Shiny new buildings and swish interior design doesn’t guarantee a high quality of care, and a culture which promotes respect and dignity for the elderly.
Currently, there is no system in place which measures and reports on the quality and safety of aged care providers. The Aged Care Royal Commission has recommended a star-rating system to allow older people and their families to make meaningful comparisons between different aged care homes. But, for now at least, we have to make these judgements on the basis of our own research.
It really boils down to doing your homework, including online research, visiting facilities of interest and asking the right questions.
Where to start?
The Government’s My Aged Care website (https://www.myagedcare.gov.au/find-a-provider/) is the best starting point. It has a search function, which you can use to find aged care homes in your area. Here, you’ll find basic information about a facility, how much it costs, and whether it’s meeting the requirements for quality and safety.
You’ll also find direct links to each facility’s website. Visiting an aged care facility’s website is useful to learn a little more about the home, and to see some photos, but nothing beats the good, old-fashioned ‘meet and greet’: visiting each facility of interest in person. Phone the facility, ask whether they run tours, or – better still – if you can arrange a one-on-one tour.
If you can manage it, try to visit on more than one occasion, at different times of the week and day. The staffing levels might be very different on a weekend, and visiting more than once will give you a chance to see different staff and how they interact with the residents. Stay for a while. Sit, and observe the activity around you. How does it feel? Can you imagine your mother, father or loved one living here happily?
Your loved one’s needs and wishes are front and centre
The chosen facility must be able to cater to any specific medical and health requirements. If your loved one has dementia, or is entering palliative care, you’ll need to look for a home which is set up to offer the right sort of specialist care. Some facilities, for example, have dedicated dementia wings and expertise in supporting residents living with dementia.
Your loved one might have requirements and wishes around spiritual practice, diet and language. If so, how well does a facility accommodate these needs?
Geography will likely be an important factor. Who will be responsible for overseeing your loved one’s care, and how important is geographical convenience? It might be important for your loved one to find a care home in their local community, so that friends and family can visit without travelling too far.
What sort of community and sociability experience is your family member looking for? They might love drawing or painting, so a home with an established art program would suit them well! Or perhaps regular outings are important, in which case you’ll need a home that has transport options to get residents out and about on programmed excursions. If gardening is a favourite pastime, then you might look for a facility which encourages its residents to participate out in the garden.
Things you can observe
When visiting a facility, be mindful of all that you can observe through what you see, hear, feel, smell and taste. Here are some ideas for what you might think about.
What do you see?
- Do staff greet you with a smile?
- Does the home have views to the outside?
- Is there good natural lighting?
- Do you see residents interacting?
- How does the environment promote sociability?
- Are staff easily identifiable?
- How do staff engage with residents?
- Is the environment clean and tidy?
- Consider the age profile and sociability of the other residents – can you imagine your family member fitting in well?
What do you hear?
- How do the staff engage with the residents? Are they cheerful, do they know everyone by name?
- Is there laughter?
- Do you hear the sounds of people enjoying themselves (music, singing)?
- Can you hear sounds from outside, both pleasant (birds, animals, children) and less pleasant (traffic)?
- Can you hear the familiar ‘home’ sounds in the background, like a TV, radio, the sound of household chores?
How does it feel?
- Is the furniture comfortable and in good condition?
- Is it furnished like a family home, rather than a hospital or sterile space (think art, flowers or plant, and decorations)?
- How does the bed linen feel?
- What sort of outside space is available to enjoy?
- Does it have gardens that the residents can enjoy (or perhaps potter in)?
What do you smell?
- Does it smell like a hospital?
- Can you smell pleasant food aromas?
- Are there any smells from the outside, like trees, plants or rain?
And finally, taste
(or, how does the food rate?)
- Consider visiting during meal time to see, smell (maybe even taste) the food.
- Do the residents seem to enjoy the food?
- How are the menus selected, and how often are they rotated?
- How much choice do residents have at each meal?
- Can dietary preferences be accommodated?
- Is tea and coffee available for the residents and their visitors?
- What food or snacks are available outside of set meal times?
- Is there a kitchenette where your family member can make a cup of tea or prepare a snack?
