Finding a Care Home

Once you have decided to look for a place in a residential care home, try to focus on the positive rewards of being with other people and getting care and support when you need it. Take time to choose a home which suits your needs and your personality.

Also, remember that a stay in a care home doesn't have to be permanent - many homes keep beds free for short-term stays and respite care. If you are worried about whether living in a care home is the right choice for you, you should be able to arrange a stay as a temporary resident to see how you get on.

What is a care home?

In England, Scotland and Wales, all long-term care homes are called 'care homes' rather than residential or nursing homes, as was once the case. It is important to know that these care homes still provide different levels of care - for example, some will have the staff and expertise to provide personal care (i.e. assistance with washing, dressing or going to the toilet), while others will offer nursing care too (in which case a qualified nurse will be on duty 24-hours a day).

Care home standards

In England all care homes are registered and regulated by the Care Quality Commission (CQC). In Scotland care home are inspected by the Care Inspectorate (CIS) and in Wales care homes are inspected by the Care Inspectorate Wales (CIW).

Care Quality Commission

The Care Quality Commission (CQC) ensures that all health and adult social care services in England, including care homes, hospitals and GP surgeries, provide people with safe, effective, caring, responsive and well-led care. They regulate services whether they are provided by the NHS, local authorities, private companies or voluntary organisations, and they encourage continuous improvement across these services.

The CQC sets standards of quality and safety that people have a right to expect. They register providers, monitor services and carry out inspections to ensure that these standards are being met. The findings and ratings from inspections are published on the CQC website and are available for the public to view.

The CQC’s current inspection model, introduced in 2014–2015 and developed since, includes a mixture of announced and unannounced inspections.

There are two main types of inspections for care services: Comprehensive inspections and Focused inspections.

• Comprehensive inspections assess whether a service is safe, effective, caring, responsive to people’s needs and well-led. These inspections usually review all areas of the service and result in an overall rating. Many inspections are unannounced, although some services, such as domiciliary care agencies, may receive short notice to ensure inspectors can access staff and people using the service.

• Focused inspections are narrower in scope and concentrate on specific concerns identified through monitoring activity or previous inspections. They do not usually look at all five key areas. These inspections are often unannounced.

A report is produced following each inspection and is made available to the public on the CQC website.

Private and voluntary care homes

Care homes can be run directly by local authorities, voluntary organisations (e.g. registered charities or religious bodies) or privately, by individuals or companies on a commercial basis.

Homes run by voluntary organisations may have special rules about who they can admit; for example, members of the armed forces or people from a particular ethnic group or religion.

Specialist care

Finding a home for someone with very specific care needs - for example, severe dementia - can be difficult. We would recommend asking your local authority for advice and support; you may also wish to contact a relevant specialist group or charity such as The Alzheimer&rsquo:s Society, Stroke Association or Parkinson&rsquo:s UK Society for guidance.

Respite or convalescent care

If you need a short stay in residential care to convalesce from illness, your local authority social services department can advise you about possible help with paying for care.

Care Standards

All agencies that provide care at home should be registered with a care standards authority and have to abide by a national minimum care standard. These standards cover issues such as your right to a written care plan contract and your privacy and dignity.

To find out more about the five standards of care and to determine whether the agency you are considering is registered, check with the Care Quality Commission (different authorities apply to Wales and Scotland).

It is useful for anyone choosing a care provider to read the Care Quality Commission's report on them.

Paying for a care home

Organisations like Age UK are able to give you current information about the methods of funding your place in a care home. The options can be complicated and subject to change, which is why it is important to ask questions and find out as much as you can.

As a general overview, funding for a place in a care home is available through the following sources:

You are entitled to an assessment of your needs through your local authority's social services department. Your local authority is responsible for arranging and paying for your place in a care home and they are also responsible for collecting a payment from you towards the cost of this care, although the amount will depend on your income and savings. It's worth noting that savings limits can change each April.

If you are assessed as needing nursing care, the NHS may also make a contribution to your fees (you may even get your care paid for fully by the NHS, depending on your circumstances, although it can be difficult to qualify for fully-funded NHS care).

If you would prefer to live in a care home that costs more than your local council would usually pay but has been assessed as meeting your individual needs, this may be possible if someone - usually a friend, relative or even a charity - is able to pay the difference. This is known as a 'third party top up payment', where a third party will enter into a contract with your local council to pay a contribution towards your care home fees.

You cannot use your own savings towards the top-up. Although in England, there are two exceptions to this rule:

• if you have a deferred payments agreement with your local council; or
• if your property is being disregarded for the first 12 weeks of entering into care.
• If your care home place is provided as after-care under section 117 of the Mental Health Act 1983.

Your local council should only ask for top up fees if you are asking to live in a care home that genuinely costs more than one you have already been offered that can meet your individual assessed needs. However, the council must be able to show that a less expensive home can appropriately meet your needs and has a place available.

If you have not requested an alternative care home and the one that has been assessed as meeting your needs is more expensive than the council's usual threshold, the council would still be required to make up the extra fees if they cannot find you a suitable alternative.

A third party, such as your son or daughter, cannot be forced into paying top up fees. This is likely to be an ongoing commitment between the third party and the council, which will stand for as long as the resident is in the care home, so it is not a contract to be entered into lightly. If a third party is unable to meet increased fees in the future, you may have to move into a cheaper care home.

