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CareSectorWatch

Choosing a care home

Written by Dr Mustafa Ghafouri, a medical doctor and data scientist. Last reviewed 5 Aug 2026.

A rating and a date tell you what inspectors found; a visit tells you the rest — whether it feels warm, safe and right for someone you love. This is a plain-English guide to what to check before you go, what to look for on the day, and the questions worth asking, with a checklist you can print and take with you.

This helps you weigh things up for yourself. It is not a recommendation of any home, and it does not decide what care someone needs — the council’s free needs assessment does that.

Before you visit

Do a little homework first, so the visit is time well spent:

The visit checklist

Take this with you. There are no right answers — it is a way to notice the things that matter and to remember to ask. Print it, and use one copy per home so you can compare afterwards.

First impressions

  • Is it warm, clean and free of unpleasant smells?
  • How are you greeted — and how do staff speak to residents?
  • Do residents seem relaxed, occupied and comfortable?
  • Is it homely, or does it feel institutional?

Staff and care

  • How many staff are on, day and night — and do they know residents by name?
  • Is there a registered nurse on site (for a nursing home)?
  • How quickly are call bells answered?
  • How do they support someone with the specific needs your relative has?
  • How much do staff change — is there a lot of turnover or agency cover?

Daily life

  • What is the food like — is there choice, and can you see a menu?
  • What activities and outings happen, and did you see any today?
  • Can residents keep their own routine, get up and go to bed when they like?
  • Can they bring their own furniture and personalise their room?
  • Are visitors welcome any time, and is there somewhere private to sit?

Health and safety

  • How is medication managed and recorded?
  • How do residents see a GP, dentist or district nurse?
  • What happens in an emergency, or if someone's health changes?
  • How do they keep people safe without being restrictive?

Money and the contract

  • What is the weekly fee, and exactly what does it include?
  • What costs extra — hairdressing, outings, chiropody, escorts to appointments?
  • How much notice is needed to leave, and what is the refund policy?
  • How often, and by how much, have fees risen recently?
  • What happens if savings run low and council funding is needed later?

When things aren't right

  • How do they handle complaints, and can you see the policy?
  • How would they keep you informed if your relative was unwell or unhappy?
  • Ask to speak to a current resident or a relative if you can.

Your gut

  • Could you picture your relative living here, and being happy?
  • Did staff seem to genuinely like the people they care for?
  • What is your instinct telling you as you leave?

If they have particular needs

The checklist above works for anyone. These are the things an occupational therapist would look at on top, for the situations families most often ask about — the building, the equipment, and how the staff actually work. None of it is in CQC’s published data (there is no field anywhere for door widths, hoists or wet rooms), so asking is the only reliable route.

These are things to check and questions to ask— not a view about what anyone needs. What care someone needs is established by the council’s free needs assessment, and an occupational therapist can assess the person and the building in a way no website can. If an OT is already involved, ask them for the moving-and-handling and equipment recommendations in writing and take that sheet with you.

Wheelchair use and limited mobility

There is a great deal that makes a building work or not work for someone using a wheelchair, and almost none of it shows up on a viewing unless you know to look. Here is what's worth checking, and what to ask.

Worth looking at

  • The entrance she would actually use every day, not the show one — is it level or ramped, and does the ramp have a gentle gradient (roughly one in twelve or shallower) with a flat landing at the top big enough to open the door from.
  • Door widths, and the bathroom door above all — a standard internal door gives about 720mm clear when open, which many wheelchairs will not take; around 800mm clear is what's designed for. Bathroom doors that open inwards are the ones that trap people.
  • Turning space: roughly a metre and a half of clear floor to turn a self-propelled chair, and space on BOTH sides of the bed if two carers or a mobile hoist have to work there.
  • A wet room — level access, no lip, room for a carer — versus a bath with a bath lift, which suits far fewer people. Ask to see the bathroom she would use, not the best one.
  • Which floor the available room is on, how close it is to the lounge, the dining room and a toilet, and how far she would have to be pushed to get to any of them.
  • Flooring: flush thresholds throughout, and firm flooring rather than deep pile, which is exhausting to self-propel across.
  • Grab rails by the WC and in the shower, in a colour that stands out sharply from the wall — contrast matters as much as position.
  • The garden: a firm level path rather than gravel or bark, somewhere shaded to sit, and whether she could get out there herself or would have to wait to be taken.