Things you should ask
There are some things that you won’t necessarily be able to observe, so arrive at your tour armed with any questions you may have about how the facility runs, its policies and practices, and – very importantly – it’s overall philosophy regarding the care of its elderly residents.
There are no laws at this stage around the staff-to-resident ratios in Australian aged care facilities. In its final report (March 2021), the Aged Care Royal Commission found that in 2016 the residential aged care workforce comprised 15% registered nurses, 10% enrolled nurses and around 70% personal care workers.
It’s essential that you ask plenty of questions to understand what level of care will be provided. You might start with these:
- How many residents does one staff member have to look after at once? (Be careful that this number includes care staff only, and not support staff such as those working in the kitchen, laundry, maintenance and administration).
- What kind and level of training, qualifications and experience do the various staff have?
- Is there a registered nurse on duty 24 hours?
- What are the staffing arrangements overnight?
- How are all staff – care, kitchen, administration, maintenance, etc – trained to understand the needs of elderly residents, including those with dementia?
- Does the home have volunteers? What do they do, and how are they vetted?
- What are staff turnover rates? Regular changes in staff can be upsetting or confusing for some residents, and could indicate deeper issues at the facility.
- To what extent does the facility use agency staff, who may be called in at short notice and not be familiar with the residents and their needs?
Medical, health and wellbeing
- How will the facility prepare an individual health care plan for your loved one?
- What level of complex care can the staff deliver? Is there anything which cannot be provided?
- What happens if a resident’s care needs become more complex?
- Does the home have a visiting GP? How often do they visit?
- Is your own doctor able to visit?
- How are allied health services provided? Think about, for example, physiotherapy, podiatry, optometry and dentistry.
- What options and programs are available for people living with dementia?
- If your loved one has dementia, you should have a frank conversation with the facility about its use of restraints and sedation.
- How does the facility ensure each resident receives appropriate, everyday health and wellbeing care, such as brushing teeth, skin care, promoting continence, and managing incontinence?
- How does the facility promote mobility, which is so important to reduce the risk of falls and reduced muscle strength?
The day-to-day routine in an aged care facility is really important. There’s a balance between what’s easiest for the facility, and what’s best for the residents. Many elderly people place enormous value on doing things on their own terms. To have this completely upended when moving into residential care can be hugely upsetting.
So, try to establish how the day-to-day routine works. Think about bedtime, meal times, access for family and friends to visit. How rigid are these routines? Can residents choose when they want to sleep, wake, shower and eat?
It’s not unusual for some facilities to wake residents before dawn for their showers. They do this because it’s easiest for them, but how does the resident feel about it? How would you feel about it?
Activities and lifestyle
Social connection is a key part of a fulfilled and meaningful life. Residential aged care should make sociability easier. For many older Australians, moving into residential aged care actually reduces social isolation, because there is an on-site community of like-minded folk, and – hopefully – a rich program of activities for the residents to enjoy.
Ask to speak with the activities coordinator, and explore with them the sorts of activities on offer, how often they’re available to residents, and whether residents have any input into what’s on offer.
How will the home cater to a resident’s specific hobbies (eg music, gardening, woodwork, cards)?
How are birthdays, and religious or cultural events celebrated and observed?
Finally, how will the facility encourage ongoing family connectedness? Is there a space which can be used by families to celebrate birthdays? Can family members join their loved ones for a meal?
Try not to leave things to the last minute
Nobody wants to make decisions in a crisis situation, but this is how the transition to residential aged care all too often plays out.
For some of us, starting the conversation about aged care can be difficult. So, we avoid it altogether.
For others, care needs can change dramatically with a single event, such as a fall or a medical crisis.
In an ideal world, we’d be thinking ahead. We’d give ourselves time to consider all the options, do the research and feel equipped with all the information required to make the best decision.
All it takes is a conversation, which could start with a single question of your loved one: “What are your expectations for your own aged care?”
Making the best choice about aged care for your partner or parent can be overwhelming. If you keep this guide on hand when visiting facilities, you’ll have some prompts to help you walk away feeling you’ve covered off many of the key factors.
Download your copy of “Choosing the right aged care home”.
Use the printed copy for helping with your research, and when visiting aged care facilities.
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