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Interviewees name and age: Ann Walton (49)

Job title: Quality Manager

Current place of employment: Mainly West Midlands, for Redwood Care Homes

Time in industry: 31 years

When should someone start looking at residential care as an option?
This varies hugely; the right time will not be the same for everyone. It might be when the person needs day and night supervision or care, it could be because the carer at home is ill themselves or dies, it could be after witnessing aggressive behaviour or incontinence. Often carers delay looking for a home until there is a crisis. This is a shame as choosing a home is best done in a calm and timely manner. When a choice is made in haste it may be the wrong one, e.g. it was the only home with a vacancy. Best to plan ahead, however difficult this is emotionally, and put the person’s name down on their list so that when they need a home one is already identified.

What should they look for?
Try to look from the resident’s point of view, not your own. It will be them who will be living in the home all the time, you will only be in and out, so what would they like most? Most importantly, does it meet their needs? (Check the registration categories and read the inspection reports). If yes, eliminate all that smell of stale urine or old cabbage. When you phoned, were you helped? You could pay an unannounced call BUT the home is likely to be a very busy place and staff will be busy delivering care so you may have to wait. This may annoy you now, but if your loved one was in the home receiving that same care you would be glad that care was being delivered. You may be better making an appointment to see the manager who should set aside an hour for you to discuss needs and view the home. How it feels is a very valuable tool, but how it looks is more tricky. Remember that care homes are likely to be full of old, very frail or ill people so don’t expect everyone to be playing bridge. It is not uncommon to think your loved one “isn’t like that” but actually they may be. It is just that you see them as an individual, and what you see on your first visit is a mass of older people in a room. But when you get to know them and their families as well, it will feel different. Accepting the reality of how frail your loved one is can be really tough on the heartstrings. You should expect friendly, knowledgeable, genuine staff who are seen around; well-groomed residents in clean clothes, a homely, clean environment and good plentiful food. Do you get the impression the staff are doing all they can do, or the least they can get away with? How long has the manager been there? Are they passionate about what they do? When you talk to the manager does he/she “connect” with you?

How much significance should be placed on independent ratings?
Some things are very important, whilst others are more a matter of opinion and the view of the inspector on the day. I would advise reading the entire report, not just the rating, and ask yourself what in the report matters to you.

In your experience what tends to be the most important factors that make a resident as comfortable as possible?
Skills and attitude of staff. Everything flows from there, as staff will be responsive to individuals’ needs and preferences.

What are the common misconceptions?
That all Homes only exist to make money. That if a resident needs nursing that they would be alright in a personal care home as it will be cheaper (it is cheaper but placement is likely to break down as staff are not able to meet the resident’s needs).

How long does the process tend to take?
The home can usually be very responsive if it has a vacancy. Delay is usually down to local authority funding, which can take weeks.

What should a family reasonably expect to learn from an initial visit?
A positive first impression, availability, fees and what they include. An idea of whether the home could meet the needs of the individual and a clear understanding of how to proceed if they choose to do so.

Is it best for the family to make the initial visit by themselves or with their loved one?
If the loved one is mentally ok they should go too. If the resident has dementia this may be possible, but may not be ideal. It can be confusing and distressing for both “viewers”.  I would suggest a third person comes along so that if the confused person becomes agitated there is a familiar face to take them for a little walk whilst the viewing continues. 

What questions should they ask?
See answers above but also ask to see the bedroom that would be on offer (otherwise you might just get shown the nicest rooms). Try and get a look at a meal. Ask about training of staff and turnover of same.

How much time should they allow?
A good hour.

Ideally, how many homes should the family visit on average?
Two or three, to get a comparison.  

Would you advise them to stay the night?
No, but ask if they would be able to if the resident, once admitted, was to become very ill in the future.

How can a family help make the transition as easy as possible?
Take personal items to the room so they are there waiting for the resident on arrival. Give the home as much information as possible; it will be a more successful placement if there is a partnership approach. Supply more clothing than you think is needed, a laundry needs at least 24 hours to turn things round and some people need four or five changes a day. Use machine washable items and name clothing very securely and clearly. Try to accept that a care home, however good, does not provide one to one care, there are other residents equally as important to your loved one who also need care. If in doubt ASK, do not go home and stew. If you have concerns voice them and allow the home the opportunity to respond. Visit as often as you want to, but accept that what you need and what your loved one need may be different.

How can they best support the home in looking after their loved ones?
Communicate. Try to see yourself as a part of the care team.

What support should the family reasonably expect from the home?
Sound professional judgement and knowledge. Honesty and integrity. Accurate and timely information. Empathy and genuine concern. Reliability.

What bodies or associations of support would you recommend?
It depends what you need support with: Money, knowledge about specific illnesses, decision making via an advocate etc. Age Concern and the Alzheimer’s Society may be helpful starting points.

What’s the best part of your job?
Seeing how my knowledge and experience can support the development of best practice and hence improve outcomes.

What’s the worst part?
It can be frustrating if things don’t improve quickly enough!

What’s the biggest frustration?
See above. Also, the mountains of bureaucracy from inspectors etc, which are constantly growing. The inconsistency, and thus inherent unfairness, of the star rating CQC inspection system.

How has the industry changed?
We have had to become more accountable, which is good, but professional judgement is not trusted much anymore. Criteria for securing a funded place has changed too much; the system is rationing and restricting access to care for older people which would not be tolerated in any other group of society. Public expectations are changing and also higher although unease about care homes seems to persist. 

How would you like to see it improved?
Find a sustainable and fair way to fund care for older persons.