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If you are looking for appropriate care it is important to weigh up the different options available to you. There are many types of care from 24 hour residential nursing to sheltered living, this guide aims to clarify the differences between types of care homes and assist you to make the best choice whatever your needs.
A nursing home provides 24 hour medical care when necessary and the maximum level of personal care. They are staffed in part by professional registered nurses and will have a range of experienced carers to facilitate any care recommended by a doctor.
As such a nursing home is appropriate housing for individuals who are particularly frail or unable to look after themselves as well as those with many different medical and health needs.
Most nursing homes will offer a range of specialist care and rehabilitation therapies. These could include, physiotherapy, counselling, speech therapy and pain management. This is in addition to all of the personal assistance required, from personal hygiene and toileting, to providing and assisting with meals.
Many nursing homes offer specialist treatments for particular conditions. It is important to make sure that their specialities are suitable for your needs. Specialist care includes services for dementia, the Elderly Mentally Infirm (E.M.I.) and cancer, as well as care of young people (18-64) with physical disabilities.
There are many different types of nursing home ranging from small family-style accommodation to 5* hotel standard homes. So it should always be possible to find a home that is suited to the individual.
Residential Care Homes
Residential care homes do not provide 24 hour nursing. Health care assistants will be available at specified times in order to assist with basic medical needs such as taking medicines, the application of dressings and creams or oxygen therapy.
These homes are suitable for those who wish to retain a certain level of independence whilst having the reassurance of being assisted with daily tasks such as washing and dressing and being able to get help easily if necessary.
Most residential homes will assist residents in the following ways:
Personal care including washing, bathing, shaving, oral hygiene, getting up and going to bed. In addition to this they provide continence management. So help can be provided for toileting and dealing with incontinence laundry.
Food and dietary advice are provided at most care homes. Help with eating should also be available.
Counselling and related support, ranging from companionship and personal reminders to behaviour management and psychological services, are generally offered.
Retirement homes are normally purpose built for the elderly, often in the form of flats or bungalows. They are designed to facilitate independence, for example by having their own front door, whilst offering daily care when necessary. There are two main types of retirement home; sheltered housing and assisted living. These types of housing are favoured by residents because they create safe independent communities. Often they are referred to as care villages because of a community feel and the presence of basic amenities such as a hairdressers, shop, café or gym.
Sheltered housing often features a shared entrance and some communal facilities. Most commonly the shared facilities would be a lounge, laundry and guest rooms. Each resident is entitled to have their own bedroom in addition to private living areas generally consisting of a kitchen, sitting room and bathroom. The main advantage to this kind of living is that the housing is regulated by a manager or warden. Whilst this person is unlikely to have specific medical training they are on hand to organise health care and get help in emergencies. Most wardens develop personal relationships with the residents in order to ensure that their needs are met.
A range of subtle safety features will normally be installed. Most commonly pull chords that summon either on site personnel, friends or family members.
Sheltered housing is provided by local councils, housing associations, voluntary and not-for-profit organisation as well as by private firms.
Assisted Living / Close Care
Close care or assisted living has similar benefits to living in a residential care home. This relatively modern form of care generally consists of specifically built apartments, bungalows or cottages constructed in the grounds of a care home. What this means is that residents can retain independence whilst being assisted where necessary. This type of care can provide reassurance to the individual and their family as immediate assistance is available when it is needed.
There are three types of assisted living:
A high level of nursing care is available, normally the resident would live in an apartment and would be unlikely to need to move to a nursing home if their condition worsened. This option would be beneficial to an individual who may find moving home confusing or upsetting.
Much of the accommodation in the grounds of the care homes is suitable for those who are not completely dependant on the assistance of others. The resident would run their household affairs personally as these houses are available for either rent or purchase this allows a greater degree of personal control and freedom. The assistance offered to those in the care home itself would generally be available for the residents of these houses. They are ideally suited for a couple who need differing levels of care.
The third option is to be a resident in a house that is situated within the community where care is provided by an external agency.
Respite and Convalescent Care
Many care homes offer rooms on a temporary basis. Respite care allows carers, often family members, to take a break from their duties. It is important for a carer to not be on duty 24/7, so a temporary stay at a care home can ease the burden of continual care.
After an operation extra care is sometimes needed for a patient to convalesce. A care home can often be the best and safest place to recuperate.
The same services offered to permanent residents should be available on a temporary basis at both nursing and care homes, so the type of home chosen must be suited to the degree of assistance required.
