Here is a suggested checklist which might be helpful when considering or comparing residential care facilities. Make sure that the facilities you consider meet your assessed care level needs. This list is provided to give you ideas. Use it to form your own questions.
• How do the residents relate one to another and to staff?
• How does the manager relate to staff, residents and all visitors including tradespeople?
• Do relationships seem natural and easy?
• How do staff members speak to you? (Do they give you their full attention or do they tend to talk to those accompanying you?)
• How engaged in the life of the place do people seem to be? (Are residents sitting around the edge of a lounge where it is difficult to connect with others or do the seating arrangements on the lounge areas encourage interaction?)
• Do the residents appear happy and well cared for? (If a resident is calling out for attention are they assisted promptly?)
• How well does individual differences (e.g. appearance, need etc) seem to be catered for?
• Are buzzers answered promptly?
• How well is resident privacy managed? (This may be especially important if the rooms don’t have ensuites.)
• Do staff members knock and wait to be invited in before entering rooms? (Staff should await permission before entering someone’s private space.)
• What does it smell like? (An all over pervasive 'fishy' smell may mean a high number of urinary tract infections. What is being done to treat and prevent these?)
• Do residents look comfortable? Can they move about in their beds and chairs easily? If not, are they regularly checked and repositioned comfortably?
• Are residents cleanly and tidily dressed?
• Watch staff responses to those who need help e.g. at meal time; are they helpful? Are there enough staff members available to help all those that need it at busier times?
• What is the carer to resident ratio? How is this different at night and weekends?
• When are the registered nurses on duty?
• How stable is the staffing? (Are you able to regularly have the same caregiver assist you or is there no set assignment of caregivers to residents).
• Who fills in for staff when they are absent? (You may like to ask how the caregivers that “fill in” are sufficiently orientated and familarised with the facility and residents and whether security checks have been done on relieving staff.)
• What is the policy regarding the use of Bureau nurses and caregivers? (Bureau personnel may be engaged from time to time to cover staff leave/ sickness etc. Constant use may indicate difficulty obtaining/retaining staff.)
• Does the facility management perform police/background checks on potential new staff members?
• What system do staff have for updating each other between shifts?
• What does the facility do to ensure safe medicine management?
• Do many people keep their own doctor? (Residents are entitled to retain their own General Practitioner [GP], however if the residence is a considerable distance from the medical practice it is often practical to change doctors. You will probably have to pay additional costs to be attended by your own GP as the 'house GP' is usually more 'cost effective'.)
• Is there a GP on call at all times?
• What qualifications do the caregivers have? (You may like to ask about ongoing staff training and what tasks various people in the facility perform e.g. caregiver, household staff, enrolled nurse, registered nurse etc. You may find this varies from facility to facility.
• What is the policy if people do not sleep well or become a little confused and disturb others during the night etc?
• Are the rooms spacious enough for you, sunny or well lit, with an outside window?
• If you are considering a particular room is there space for your own furniture and other personal items?
• Are all furnishings supplied or do you have a choice of own furnishing/furniture? (You should be encouraged to bring items that will help make your room feel like your home.)
• Can you bring your own bed? (If you require hospital level of care then this is generally not an option. Hospitals have beds that can be adjusted and are designed to ensure your comfort.)
• Are there pleasant areas you can go to, inside and outside? Are these easily accessible for you or would you require assistance to access them?
• Are the bedroom sizes and facilities appropriate for you? Are these standard rooms or do they attract extra costs (premium rooms - see also further questions below))?
• Is there easy access between areas, e.g. no tricky stairs? Are hallways wide enough if you require assistance or for a wheelchair?
• Can you control the heating in your own room?
• If the rooms don’t have ensuites are the toilets close by and easily accessible? (Ensuites are not essential for those who require assistance with bathing/showering/toileting.)
• If there are shared rooms, is there a choice of room-mate?
• What are the lounges like? Are there areas where you could comfortably entertain guests? Do all the lounges have TVs or are there some quieter areas?
• Are all living areas comfortably warm?
• Can you manage to find your way around the home? (You may need to orientate yourself so give yourself time to do this.)
• Are call bells within easy reach in bedrooms and located sufficiently throughout the rest of the facility? Take note when call bells are rung – are they are answered promptly.
• Are accidents or spills attended to promptly?
• Does the facility display a current license, building 'Warrant of Fitness' and evacuation procedures?
• Are the building/s and grounds secured at night?
• How often are emergency drills held?
• Does the facility have an emergency plan and adequate emergency supplies for each resident? (At least three days supply of food, water and essential medical supplies for each resident should be on hand if required). Are they prepared for power or communication outages? Are residents next of kin’s contact detail easily available in a non digital form?
• How are accidents recorded? What review procedures are in place to ensure similar accidents are prevented? How are these documented and are family members informed?
• Ask about meal times (rotational meal times may apply) menu range and choice? Is the weekly menu prominently displayed?
• Do residents who need help with their meals dine in another area? How do you feel about this?
• How are individual preferences catered for?
• What access do residents have to tea/coffee making facilities? Can you help yourself to snacks or fruit at any-time?
• Can a friend/relative join you for morning/afternoon tea or main meals occasionally; if so, is there a cost?
• What do current residents say about the meals?
• What do the meals look like? (It's a good idea to make your visit at a time when you can see these.)