Equipment

  • A ceiling track hoist, which runs on a fixed rail — the useful run is bed to en-suite — versus a mobile hoist, which needs floor space to manoeuvre and clearance under the bed for its legs. A solid divan base with a plinth blocks a mobile hoist completely, which is a genuinely common and invisible problem.
  • A profiling bed whose height adjusts, so transfers happen at a safe height rather than whatever height the bed happens to be.
  • Slings: individually issued, sized to the person and named — not shared around the home.
  • The chair she would sit in for most of the day: height, depth and arms she can push up from, and a pressure-relieving cushion if one has been recommended. A chair that is too deep or too low is the reason many people stop standing.
  • A call bell she can actually reach — from the bed, from the chair, from the WC, and from the floor.
  • Knee clearance under the washbasin and a table she can get her knees under, so she is not eating from a tray on her lap.
  • A charging point for a powerchair in the room, if she has one.

How the staff work

  • Whether the home does its own moving-and-handling assessment before admission and who writes it.
  • How many staff do a transfer, and whether that is the same at night.
  • What the plan is if the lift breaks — this is the question that decides whether a first-floor room is safe.
  • How often anyone is repositioned, and who checks skin.
  • Whether staff are trained on the specific hoist and when it was last thoroughly examined.

Questions to ask

  • "Could I see the bathroom she'd actually use, and measure the doorway?"
  • "Is there a ceiling track anywhere, or is it all mobile hoists? And does the bed base let a mobile hoist get underneath?"
  • "How many staff would do her transfers, and is that the same at night?"
  • "What happens if the lift is out of service — where do first-floor residents go?"
  • "When were the hoists and slings last thoroughly examined, and would she have her own sling?"
  • "Can she get out into the garden on her own, or does she wait for someone?"
  • "Which rooms are available, and how far is it from that room to the nearest loo and to the dining room?"

A good answer sounds like

  • They walk you to the actual room and the actual bathroom without being pressed, and let you measure.
  • They can say which rooms have ceiling track and which do not.
  • They have a lift breakdown plan and have used it.
  • They ask for a copy of the hospital or council OT's moving-and-handling plan before they answer.

A worrying answer sounds like

  • "All our rooms are accessible" with no detail, or the only bathroom shown is the assisted one nobody has a key for.
  • A first-floor room and no answer on the lift.
  • "We'd manage her transfers," or slings kept in a communal cupboard.
  • Being told what she can and cannot do before anyone has assessed her.
Stroke and one-sided weakness

After a stroke, the things that decide whether a place works are mostly about which SIDE the room is set up for, how she is seated, and whether therapy carries on through the front door. Here's what's worth checking and asking — an occupational therapist who has actually seen her is who works out what she needs.

Worth looking at

  • Which side of the bed can be approached, and whether the bed can be moved. Transfers are usually planned towards the stronger side, so a bed fixed against a wall on the wrong side changes everything.
  • Which side the call bell, the locker, the light switch and the door are on relative to the bed.
  • Where the chair sits in relation to the television, the window and the door — if there is visual field loss or inattention on one side, everything arriving from that side is missed.
  • The route from the chair to the loo, and whether it is short enough to manage when tired.
  • En-suite versus down a corridor, and whether there is space for a carer on the working side.

Equipment

  • Seating, which is the thing most often got wrong: not a generic armchair but the right seat height, depth and width, with support at the sides if she leans, a footplate or footstool, and a pressure cushion if one has been recommended.
  • Whether a specialist chair or wheelchair provided by NHS wheelchair services or an OT can be used in the home, and where it would be stored and charged.
  • A profiling bed for positioning, and whether there is anything written about positioning the weaker arm and shoulder.
  • Adapted cutlery, a plate guard, a non-slip mat, a one-handed board — small things that decide whether someone feeds themselves.
  • Communication aids: a picture or yes/no board, a communication passport, and whether staff have actually read it.

