Choosing a home

Nursing and Residential Homes
A guide issued by HKF Publishing

WHAT IS THE DIFFERENCE?

Residential Homes (sometimes called Rest Homes or Retirement Homes) are for people who can no longer cope with their day to day activities alone in their own home, even with a carer or outside help. 

This type of Home is either provided by the Local Authority or by a private (or voluntary) agency, or by both. All private and voluntary Homes have to be registered with the appropriate Social Services.

You can obtain a list of all Residential Homes in your area by contacting the Social Services Inspection Unit. 

Nursing Homes are for people whose infirmity, illness or injury requires nursing care on a regular basis which cannot be provided for them at home by the District Nursing Service. This sort of care, the law says, can only be provided by a qualified nurse or under the direct supervision of a nurse. Please bear in mind that Nursing Home care is usually provided by the private and voluntary sector and not usually by the National Health Service. All Nursing Homes must be registered and regularly inspected by the appropriate Health Authority. You will find some of your local private Homes advertised in this guide and you can obtain a list of all Nursing Homes in the area by contacting the relevant Health Authority.

Some Homes are dual-registered and offer both types of care. It is important to make sure that the Home you choose is the right kind for your needs, both now and in the future. You can get advice and information from your local Social Services, Surgery or Health Centre.

You may qualify for financial assistance towards fees under the Community Care assessment procedures. If you are to have an assessment by the Social Services under the Community Care arrangements, they will help to decide - along with qualified health personnel, where appropriate - what sort of Home is right for you.

Your Care Contract

If the Social Services is assisting with the costs, they will contract with the Home on your behalf and specify the standard of care. If you are paying the full cost of going into a Home yourself, it is a very good idea to have all the details of costs and facilities written down in a Contract. That way, everybody knows where they stand. Most Homes will have a standard contract already.

Don't forget, you are a consumer and you do have rights. Therefore, the contract must explain your guarantees and your rights as a resident and consumer. Most Homes understand this and have guarantees built into their contracts.

This next part is very important so please read it carefully: The contract between you and the Home may well be a legally binding document (both on you and the Home), so make sure you read it thoroughly and that you understand it before you sign. Don't worry if the words or phrases are a little confusing, there are plenty of people you can contact who will go through it with you and explain it properly and clearly. You can get this sort of help, of course, from a solicitor, or your local Citizens Advice Bureau will help you for free.

A Contract should normally explain all of the following:

* What fees are payable in advance?

* What is included in the fees (for example: personal laundry, sheets, chiropody, physiotherapy, hairdressing, outings, etc)?

* Are relatives expected to make up any shortfall ( normally expressed as Top Up ) from funds the Social Services may contribute towards the fees? If so, this should be spelt out in clear terms in any contract either with the Home or the Social Services.

* How often, and at what time of the year, are the fees reviewed?

* Are fees still payable if you have to go into hospital temporarily or, say, when you go away on holiday?

* Are there refunds available when you cease to occupy a room?

* Is money received for personal use? Who looks after it?

* Is there a minimum period of notice required to vacate the Home?

Assessment & Finance

People going into a Home for the first time will have their care needs assessed by the local Social Services Department. This assessment will determine whether, with more help, you could continue to live in your own home, or whether a Nursing Home or a Residential Home is the right type of Home for you.

For Nursing Homes, the Social Services must make the assessment together with a person who has a professional medical or nursing qualification. The Social Services will also assess whether or not you qualify for financial help towards the cost of the fees. There is a "sliding scale" of help available, usually dependent on your own financial position, or "assets" as they are sometimes known. Generally, if you have more than £22,500 worth of assets, you will be expected to pay the full cost of the fees yourself.

To make things easier, all the financial help you are entitled to is normally gathered together and administered by the local Social Services (the people who will make the "assessment"). They will normally pay this money directly to the Home for you, but please check, as arrangements differ from area to area.

Previously, the Government fixed the total amount of help you could get in any one year. Since the new arrangements came into force, however, local Social Services Departments have had to set their own local budgets according to perceived needs and funds available.

Of course, you may be one of the many people who make their own private arrangements. In that case you can negotiate the level of fees directly with the Home, or have someone negotiate for you; maybe a friend or relative can do that for you.

You can obtain lots more information by contacting the relevant department. If you are not sure whom to contact, you can get help from your local Social Services Department, Citizens Advice Bureau, Surgery or Health Centre.

