PSSRU Full Report · 2016. 4. 6. ·...

Study of Care Home Residents’and Relatives’ Expectationsand ExperiencesA report by Robin Darton, Personal Social Services Research Unit,University of Kent, for the Registered Nursing Home Association

December 2011

PSSRU

This study was funded by the Department of Health (DH), via its Policy Research Programme support of thePSSRU, and by the Registered Nursing Home Association (RNHA). The methodology for the study was developedin collaboration with BMRB (now TNS-BMRB), who undertook the fieldwork. The author would like to thank IanTurner and Frank Ursell, of the RNHA, for their advice and support; the staff of the homes, the residents and theirrelatives for their participation; and colleagues at the PSSRU. The views expressed in this report are those of theauthor and are not necessarily those of the DH or the RNHA.

Acknowledgements

The authorThe author of this report is Robin Darton, Senior Research Fellow, Personal Social ServicesResearch Unit, University of Kent, Cornwallis Building, Canterbury, Kent CT2 7NF.Telephone: 01227 823963. Email: [email protected]

The publishersThis report has been published jointly by the PSSRU at the University of Kent and theRegistered Nursing Home Association, which commissioned the study.

First published December 2011

ISBN: 978-1-900902-18-2

© Registered Nursing Home Association

Requests for further copiesThese should be made to the Registered Nursing Home Association, John Hewitt House,Tunnel Lane, off Lifford Lane, Kings Norton, Birmingham B30 3JN.Telephone: 0121 451 1088. Email: [email protected]

PhotographsPictures of care home residents used in this report are from the RNHA photo library and do not depict any of theindividuals who took part in the study.

2 | Care Home Residents’ and Relatives’ Expectations and Experiences

4 Summary

6 Introduction

7 Aims and Objectives

8 Design

9 The Sample of Homes

10 Survey of Residents: Background Information

12 Survey of Relatives: Background Information

13 Comparative Characteristics of Residents

15 The Decision to Move to a Care Home

19 The Choice of Care Home

21 Expectations of Life in the Home

26 Experiences of Life in the Home

28 Care Services and Staff Support

30 Satisfaction with Life in the Home

32 Health and Quality of Life

33 Conclusions

35 References

Contents

Care Home Residents’ and Relatives’ Expectations and Experiences | 3

Summary


Residents and RelativesInvolved in the StudyThis study examined the differences betweenolder people’s expectations and experiences ofliving in a care home setting, and collectedcomparable information from relatives involved inchoosing a care home for residents who wereunable to participate.

The study involved two parallel surveys: aninterview survey of new residents admitted to carehomes for older people in England forlong-term care; and a telephone survey ofrelatives of residents judged to be unable toparticipate.

Recruitment of care homesA national sample of 605 homes was recruited,and data were obtained from 69 residents and33 relatives of residents in 46 homes using twoquestionnaires in each case, an initialquestionnaire soon after admission and afollow-up approximately three months later.The 46 homes included 19 homes providingnursing care and 27 homes providing personalcare.

People’s Reasons forMoving to a Care HomePhysical and mental health problemsThe most important reason reported for movinginto a care home from individuals’ own homes wasphysical health. The survey of residents excludedthose who were incapable of consenting toparticipate, but a majority of relatives reported thatthe resident was a danger to themselves orothers, or had mental health problems.

Difficulties with mobility,household tasks and social isolationOther important reasons for moving into a carehome were difficulties with coping with householdtasks, mobility in the home and general upkeep.An inability to return home from hospital or toprovide continuing support in their home wereimportant reasons for the residents covered in thesurvey of relatives, and for one-third of those inthe survey of residents. Relatives identified socialissues, such as social isolation, living alone and afear or experience of crime as somewhat moreimportant factors than residents themselves.

However, a minority of residents were lessdependent. These residents were more likely tohave been single or divorced and to have beenliving in their own home as owner-occupiers.They were also more likely to have been living inhomes providing personal care, and to have beenprivately funded.

Health and mobility problems were the main reasonswhy people decided they needed to move into acare home.

Of the 69 residents, 28 had moved into nursinghomes (often now referred to as ‘care homes withnursing’) and 41 had moved into care homesproviding personal care only.

REASONS FOR THE MOVE:Why residents felt they neededto go into a care home

79%said that deterioratingphysical health wasthe most importantreason behind their

decision to move intoa care home.

reported difficultieswith their mobility, copingwith household tasks andthe upkeep of the house.

60%

33%

28%

20%

said a family carer couldno longer look after them.

said their home needed adaptationsor was too far from shops and amenities.

20% said they no longerwanted to live alone.

cited a lack of familyor friends nearby.

Making the Decisionto MoveIn the survey of residents, the decision to move intoa care home was entirely or partially the resident’s,supported by family and friends. Family and friendsprovided the main source of help according to therelatives, but a doctor or other professional wasmore likely to be involved than in the survey ofresidents.

How Experiences Comparedwith ExpectationsBoth residents and relatives reported improvedquality of life following the move into a care home.Relatives reported that quality of life changed frombad or very bad to very good or good for asubstantial number of residents.

Having a say in day-to-day lifeResidents’ experiences of day-to-day life in thehome tended to be higher than their initialexpectations, with the majority (over 80%)indicating that they had a say in most aspects oftheir daily life. However, fewer had control overwhether they could lock their bedroom on leaving itor over the heating in their bedroom, although theproportions were higher than initially expected.Residents were also generally satisfied with thehelp received from staff.

Despite generally favourable impressions of thehomes, both residents and relatives retained abelief that residents may be abused in care homes.While public perceptions of the relative level of

abuse in care homes and private households maybe influenced by media and other reports, it is ofconcern that a higher proportion of residents in thefollow-up survey stated that residents may bepsychologically or physically abused, whilesubstantially higher proportions of relatives in thefollow-up stated that some residents may havemoney or other possessions stolen, since theseviews may have been affected by their experiencesof living in or visiting a home.


The vast majority of care home residents had eithermade the decision to move there entirely on theirown or had done so with the help and support of theirfamily, friends and professionals.

THE DECISION TO MOVE:Who took it, who influenced it

42% said the decision to move into acare home was entirely theirs.

70%felt their quality of life was‘good or very good’ beforemoving to a care home.

39% said the decision to move into acare home was partly theirs.

In the follow-up surveythis figure rose to...

The proportion of residents whofelt their quality of life was ‘very

good’ rose from 26% before theirmove to a care home to 48%

after they had settled in.

82%

26%

48%

THE VAST MAJORITYOF RESIDENTS SAIDTHEIR EXPERIENCEOF LIVING IN A CAREHOME WAS GOOD

IMPROVEMENTS INQUALITY OF LIFE

The follow-up study found that residents weregenerally satisfied with the care home they werenow living in. 86% said their experience of living intheir care home was good, with 14% saying it wasboth good and bad. None thought their care homewas bad.

86%said their overall

experience of living in acare home was good.

14%said their overall experience of living in acare home was good and bad.

Paucity of Informationon Care Home Residents’ExperiencesAlthough residential care has long been viewed innegative terms, notably in Townsend’s The LastRefuge (1962), relatively little information has beenobtained about residents’ experiences of living in acare home.

From Townsend’s study onwards, obtaining anaccurate picture of residents’ views has proveddifficult, with residents tending to expresssatisfaction with their home, either because of areluctance to complain, or because they find itdifficult to think of alternatives (Sinclair, 1988).However, anecdotal evidence suggests that,although people may dread moving into a carehome, their experiences once there can be verydifferent.

Place of Care Homes inMeeting NeedsSome recent work (Towers, 2006) has indicatedthat the experience of living in a high quality carehome environment can afford residents the samelevel of well-being and sense of control that isexperienced by residents of extra care housing.