How the staff work

  • Who provides physiotherapy, occupational therapy and speech and language therapy after discharge, how often they come, and who refers. Care homes very rarely employ therapists — it usually comes in from NHS community teams, and it can quietly stop.
  • Whether care staff carry out the therapy programme between visits, and whether it is written up where staff can see it.
  • Whether there is a written transfer and positioning plan, and whether staff know not to pull on a weak arm — a shoulder after a stroke injures easily and painfully.
  • How communication is handled: whether staff give time, use gestures and a board, and speak to her rather than about her.
  • Fatigue, and whether the day allows for rest rather than being fixed around staff shifts.
  • If swallowing is affected, see the swallowing and modified diets material — it is its own set of questions.

Questions to ask

  • "Can the bed be positioned so she transfers towards her stronger side?"
  • "Who assesses her seating, and can a chair from wheelchair services or the OT be used here?"
  • "Who does physiotherapy here — is it NHS community or private, how often, and who makes the referral?"
  • "Do your staff carry out the exercises the therapist leaves between visits, and where is that written down?"
  • "Is there anything written for staff about how to move her without pulling on her weaker arm?"
  • "How do your staff communicate with someone whose speech has been affected — has anyone here been trained by a speech therapist?"
  • "What happens to the therapy if she stops making progress?"

A good answer sounds like

  • They name the community stroke or rehabilitation team by name and describe how referrals work.
  • There is a positioning and transfer plan in the care plan, and staff on the floor can tell you what it says.
  • They ask to see the hospital therapy notes before answering.
  • They talk about what she can do, and about doing things WITH her, rather than for her.

A worrying answer sounds like

  • "The GP would arrange that," as the whole answer on therapy.
  • "We do chair exercises" offered as physiotherapy.
  • Nobody can say who would position her, or the answer changes between the manager and the care staff.
  • Staff talking to you about her while she is in the room.
Dementia

Dementia-friendly design is a real, well-established thing, and most of it is invisible unless you know what you are looking at. Here's what's worth checking, and the questions that tell you most — none of it is a judgement about your mum, and a needs assessment is what establishes what she needs.

Worth looking at

  • Whether she could see the toilet door from the bed and from the chair. Being able to SEE the loo is the single biggest thing a building does for continence and dignity.
  • Signs on doors at a low height — people with dementia tend to look down — with a word and a picture, and toilet doors in a distinctive contrasting colour.
  • Something personal by the bedroom door: a photograph, a memory box, her own name in her own handwriting. It is how people find their own room.
  • Short, legible routes with a clear sight of something recognisable at the end, rather than long identical corridors.
  • Lighting: bright and even, roughly twice what a younger eye needs, with no pools of shadow and no glare — and a lit route to the loo at night.
  • Flooring: plain and matt throughout. A shiny floor reads as wet, a dark mat reads as a hole, and a change of colour reads as a step — all three stop people walking.
  • Contrast where it matters: the toilet seat against the pan and floor, grab rails against the wall, crockery against the table.
  • A safe outdoor space she could walk into without asking anyone: enclosed, with a path that comes back round on itself rather than ending at a fence, level, with somewhere to sit in shade.

Equipment

  • Clocks and calendars with the day and date in plain words, in the places people sit.
  • Her own furniture, bedding, pictures — and whether the home actively encourages that or has a house style.
  • Assistive bits that are worth asking about: a large-faced telephone, a dementia-friendly clock, sensor lighting to the loo at night.

