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Anti-ageing, Mind

21st February 2015

Speed dating on morphine probably isn’t the best way to choose a long-term partner. But it’s a bleak necessity for many people looking for a care home. Incapacitated in a hospital bed by a sudden illness, such as a broken hip, that slams shut the door back to an independent life, they urgently need to find somewhere to support them in their final years. Even if their health has deteriorated more gradually, the problems that have left them in need of care tend to undermine their ability to search for the right home. So the task often falls to family or friends.

This domestic matchmaking involves finding a place where you feel understood, where you can easily relax but where your wounds can safely be exposed. Few people make clear plans for their final days long in advance of physical decline (apart from an occasional desperate cry of ‘whatever happens, don’t ever put me in a home’). So working out what would be the right home for someone else can be a challenge: ‘arranged marriages’ don’t always work.

The first imperative is to get finances clearly outlined. The principal question is whether the person will be paying for their care home themselves (‘self-funding’) or whether it will be funded by the local social services. Even if you’re self-funding, you are entitled to help from a social worker. They can guide you through the finances and advise about possible extra allowances. They are also an important contact if you become worried about the standard of care in the home you choose. AgeUK also has some useful advice, while in some areas care agencies provide a free service to help those seeking care (although they work on commission from the homes).

New funding arrangements coming in over the next couple of years, under the Care Act 2014, should consolidate what has become a confusingly complex system. Economics are increasingly driving the system towards supporting people in their own homes for as long as possible. So don’t assume a care home is an inevitability. When it works well, there’s no doubt that care at home is a better option. However, it can take the logistics of a military manoeuvre to make the arrangements run smoothly.

Once a care home becomes necessary, there is the brutal question of how long the person is likely to survive and how much funding will therefore be needed. These are very difficult to predict although the medical team might give you a rough idea by looking at indicators of frailty such as poor mobility, frequent infections and multiple medications. A recent survey of Bupa homes found that the average length of stay was 801 days (although some long-stayers skewed this — half of all residents had died by 462 days, but one lived for over 20 years). The median stay in a residential home was nearly 27 months but when nursing care was needed it was only about 12 months (i.e. when there was more serious disability). But patients often surprise — some go downhill quickly in a care home, perhaps losing the will to carry on, while others find a new lease of life in a place where they are supported and happy.

Exactly what to look for in a care home is as idiosyncratic as choosing a partner. The building and decor will matter to some and not a jot to others. Some people put a premium on peace and privacy while others look forward to communal fun and conversation. Bingo nights may be a source of relish or revulsion. Some families move a parent to be closer to them. It works for a few but many feel isolated in an unfamiliar community. People with dementia do particularly badly when they are uprooted like this.

For those who can afford them, expensive options may be very tempting. Who wouldn’t love to live in a luxury hotel? Actually quite a lot of people, who find it oppressive to be living somewhere where they are scared about every crumb they drop on the floor (a lot of crumbs will fall in those shaky frail months). Working in affluent Surrey I often see families who, wracked with guilt that they cannot take in a frail parent, look for glossy options. But when you are at your worst, a scruffy yet clean old building staffed by kind people may be far more soothing than wall-to-wall parquet and Wilton, with nurses who have crisp uniforms and starched attitudes.

And that really is the nub of choosing a care home — finding out what would indeed feel like home to you. You need to step through the door, poke around the facilities, hear the noise, smell the smells and get a feel for the vibe. On a broad scale, there’s a range to choose from — residential, nursing, dementia. The small details can make all the difference. Is there open visiting, do some people’s pets roam around, how are spiritual needs met? More important clues to the running of the home include staff turnover (often a good way to spot an unhappy home) and training, and the activities of the residents’ committee. AgeUK have some helpful checklists to guide you when looking at a home.

Once a home appears promising, check that it is registered to provide the level of care needed. And keep one eye on the future. If a resident becomes weaker, can they transfer within the same home from a residential to a nursing bed? Read the home’s contract and conditions and look at recent inspection reports by the Care Quality Commission (CQC — the independent body responsible for regulating and maintaining standards in health and adult social care in England). But don’t expect these to be a guarantee that abuse would never happen. The CQC has had a turbulent few years, criticised for failures in a number of cases, including abuse at Winterbourne View private hospital. It is now undergoing a major overhaul of the way it works.

But nothing can change the fact that things can go wrong, no matter how carefully you choose a home. Sometimes it’s just a clash of personalities, but abuse in a care home is every family’s nightmare. It can take many forms, from physical to emotional or financial. Be on alert for anything which doesn’t feel right. Does your loved one look happy and bright, dressed in clean clothes and well nourished, or are they subdued, grubby or losing weight? Has behaviour changed, are they tearful or depressed? Clues to physical abuse include unexplained cuts, bruising or other symptoms but try not to jump too quickly to conclusions as the cause can be muddied. Very thin elderly skin can tear with the evening breeze, while spontaneous bruising may just be the result of taking anticoagulant drugs.

From the start you need to be clear about the official channels for making a complaint but it’s more important to find someone you can trust, with whom you can discuss worries informally at an early stage. If you dislike a member of staff, ask to speak to the home’s manager. It may simply be a matter of changing who works with each resident — we can’t all get on with everyone else. Other channels for complaints include the social services case manager, the local council or local government ombudsman (if it is a council-funded home) or directly to the CQC. You could also turn to the charity Action on Elderly Abuse, which has a UK-wide helpline.

If your concerns aren’t addressed adequately, starting looking around at alternative homes to help pin down your own feelings about what should be right. But striving to find just the right home can be fruitless. Like all marriages it takes work and ultimately will be a matter of compromise.