Despite the development of such new forms ofprovision, care homes still provide the greatmajority of places, and are likely to continue tosupport people with intensive care needs(Laing & Buisson, 2010).

RNHA Approach to PSSRUThis study examined the differences between olderpeople’s expectations and experiences of living ina care home setting, and collected comparableinformation for relatives involved in choosing acare home for residents who were unable toparticipate.

The Registered Nursing Home Association (RNHA)approached the PSSRU to examine the neglectedarea of residents’ own views of living in carehomes. The Department of Health also agreed tosupport the study, in particular to examineconcerns about the possibility of abuse of residentsin care homes, following the national study of theprevalence of abuse and neglect of older peopleliving in their own homes (O’Keeffe et al., 2007).

The methodology for the study was developed incollaboration with BMRB (now TNS-BMRB), andwas based on two earlier surveys undertaken byBMRB (Charlton et al., 2010). BMRB wasresponsible for the fieldwork for the study.


Introduction

Aims and Objectives


The Study Aimed to:

� Compare the expectations and experiences ofresidents living in care homes for older people.

� Compare the expectations and experiences ofrelatives involved in choosing a care home forresidents unable to take part in the study.

� Examine people’s reasons for moving into orchoosing care homes, and their perceptions andbeliefs about them, and compare these with theirexperiences or their older relative’s experiencesof living in care homes for a period of threemonths.

� Compare the experiences of residents whomoved into care homes with those of individualswho moved into extra care housing.

� Identify the characteristics of residents for whomcare home provision is a positive choice.

� Provide evidence for the future development ofthe care home sector.

This summary report focuses on the findings of thesurveys of residents of care homes and of relativesof residents of care homes.


Two Parallel SurveysThe study involved two parallel surveys: aninterview survey of new residents admitted to carehomes for older people in England for long-termcare; and a telephone survey of relatives ofresidents judged to be unable to participate.

Selecting Care HomesLocal authorities groupedinto six regionsThe local authorities in England were grouped intosix regions (strata), and a local authority or groupof local authorities was selected within eachstratum. The selected local authorities includedareas with different levels of affluence, levels ofurbanisation and rurality, and levels of minorityethnic population.

Random sample ofhomes approachedA random sample of 150 care homes run byprivate or voluntary organisations in each of the sixlocal authorities/groups (areas) was approached toparticipate in the study, using the list maintained bythe Commission for Social Care Inspection (CSCI)as the sampling frame. Before selecting thesample, the CSCI list was updated to removehomes that had closed. Each sample of 150homes was expected to yield an achieved sampleof about 100 homes, but the remaining homes ineach area were kept in reserve in case recruitmentrates were lower than anticipated. Each surveywas designed to yield a minimum of 200respondents, based on admission rates andestimated response rates.

Separate samples of homes providingpersonal care and nursing careSeparate samples of care homes providingpersonal care and nursing care were selected toensure that sufficient homes providing nursing carewere included.

Although homes providing nursing care are larger,on average, than those providing personal care,there are fewer such homes, and the higher levelsof dementia and ill health among residents inhomes providing nursing care were expected toresult in a smaller proportion participating in the

survey. All homes providing nursing care wereselected in each area, up to a maximum of 75homes, and then homes providing personal carewere selected to generate a sample of 150 homes.A random (systematic) selection procedure wasused to select homes.

The recruitment of homes is described in thetechnical report (Charlton et al., 2010). Theapproach to the initial sample of 900 homes didnot yield the required number of homes, and so afurther sample of 300 homes was selected in thesix local areas using the same procedure as forthe main sample. From the combined sample of1,200 homes, 601 homes were recruited, with thenumber of homes in each area ranging from 91 to108. During the recruitment stage, 61 of the 601homes withdrew, leaving 540 remaining in thestudy. The recruitment of homes took placebetween February and April 2008.

Selecting ResidentsObtaining consent forstudy participationFollowing recruitment, homes were asked to askeach new resident whether they would be willing toparticipate in the study. Once such informedconsent was obtained, contact details were sent toBMRB and an interviewer assigned to visit thehome to conduct an interview. In cases where thehome decided that the resident was not capable ofproviding informed consent, it was asked toapproach a relative to invite them to participate inthe study.

Interviews conducted betweenMarch 2008 and April 2009Once consent was obtained, contact details weresent to BMRB and a telephone interview set up.Two interviews were conducted with residents andrelatives, the second a minimum of three monthsafter the first. The initial interviews were conductedbetween March 2008 and January 2009, and thefollow-up interviews were conducted betweenAugust 2008 and April 2009.

Ethical approvalThe study received ethical approval from theappropriate Research Ethics Committee at theUniversity of Kent.

Design

Care Homes Recruitedfrom Original SampleThe homes approached for the study wererecruited from an original sample of 1,200 homes,plus four additional homes in Suffolk recruited viathe RNHA. 605 homes were recruited, and datawere obtained for residents in 46 homes.

Residents andRelatives InterviewedData were obtained from 69 residents and 33relatives of residents in the 46 homes using twoquestionnaires in each case, an initialquestionnaire soon after admission and a follow-upapproximately three months later.

Types of Home InvolvedThe 46 homes included 19 homes providingnursing care and 27 homes providing personalcare. The residents were living in 34 homes, 11providing nursing care and 23 providing personalcare, while the relatives provided information aboutresidents who were living in 21 homes, 13providing nursing care and eight providing personalcare.

Among the 69 residents, 28 were living in homesproviding nursing care and 41 were living in homesproviding personal care. The 33 relatives providedinformation about 24 residents living in homesproviding nursing care and nine living in homesproviding personal care.

All Star RatingsRepresentedCSCI star ratings were obtained for 91% of thesample of 1,204 homes to provide a means ofcomparing the participating homes with the wholesample. Table 1 shows the proportion of homes ineach group that received each star rating.

Although the participant homes included a slightlyhigher proportion of homes with the highest starrating, each star rating category was reasonablywell-represented.

Presentation of ResultsIn the presentation of the results of the study, mostresults are expressed in the form of percentages,despite the small number of responses. This is topermit comparisons between the different parts ofthe study, and is not intended to provide estimatesfor residents in care homes as a whole.

Table 1: CSCI Star Ratings for the Sampled, Recruited and Participant Homes

0 1 2 3 Not available Number of homes

% % % % %Sample 3.3 16.7 55.0 15.9 9.1 1204Recruited homes 4.1 18.3 55.0 15.9 6.6 605Participant homes 4.3 10.9 58.7 19.6 6.5 46

The Sample of Homes



Table 2 shows details of the demographiccharacteristics of the residents included in thesurveys of residents and relatives.

DemographicCharacteristics of ResidentsMost were female andover 80 years oldOf the 69 residents who participated in the study,just over three-quarters (77%) were female andfour-fifths were aged 80 or over, with one-thirdbeing aged 90 or over. Sixty-two per cent of theresidents were widowed, nine (13%) were singleand 13 (19%) were married. Seven of the 13married residents were living in the care home withtheir spouse. All of the residents reported theirethnic origin as white.

Previous AccommodationMost previously livedin their own homeThe majority of the residents (75%) had been livingin their own home, including five in shelteredhousing, prior to admission. However, informationon reasons for admission indicated that at least 19had moved to a care home following a stay inhospital. Twelve had been living in another carehome prior to admission, and another 11 hadpreviously lived in a care home.

Types of property occupiedAmong those living in their own homes, similarnumbers had been living in a house or a non-ground floor flat (29 cases, 51%) or in a bungalowor ground floor flat (26 cases, 46%). Twenty-nine(51%) were owner-occupiers and 26 (46%) rentedtheir accommodation, the majority from a localauthority or a housing association.

