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The Difference Between Residential & Nursing Homes

This is a question often asked when someone is first looking to move into a care home.  Just what IS the difference between a residential home and a nursing home.  The clue is really in the name.  A residential home is somewhere where you live and have assistance from staff to help you wash and dress, moving around the home and going to the toilet.  A Nursing home is for someone who needs nursing care, whose care needs are more complex and cannot be assisted by carers alone.

But unfortunately it's more complicated than that, as things often are.  My experience is mainly in Scotland and so that is what I shall talk about, but there maybe other differences in England and Wales.

Residential Homes

As I have mentioned, these are for people who need some help with their daily living.  They may need a hand to get washed and dressed, to get to the toilet. to have a shower or bath etc..  There does not need to be a qualified nurse in the building and carers are responsible for planning and carrying out care.  They can assist you with medication but do not have the knowledge or experience with medication of a qualified nurse.  District nurses would come in to attend to any nursing needs that someone might have such as a dressing just as they would if you were in your own home.

Because Residential homes cater for people who are more independent, on the whole the residents have less communication difficulties or memory problems.  Any activities organised therefore tend to be directed towards those with more physical and mental abilities than Nursing homes.

Nursing Homes

Nursing Homes always have at least one qualified nurse in the building, twenty-four hours a day.  The home cares for people with more complex needs.  This includes things like

• one to one assistance with eating and drinking
• assistance from two people and and a mechanical aid to move from bed to chair
• regular assistance throughout the night
• regular supervision to help maintain safety
• high levels of emotional support either during the day or at night
• at high risk of pressure sores

The nurses can attend to any nursing needs such as dressing changes and are more knowledgeable regarding medications.  They can administer medications by injection.  District nurses can still be involved as care home nurses can often turn to district nurses for advice.

Dual Registered

Some homes cater for both residential and nursing clients and this is often a good choice if your needs are currently in the residential bracket.  Whilst any home will do their utmost to assist you for as long as possible, a dual registered home will be able to cater for you if your condition deteriorates and you require nursing care.

Now all that sounds pretty straight forward I know but it can all be a bit grey as to which category someone might fit into.  This has only become more of a muggy area in Scotland since the funding system changed.  People living in Scotland, who have a certain amount of money, are required to pay for their care.  But from 2005 they have been refunded a certain portion of that money.  If they are in residential care they get back a personal care allowance but if they are in nursing care they get a nursing care allowance on top of the free personal care.  

This has meant that from 2005 it has been important that are placed in the right category as this can at current rates make a difference of around £3800 per year.

For further information about free personal and nursing care in Scotland click here

But what has tended to happen and I have certainly noticed this myself is that what was once considered a nursing need is now being considered as something that could be managed in a residential home.  Local councils in Scotland carry out an assessment of needs and then this is then put forward to a funding panel.  This panel decides if a) the person needs to be in a care home and b) if they qualify for the nursing care element.  I feel this is important to know, as if a social worker or care manager visits you to assess your needs it is really important that you do not hide or underplay any of your needs as it may mean that you are not funded appropriately.  Please bear this in mind.

And Finally

If you have had any experiences of the differences between nursing and residential homes, or if you can advise on the different homes in England or elsewhere in the world I would love to hear from you!

Please leave a comment below.

Care Homes - Does size matter?

Large Versus Small

When you are choosing a care home the number of people it can take should factor into your decision.

There are advantages and disadvantages to both and I'll try to cover these factors as comprehensively as possible.

Large

A large care home can seem more impersonal.  It can be very difficult for staff to know all your needs, likes and dislikes, when they have a lot of other people to care for.  Even if the home has certain staff working in the same areas, there will be times when they will have to work elsewhere to help cover for staff holidays or sickness.  If there are different staff it will be more difficult for you to get to know them, especially if you have a memory problem.