How the staff work

  • Night staffing, which for dementia is the whole question: how many awake staff for how many residents, and what actually happens for someone up at three in the morning. Is there a lit room, something to eat, someone to walk with — or is everyone expected to be in bed.
  • How they respond when someone wants to leave. Walking with purpose and distress at being kept in are common and normal; the response tells you everything. Good homes talk about what the person is looking for and walk with them; poorer ones talk about locked doors and medication.
  • Whether the person is or would be under a Deprivation of Liberty Safeguards authorisation — who applies for it, when it is reviewed, and whether the family is told.
  • Their approach to distress, and how many residents are on antipsychotic medication. Good homes treat distress as communication and can describe what they changed; some reach for medication first.
  • Whether routines follow the person — when she likes to get up, what she has for breakfast, a lifetime of habits — or follow the shift pattern.
  • Whether life-story work actually happens and whether staff on the floor know her history, not just the manager.
  • What happens at three in the afternoon. Turn up unannounced and see. Meaningful activity includes people who cannot join in a group — ask what one-to-one time exists.
  • Whether staff dementia training is more than an e-learning module, and who delivered it.

Questions to ask

  • "How many staff are awake at night, for how many residents — and what happens if she's up at three in the morning?"
  • "Can she get out into the garden herself, at any time, without asking?"
  • "What do you do when someone is trying to leave and getting distressed about it?"
  • "How many of your residents are on antipsychotic medication, and who reviews it?"
  • "Could she keep her own routine — her own getting-up time, her own breakfast?"
  • "Can she bring her own furniture and pictures?"
  • "What's happening here at three on a Sunday afternoon, and what do you do for someone who can't join in a group?"
  • "What dementia training have your staff had, and who gave it?"

A good answer sounds like

  • They tell you the night number without hesitating, and describe a lit lounge, a kettle and someone to sit with.
  • The garden door is open and they say so with pride.
  • They answer the leaving question with a story about a particular person and what they worked out.
  • Bedroom doors look different from one another. Signs are low, with pictures. The floor is plain.
  • They ask about her life before they ask about her diagnosis.

A worrying answer sounds like

  • "Everyone's settled by eight."
  • The garden door is locked and the answer is about risk rather than about how they manage it.
  • "We'd get the GP to review her medication" as the first answer to distress.
  • Shiny floors, identical doors, and a long corridor with nothing at the end.
  • "We're a dementia home" with nothing behind it — registration is a registration, not a quality judgement.
Falls

A fall is treated as a signal rather than an accident, and what a home does after one tells you far more than the building does. Here's what's worth checking and asking — what caused any particular fall is for a doctor and a falls assessment, not for me.

Worth looking at

  • Lighting levels generally, and specifically at night on the route from bed to loo, which is where most falls in care homes happen.
  • The distance and the sightline from bed to toilet — an en-suite you can see beats a nicer bathroom down the corridor.
  • Chair height and bed height. A chair too low to stand from and a bed too high to sit down onto are both fall causes and both fixable in an afternoon.
  • Flooring transitions and thresholds, trailing leads, and whether corridors have handrails on both sides.
  • Contrast on the first and last step of any stairs, and a rail on both sides.
  • Whether her walking frame or stick would be within reach of the bed at night, rather than parked across the room.

Equipment

  • Bed and chair sensors, and sensor mats — and whether they are actually used or sitting in a cupboard.
  • A low or ultra-low bed with a crash mat, which is usually far safer than bed rails.
  • Bed rails: worth asking about directly, because rails on someone who climbs over them make things worse, and rails that stop someone getting up are a form of restraint with rules attached.
  • Proper footwear. A remarkable proportion of falls come down to backless slippers, and a good home will say so.
  • A call bell reachable from the floor, and an inflatable lifting cushion so that someone who has fallen without injury is not left on the floor waiting for an ambulance.

How the staff work

  • How many falls there have been in the last three months, and what changed as a result. The number matters less than whether anything changed.
  • Who does the review after a fall, and whether they check lying and standing blood pressure — a large share of falls are a blood-pressure or medication problem in disguise.
  • Whether a medication review has been asked for. Sedatives, blood pressure tablets and anticholinergics are the most fixable cause there is.
  • Whether eyesight is checked, whether a strength and balance programme exists, and whether anyone does vitamin D.
  • What happens after a fall with no obvious injury — do they call an ambulance every time, or do they have a protocol and the equipment to lift someone safely.
  • Whether continence is part of their falls thinking — rushing to the loo at night is one of the commonest patterns.