Majority lived aloneAround two-thirds (67%) lived alone and one-fifth(21%) lived with a spouse or a partner. Theremaining residents lived with their children, otherfamily members or other people.

Most had not movedfar to care homeThe majority (72%) reported that they had notmoved far from their previous accommodation, but17 (25%) had moved a ‘long’ or a ‘fair’ way.

Care Funding ArrangementsJust under half receivedpublic fundingInformation on the payment of fees was obtainedfor 67 of the residents. In 30 cases (45%), theresident received public funding for some or all ofthe fees, and in 36 cases (54%) the fees were paidby the resident or another person or organisation,such as a relative or a charity.

Receipt of Informal andFormal Help and SupportAmong those who were living in their own homesprior to admission, including those who had beenin hospital, nearly three-quarters received informalhelp or support, principally from someone outsidethe household (33 cases), and just over halfreceived formal care services, including home care(21 cases, 37%), meals (15 cases, 26%), nurse orhealth visitor visits (15 cases, 26%) and day centrevisits (5 cases, 9%). Over one-third of all residentsreceived chiropody services (25 cases), but veryfew received other therapy services such asoccupational therapy, physiotherapy or speechtherapy.

Survey of Residents: Background Information

Table 2: Demographic Characteristics of Surveyed Individuals

Age groupUnder 6060 to 6970 to 7980 to 8990 to 99

SexMaleFemale

Marital statusSingleMarried/living as marriedWidowedDivorced/separated

Prior accommodationOwn permanent accommodationSheltered housingHospitalCare homeOtherDon’t know

Household tenureOwner occupied/mortgagedRented from LA/HAPrivately rentedRented/rent free in other’s accom.Don’t knowNot applicable (care home)

Household sizeLiving aloneLiving with spouse/partnerLiving with childrenLiving with other family membersLiving with othersDon’t knowNot applicable (care home)

Total number of cases

No.

028

185

1320

311181

1717710

1641327

10960017

33

%

0.06.1

24.254.515.2

39.460.6

9.133.354.53.0

51.53.0

21.221.23.00.0

48.512.13.09.16.1

21.2

30.327.318.20.00.03.0

21.2

100.0

Survey of Residents Survey of Relatives

No.

11

103423

1653

913434

4752

1203

2918532

12

38123220

12

69

%

1.41.4

14.549.333.3

23.276.8

13.018.862.35.8

68.17.22.9

17.40.04.3

42.026.17.24.32.9

17.4

55.117.44.32.92.90.0

17.4

100.0



DemographicCharacteristics of RelativesMainly grown up childrenof residentsThe majority (19 individuals, 58%) of the 33relatives in the survey were children of residents,including children-in-law. Sixteen of the children ofresidents were married or living with a partner andsix had a child aged 16 or under living with them.Ten (30%) of the relatives were the spouse or thepartner of the care home resident, and theremaining four were other relatives. Apart from oneperson who was not sure, none of the spouses orpartners of the residents were intending to live withthem in the care home.

Majority of female relativesTwo-thirds (64%) of the relatives were female,including eight of the 10 spouses and partners ofresidents. The spouses and partners were all aged65 or over, while the majority (73%) of the otherrelatives were aged 45 to 64. The majority of theother relatives were either in employment (10individuals, 43%) or retired (11 individuals, 45%).

DemographicCharacteristics of ResidentsSlightly higher proportionof men represented in thisresidents’ groupThe residents covered by the survey of relativesincluded a higher proportion of men (39%). Notsurprisingly, they were slightly younger, 70% beingaged 80 or over and 15% being aged 90 or over,and more likely to be married or living with apartner (33%) and less likely to be widowed (55%).As in the survey of residents, all of these residentswere white.

Previous AccommodationMajority lived in their own homeSeven of these residents had been living inanother care home prior to admission (21%), and

another had previously lived in a care home.Although the majority of the residents had beenliving in their own home, most of these residents(17 cases) had moved to a care home following astay in hospital. As in the survey of residents, thenumbers who had been living in a house or non-ground floor flat (10), or in a bungalow or a groundfloor flat (13), prior to admission were relativelysimilar. A higher proportion of the residents wereowner-occupiers (62%) and a lower proportionrented their accommodation (31%), including threewho lived rent-free.

Apart from those living in another care home (7cases), 11 (42%) lived with the relative, 10 (38%)lived alone, and four lived with a spouse or partneror with their children.

Over half received publicfunding for their care costsThese residents were more likely to receive publicfunding for some or all of the fees than in thesurvey of residents (20 cases, 61%). In 13 cases(39%) the fees were paid entirely by the resident oranother person or organisation.

As in the survey of residents, the majority werereported to have moved not far from their previousaccommodation (70%), but the proportion that hadmoved a ‘long’ or a ‘fair’ way (30%) was slightlyhigher. Excluding those who were living with theresident in their previous accommodation (11cases), 82% reported that the resident was movingcloser or would be a similar distance from themafter the move.

Receipt of Informal andFormal Help and SupportAmong those who were living in their own homesprior to admission, including those who had beenin hospital, 22 (85%) received informal help orsupport and almost 70% (18) received formal careservices, including home care (12 cases, 46%),nurse or health visitor visits (10, 38%), day centrevisits (8, 31%) and meals (6, 23%). Nearly two-thirds (21 cases) received chiropody services, butfewer received other therapy services.

Survey of Relatives: Background Information

Table 3: Disability of Surveyed Individuals, Compared with 2005

Unable to do without helpBath/shower/wash all overGo out of doorsDress/undressGet up/down stairs or stepsUseWCWash face and handsGet around indoors (except steps)Get in/out of bed (or chair)Feed self

Use wheelchairUse other mobility aid

Number of casesTotalMinimum valid number

2008-09 Survey 2005 Survey of Care Homes

Survey ofresidents

%

76.876.539.164.236.215.934.830.47.2

52.936.2

6967

Survey ofrelatives

%

93.993.987.978.875.878.869.762.527.3

60.66.1

3332

Personalcare

%

91.283.076.674.345.947.440.637.718.5

19.1-

494456

Nursingcare

%

94.994.992.590.980.874.776.175.049.6

39.9-

271248

Allhomes

%

92.887.382.680.458.657.753.350.830.3

26.5-

820761


Less Dependent thanResidents in GeneralIt was anticipated that the residents whoparticipated in the study would be less dependentthan residents in general, and partly for this reasonthe study was extended to include a sample ofrelatives of residents.

Levels of disabilityTable 3 shows the level of disability reported by theparticipating residents and relatives, compared withdata from a survey of older people admitted to carehomes in 2005 (Darton et al., 2006). As may beseen from the table, the sample of residents wasgenerally less dependent than the residentsadmitted to homes providing personal care in the2005 survey, particularly in relation to self-care.However, differences in mobility levels were lessmarked, and a much higher proportion used awheelchair. It should be noted that the data werecollected prior to admission in the 2005 survey,and the relatively high use of wheelchairs may

reflect the different circumstances of care homescompared with residents’ previous accommodation.The residents covered by the survey of relativeswere more dependent, as expected, and includedmore individuals living in nursing homes.

Aggregate measure ofphysical functioningThe information collected in both studies could beused to estimate a short form (Hobart andThompson, 2001) of a well-known aggregatemeasure of physical functioning, the Barthel Indexof Activities of Daily Living (Mahoney and Barthel,1965), and this is shown in Table 4.