The regulations regarding top up fees and third party payments may be subject to change and are quite complicated, so you should find out as much as possible from organisations such as the Elderly Accommodation Counsel or Age UK, for example.

Your local Social Services department should be able to give you more information nearer the time.

If you can afford to pay for a place in a care home yourself, you may choose not to consult with your local authority and to approach a care home directly. However, if you feel that you might need help with your fees in the future, it is important that you are assessed by your local authority before making any private arrangements.

Care Rights UK (formerly known as Relatives and Residents Association) produces a useful 'framework contract' if you are considering arranging your own care without an assessment by your local authority.

You should be aware that it is illegal to give your property or savings to another person in order to qualify for help from your local authority. This is called 'deprivation of assets' and your local authority may try to claim back any fees you have been given if they feel that you have deliberately given your assets away.

Privately funding your place in a care home

At this point in time, most people are expected to contribute towards the costs of living in a care home. This money will have to come from your income, savings and capital. Certain benefits may not be taken into account for the purpose of means testing. Age UK publish a helpful factsheet (No.10, 'Paying for permanent residential care') that explains this in more detail.

Options for self-funding your place in a care home include a Deferred Payments Scheme, purchasing a Care Fees Annuity, selling your property, selling your house and investing the proceeds, or even renting your home to provide an income.

Points to consider when choosing a home

Don't rush the decision. Draw up a list of questions that will help you compare one home with another and focus on what your most important needs are.

Select homes to visit, take someone with you, perhaps stay for a while and have a meal. Talk to staff as well as the person in charge. Talk to other residents and listento what activities they get involved in. If you are unable to visit a selection of homes yourself, ask someone from the home to visit you so that you can ask them questions about the home and services on offer. You might also want a trusted friend or family member to visit the home on your behalf.

Remember that the CQC, CIS or CIW can give you information about the suitable care homes registered in your area, including their areas of expertise, facilities and provisions. Care standards now cover issues such as how staff distribute medicines, heating and lighting, your dignity and privacy, the handling of residents' money etc., so don't be afraid to know your rights and ask questions.

Organisations such as Counsel and Care are also able to give you information and advice about what to look for in a care home, while the Elderly Accommodation Counsel has a comprehensive database of care homes in the UK. Remember, that even if your local authority is arranging and paying for your care home, you should still have some choice over where you live. You have the right to refuse a place in the home (or homes) on offer and can request that your local authority tries to find you a place in your preferred choice of care home if at all possible.

Questions about the home you are considering

It's important to ask lots of questions about any new home you're considering. Don't feel embarrassed or worry about wasting people's time - you have to make sure that the home feels right to you, after all, you are making an important decision about your future.

• Is respite care available? Can you stay for a trial period before deciding on permanent residence?
• Is it within easy reach of family and friends?
• Is the atmosphere homely and friendly?
• Are residents lively, happy and well cared for?
• Are the staff caring and efficient? How do they relate to residents?
• Is there an attractive choice of menus? Are special diets catered for? Is alcohol allowed? Can you visit the kitchen and talk to the chef or cook?
• What activities, outings and entertainment are available for the residents?
• Can residents spend their time as they wish?
• Are residents free to see visitors when and where they choose?
• Are pets allowed?
• Does the home have a brochure that you can take away and read?
• What opportunities do people have to satisfy their religious and social needs?
• How are complaints dealt with? Is there a formal procedure?

Find out about the type of accommodation

• Can residents bring personal possessions and/or furniture?
• Can residents have a TV in their room? Is there a TV in one or more common rooms?
• Is there a quiet room without a TV?

• Are there designated smoking areas (if permitted)?
• Can residents use specialist equipment such as hoists and assisted baths?
• Can residents get to the toilet easily day and night?
• Can residents make and receive private telephone calls?
• Can residents enjoy the company of friends and relatives in privacy?
• Will you have your own bathroom or will you have to share?

Find out about fees and about security for your money and valuables

• What are the fees and how often are they reviewed?
• What do the fees cover? Do they cover items such as laundry, hairdressing, chiropody and incontinence pads?
• What are the fees during a temporary absence such as a hospital stay?
• How do residents gain access to their personal money?
• Can valuables and money be deposited in a secure place?

It is very important to agree fees in writing.

A contract should be agreed and signed by both parties (preferably with prospective resident and thier next of kin/relative or friend as joint signatories).

Ask your local Social Services office for advice about the payment of fees, and about a 'personal expenses allowance'.

Ask the Citizens Advice Bureau for information and advice.

Medical and nursing care

When a person cannot be adequately cared for at home, or in a relative's home, then generally speaking, a care home with registered nursing care is the answer. Ask your GP, hospital consultant or Social Services care manager what type of care you need before looking at individual homes.

• What range of specialist care is available in the Home when needed (e.g. for senile dementia, physical disability, terminal illness)?
• Can a resident be visited by their own GP? If another local GP takes care of the residents, do they visit the Home regularly?
• Is there a rehabilitation programme for residents whose condition could improve?

Living in a care home

If you decide to move into a care home, you should expect to go through a period of readjustment. If you have specific worries, do talk to a member of staff as they should be able to address your concerns.

Similarly, if you are the friend or relative of an older person who has moved into a care home, you should voice any concerns you might have about the care they are receiving.

Care Rights UK (formally known as Relatives and Residents Association) can tell you more about what to expect from living in a care home, as well as giving you coping strategies to effectively deal with any problems you might encounter.