides a door-to-door transport service for people with disabilities that prevent them from using public transport. Carers can travel with the disabled person for an additional charge. Ask your local authority for more details.

Discounts on travel costs

There are many schemes to cut your transport costs, so it's worth making enquiries before you travel. These schemes include:

  • The Disabled Person's Railcard, which allows a disabled person to buy rail tickets at a discount of up to a third. If another adult accompanies them they can travel at the same discounted fare.
  • Eurostar has a Special Needs Passengers ticket for wheelchair passengers and carers who accompany them.
  • Some councils offer bus passes or discounts on buses for carers when they accompany the person they're looking after.

Exemption from road tax (vehicle excise duty)

If the person you're looking after receives the high rate mobility component of Disability Living Allowance (DLA) they may be exempt from paying road tax. If you use your own car for their purposes they could nominate your car for the exemption.

If you're studying

Some colleges give reductions to carers on benefits and some provide help with funding for transport costs and course fees.

Direct payments

You could ask for a carer’s assessment to explain why you need help with transport costs because of your role as a carer. Social services may be willing to help you with a direct payment that you could use to pay for those costs. They could include the cost of:

  • driving lessons
  • petrol
  • repairs
  • taxis

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The 1 comments posted are personal views. Any information they give has not been checked and may not be accurate.

theresa Heath said on 25 May 2014

What is the criteria for choosing a nursing home for an elderly relative .please

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Page last reviewed: 19/08/2013

Next review due: 19/08/2015

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