The short form is based on five functions (bathing,using stairs or steps, using the WC, mobility/wheelchair use, and getting in/out of bed). Thescores on the index range from zero (maximumdisability) to 20 (minimum disability). The (rounded)Barthel scores have been grouped into fivecategories (0–4, 5–8, 9–12, 13–16, 17–20),following Granger et al. (1979), but with anadditional subdivision of the scores from 13–20.

Comparative Characteristics of Residents

Barthel 5 Item Index of ADLMean

Barthel 5 Item Index of ADL(banded)Very low dependence (17-20)Low dependence (13-16)Moderate dependence (9-12)Severe dependence (5-8)Total dependence (0-4)

Number of casesTotalValid number

2008-09 Survey 2005 Survey of Care Homes

Survey ofresidents

%

10.6

23.226.110.111.629.0

6969

Survey ofrelatives

%

6.1

6.115.29.1

15.254.5

3333

Personalcare

%

10.4

14.329.318.022.915.5

494433

Nursingcare

%

5.2

4.011.79.7

17.357.3

271248

Allhomes

%

8.5

10.423.015.020.930.7

820729

The mean values of the Barthel Index for thesample of residents and for the residents coveredby the survey of relatives were similar to those forhomes in the 2005 survey providing personal careand nursing care, respectively. This would appearto be due to the higher proportions of residentsrecorded as using a wheelchair, since smallerproportions of residents were recorded as requiringhelp with the other component functions of theBarthel Index than in the 2005 survey.

Higher proportions in the very lowand total dependence categoriesthan in 2005 surveyFor the sample of residents, the groupeddistribution of Barthel scores indicates that higherproportions of residents were in the very low

dependence and total dependence categories thanresidents admitted to homes providing personalcare in the 2005 survey.

Although the proportions are based on relativelysmall numbers of individuals, residents with lowlevels of dependency are of particular interest sincethey may not have had much advice aboutalternatives to moving into a care home (Nettenand Darton, 2003).

In particular, privately- or self-funded residentswhose capital assets fall to the level where theybecome eligible for local authority funding may nothave care needs that meet the increasinglystringent levels of eligibility criteria (Department ofHealth, 2002) applied by local authorities, and thusbe forced to consider leaving the home.


Table 4: Barthel 5 Item Index of ADL for Surveyed Individuals,Compared with 2005

79% of residents mentioned it

88% of relatives mentioned it

Resident’s state of physical health


Resident’s state of mental health


Resident’s danger to self and others

Table 5: Reasons for Moving into a Care Home



Family/carer not able to look after resident



Resident unable to go home after hospital


Local authority not able to support resident



Resident no longer wanted to stay in previous accommodation


Resident would not accept help from family



Tables 5, 6 and 7 show the health and carereasons, the housing reasons and the social issuesinvolved in moving into a care home, as reported bythe residents and relatives.

Residents’ viewsTaking the decisionOver four-fifths of residents (56 cases, 81%)reported that the decision to move into a care homewas entirely (29 cases, 42%) or partially theirs (27cases, 39%). Sixteen residents reported thatnobody had helped them in the decision, but for therest, help was largely provided by family or friends(47 cases). A doctor helped in five cases andanother professional helped in six cases.

Physical healthThe most important reason reported for moving intoa care home by those who were living in their own

homes prior to admission, including those who hadbeen in hospital, concerned their physical health,which was reported by 45 (79%) residents.

Difficulties with upkeep,mobility and household tasksAround 60% of residents reported difficulties withthe upkeep of the house, their mobility in the homeand coping with household tasks, and 19 (33%)reported that their family or carer could no longerlook after them. One-third also reported that theycould not return home following a stay in hospital,as noted above, and around 20% reported that theirhome needed adaptations or was too far fromshops and amenities.

Health of spouseFor around half of the married residents the healthof their spouse was an important factor, and for afew of the widowed residents the death of theirspouse or partner was an important factor.

The Decision to Move to a Care Home

Resident unable to manage upkeep of home

Table 6: Housing Reasons for Moving into a Care Home



Resident unable to cope with cooking/cleaning



Home required adaptations



Cost of living



Distance from shops and amenities





Difficulty getting around house


Moving from another care homeAmong those who moved from another care home,two-thirds reported that their physical health was animportant factor in deciding to move, and one-quarter no longer wished to live there.

Social issuesA minority of all residents identified social issues asimportant factors in the decision to move, principallythe lack of family or friends nearby (28%) and adesire not to live alone (20%). A few (7%) identifiedthe fear of crime as important, and in one case theexperience of crime or being taken advantage ofwas a very important factor for the resident.

Relatives’ viewsThe respondents in the survey of relatives reportedthat the resident had been involved in the decisionto move into a care home in one-fifth of cases(7 cases). Six respondents reported that nobodyelse had been involved in the decision. As for thesurvey of residents, help was largely provided byfamily or friends (23 cases). A doctor helped in ninecases (27%) and another professional in 15 cases(45%).

Physical health of residentsAs in the survey of residents, the most importantreason reported for individuals moving into a carehome from their own homes concerned theirphysical health, reported for 23 (88%) residents.

Residents’ other pre-admissionhealth and social care problemsA wider range of reasons for the move to a carehome was offered in the questionnaire to relativesthan to residents. Eighty-one per cent of residents(21) were reported by relatives to be a danger tothemselves or others. In 18 cases (69%) relativescited mental health reasons as a reason for themove into a care home. Sixty-two per cent ofrelatives (16) reported that the resident’s family orcarer could no longer look after them and 65% (17)also reported that the resident could not returnhome following a stay in hospital, as noted above.In around two-fifths of cases (11, 42%) relativesindicated that the local authority was no longer ableto support the resident.

Difficulties with coping with household tasks weremore important than in the survey of residents,reported in 20 (77%) cases, and problems with

No family or friends nearby

Table 7: Social Issues in Moving into a Care Home



Did not want to live alone



Isolated from local community



Taken advantage of/victim of crime



Fear of being taken advantage of/crime




mobility in the home were reported in a similarproportion of cases (17 cases, 65%), but fewerreported problems with general upkeep (11 cases,42%). However, a higher proportion of relatives (13cases, 50%) indicated that the individual’s homerequired alterations.

Relatives reported that physical health was animportant factor for all seven residents who movedfrom another care home, and that mental health wasan important factor in six cases. Relatives alsoreported that three residents no longer wished to livein the previous home, three were unable to returnafter a hospital stay and three moved due to a poorstandard of care.

The relative importanceof social issuesThe respondents in the survey of relatives identifiedsocial issues as somewhat more important factors inthe decision to move than in the survey of residents.A similar proportion (30%) identified the lack offamily or friends nearby (28%), but 36% indicatedthat the resident was isolated from the localcommunity and 42% identified a desire by theresident not to live alone.

Fear and experience of crimeMore relatives (15%) than residents identified thefear of crime as important, and 30% of relativesreported that the resident’s experience of crime or

being taken advantage of was an important factor. Ineight cases (24%) relatives thought the resident’sexperience of crime or being taken advantage ofwas a very important factor, compared with onecase in the survey of residents.

Residents with Low Levelsof DependencyExploring why they choseto move into a care homeAs shown in Table 4, the sample of residentsincluded a larger group of residents with low levelsof physical dependency than in the 2005 survey.Only residents judged by home staff as capable ofparticipating in an interview were included in thesurvey, and thus it is of interest to examine thereasons why residents with low levels of physicaldependency chose to move into a care home.

Sixteen of the 69 residents were in the lowdependency group, having a Barthel Index score of17–20. Compared with the residents in the surveywith a Barthel Index score of 0–16, there was aslightly larger proportion of male residents amongthe low dependency group (5 cases, 31%), and theywere more likely to be single or divorced (7 cases,44%). For the higher dependency group thecorresponding figures were 21% and 9%,respectively.


