What to expect from your chosen care home
Helping your parent into care can be a difficult decision especially when you don’t know what to ask from your parent’s care provider. Kris Scotting, an expert in nursing and care home management, answers some of your top concerns about the working practices of care homes and what you can expect.
A good care home will always outline all they can do for you and your parent but just in case they don’t here are some general answers to your top concerns. Do talk to your home directly to find out more about what happens there.
Who contacts whom and when?
It sounds like a simple thing but an initial agreement about who the care home should contact if there’s a change in your parent’s health is crucial for a good relationship with care staff.
Families are complex and more often than not spread out geographically. Some of us won’t appreciate a call in the middle of the night whilst others will want to know any changes as soon as possible, regardless of time. Some families communicate with each other, and others don't.
An agreed plan with care staff detailing who to contact, when and how will ensure that you and your family stay in the loop. As long as the home has your parent’s consent they can contact you or another designated family member in the event of deterioration in health.
At the very least your parent’s next of kin should be informed if your parent:
- Has an accident or incident
- Receives medical attention
- Is involved in some way with the police
- Becomes ill
- Goes missing
- Passes away
If your parent does die in care any contact agreement is likely to be disregarded by care staff in favour of letting you and your family know the news as soon as possible.
What does your contract include?
The Care Quality Commission-Essential Standards for Quality and Safety require your parent’s care home to make sure you and your parent:
- Know how much is expected to be paid, when and how
- Know what care services are included in the fees.
It’s important that you or your parent take time to review their care home contract to determine what they do and do not provide for the fees you’re paying, and what will incur additional charges. Visits from chiropodists and other external specialists will probably warrant an additional payment for example.
What happens financially when your parent passes away is a term in the contract that should be gone through with a fine tooth comb at the beginning of their stay. Some contracts will require a notice period to be paid for, and the room to be cleared of personal possessions immediately. It may be best to seek professional legal advice before signing on the dotted line.
The contract you enter into with your parent’s home should always state how and when fees can become higher than the agreed upon amount.
In recent years care home contracts have come under fire for unfair terms. If you or your parent are worried about the terms in their contract the Office of Fair Trading has a useful guide on “Fair terms for care” that’s definitely worth a read.
Is your parent’s care plan regularly reviewed?
Your parent’s needs will change over time.
It’s good practice for your parent’s care home to carry out internal reviews of their care once a month. This review should include your parent and family where appropriate as well as the views of any other contributing agencies, care providers and nurses.
Full reviews of your parent's care, where all staff and family members involved in their care meet, are usually spaced further apart due to the need to include more people.
Who looks after your parent’s possessions?
The care home should carry out an inventory of your parent’s personal possessions when they arrive and agree the list with you and/or your parent to avoid a possible dispute over belongings in the future. It protects all parties and can be useful if your parent leaves the home for any reason.
It’s unreasonable for a home to say they take no responsibility for loss of your parent’s possessions and clothes. The most common complaint is finding another resident wearing that wonderful outfit from M&S that you bought your parent for Christmas! Make sure you protect your parent and yourself from a scenario such as this. Permanent marking of clothes with your parent’s name is often asked for so clothes don’t get mixed up in laundry or “borrowed” by others.
How do you make a complaint?
Every care home must have a complaints policy on full view and accessible to residents and visitors alike. The policy should outline how to complain, to whom you should complain, what will happen as part of the complaints process and the timescales for a response.
The policy should also detail ways to escalate a complaint if you feel that your parent’s home hasn’t dealt with it effectively as well as how to complain to the CQC and the Local Authority if the authority is funding your parent’s care.
What happens about Do Not Resuscitate wishes?
The care home should have a robust Do Not Attempt Resuscitation (DNAR) policy. A DNAR notice is basically a statement indicating how your parent wants the home and the emergency services to act if resuscitation is needed.
Each care home resident should have a DNAR notice that details their wishes to be or not to be resuscitated
If your parent lacks the mental capacity to make this decision then the appropriate person (as appointed by a Lasting Power of Attorney or Deputyship) should take the decision on in their best interests.
This can be a very difficult subject to discuss with your parent but it’s important for everyone involved that a definitive decision is reached. Everyone who needs to know about the policy should be notified and the decision should be clearly explained to them.
A DNAR notice should be reviewed regularly by care home staff and your parent to ensure that their wishes are reflected
For further information about DNARs visit the Resuscitation Council’s website.
How is end-of-life care managed?
Once end-of-life care is being considered the conversation should always be about how your parent can end their days peacefully and comfortably. Of course your parent’s and indeed your own wishes should be of paramount importance in this instance.
End-of-life care decisions are separate from DNAR, although they may include decisions about DNAR. These are more about when the end is in sight and nothing can be done medically to prolong your parent’s life.
A plan for end-of-life care should outline what’s needed to ensure that your parent experiences a peaceful and dignified death. Making sure the plan includes administering pain relief, feeding and fluids, and pressure relief as well as allowing visitors at any time will protect your parent’s last days. Often a care home will ask you about your parent’s dietary preferences, favourite hobbies, past employment and daily routines in order to individualise your parent’s care plan as much as possible as they decline.
The Care Quality Commission provides more in-depth information on end of life care.
Kris is registered nurse with 28 years of experience in health and social care, including 11 years in care home management. He offers full nursing assessments as well as advice on selecting a care home for your parent and inspections of potential homes.
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