7.3

What are the best questions to ask when you visit an aged care home?

Visiting the home is your opportunity to really get a sense of what it would be like to live there.

In general, you should expect to find a clean, comfortable, pleasant smelling environment with friendly staff and a relaxed sense of order.

Everyone has slightly different preferences about their living environment so be guided by yours.  If you are looking at a home on behalf of someone else, you should be guided by their preferences.

Remember, one person’s quiet, efficient and clear-surfaced heaven can be another person’s sterile, unfriendly hell!


Use all your senses to gain a first impression

When you are visiting the home, you will probably be feeling at least a bit anxious.  Even if you forget some of the questions you wanted to ask, you can always rely on your senses.  


Sight
 

  • Do the aged care home (nursing home) staff - including administrative staff, kitchen staff, cleaning and maintenance staff – seem friendly and professional?  Do they greet you with a smile?
  • Do residents and care staff look happy and engaged?  Do the interactions between staff and between staff and residents seem friendly and respectful?  
  • Do staff wear uniforms or are they easily identifiable? (Some homes choose not to have formal uniforms in an effort to make the home more ‘home-like’)  Staff identification should be clearly visible and should include name and title.
  • Is the environment pleasant and welcoming? 
  • Is it clean and orderly?
  • Is it too orderly or regimented? 
  • What do the meals look like?
  • Does the home have art, flowers or other decorative features?
  • Does it have a nice aspect or views outside the building?
  • Is there good natural lighting? 
  • Are the grounds and outdoor areas pleasant and well-tended?
  • Are there good spaces for larger social interactions as well as intimate places to be alone or have a quiet chat?
  • Are smoke detectors and sprinklers installed and exits clearly marked?
  • What things do you notice?  Do you like the look of it?  Why?


Sound

  • Is there laughter? 
  • Are voices friendly and respectful?  
  • Is there music or singing?  
  • Are there ‘home’ sounds? The clatter of plates, the hiss of a coffee machine, the distant murmur of voices, a radio or a television?  
  • Can you hear outside noises – birds, pets, children, lawnmowers etc?
  • Are there ‘institutional’ sounds like loudspeaker announcements?


Smell 

  • Does it smell pleasant?
  • Are there good cooking smells?
  • Are there outdoor smells? Eg. grass, trees, blossoms, rain
  • Are there ‘clean smells’?
  • Are there bad smells?


Touch
 

  • Are the building materials friendly, safe and in good repair?
  • Are surfaces clean and dust-free
  • Are the furnishings comfortable (and manoeuvrable if needed)
  • Are the fabrics clean and in good condition?
  • Is the linen fresh and in good condition?  
  • Are there outdoor areas to feel the sunshine, breeze, even the rain?
  • Are there animals


Taste 

  • Can you try some food?
  • How is the tea and coffee?
  • Is there fruit, sweets or treats available to snack on?

 

Across nearly 700 aged care homes (nursing homes) we survey every three months, each resident receives an average of 2.98 hours every day of direct staff care.  Adding meal preparation and administration takes it to 3.85 hours a day, 7 days a week.

Stuart Hutcheon, Marketing Partner,
StewartBrown

 Ask questions about specific topics

Impressions and observations are an important part of choosing a home that’s right for you but there are some features of the care home that you can’t easily observe and that you should ask about.  

You may not need or want to ask all of these questions but they are intended to give you some clues and tips about some of the things that might be important in choosing the home that is best for you – and that you may not otherwise think of!

Some people like to ask the BIG QUESTIONS to staff in the care home they are visiting.  If you needed an aged care home (nursing home), would you choose to come here?  Why?  If you were living here yourself, what changes would you like to see to make it even better?


General philosophies, policies and rules

  • What principles and philosophies does the home have?  
  • How does the home, through its policies and the practices of individual staff members demonstrate these principles and philosophies?
  • How does the home ensure quality services? Do they do more than just ‘meet’ the minimum standards set by the Australian Aged Care Quality Agency? 
  • How are new residents welcomed and assisted to settle in?
  • What are the general ‘house rules’ and regulations of the home?  
  • Are there ‘strict’ routines that can’t be varied? 
  • Can family and friends visit any time?  
  • What are the entry and exit procedures for visitors?
  • What are the protocols for staff entering and exiting the resident’s room?  
  • Are there specific rules and policies around dementia specific areas or generally relations to people who have dementia?
  • Are any pets allowed?  Can animals visit?
  • How are disputes/issues handled by the home?
  • How does the home deal with residents’ personal laundry?
  • What role do volunteers have in the home?
  • Who looks after the resident’s day-to-day finances?  How does it work? Can residents keep small amounts of cash in their rooms? Which staff assist residents with their finances?
  • Can residents be asked to leave the home?  Why and how would this happen?
  • How long is the waitlist?
  • What ‘hard and fast’ rules are there that prospective residents need to know?