More likely to have been living intheir own home than the higherdependency groupThe low dependency residents were more likely tohave been living in their own home (14 cases, 88%)than the higher dependency group (33 cases,62%), and the majority (10 cases) of the lowdependency residents had been owner-occupiers.Only two of the 19 residents who moved to a carehome following a stay in hospital and two of the 12that had been living in another care home were inthe low dependency group.

Link between physical dependencyand type of home selectedPhysical dependency was associated with the typeof home that residents moved into. Overall, 41 ofthe 69 residents were living in care homesproviding personal care, but 14 of the 16 lowdependency residents were in such homes.

Seven residents were living in voluntary homes,and all of these residents were in the two lowestdependency groups.

More likely to be privately fundedThe low dependency residents were also morelikely to have been privately funded. In ten cases(63%) the fees were paid by the resident or anotherperson or organisation, compared with 51% of thehigher dependency group.

Less likely to be receiving informalor formal help and supportPrior to moving into a care home, the lowdependency residents were less likely to havereceived formal or informal help and support thanthose in the higher dependency group.

Similar level of involvementin decision to moveThe degree of involvement of the resident and thesources of help for the decision to move into a carehome were similar for the low dependencyresidents as for the residents as a whole, althoughnone received help from a professional other than adoctor.

Other reasons for movingFor the low dependency residents who were livingin their own homes prior to admission, the mostimportant reason for moving into a care homeconcerned the upkeep of the house, reported bynine (64%) of residents.

Other reasons were reported by fewer residentsthan among those in the higher dependency group.For example, physical health was reported as areason by five (36%) residents, compared with 40(93%) residents in the higher dependency group.

The Choice of Care Home


Table 8 shows the reasons reported by theresidents and relatives for the choice of the home,and the degree of satisfaction with different featuresof the home reported in the follow-up survey.

Residents’ ViewsChoice of suitable homesTwenty-eight residents (41%) indicated that therehad been a choice of suitable homes and nine(13%) indicated that the alternatives wereunsuitable, while 26 (38%) stated that there hadbeen no choice.

Majority made decisionentirely or partiallyAmong those who had a choice of home, includingunsuitable ones, 78% reported that the decisionwas entirely (16) or partially theirs (13), similar tothe proportion that made the general decision tomove to a care home.

Seven residents reported that nobody had helpedthem in the decision, but for the rest, assistance inthe choice of home was largely provided by familyor friends (23 cases, 79%), while a doctor or otherprofessional helped in a small number of cases, asin the general decision to move to a care home.

Over half visited homebefore movingJust over half of the residents (55%) visited thehome before they moved in, and 22% visited otherhomes. In 83% of cases the resident reported thattheir family or friends visited the home before theymoved in and 41% reported that their family orfriends visited other homes, although a further 16%were unsure about this.

Main reasons for choosingtheir homeInformation about the reasons for choosing thehome was only collected from those residents whohad been involved in making a choice and forwhom there was a choice of home, accounting for29 of the 69 residents.

The main reasons cited by residents for choosingthe particular home were the fact that it catered fortheir care and health needs (76%), staff friendliness(76%), homeliness (69%), proximity to family andfriends (69%), the standard of care (66%) andcleanliness (62%).

In the follow-up survey, all but one of the residents(98%) reported that the home catered for their careand health needs and 86% stated that it had ahomely feel, and residents cited staff friendliness(94%), security (92%), cleanliness (90%), thestandard of care (88%) and the size of the home(84%) as the factors with which they were mostsatisfied.

Cost of livingAlthough the cost of living was only cited by 10% ofthe 29 residents in the initial survey as being afactor in the choice of home, it was the leastsatisfactory factor in the follow-up survey: only 40%of residents were satisfied with the cost of living.

Proximity and reputation of homeResidents were also less satisfied with the proximityof the home to their previous home (48% satisfied)and the reputation of the home (54%). However,70% of residents in the follow-up survey reportedthat the home catered for their ethnic or religiousneeds, whereas only 10% of the 29 residents in theinitial survey reported that this was a factor in thechoice of home.

Bringing possessionsThe majority of residents (87%) indicated that theywere able to bring all the possessions that theywanted into the home. A small number were unableto bring furniture (3 cases), paintings orphotographs (one case), books (one case) or otheritems (3 cases).

Relatives’ ViewsChoice of suitable homesIn the survey of relatives, a similar proportion, 42%(14 cases), as in the survey of residents indicatedthat there had been a choice of suitable homes, butmore indicated that the alternatives were unsuitable(36%) and fewer indicated that there had been nochoice (18%). One-third reported that the processof finding a home was fairly or very difficult.

Making the decisionAmong those who indicated that there had been achoice of home, including unsuitable ones, 18(69%) reported that the choice was entirely theirs.The respondents reported that the resident hadbeen involved in the choice of home in three cases.Seven respondents reported that nobody else hadbeen involved in the choice of home. As for thesurvey of residents, assistance with the choice ofhome was largely provided by family or friends (17cases, 65%), while a doctor or other professionalwas involved in two cases.

Table 8: Reasons for Choice of Care Home and Resident Satisfaction

Catered for care and health needsStaff friendlinessHomelinessProximity to family and friendsStandard of careCleanlinessSecurityReputationProximity to previous homeSize of homeRecommended by health professionalStayed in home previouslyCost of livingCatered for ethnic or religious needs



Choice

%7676696966624848281414141010

29

Satisfaction

%98948670889092544884--

4070

50

Choice

%10010010069

100100100816269274

6246

26


Visits and informationbefore the moveAll but one of the respondents (97%) visited thehome before the resident moved in, and 76%visited other homes. In choosing the home, 79% ofrelatives reported that they were aware ofCommission for Social Care Inspection reports.Nearly three-quarters of these relatives (73%)made use of these reports to choose the home, andall but one found the reports very or fairly useful.Around half of the relatives (52%) sought advicefrom social services and 15% sought advice fromother agencies about care homes. Around half ofthe relatives (48%) also indicated that they wereaware of their right to demand certain standards ofcare, as set out in the National Minimum Standardsfor Care Homes.

Reasons for choosing a homeInformation about the reasons for choosing thehome was only collected from the relatives whoreported that they had had a choice of homes,accounting for 26 of the 33 relatives. Relatives citedsimilar reasons to those cited by residents forchoosing the particular home, including the fact thatit catered for their care and health needs (100%),staff friendliness (100%), homeliness (100%),

cleanliness (100%), the standard of care (100%)and proximity to family and friends (69%). Ingeneral, a higher proportion of relatives reportedthat these factors were important in choosing thehome. In addition, relatives cited security (100%),the reputation of the home (81%), the size of thehome (69%), the cost of living in the home (62%)and the closeness of the home to their previoushome (62%) as reasons for choosing the home.Eight of the 33 relatives reported that they hadcompromised in the choice of the home, the mainreason, reported by four of the relatives, being inthe proximity to family and friends.

In around half the cases relatives reported that theresident was offered the choice of an en suiteroom. Relatives reported that the resident wasoffered the choice of a single or shared room in justunder one-half of the cases where shared roomswere available. However, shared bedrooms usuallyrepresented a small proportion of the total number,and relatives said that residents were more likely tobe offered a choice where there were more sharedbedrooms.

All but one of the respondents indicated that theresident was able to bring all the possessions thatthey wanted into the home, the exception beingfurniture.


Tables 9 and 10 show the expectations andexperiences of life in the home reported by theresidents and relatives in the initial and follow-upsurveys.

Residents’ ViewsResidents in the initial survey felt that they werelikely to have a moderate say in the day-to-day lifeof the home, but their expectations of the comfortand care provided and in aspects of their controlover their life were more positive.