Questions to ask

  • "How many falls have you had in the last three months, and what did you change afterwards?"
  • "Who reviews a fall, and do you check lying and standing blood pressure?"
  • "Would you ask the GP for a medication review — and how quickly does that happen?"
  • "What's your policy on bed rails, and what would you use instead?"
  • "How far is it from her bed to a toilet, and what's the lighting like on that route at night?"
  • "If she fell and wasn't hurt, what would happen — would you call an ambulance, or can your staff lift her safely?"

A good answer sounds like

  • A real number, and a specific change — "we moved her room nearer the loo," "we got her a lower bed," "the GP stopped one of her tablets."
  • They talk about causes rather than about supervision.
  • They own a lifting cushion and their staff are trained on it.

A worrying answer sounds like

  • "We don't really have falls." Every home has falls; a home that says otherwise is either not counting or not telling.
  • The answer is bed rails, or a chair she cannot get out of.
  • An ambulance every time, with hours on the floor.
Continence

Continence is where dignity is won or lost, and it is far more about the building's geometry and the home's habits than about products. Here's what to check and ask — an assessment by a continence service is what establishes what someone actually needs.

Worth looking at

  • How far the loo is from the bed and from the chair, and whether it can be SEEN from both. Distance and sightline do more for continence than anything else in a building.
  • En-suite versus shared, and how many WCs there are for how many residents in the communal areas.
  • Space beside the WC for a carer, on the side she would need them.
  • Grab rails positioned for her stronger side, and a WC at a height she can rise from — or a raised seat.
  • A basin, soap and a bin actually in the toilet, and a door she can open one-handed.
  • Night lighting on the route, and a call bell within reach of the toilet.

Equipment

  • A commode by the bed for the night, and whether they would provide one.
  • A shower-commode chair that can be wheeled over the WC, which for some people is the difference between a shower and a bed wash.
  • Continence products, and who supplies them — practice varies a great deal between areas and homes, and it is a common surprise on the bill.
  • Skin care products and pressure-relieving equipment, because continence and skin damage travel together.

How the staff work

  • Whether there is a proper continence ASSESSMENT — looking for a cause and a pattern — or whether the answer to everything is a pad.
  • Whether toileting follows the person's own pattern, or a round at fixed times.
  • Who does catheter care. In a home without nursing that usually means district nurses, so ask how quickly they come and what happens at a weekend.
  • How they handle an accident, and whether anyone would know about it from across the lounge.
  • The language staff use. Homes that say "pad" in front of residents say other things in front of them too.

Questions to ask

  • "How far is it from her chair to a toilet, and can she see the door from where she'd sit?"
  • "Who assesses continence here — is there an NHS continence service involved?"
  • "Are continence products included in the fee, or charged as an extra?"
  • "Do you toilet people to their own pattern, or on a round?"
  • "Who does catheter care here, and what happens at the weekend?"
  • "How would you handle an accident so that nobody else in the room knew?"

A good answer sounds like

  • They talk about assessment, patterns and causes before they talk about products.
  • They can tell you the arrangement for products and whether it costs anything.
  • They describe toileting as something they plan around the person.

A worrying answer sounds like

  • "Everyone's padded at night."
  • No idea who assesses continence, or the answer is "the GP."
  • A charge for pads that appears only in the contract.
Swallowing difficulties, modified diets and PEG feeding

Swallowing is the area where the gap between homes is widest, and where the questions are most specific. Here's what to check and ask — what someone can safely eat is set by a speech and language therapist, never by me and never by the home alone.

Worth looking at

  • The dining room: whether it is calm enough to concentrate in, whether people who need help eat there or are taken away to a corridor, and whether there is somewhere quiet for someone who needs it.
  • Seating at the table that supports someone upright, at a height where the plate is reachable — posture is half of safe swallowing.
  • A kitchen that can actually produce modified food. Ask to see it, and ask to see a plate.