Medical and care policies

  • Does each resident have their own care plan and who prepares the care plan?
  • Is the resident and family involved in the preparation of the care plan?
  • Is there a registered nurse on duty at the home at all times?
  • What training and qualifications do care staff have? 
  • What system does the home have for dispensing medications?
  • Which staff are able to dispense medication?
  • What forms of pain relief are available to residents?
  • What dementia specific care options are available for people who have dementia?
  • How is caring for people with dementia different to caring for other people?
  • What policies and practices does the home follow when dealing with some of the difficult behaviours often associated with dementia?
  • How are staffing levels maintained over seven days of the week?
  • What level of complex medical care are staff able to provide? (eg. stoma care, catheters, enteral feeding, wound management, etc.)
  • What type of care services cannot be provided? 
  • What happens if your care requirements change or become more complex?
  • Does the home have visiting medical practitioners and if so, how often do they visit?
  • Can you have your own doctor visit?
  • Can the home provide other health services such as physiotherapy, podiatry, optometry, occupational therapy, speech therapy and dentistry? How does this work?
  • Does the home have access to electronic health records that can be shared with GPs, hospitals and other health services?
  • Can you take your own medications yourself?
  • What policies are in place in relation to medical emergencies and sending residents to hospital?
  • What is the home’s policy in relation to respecting a resident’s end of life wishes or advanced care directive?

 

Health and wellness

  • What health and wellness opportunities or services are available to residents?
  • Are residents able to participate in exercise programs tailored to their needs?
  • Is there a pool/gym/and/or other facilities or appropriate equipment designed for older, frail people?
  • Are there relaxation or massage services?
  • Is there counselling and psychological support?
  • What options and programs are available for people who have dementia?


Activities and engagement

  • Can you speak with the activities/lifestyle coordinator for the home?
  • What activities are generally offered – indoor and outdoor?
  • How are activities decided?  What input do residents have in the choice of activities available?
  • Can residents request specific activities or hobbies?
  • What special programs or facilities does the home offer for personal enjoyment, leisure and social activities?  
  • Are residents able to go outside and spend time in the garden when they want to? 
  • Do residents have fun?
  • Can residents attend individual external social activities such as visiting the theatre or going to a restaurant?
  • Are residents of the home encouraged and supported to engage in meaningful activities?
  • Can residents participate in gardening?  Is there a vegetable garden? 
  • Are newspapers and library services offered?
  • Is there internet access and internet connected devices for resident use?
  • Is there transport and support available to attend outings?
  • Is there a library?  Cinema? Computer room? Men’s shed? Art room? Music room? Swimming pool?
  • Are religious and cultural festivals and events observed and celebrated?
  • Can family members and friends also participate in activities?


Communication and consultation

  • Is there a person or people dedicated to ‘client liaison’?
  • How is the health and well-being of residents observed, monitored and documented within the home?  What systems are used?  Can family have access?
  • What systems and processes are in place for keeping residents and families informed about events, issues and changes in the home?
  • How much input can residents and their families have into the way the home operates, in particular how their own care is provided.
  • How do staff/management consult with residents and families, eg regular family conferences/meetings, phone calls, wine and cheese evenings etc
  • Can family members phone the home and speak to care staff any time?
  • Is there a residents’ committee?  How does it work?
  • How does the home protect resident privacy?


Staff 

  • What are the staff to resident ratios (how many residents does one staff member have to look after at once)?
  • What are the staffing arrangements overnight?
  • What other kinds of training, qualifications and experience do different staff have?
  • Are staff trained specifically in caring for people with dementia 
  • Do all staff have security/police checks? 
  • Are there any policies in place about relationships between staff and residents?
  • What kind of training do staff members – including kitchen, laundry, administration and maintenance staff – have in understanding the needs of residents with cognitive or memory care needs. 
  • Do staff speak languages other than English?
  • Are there staff members who share and understand your particular religious or cultural needs?
  • How do staff address residents and vice versa?