How much say they expectedto have over their daily livesOver three-fifths expected that they would have asay in when they had visitors (74%), in coming andgoing from the home (64%), or being able to bealone (62%), and over one-half expected that theywould have a say in the time that they went to bed(58%), whether they could remain living in thehome (57%), when they could have a hot drink(55%), or the way they could arrange their bedroom(51%). However, fewer than half expected that theywould have a say in when staff helped them (49%),the time they got up in the morning (43%), thechoice of meals (41%), the staff who helped them(41%), whether they could adjust their bedroomheating (35%), or whether they could lock theirbedroom when leaving it (29%).

Expectations about meetingtheir health and other needsIn contrast, 93% expected that staff would look aftertheir health and needs, 90% expected the home tobe comfortable and warm, 88% expected to beclean and appropriately dressed, 88% expected thehome to be secure, 87% expected to feel safe inthe home, 83% expected the staff to be caring andsensitive and 81% expected to have company inthe home.

Slightly lower proportions expected to have accessto money for personal items (74%), or to buyclothes and shoes (72%), and 65% expected thatthe residents would be friendly. In terms of controlover their life, 80% expected to keep their ownpossessions, and 93% expected to keep their ownclothes. However, a relatively small proportion ofhomes provided an adequate explanation of thearrangements for clothing and laundry prior tomoving in. Fifty-five per cent of residents wereadvised about the arrangements for washing andcleaning, but only 38% were advised of what

clothing would be needed and only 23% wereadvised about the quantity needed.

Around half of the residents (49%) reported thatstaff explained how the fees would be paid beforethey moved into the home, but 14% were not surewhether staff discussed the fee arrangements.

In terms of their expectations about the social life inthe home, a majority of residents expected eitherno change or an improvement in the level of socialcontact. Seventy-one per cent thought that theywould socialise more or that there would be nodifference in their social life, and 78% expected tosee their family and friends as much or more thanbefore.

Relatives’ ViewsHigher expectations than residentson a wide range of key issuesRespondents in the initial survey of relatives feltthat residents would have a greater say in the day-to-day life of the home than the residentsthemselves, with the exception of coming and goingfrom the home, locking their bedroom when leavingit and adjusting the bedroom heating. Respondentsalso had higher expectations of the comfort andcare provided and of aspects of the resident’scontrol over their life.

Over four-fifths expected that residents would havea say in when they had visitors (88%), when staffhelped them (82%), and in the choice of meals(82%), and 70% or more expected that residentswould have a say in being able to be alone (79%),when they could have a hot drink (76%), whetherthey could remain living in the home (73%), thetime they got up in the morning (70%), the time thatthey went to bed (70%), or the way they couldarrange their bedroom (70%). Sixty-seven per centexpected that residents would have a say in thestaff who helped them.

However, the proportions of respondents thatexpected residents to have a say in coming andgoing from the home (64%), adjusting the bedroomheating (33%) and locking their bedroom whenleaving it (27%) were almost identical to theproportions reported in the survey of residents.

All respondents in the initial survey of relativesexpected the home to be comfortable and warm,that staff would look after the resident’s health and

Expectations of Life in the Home


74% expected a say in when they had visitors

94% received visitors when they wanted

When can be visited

64% expected a say in coming and going

When can come and go from home

62% expected a say in when they could be alone

When can be alone

Table 9: Expectations and Experiences of Say in Life in Home

58% expected to go to bed when they wanted

96% went to bed when they wanted

Time to go to bed

83%said resident was alone when they wanted

70% expected resident to go to bed when they wanted

75%said resident went to bed when they wanted

88% expected resident to have a say

83% said resident received visitors as they wanted

67% said resident could come and go when they wanted

Whether can remain living in home

73% expected the resident to remain in the care home

83% felt the resident could remain in the home

74% came and went as they wanted

64% expected resident to come and go when they wanted

100% were alone when they wanted

79% expected resident to be alone when they wanted

86% now felt they could remain living in the home

57% expected they would be able to remain in the care home

RESIDENTS’ expectations

RESIDENTS’ experiences

RELATIVES’ expectations

RELATIVES’ experiences

















needs, that the staff would be caring and sensitive,that the resident would feel safe in the home, andthat the home would be secure.

Almost all expected the resident to be clean andappropriately dressed (97%), to have company inthe home (91%), and that the residents would befriendly (88%). In terms of the resident’s controlover their life, almost all expected the resident tokeep their own possessions (97%), and allexpected them to keep their own clothes.However, as in the survey of residents, smallerproportions of homes provided an adequateexplanation of the arrangements for clothing andlaundry prior to moving in. Although almost all wereadvised about the arrangements for washing andcleaning (94%), only 67% were advised of whatclothing would be needed and only 39% wereadvised about the quantity needed.

As expected, a higher proportion of relatives thanresidents reported that staff explained how the feeswould be paid before the resident moved into thehome, but staff did not discuss the feearrangements in six cases (18%). Nonetheless, allrespondents indicated that the staff were veryhelpful at the time of the move into the home.

In terms of their expectations about the social life inthe home, 15 relatives indicated that they expectedthat the resident’s social life would be affected bytheir state of health, such as dementia. Apart fromthese cases, the majority of relatives expectedeither no change or an improvement in theresident’s level of social contact. Seventy-two percent of relatives thought that residents wouldsocialise more or that there would be no differencein their social life, and 94% of all respondentsexpected that the resident would see their familyand friends as much or more than before.