Home / Domiciliary Care
There is a variety of different home care available. You can choose from either care workers or registered nurses dependent on your needs. The time that the carer would spend in the home can be anything from a few hours a day to assist with key tasks such as bathing or meal preparation to having a 24 hour live in carer. Services such as physiotherapy can also be arranged through the home care system. Help can be on an intermittent basis or permanent. It is a completely flexible service that can be tailored to your needs.
A key advantage to home care is that the individual can remain within their local community and continue to live as normal a life as possible, whilst having the comfort of regular companionship and assistance.
Home care can be arranged through your Primary Care Trust (the branch of your local council that deals with health care), agencies or an association of home care providers, e.g. UKHCA.
The National Care Standards Commission (NCSC) was created by the government in 2000. Their report 'The National Minimum Standards of Care Homes for Elderly People' of 2003 outlines the minimum standards that anybody living in care should expect. There are 7 areas which their report goes into great detail about. We have summarised the key points from this report in order to provide an insight into what constitutes the minimum standards that a care home must provide. Care homes provide such a wide variety of treatments it is important to remember that in some cases these rules may not be followed, for example with the care of dementia patients.
Choice of home
It can be daunting to choose a care home, but you are legally entitled to certain information that should help you to be better informed before you make your choice.
A residents guide will be supplied which will contain all of the relevant information about the home. This should cover everything from a description of the rooms, the qualifications of the staff to the range of facilities and services available. It should be in a clear, accurate and concise form, and available in different formats in order to provide for those with disabilities.
You will undertake a needs assessment in order to clarify that the home can provide for your specific needs. This includes the evaluation of social and dietary requirements as well as mobility issues and medical attention required. If you take a place in the home you will be provided with a personalised programme based upon the results of the needs assessment.
You are able to have a trial period in the home to ensure that it is the right place for you.
Health and Personal Care
it is essential that privacy and dignity are maintained at all time. A summary of the guidelines to ensure that this is the case are as follows;
The resident is entitled to access financial and legal consultation.
Phone calls must be able to be made privately if necessary, and letters must be received by the resident unopened.
Social contact must be allowed, including the right to have visitors at any time.
The resident must be allowed to wear their own clothes.
Respect must be shown by the staff to the residents at all times, including addressing them in the way that they prefer.
Medical examination should be available and always done in private.
Accurate records must be kept of all treatments and medication.
All of the respect that is shown to a resident must continue if they are dying, and in death their wishes must be respected as far as is possible.
Daily Life and Social Activities
It is of vital importance that a resident is as happy as possible at any given time. As such food and meals should be regarded as key times for residents. It is essential that residents are not hurried whilst eating, and the food provided should be wholesome and varied. If a resident has particular dietary requirements then they should be catered for at all times.
All of the factors of personal autonomy must be facilitated as far as possible, these include; exercise, leisure, social and cultural preferences. The routines and preferences of the individual must be prioritized particularly in regard to daily routines, personal and social relationships and religious observations. Homes should provide up-do-date information about activities in a suitable format for the recipient.
Complaints and Protection
Complaints must be “listened to, taken seriously and acted upon”. There must be defined channels through which to register complaints with no fear of victimisation or repercussion.
And of course the residents must be “safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory, abuse or self-harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance.”
It is seen to be of essential importance that the home has a philosophy of care that is linked to the design and layout of the building itself. For example a home with an advertised family-like care ethos should not have too many residents or be in too large a building as it is unlikely that this is what their clientèle would be expecting.
Other essentials are;
Premises should be well suited for their purpose, tidy, clean and safe at all times.
CCTV should only be installed in the entrances, and should never impinge on the privacy of residents.
Toilets should be accessible from the main rooms as well as within a short distance of bedrooms. New build care homes will all have en-suite facilities.
Specialist equipment should be available, such as grab rails or wide doorways for wheelchair users, to maximise independence.
A resident always has the right to have their own room, if they choose to share additional screening must be supplied.
Every resident should have a lockable space, either their room itself or somewhere in their room.
The quality of the staff is one of the defining features of a care home experience. As such a care home is obliged to always have enough qualified as well as domestic staff. Higher numbers must be available at peak times of day. All trainee staff must be appropriately registered. Any staff hired must have at least two good references. Regular training should be seen as a necessity.
Management and Administration
Good management is also listed as essential. The guidelines insist that a manager must be of good character and have at least two years relevant experience within the last five years. They must aim to create an “open, positive and inclusive atmosphere”. The business itself must be transparent with financial plans open to inspection and reviewed annually. Accurate records of all things must be kept, and should be available to be inspected in compliance with the Data Protection Act.
The NCSC conclude that the most important job of the manager is to ensure that the home is run in the best interests of the residents.
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