Food & drink

  • Are meals cooked fresh on the premises? If not, how are meals planned, prepared and provided?
  • Are there choices about where to eat?  Is there one dining room?  Can meals be taken in other places or in your room? 
  • How is seating decided and arranged for meals?  Does it change?
  • Are meals served only at set times?  Or is there flexibility around when residents eat?
  • Can family members and friends join you for meals or have meals provided on request?
  • Is there a café or other alternative place to the main dining room to get snacks and meals, especially if you have visitors?
  • Can you get fruit, sandwiches and other snacks any time if you want to, between meals?
  • Are menus displayed or previewed to residents?
  • How are menus compiled?  Are residents able to contribute suggestions and requests? 
  • Can residents be involved in food preparation? 
  • How are menus reviewed, updated and rotated over time? Do they have long running weekly or monthly cycles?  Do they try new things from time to time?
  • How many menu choices are offered for each meal?
  • Are there special meal events – including casual barbeques or special celebrations?
  • Do they cater to particular diets or cultural requirements (ag kosher or halal, vegetarian, gluten free, pureed options etc)
  • What rules or policies about food – including food safety policies - do they have at the home?  
  • Are alcoholic beverages available?
  • What happens if you are unable to feed yourself?
  • What can’t you do or have?


The physical environment

  • What are the inclusions and exclusions in relation to your room and its contents (furnishings, television, internet, pay-tv services?
  • What kind of adapted furnishings or equipment can be provided? 
  • Is there a safe available for valuables?
  • What additional services or facilities are available at the home eg. hairdresser, kiosk, meeting room, prayer room?
  • Are residents able to access all parts of the home, regardless of how mobile they are?
  • What measures and design elements are in place to particularly support people who have dementia? 
  • What kind of design and safety arrangements are in place – either physical, technological, or policies and procedures - to ensure a safe environment and prevent falls and other accidents?   
  • What technology does the home use for entertainment, communication, safety systems and other settings?
  • How does the home manage heating and cooling?  
  • Is there natural circulation of fresh air, open doors and windows etc?
  • How do staff communicate between themselves – what systems do they use?
  • What security measures does the home have in place? 
  • What environmental sustainability measures does the home take?


Personal factors

  • Are there rooms or provisions made for couples to share?
  • Can residents bring their own furniture, bedding, lamps, pictures, televisions, music systems or other personal items? What are the rules around this?
  • How does the home cater to people who have specific cultural or religious needs or language requirements? 
  • Can family members and friends be involved in your care? Can they stay overnight if needed?
  • Can residents invite partners to stay overnight? 
  • Do staff always knock and ask permission before entering a residents’ room?
  • Do staff accept and welcome people who are gay, lesbian or bisexual or have other non-heterosexual identities?
  • How are birthdays and personal milestones celebrated?
  • Can residents choose when they want to sleep, wake, shower, eat meals?


The Bottom Line

You know it’s a good aged care home (nursing home) when....

  • The focus is on you - the staff take time to learn about you and your life, your current situation, your special needs, like and dislikes, interests and routines in order to tailor both care and activities to your needs.   
  • There is encouragement, inclusion and collaboration - Residents are encouraged to contribute, as actively as they are able, with assistance as needed, to their care planning, to the home’s activities and to their own independence, health and well-being.
  • There is good leadership – the manager and senior staff are visible and openly engaged with staff, residents and families. They personally model the standard of service and care expected.
  • It is open and welcoming – staff smile warmly, there is open communication, and families and friends are encouraged to visit and make themselves at home. 
  • It is up front and transparent – whether it is the organisation’s values and vision, costs, policies or accreditation status, the home makes sure everything is crystal clear.
  • There is a yes culture – while acknowledging that not everything will be possible, the aged care home (nursing home) gladly does its best to meet the specific individual needs and desires of every resident.
  • It is connected to its community – whether it is local business, schools, community events, market stalls, annual fetes or special celebrations, the home participates in the local community and brings the local community in.
  • It is comfortable, professional and safe – the environments are pleasant, comforting and easy to move around; policies are sensible and clearly explained; and there are clear and observable practices and regulations to minimise risk, promote safety and ensure dignity for both residents and staff. 
  • There is dignity and respect – residents are clearly accorded the same rights, dignity and respect as all individuals in the community – their spiritual, cultural and sexual preferences are positively acknowledged and accommodated; they can make choices, express views, be heard and responded to.
  • The home has full three year accreditation – if the home has received three year accreditation at its most recent audit, it is working hard at meeting or exceeding the standards and outcomes expected by the Australian government’s Aged Care Quality Agency.
 

Top Tip - Try not to allow smart new buildings and nice interior design cloud your genuine and thorough assessment of all aspects of the home and the care provided.  A smart physical environment can be important but it bears no direct relationship with the quality of care.

 


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