84% got up when they wanted

Time get up

When can have a hot drink

86% had a say in arranging their room

How arrange bedroom

49% expected a say in when they had help from staff

82% had help from staff when they wanted

When staff come to help

41% expected a choice of meals

84% had a choice of meals

Choice of meals

29% expected to be able to lock their room on leaving it

Locking their room

41% expected a say in which staff came to help them

62% had say in which staff came to help them

Which staff come to help

35% expected to be able to adjust their bedroom heating

54% were able to adjust their bedroom heating

Adjust bedroom heating

70% expected resident to get up when wanted

67%said resident got up when they wanted

79%said the resident had hot drinks when wanted

70% expected resident to arrange their room as they wanted

67% said resident arranged room as they wanted

82% expected resident to influence when help given

54% said resident influenced when staff came to help them

82% expected resident to have a choice of meals

88%said resident had a choice of meals

21% said resident was able to lock their room on leaving it

67% expected resident to influence which staff came to help

17% said resident influenced which staff came to help them

33%expected resident to be able to adjust their bedroom heating

25% said resident was able to adjust their bedroom heating

Table 9: Expectations and Experiences of Say in Life in Home

60% were able to lock their room on leaving it

27% expected resident to be able to lock their room on leaving it

43% expected a say in when they got up

55% expected a say in when they had a hot drink

80% had a hot drink when they wanted

76% expected the resident to have hot drinks as wanted

51% expected a say in how they arranged their room

























RELATIVES’experiences









93% expected their needs to be met

96% felt their needs were met

Staff look after health and physical needs

Feeling comfortable and warm

88% expected to be clean and appropriately dressed

96% felt clean and appropriately dressed

Feeling clean and appropriately dressed

Table 10: Expectations and Experiences of Living in Home

Home secure

Feeling safe

100% expected the resident’s needs to be met

100% felt resident’s needs were met

100% felt resident was comfortable and warm

97% expected resident clean/appropriately dressed

100% felt resident was clean/appropriately dressed

100% felt care home was secure

98% felt comfortable and warm

90% expected to be comfortable and warm

100% expected resident comfortable and warm

100% expected care home to be secure

98% felt their care home was secure

88% expected their care home to be secure

98% felt safe in their care home

87% expected to feel safe in their care home

100% expected resident to feel safe

92% said resident felt safe






















72% expected to be able to buy their clothes and shoes

94% were able to buy their clothes and shoes

Money for clothes and shoes

88% felt staff were caring and sensitive

Staff caring and sensitive

Company

74% expected to use their money to buy personal items

94% used their money to buy personal items

Money for personal items

65% expected other residents to be friendly

Friendly residents

Table 10: Expectations and Experiences of Living in Home

100% expected caring and sensitive staff

100% felt staff were caring/sensitive

83% expected staff to be caring and sensitive

91% expected resident to have company

79% felt resident had company

86% felt they had company in their care home

81% expected to have company in their care home

92% found other residents to be friendly

88% expected other residents to be friendly

96% found other residents to be friendly



















Experiences of Life in the Home

Residents’ ViewsSocial life better or at leastas good as beforeIn the follow-up survey, 78% of residents indicatedthat they socialised more or that there was nodifference in their social life, and 82% saw theirfamily and friends as much or more than before,both proportions being slightly higher than in theinitial survey. For the majority of residents (68%)the home was the focus of their social life, but 28%indicated that at least half their social life wasoutside the home. The majority were happy with theamount of contact with their family and friends(68%), but 20% indicated that they would like tosee their family and friends a fair amount or a lotmore. Within the home, 70% of residents in thefollow-up survey reported that they had made twoor more friends, but 18% were not interested inmaking friends.

Majority took part in activitiesTwo-thirds of the residents in the follow-up surveyreported that they took part in activities in thehome. However, 40% indicated that health andmobility problems prevented them from taking partin social activities.

The main activities that residents participated in,reported by at least one-third of those who tookpart, were: sing-songs or music; board games,bingo and card games; and sports or exerciseclasses. The main benefits of participation,reported by around one-half of those who took part,were in the enjoyment of friendship and company.

Generally a greater saythan expectedIn the follow-up survey, residents reported having agreater say in the day-to-day life of the home thanin the initial survey. Residents felt that they had asay in being able to be alone (100%), the time theywent to bed (96%), when they could be visited(94%), the way they could arrange their bedroom(86%), whether they could remain living in thehome (86%), the time they got up in the morning(84%), the choice of meals (84%), when staffhelped them (82%) and when they could have a hotdrink (80%). Fewer felt that they had a say inwhether they could lock their bedroom whenleaving it (60%), or whether they could adjust theirbedroom heating (54%), but these proportions were

still higher than in the initial survey. All of those whofelt that they had a choice of meals were happywith the range of food offered.

Expectations generallyexceeded on comfort and careAs in the initial survey, residents were asked in thefollow-up survey to indicate whether a number ofstatements about the comfort and care providedwere true of living in the home. Although residentshad relatively high expectations about theseaspects of living in the homes in the initial survey,the proportion of positive responses in the follow-upsurvey was higher for each statement, and over85% of residents gave positive responses to eachof the questions.

In terms of the design of the home, 74% of theresidents in the follow-up indicated that their roomwas well-designed to meet their needs, and 78%indicated that the home was well-designed. Tworesidents reported that their room was totallyinappropriate. For 92% of residents the size of theirroom was ‘just right’, but for four residents it wastoo small. Similar proportions of residents weresatisfied with the size of the communal rooms(88%) and the size of the home overall (94%).Forty-four per cent of residents were able to getaround the home without problems, and 46% wereable to get to all the places in the home that theyneeded to with help. For 64% of residents, mobilityin the home was much or somewhat easier than intheir previous accommodation.

Relatives’ ViewsImpact of move on social lifeIn the follow-up survey, 75% of relatives indicatedthat the resident socialised more or that there wasno difference in their social life, and 88% indicatedthat they saw their family and friends as much ormore than before. However, in five cases (21%) theresident’s social life was affected by the presenceof a condition such as dementia, and almost all ofthe other residents had the same or more socialcontact than before moving in, a higher proportionthan expected in the initial survey.

Participation in activitiesThree-quarters of the relatives reported that theresident took part in activities in the home.However, 71% indicated that health and mobility


problems prevented the resident from taking part insocial activities and one-third indicated that hearingproblems prevented the resident from participating.As in the survey of residents, the main activities thatresidents participated in, reported by at least one-third of respondents, were: sing-songs or music;and board games, bingo and card games. However,fewer took part in sports or exercise classes, whichmight be expected from the greater level ofdependency among these residents. The majority ofrelatives (83%) indicated that they were very orfairly happy with the range of activities offered bythe home.

Perceptions of the amount ofsay residents had in shapingtheir daily livesIn the survey of residents, residents reported havinga greater say in the day-to-day life of the home inthe follow-up survey than in the initial survey.However, in the survey of relatives the responses tothe corresponding questions in the initial and thefollow-up surveys were generally very similar, withthe exception of the questions on the choice of whowould help the resident and when staff helpedthem. Fewer relatives indicated that residents had achoice in these matters in the follow-up than in theinitial survey: in the initial survey, 67% of relativesthought that the resident would have a say in whowould help them and 82% thought that the residentwould have a say in when they would be helped.

However, in the follow-up survey the correspondingpercentages were 17% and 54%, respectively.

Comfort and careRelatives had very high expectations of the comfortand care provided for residents, and theirexperiences were very similar to their expectations,apart from a smaller proportion that reported thatthe resident had company (79%) than was expectedin the initial survey (91%). All of those who felt thatthe resident had a choice of meals were happy withthe range of food offered.

Design of the homeIn terms of the design of the home, 67% of therelatives in the follow-up indicated that theresident’s room was well-designed to meet theirneeds, and 75% indicated that the home was well-designed. For one resident the room and the homewere reported as totally inappropriate. In themajority of cases, the size of the resident’s roomwas described as ‘just right’, but for two residents itwas judged to be too small. All respondents weresatisfied with the size of the communal rooms andthe size of the home overall. One-third of residentswere reported as being able to get around thehome without problems, and 63% were able to getto all the places that they needed to with help. For63% of residents, relatives thought that mobility inthe home was much or somewhat easier than intheir previous accommodation.


Residents’ ViewsAccess to therapy servicesand healthcare

Prior to admission, over one-third of residentsreceived chiropody services, but very few receivedother therapy services.

After moving in, the proportion that receivedchiropody services more than doubled, to 72%,and 20% reported that they received physiotherapy.However, few residents received occupationaltherapy and none of the residents received speechtherapy.

Since moving in, 80% had also had a consultationwith a GP or a practice nurse, and 30% had beento hospital.

General satisfaction with helpreceived from care home staffResidents were generally satisfied with the helpthat they received from staff, with 80% being verysatisfied, and 92% reported that staff were verywelcoming to visitors.

The majority of residents (86%) reported that theywere always treated with respect by staff, 82%reported that staff always knocked on their doorand waited before entering their room, 78%reported that all staff treated them as an individual,and 74% reported that staff were never in a rushwhen helping them.

However, excluding those for whom the questionwas not applicable, a smaller proportion (61%)reported that they were always informed aboutchanges in their care.

Two-thirds (68%) of residents considered aparticular member of staff to be a friend, themajority of whom were senior nurses or carers.

Knowing how to make a complaintThree-quarters (76%) of the residents included inthe follow-up indicated that they knew how to makea complaint to the home, if they needed to. Fiveresidents (10%) had been dissatisfied with thehome or the staff, and four of the individualsconcerned had made a complaint.