Equipment

  • Thickener: prescribed, stored safely, with a chart at the bedside, and every member of staff knowing the number of scoops. Getting this wrong in either direction is dangerous.
  • Adapted cutlery, plate guards, non-slip mats, beakers of the right kind — and whether staff know that certain spouted beakers are unsafe for some people.
  • Moulded or shaped purees, so that a level 4 meal still looks like food, rather than three beige spoonfuls run together.
  • For PEG feeding: pumps and stands, giving sets, and somewhere clean to prepare.

How the staff work

  • The IDDSI level. Diets and drinks are described on a numbered framework from 0 to 7 — thin, slightly thick, mildly thick, moderately thick, extremely thick or pureed, minced and moist, soft and bite-sized, and regular. Ask which level is on the plan, who set it, and how the kitchen and the care staff both know.
  • Who trained the staff and the kitchen, and whether they check consistency with the standard flow or fork tests rather than by eye.
  • Positioning: upright to eat, and staying upright for a while afterwards. Ask whether that is written and whether staff do it.
  • How many staff are available at mealtimes for how many people who need help, and whether there is a protected mealtime.
  • Whether intake and weight are recorded and screened, and what triggers a referral to a dietitian or speech and language therapist.
  • What they do when someone starts coughing at meals — who they call, and how fast.
  • Whether they know the phrase "eating and drinking with acknowledged risk". Some people choose to keep eating normally knowing the risks; a home that has heard of the concept and can describe a documented plan is a home that has thought about this properly.
  • For PEG: whether the home is staffed to manage tube feeding at all — this usually means a home with nursing. Who sets up the feed, who is trained on the pump, who changes the tube, and above all what they would do at two in the morning if the tube came out, because the tract can begin to close within hours.
  • Medicines through a PEG need liquid or dispersible forms — ask whether their pharmacy is set up for it.
  • Mouth care for someone who is not eating, which is frequently forgotten and matters enormously.

Questions to ask

  • "What IDDSI level is she on, who set it, and how do the kitchen and the care staff both know?"
  • "Could I see what a level four or level five meal actually looks like on a plate here?"
  • "Who trained your staff on thickener, and how do you check the consistency?"
  • "How many staff are on at lunchtime for the people who need help to eat?"
  • "How quickly can you get a speech and language therapist or a dietitian, and who refers?"
  • "Have you heard of eating and drinking with acknowledged risk — do you have residents on that kind of plan?"
  • "Are you registered and staffed for PEG feeding? Who'd do the feed at night, and what would you do if the tube came out at two in the morning?"
  • "If her swallowing got worse after she moved in, would she have to leave?"

A good answer sounds like

  • They say the IDDSI number back to you without looking it up, and the chef knows it too.
  • The pureed plate has three separate colours on it.
  • They name their speech and language therapy route and say how long it takes.
  • On PEG, they describe the out-of-hours plan and know the tube has to be replaced quickly.

A worrying answer sounds like

  • "We just blend everything."
  • Nobody can say who set the thickener level, or different staff say different numbers.
  • "We'd manage" on PEG feeding in a home without nursing.
  • Mealtimes where people who need help are fed standing up, quickly, or last.
Sight and hearing loss

Sight and hearing loss are the needs most often missed in a care home, and the fixes are cheap and specific. Here's what to check and ask — how much someone can see or hear is for an optometrist and an audiologist to establish.

Worth looking at

  • Light levels, which need to be considerably higher for older eyes — roughly twice what a younger person needs — and even, without dark patches between fittings.
  • Glare, which is as disabling as darkness: polished floors, a window at the end of a corridor, an unshaded bulb.
  • Tonal contrast everywhere it matters: the door against its frame against the wall, the toilet seat against the pan, the handrail against the wall, the plate against the table. A red plate genuinely helps people eat more.
  • A consistent layout, with furniture that does not get moved without telling her.
  • Handrails that can be followed, and no low obstacles or half-open doors in circulation routes.
  • For hearing: somewhere quiet to talk, soft furnishings rather than a hard echoing lounge, and whether there is a hearing loop.