But a larger home generally has a larger pool of funds to dip into for equipment.  If you need a profiling bed for example (this is a bed that can be lowered almost to the floor and is used for people at risk of rolling out of bed to minimise the risk of injury) then a smaller home may have to delay purchasing it until funds are available.  They should, in fact, buy any equipment you need, but sadly in practise this is often not true.

A larger home should also have a larger pool of staff to call on at short notice if someone calls in sick.  There are nursing agencies that will supply staff to homes to help maintain staffing levels, but they don't know any of the residents, the lay out of the building, or your normal routine.

Larger homes tend to be purpose built and so are designed with you in mind. They have larger corridors and bathrooms for easier wheelchair access and the layout of the bedrooms and communal areas can be easier for people to find their way around.  Purpose built homes generally have a large number of fire escapes.  Any care home being built now in Scotland has to install a sprinkler system and all bedrooms have to have en suite shower rooms.

Small

A smaller care home is one catering for around 30 residents or less.  Here it is far easier for every member of staff to know all your details.  They can, for example, remember how many sugars you take in your cup of tea. But, in a smaller home, everyone seems to know everyone else's business.  The staff will do their utmost to protect your confidentiality but the residents are only human and there will be some among them who enjoy a good gossip.

Whilst there will be some smaller, purpose built home, most tend to be conversions from hotels, or large country houses.  This may mean the layout is not ideal, rooms may have irregular shapes and may not have en suite facilities.  But this may also help if you have memory problems.  In a home with different size corridors and doors it may be easier for you to find your room than one where all the corridors and rooms look identical.  Care homes often put the name of the resident on their bedroom door, but this won't help if you have a visual impairment.  

Another advantage of a home that has been converted is that they often have a more homely feel, rather than an institutional one.

Decisions

It is probably better not to rule out a home at this stage because of it's size, but simply bear these points in mind for when you come to make your decision. 

If you have started a spreadsheet, you could use the next column to add the size of the home.  This information can be found on the inspection reports.  Click here to go to the page where I talked about spreadsheets.

What do you think?

Are you already in a care home?  Do you prefer a large or a small home?  Was that an important factor when making your decision?

I'd love to receive your comments

BBC Panorama Programme - How To Read An Inspection Report

My next posting was going to discuss the differences between a large care home and a small care home but having watched the BBC Panorama programme showing secretly filmed footage of abuse in a care home I feel I need to talk about this instead.

If you haven't seen this documentary it is currently available at BBC Panorama Programme

The daughter of the woman being filmed said that she picked the care home because the Care Quality Commission gave it an excellent rating.  If this is true, then just how trustworthy are these inspection reports?  How can you be certain that the care home offers quality care if your relative can no longer communicate with you or their short term memory is badly impaired and they can't remember what happened to them five minutes ago let alone the night before.

Well, the short answer is, you can't.  There will always be a risk of things happening from unscrupulous members of staff unfortunately, but there are things you should be aware of when reading an inspection report.

Paperwork

Nowadays, when a care home inspector visits, it is up to the home to provide evidence that they provide good care.  The inspectors often take the stance that if it isn't written down it didn't happen.
One example of this is care plans.  The inspectors want every single thing to be documented in order for these care plans to be personalised and not generic.  Keeping this paperwork up to date takes an inordinate amount of time and often keeps nurses busy instead of looking after residents.  The reason behind this is so that the staff looking after a resident know all their likes and dislikes, what their normal routine is etc.  This is a good thing, but the carers who look after these residents do not have time to read these increasingly unwieldy documents and learn about how to care for a resident during handover from the previous shift and from speaking to the resident and the relatives themselves.  In essence, good care plans do not necessarily means good care.  You should be aware that a poorly written care plan may indicate that the staff focus on the resident first instead of the paperwork and pleasing a care inspector.  And paperwork can always be faked! When you read an inspection report, bear this in mind.