Some Other Points

It might be a good idea to print out and take along this guide, which you could then use as a checklist, to help you remember what questions to ask.
Here are some other points you may want to consider:

* How are residents selected? Is it possible that other admissions could change the character of the Home?

* Is there easy access to a telephone? Can calls be made and received in private?

* Will someone post your letters for you? Is there a Post Office nearby?

* Are personal radios and televisions allowed for own rooms?

* What social activities are provided? Outings? etc.

* If you have an interest or hobby, could you keep it up?

* Can you still get your regular newspapers, books and magazines?

* Is there a Library nearby which you might want to use?

Dissatisfaction: Find out when selecting a Home how complaints or other problems are dealt with. If any kind of dissatisfaction arises, or you feel there is a problem with the standards of care, it is always wise to discuss it first with the people in charge of the Home. But ultimately, if the problem persists, you can inform the registering Authority that you are unhappy. They have the power to look into these matters on your behalf.

Registration and Inspection: The purpose of registration and inspection is to guarantee the standard of care you are entitled to receive. In order to be registered, a Home has to comply with a law - the Registered Homes Act 1984 - and often also with the registering Authority's own guidelines. These specify the high standards required, for example the room sizes, number of bathrooms and toilets, staffing levels, food, services and facilities, fire safety and records to be kept.

Each Home is regularly inspected. After each inspection a report is sent to the Home detailing any recommendations and actions required. Homes may be willing to let a prospective patient view the latest report, so ask to see it.

Things to Remember

No two people will have precisely the same needs or the same priorities and this Guide doesn't try to define what's good or bad. It is a guide to some points that you should know before you decide what sort of Home is right for you.

Going to live in a Residential or Nursing Home needn't be a difficult move to make. The positive points are: security, being looked after, greater comfort and, perhaps, more companionship and new friends!

You will be cared for by trained and experienced people who, quite often, can give expert help, guidance and encouragement to continue your hobbies and interests.

So, ask yourself:

What kind of Home do I need? Your Social Services Department, Health Centre or Hospital Social Worker can help you make the right choice. Remember, you are a consumer, you do have rights (see the next panel headed "Your Rights").

Ask if you can stay for a trial period (say, about four weeks) to see if you like the Home, before agreeing to become a resident.

Right then, let's recap:

Take care in selecting the right type of Home for you. Weigh up all the advantages and disadvantages (and let's face it, these will differ from person to person). Then, if you decide to go and live in a Residential or Nursing Home, you can be confident that you have taken into account all reasonable measures to reach the right decision.

It is a big step, but there are plenty of people who you can ask for help at your local Social Services Department, Health Centre or Surgery.

The charity Help The Aged has a FREEPHONE telephone number (you don't pay for the call) that you can ring to get free advice on any topic affecting the elderly or contact their website at www.helptheaged.org.uk 

Health Authorities and the Social Services Inspection Units can't advise on which are the best Homes, but they can tell you whether a Home meets their vigorous inspection standards. They are there to help you, so don't feel you are troubling someone by asking lots of questions!

Your Rights

Please choose your Home with care. Take your time and try to visit several, with a friend or relative if possible. You will find a number of your local Homes advertised in this guide, all of which are inspected and registered with the appropriate authority. You can get a full list of Nursing Homes in the area from the appropriate Health Authority, or from Social Services Inspection Units for Residential Homes. 

Remember at all times that you are a consumer and that you do have rights. This applies not only to any contract you may sign with a Home, but also to any assessment made by the Social Services under the Community Care arrangements. Remember, you have the right to choose any other home, Including one in another part of the country (perhaps one nearer to your Family or friends if you wish), as long as:

* That Home meets your assessed needs.

* The Home is willing and able to take you under the Social Services Usual arrangements.

* It would not cost the Social Services more than they would normally Pay for someone with similar needs.

Another of your rights as a resident says you ought to be free to live as Independently as you wish and as you are able, with dignity and contentment. To aid you, think about these rights after your visit:

* Is information on each resident stored confidentially?

* When can relatives and friends visit?

* Were you encouraged, on visiting, to talk in private with other residents to seek their views?

* Does the Proprietor understand your financial position with regard to assistance from the Social Services and Department of Social Security, if appropriate?

* Does the Home maintain rigorous standards set out in a Residents' Charter of Rights?

* Does the Home produce a brochure or information sheet accurately describing its facilities, services, aims and objectives?