Age concern: even when we know a parent has needs that would make a care home the best choice, we can still feel guilty about actually making it
Age concern: even when we know a parent has needs that would make a care home the best choice, we can still feel guilty about actually making it

The search for care home comes with guilt, but there are 10 key things to look out for

A decade ago, Penny Hancock was choosing a school for her youngest child. Now she is looking for a care home for her mother. The process is similar, but the guilt is overwhelming

Penny Hancock
Monday 17 August 2015 19:03

Pluses: there are books on display, plants, art on the walls, a piano. Dressing-up clothes. A weather chart and timetable of activities; painting, singing, dance, films. Photos of trips out. This is promising: the last place we saw wouldn’t show us an activity schedule. The staff seem cheerful. There’s a large outdoor area, partly laid to grass, but it’s winter, hard to know what it will be like once things are growing, whether it’s used much.

Minuses: there’s a faint odour, carefully disguised, the waft you get from the boys’ toilets in an infants’ school. The paint and carpets don’t look new like they were in the last place with the flashy reception area and coffee machines, but where there wasn’t as much to look at, to watch or listen to.

The menu tells us lasagne or macaroni cheese is on offer, followed by apple crumble. And that the food is cooked on site and locally sourced, some even grown in the vegetable patch. Through a glass panelled door, a group is engaged in some kind of show and tell. We’re trying to take everything in, the feel, the expressions on people’s faces. Perhaps I’m being too exacting but you only get one or two chances to form an impression and so much hangs on it. The rest of a life, in fact.

Looking around care homes with my mum feels familiar, but inverted. It’s less than 10 years since I chose a primary school for my youngest child, three since I was visiting universities with the middle one. The anxiety about getting it right is the same, as are many of the criteria I’m ticking off in my head.

While it’s impossible to ignore how it mirrors what I’ve been doing for the kids, mirror is the operative word, everything’s the other way round; while finding the right nursery, school or university for your children is a step towards increasing their independence, the home you choose for a parent is a step closer to taking it away. In finding the right school, you’re setting them off on a journey, in finding a care home for a parent you’re guiding them towards their final destination. The poignant subtext is that this is the beginning of the end.

Choosing a school is exciting, the same can’t be said for finding a care home – and the most striking difference is that finding a safe, nurturing, caring institution for a parent is a choice. After all, a child has to go to school, but a parent does not have to go into a home. And we live in a culture where negativity towards homes is pervasive. I don’t know anyone who hasn’t felt guilt about choosing a care home for their parent, deciding this is the best – probably, if they’ve got to this stage, the only – option.

We, the “sandwich” lot (those of us caring for elderly parents while we still have children at home), are bewildered. We are perplexed about how best to accommodate this generation, most of them over 80, because it is new. In 2002 there were 7,740 centenarians living in Britain. But by 2012 there were 13,350, almost twice as many.

My mother doesn’t live with us – her choice. She bought her own warden-controlled flat a few years ago when she was becoming disabled but could still go out by herself, drive, navigate. However, since then she has joined the vast raft of the “real seniors” – the post-85s with complex needs. She is losing her memory and mobility. Her needs outweigh what we’re able to do for her, or what she’ll let us do. The shrinking of what she’s able to do leaves her depressed. Her failing memory means she’s often disorientated and distressed. And so a home seems as if it might become the kindest, most practical option.

Yet, I feel, even as I write this, that there is a subtle, unspoken judgement towards families who decide who opt for this. With bad press rife and revelations of abuse by staff, homes for the elderly feel like a last resort. And on top of our collective disapproval is the guilt-inducing myth that “other cultures” treat their elderly better, keeping them in the bosom of the family until they die. An Italian friend assures me that – in Italy, anyway – this is simply not the case. Not now that most women work, not now that running families and careers has become so pressured – and not now that the elderly live so very long and often need nursing care as well as company.

And my mother’s Spanish GP backs this. “I don’t understand the resistance in this country to letting your elderly go into care homes where there is a better social life, where they are safe and fed and looked after. We no longer expect women to stay home and do 24-hour childcare, so why on earth would we expect them to leave jobs to do 24-hour parent care?” Which, in reality, is what caring for a very elderly person, particularly one with dementia, requires.

But have homes in this country really changed? And how do you know that a home is the right one? The Care Quality Commission is responsible for inspecting homes, but this only happens once a year, and homes are only closed down if the results are really dire, so ratings don’t always give much of an idea. You can visit a home in the day many times but not know what happens after dark. So it’s down to gut instinct, word of mouth and, of course, cost. Care homes are never cheap – but it seems that the more you pay doesn’t necessarily mean the better you get.

When I was looking at schools, the factors I took into consideration, far more than league tables and exam results, were the atmosphere and ethics. The warmth and friendliness of the staff and the happiness of the children would always trump statistics or glossy brochures.

As I visit more care homes, I find that similar criteria are relevant. Friendly, happy-looking staff who interact in a non-patronising way, and a good mix of people who look content and stimulated, say more to me than hermetically sealed rooms smelling of bleach.

So here we are, following the carer through the dining room, just as I recently followed a head teacher through the school dinner hall, except instead of children’s bright eyes meeting us, the pale eyes of the very elderly stare back, breaking into curious smiles as we greet them. They look happy, they look busy, everyone who wants it has company, either of their peers or carers. It’s the fifth home we’ve seen and the most promising, offering all the social things you or I might like to spend our time doing.

After this visit, I feel a little less guilty. But it would be good if we could expect the same quality of provision from all care homes that we expect from schools. It would be good to feel that the best kind of care for the elderly is a given, with the job given proper status, as our parents and relatives – who will one day be us – live into their “real senior” years.

Penny Hancock’s latest novel, ‘A Trick of the Mind’ (Simon & Schuster, £7.99) is out now

Choosing a home things to look out for

(Good fresh food served at mealtimes snacks and drinks available when wanted and clean accessible bathrooms are all a given.)

1. That someone will show you round even if you arrive unannounced – it shows they have nothing to hide.

2. Reasonably sized bedrooms that the residents can make their own, with their own furniture – it needs to feel like home.

3. Good ratio of staff to residents. Smaller homes seem more intimate and warmer, and communal areas more accessible to people with restricted mobility.

4. Outdoor areas/garden.

5. A well organised activity schedule - other than, or as well as, a hairdressers and manicurist. Music, singing, art, gardening, card games, cookery, films, talks and reminiscence - all the things you or I might enjoy doing for fun, in fact.

6. Pleasant smell. Nowhere has to stink of urine, or even of air freshener covering up the urine.

7. Plenty to do, to look at, to engage in - reminiscence areas, multisensory areas, paintings books music.

9. Things for visiting grandchildren/great grandchildren to do – pets, sweet shop etc.

10. Low turnover of staff. If staff stay, it means they are happy, well treated, hopefully decently paid – as they should be for doing one of the hardest, most grueling but important jobs of our age.

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