Views of relatives and residents

When an inspection report quotes the positive or negative feedback they have gained from relatives or residents this can give a good indication of the quality of care.  But these are the voices of individuals expressing their own opinion and everyone has their own likes and dislikes.  Also be aware that if an inspector speaks to a resident that this may be someone with a memory impairment who cannot remember that they didn't like the choices on offer for breakfast or that they've had to sit bored for two hours.
And I have heard of unscrupulous managers who have steered inspectors away from 'difficult residents' who are known to be dissatisfied with the service.

Complaints

The SCSWIS website (see my previous post Click Here) allows you to look at a list of complaints that they have received about a home and whether they were upheld or not.  I cannot see this information on the CQC website but I feel this is very useful.  If the home has been receiving good inspections and yet has had several upheld complaints it may indicate problems.  People who complain to the Inspecting Bodies are normally residents and relatives who see what goes on in the home on a daily basis and not over a one or two day period.  They normally resort to complaining when they feel that the management of the home has not addressed their concerns, or are unapproachable, neither of which are a good thing.  Bear in mind that there are people out there who are never satisfied and who complain for complaining's sake, but if this is so, their complaints should not be upheld.


But the thing from the BBC programme that I think speaks volumes is that the daughter felt concerned, so concerned that she placed a hidden camera in her mothers bedroom.   Her instincts told her  something was wrong.  And so, this is the best piece of advice that I can give you...

...Trust your instincts!

I would love to hear your views on this subject.

Would you consider secretly taping the care home where your relative lives?

What's your story?

Create a List of Possible Care Homes

So
Now you have some idea of what you are looking for in a care home, and what you think they should be able to offer you it's time to search the internet.  To get a really comprehensive list of care homes in your area it is useful to use the websites of those that inspect homes.

In Scotland this is Social Care and Social Work Improvement Scotland (SCSWIS) and can be found at http://www.scswis.com/

In England and Wales it is the Care Quality Commission (CQC) found at http://www.cqc.org.uk/

A useful website in the USA is http://www.medicare.gov/
although I will admit that there may be others as my area of expertise is UK based.

Each of these websites allow you search for a care home within a specified area and will give you a list of potential homes.  They will all tell you how many people are accommodated at that care home and allow access to recent inspection reports.  Don't concentrate on these or any gradings too much initially. Just write a list of homes within the area you choose to live.  I'll help you to sift through these in future postings.  If you are computer savvy you might like to start a spreadsheet to help you contrast and compare these homes.  It doesn't need to be anything fancy.  Just write the names of the care homes you find in a list down the left hand column. See my example below.

Next Time : Does Size Matter?

First Things First

So, where to begin in this minefield that is choosing a care home.
I think the first thing to do is to think about your lifestyle, what is important to you and what makes your life worthwhile.
If a care home is going to provide you with quality care they will need to give you the freedom to live your life the way you want to live it.
Think about what you do during the day and what you enjoy doing. Do you have lots of visitors? Do you like to watch television. Do you play the piano? Do you like to go shopping? The list is endless!
The important thing to consider when choosing a care home is to remember it is a care HOME and a good one should be able to help you continue to live as if it is your home.
So before you start trawling websites and getting lists of homes in your area, write a list of things you would want a home to be able to provide for you. This will be a good starting point to help differentiate between the multitudes of homes out there.

Welcome to Choose a Care Home Blog

Welcome to the first posting on this new blog.  

I am a nurse and have worked in Care Homes in the UK for over twenty years.  I have worked my way right up to senior management positions.

I have often had to show people around the homes in which I have worked when people are looking for a care home either for themselves or a loved one.  This has made me appreciate what a difficult decision this can be and often people are unsure what to look for, what questions to ask and how to tell if the Care Home provides good care.

This is why I have decided to start this blog - to help people who are having to make this difficult decision.

I am currently employed full time and so am unsure how much spare time I can commit to this blog but I will endeavour to post at least weekly on a Thursday as I generally have this day off.

I hope that this blog will prove to be invaluable and look forward to hearing from others experiences.