• What does the dining room look like? Are the tables and chairs clean? Is any table linen fresh and clean?
• What is the policy about having meals in your room?
Routines and Activities
• Is there an activities programme displayed? Who decides what goes into it?
• What is offered in arranged activities? How frequently are these? Are individualised activities arranged and if so can they cater to your hobbies/interests? (A well constructed programme should not be patronising.)
• What qualifications does the person who arranges the activities hold? Many now hold a Diversional Therapist qualification.
• How frequent are the outings? Who chooses where to go? Can everyone be included? Are there any associated costs? Does the facility have a bus or minivan onsite?
• What opportunities for community involvement are there? (Many facilities have regular visits from the RSA or Age Concern Accredited Visitors or arrange outings to these community groups.)
• Does the person arranging the activities program also assist residents to keep in touch with friends and family e.g. letter writing, email, Skype, regular phone calls or visits.
Dignity/Privacy and Independence
• When you visit do you feel comfortable about the way in which residents are addressed and their privacy and dignity respected? Would you be happy to be treated in such a manner?
• Is independence encouraged? How is this done?
• How are individual preferences catered for e.g. are bed times flexible, who chooses what you wear, how often can you shower etc.?
• Do the residents have a collective voice, i.e. is there a residents' committee? If there is, who chairs the meetings? (A staff member can inhibit discussion.)
• Is there a policy about money management? (People should be able to continue to manage their own financial affairs if they wish or unless it has been determined that they do not have the capacity to manage this.) How is the security of your money and personal belongs managed? *you are responsible for the insurance of you own personal items.)
• If you don’t have your own phone in your room can you use the facility phone? Is this located in a private place?
• If there is a computer with internet access onsite can this be used privately also?
• What other house rules are there, e.g. how long can visitors stay, how do you inform people of your intention to go out for the day etc.?
• How are residents’ ethnic, cultural and spiritual values and beliefs respected and upheld?
• How are complaints dealt with? Do residents and their visitors feel that it is easy to make a compliant? (The procedure for making a complaint should be displayed in a public place.)
• Is there an orientation programme for new residents?
• How are disputes/disagreements between residents dealt with?
• What arrangement is there for washing your personal clothing? How do staff members ensure that clothes aren’t returned to the wrong resident?
• How much does it cost per day/month? What is included or not included in that cost? What are possible additional expenses?
• Are there any additional costs? (If so make sure these are itemised on your Agreement and included in your budget.)
• Are any additional charges separable (able to be stopped without affecting which room you have e.g. a private phone line, SKY TV etc.) or are there wider implications (e.g. move to another room)?
• How are any complaints dealt with? Ask residents and their relatives about their experiences. (Residents have the right to make a complaint.)
• In what circumstances would you have to surrender your room e.g. long hospitalisation, etc.?
• Do you have to give up your studio unit/serviced apartment if you receive a Residential Care subsidy? (See also - ' I live in a small unit in a village and I pay regular service fees. I now need rest home care. Will I have to move out of my unit?
• Can you go on holiday? If so, for how long?
• Is there a contract with the Health funders? (If you require a Residential Care Subsidy you must choose a home where the facility has a contract with the District Health Board [DHB].)
• Has the facility ever been subject to a formal complaint ie Health and Disability Commissioner? If so what was the outcome?
Specialised Dementia and Specialised Hospital Care
Mental health services for older people undertake specialised psychogeriatric assessments before determining the need to move into secure dementia or specialised hospital care and will also provide support to families. Staff in these facilities should be trained in this specialised area of care. If you are looking for a secure facility you need to consider all the previous questions and to ask what is provided for the special needs of these residents.
• Are key relatives/former carers involved in making or revising care plans?
• How is the resident's dignity maintained? (While a variety of behaviours can be observed at any time, staff should always be sensitive and caring to residents and their unique needs. Where possible, they should also make sure that things that have been important to the person in the past are not neglected e.g. applying make-up, shaving etc.)
• How are behaviours that challenge managed? (Such behaviour often indicates the person is distressed about something. Skilled care and management can often determine what this is and alleviate it.)
• Are residents engaged in meaningful activities? How do staff oversee these?
• How is respectfulness shown to residents?
• How is restraint monitored? (There should be a written policy on restraint.)
• Do staff regularly interact in a warm and caring way with residents?
• How accessible are staff? What is registered nursing staff cover like?
• How is the resident’s dignity maintained?
• How will the service manage the person’s changing needs over time?
• Does the facility operate a specific type of dementia care programme? (Several international models operate in New Zealand facilities e.g. Spark of Life, Eden.)
How long is the facility certified for? This link to the Ministry of Health website Rest Home Certification and Audits gives you the answer. Certification may be granted for up to four years. (A shorter period usually indicates that the auditors require additional work to be done in order to meet full compliance. The issue may not be major. Do not be afraid to ask.)
You may try out a home before making a commitment. If you do, you will have to pay for this yourself. Most people say a month gives them enough time to assess the facility. Although it’s not long enough to really feel ‘at home’, it’s long enough to see: how the home operates, what staff are like and whether you like it sufficiently. Going to the home ‘for a trial’ may make you feel more comfortable about moving if it’s not right for you. You are purchasing a service and have the right to expect reasonable needs to be met. Once the decision has been made, inform the management so that the next step in the process can be completed.
© Eldernet 2014