Equipment

  • Glasses: clean, labelled with her name, actually on her face — and whether there is a spare pair.
  • Hearing aids: labelled, with someone responsible for batteries and cleaning, and a routine for putting them in each morning. Aids in a drawer are the most common finding of every inspection of this kind.
  • Large-print and audio material, a talking clock, a large-button telephone, and whether a talking-books service is used.
  • A television at a volume that works for the person who needs it without dominating the room — headphones, a personal listener, or a second sitting room.

How the staff work

  • Whether a domiciliary optician and audiology service visit the home, when the last test was, and who arranges it.
  • Whether staff introduce themselves by name every time they come into the room, and say when they are leaving. Being approached silently is frightening.
  • Whether staff describe where the food is on the plate, using the clock face, and whether they guide by offering an arm rather than pushing.
  • Whether staff face the person, keep their face lit, and speak clearly at normal volume rather than shouting.
  • Whether activities include anyone who cannot see the television or hear the group.

Questions to ask

  • "Who checks eyes and hearing here, and when was she last seen?"
  • "Who is responsible for her hearing aid batteries and for cleaning them?"
  • "Do your staff say who they are when they come into a room?"
  • "How do you describe a meal to someone who can't see the plate?"
  • "Is there a hearing loop, or somewhere quiet for a conversation?"
  • "What does someone who can't see the television do in the afternoons?"

A good answer sounds like

  • A named person does aids and glasses every morning, and they say so as if it were obvious.
  • A visiting optician and an audiology route, with dates.
  • Staff introduce themselves to residents while you are standing there.

A worrying answer sounds like

  • Hearing aids in a drawer, or "she doesn't like wearing it."
  • Nobody knows when eyes were last tested.
  • A loud television in a room where nobody is watching it.
Bariatric needs

Bariatric care comes down to numbers, and the numbers are checkable. Every piece of equipment has a safe working load and the weakest link decides everything — so these are worth asking early and precisely, before anyone gets attached to a place.

Worth looking at

  • Doorway widths and turning space, because a bariatric wheelchair is considerably wider than a standard one and will not go through a standard internal door. The bathroom door is again the one that fails.
  • The lift: its capacity in kilograms and its internal dimensions, and whether it takes the chair plus a carer.
  • The bathroom: whether the WC is floor-fixed or wall-hung, since wall-hung pans often have a lower safe load, and whether the floor and the shower area are rated.
  • Space around the bed for two or more staff and a hoist to work on both sides.
  • The route out for an ambulance, and the evacuation plan in a fire.
  • Whether the lounge and dining chairs would take her — a person who cannot sit in the communal chairs ends up eating alone in her room, and this is the detail that quietly decides quality of life.

Equipment

  • The safe working load of the bed, the mattress, the hoist, the sling, the shower chair, the commode, the wheelchair and the armchairs — every one of them, in numbers.
  • Whether the home owns bariatric equipment or would have to hire it, what the lead time is, and who pays for the hire.
  • Slide sheets and the equipment for repositioning in bed, and how many staff that takes.
  • Weighing: whether they have chair or hoist scales that go high enough, because weight cannot be monitored otherwise.

How the staff work

  • How many staff would do a transfer and whether that holds at night — this is the number that decides whether care is delivered or postponed.
  • Skin care and repositioning, which is where the risk actually sits.
  • Toileting with dignity, and whether it happens on time.
  • Whether the home has cared for someone of a similar size before, and what they learned.
  • Whether they will assess honestly and early. Homes often decline late, after a family has invested weeks, so give the real weight at the first phone call and ask for a straight answer.

Questions to ask

  • "What's the safe working load of your beds, hoists, slings and lounge chairs? Could you check the labels for me?"
  • "What's the lift's capacity, and would it take her chair with a carer in it?"
  • "Do you own bariatric equipment, or would you hire it — how long would that take, and who pays?"
  • "How wide are the bedroom and bathroom doors on the rooms you have available?"
  • "How many staff would her transfers take, and is that the same at night?"
  • "Could she sit in the lounge with everyone else, in your chairs?"
  • "Have you cared for someone of a similar size before?"

A good answer sounds like

  • They go and look at the labels rather than guessing, and come back with figures.
  • They talk about hiring specific equipment and know the lead time.
  • They give you a straight no if it is a no — which is worth a great deal at that stage.

A worrying answer sounds like

  • "She'll be fine," or any answer about capacity that does not contain a number.
  • A plan that depends on equipment nobody has ordered.
  • Enthusiasm at the enquiry stage and a refusal after the assessment.
End-of-life care

For end-of-life care the questions are narrower and sharper, and most of them are about the night. Here's what's worth checking and asking — the clinical picture belongs to the GP and the palliative team.

Worth looking at

  • Whether she could stay in her own room to the end, rather than being moved.
  • Whether family can stay overnight, and whether there is a bed, a chair, a kettle, somewhere to be.
  • Quiet, and whether the room is somewhere anyone would want to sit for a long time.

Equipment

  • A profiling bed and a pressure-relieving mattress, available quickly rather than ordered.
  • Syringe drivers, and — the question that matters — who sets one up and how fast, because a residential home without nursing depends on district nurses coming out.
  • Mouth care equipment and the habit of using it.
  • Oxygen and suction if they are in the picture, and whether staff are trained.

How the staff work

  • Anticipatory or "just in case" medicines: whether they are already in the home, whether there is an authorisation chart, and who can administer them. This single arrangement is often the difference between a peaceful night and a three-in-the-morning ambulance.
  • Whether there is a registered nurse awake on site at night, or a nurse on call from home — they are very different things.
  • How long district nurses take to come out at night, in their actual experience.
  • The GP relationship: whether one practice covers the home, whether they do a regular round, and whether they will visit at short notice. Homes attached to a practice that visits weekly are noticeably different places.
  • Whether the home works with the local hospice or community palliative care team and has used them recently.
  • Where the ReSPECT form or DNACPR decision is kept, whether every shift knows, and whether an advance care plan and a preferred place of death are recorded and actually followed.
  • Who verifies a death at night, because if nobody on site can, families wait a long time.
  • Whether the home's instinct is to keep someone comfortable where they are rather than send them to hospital — and whether they can describe when they would send someone.
  • Whether they would keep her to the end at all. Some homes will not, and it is far better to know now.
  • Whether NHS Continuing Healthcare fast-track funding has been considered — it is decided quickly, is not means-tested, and can change everything about who pays and what is available.

Questions to ask

  • "If a syringe driver were needed at two in the morning, who sets it up and how long does that usually take here?"
  • "Are anticipatory medicines kept in the home, and who can give them?"
  • "Is there a registered nurse awake on site at night, or on call from home?"
  • "Which GP practice covers you, and how often do they come?"
  • "Do you work with the local hospice team — when did you last?"
  • "Where would her ReSPECT form be kept, and would every shift know about it?"
  • "Would she be able to stay here to the end, and could we stay with her?"
  • "Who verifies a death at night?"

A good answer sounds like

  • They answer the syringe driver question with a real timescale and no defensiveness.
  • Anticipatory medicines are already in the building and they explain the chart.
  • They name the hospice team and a recent example.
  • They have thought about the family — where you would sleep, what you would eat.
  • They mention Gold Standards Framework accreditation or similar, and can say what it changed.

A worrying answer sounds like

  • "We'd call an ambulance."
  • A nurse on call from home described as a nurse on nights.
  • No anticipatory medicines and no plan to get any.
  • "We don't really do end of life here" — which is at least honest, and worth hearing before you move in rather than after.

Questions that matter whatever the situation

These decide more than any doorway does. The last one is the question families most often wish they had asked.

Warning signs

None of these alone is proof of a problem, but together they warrant a closer look:

Your rights, and who to contact

Where this guidance comes from

General information to help you choose, not advice about any individual or a recommendation of any home. What care a person needs is decided by the council’s assessment and their own clinicians. Find local care homes →