Care Services and Staff Support


Relatives’ ViewsAccess to therapy servicesand healthcareAs in the survey of residents, relatives reported thata higher proportion of residents received chiropodyservices after moving in than before. Excluding oneperson who did not have access to chiropodyservices, 91% received chiropody after moving in,compared with 63% of those included in the follow-up who received chiropody before moving in.However, relatives reported that residents were nomore likely to receive other therapy services aftermoving in than before admission.

Since moving in, 92% had also had a consultationwith a GP or a practice nurse, and 46% had beento hospital. Relatives reported that 79% of residentshad had hospital treatment prior to moving in, andin two-thirds of these cases they indicated that themedical or nursing care provided in the home wasof a higher standard.

A small number of relatives indicated that theyexpected the home to provide certain medical ornursing procedures that were not available, but themajority (83%) did not identify any such procedures.

Improvements in physicaland mental healthRelatives were asked whether they detected anychange in the resident’s physical or mental healthfollowing the move into the care home. Excludingthose who had moved from another care home,relatives reported that six of those who had movedfor mental health reasons (43%) and five of thosewho had moved for physical health reasons (28%)had shown an improvement in functioning.

Homes run in the interests of residentsAll relatives were generally satisfied with the helpthat the resident received from staff, with 71%being very satisfied, and all but one felt that thehome was run in the best interests of the residents.

All relatives reported that the staff were veryhelpful, and 92% reported that staff were verywelcoming when they were visiting the home. Inmost cases (88%) the relative had regular contactwith the home, and 74% of those who needed tomake contact with a member of staff found it easyto do so. Compared with the survey of residents,somewhat smaller proportions of relatives reportedthat the staff always treated the resident withrespect (75%), that all the staff treated the residentas an individual (71%), or that staff were never in arush when helping them (63%). However, excludingone case for whom the question was not applicable,the same proportion (61%) reported that they werealways informed about changes in the resident’scare.

ComplaintsOne-quarter of the relatives included in the follow-up had been dissatisfied with the home or the staff,and four of the six individuals concerned had madea complaint. In each case the relative had noticedthe problem themselves, rather than being informedof the problem by the resident.

Awareness of care standardsthat could be expectedAs noted above, around half of the relatives in theinitial survey indicated that they were aware of theirright to demand certain standards of care, as setout in the National Minimum Standards for CareHomes. For the relatives in the follow-up theproportion had increased to 83%.


Satisfaction with Life in the Home

Table 11 shows the views of residents and relativesabout care homes in general and Table 12 showstheir opinions on the existence of abuse.

Residents’ ViewsMost said experience was goodOverall, 86% of residents included in the follow-upindicated that their experience of living in the homewas good and the remainder indicated that it wasboth good and bad. Thirty-seven residents (74%)indicated that the home was at least as good asexpected, while four stated that it had not been asgood as expected.

Among those who had previously lived in a carehome, three-quarters (76%) indicated that living inthe home was the same or better than living in theprevious home and one resident stated that it wassomewhat worse.

Good overall impressionof care homesHaving lived in the home, the majority of residentsindicated that their overall impression of carehomes was good (84%) and 12% indicated that itwas good and bad. Only 40% of residents statedthat they wished that they were living in theiroriginal home, a similar figure to that obtained inthe initial survey (43%), and the majority (92%)expected to remain living in the home at least forthe near future.

Among those who had not previously lived in a carehome (33 residents), 21% reported in the initialsurvey that they had had a bad impression of carehomes before moving into the home, and a further9% indicated that their impression had been bothgood and bad.

Among those who had previously lived in a carehome (17 residents), four (24%) reported in theinitial survey that their experience had been bothgood and bad and none reported that it had beenbad.

In the follow-up survey, residents were also asked afew open-ended questions about their satisfactionwith life in the home. Around three-quarters of theresidents responded to these questions, and themajority (58%) had no complaints or made generalpositive comments about the home. Around one-third made comments about the staff, the majority

of which were positive, but there were a fewinstances of insensitive or rushed treatment ofresidents.

The other issue that generated a number ofcomments was the quality of the food provided.Five residents made comments on the food, andfour of these were negative. Individual commentsby small numbers of residents included issues ofindependence and freedom (positive), thecleanliness of the home (both positive andnegative), the security of the home at night(negative) and the laundry arrangements(negative).

Although residents made some negative comments,overall their comments indicated a substantial levelof satisfaction with life in the home. However,although the views of residents about care homeswere more favourable in the follow-up, theproportion that believed that residents may beabused did not decrease between the initial surveyand the follow-up. Although the proportions thatbelieved that residents might be neglected, or havemoney or possessions stolen, remained fairlyconstant, the proportion that believed that residentsmay be physically or psychologically mistreateddoubled, from 12% to 24%.

Relatives’ ViewsThe relatives reported that their previousimpression of care homes was generally bad (42%)or both good and bad (30%). Around 60% believedthat some people were neglected (64%) orpsychologically or physically mistreated (61%), andaround 30% believed that some residents hadmoney (27%) or other possessions stolen (33%).

Increase in proportion thinkingcare homes were generally goodAmong the relatives who were included in thefollow-up, accounting for 24 of the 33 individuals,92% reported having a favourable generalimpression of care homes, and the others reportedthat their impression was both good and bad.

Nearly all likely to recommend the homeAll but one of the 24 relatives indicated that theywould be very likely (75%) or quite likely (21%) torecommend the home. However, among theserelatives around two-thirds still believed that somepeople in care homes generally were neglected or

Table 11: Previous and Current General Impression of Care Homes1

GoodBoth good and badBadNot sure/Don’t know



Previous -not in care

home

%399

2130

33

Previous -in carehome

%712406

17

Current

%841204

50

Previous

%1729504

24

Current

%92800

24

Table 12: Previous and Current Beliefs about Care Homes1

MistreatedNeglectedMoney stolenPossessions stolen


Note: 1. Respondents in both initial and follow-up surveys only.


Previous

%12281816

50

Previous

%63672121

24

Current

%24242020

50

Current

%67633854

24

Note: 1. Respondents in both initial and follow-up surveys only.


mistreated, and substantially higher proportionsbelieved that some residents in homes generallyhad money (38%, compared with 21% in the initialsurvey) or other possessions stolen (54%,compared with 21%).

Improved quality of lifePrior to admission, 39% of relatives reported thatthe resident’s quality of life was bad or very bad,and for the relatives included in the follow-up thefigure was 46%. However, since admission, 75% ofthe relatives included in the follow-up reported thatthe resident’s quality of life was very good or good,and 17% reported that it was neither good nor bad.All relatives in the follow-up believed that theresident was settling in better (58%) or as well asthey had hoped (42%), and all but one expected the

resident to remain living in the home at least for thenear future.

As in the survey of residents, relatives were askeda few open-ended questions about their satisfactionwith the home, and all of the relatives responded tothe questions. The great majority (83%) madegeneral positive comments, with most expressing ahigh level of satisfaction with the home. The mainissue raised by the relatives, mentioned by fourrespondents, concerned the level of staffing, whichcould limit the number of activities provided forresidents. Individual comments by relativesconcerned various unsatisfactory aspects of thedesign or maintenance of the home, and thecleanliness of the home (both positive andnegative).


Residents’ ViewsResidents were asked to rate their overall quality oflife and their general health before moving into thecurrent home and again in the follow-up. Themajority of the initial 69 residents (70%) rated theiroverall quality of life as good or very good beforemoving in.

Increase in proportion who feltquality of life was now very goodOf the 50 residents who were included in the follow-up, 41 (82%) rated their overall quality of life asgood or very good. However, of these 50 residents,the proportion that rated their quality of life as verygood increased from 26% before moving in to 48%at the follow-up.

In relation to health, 52% of the initial 69 residentsrated their general health as good or very goodbefore moving in, and at the follow-up 62% of the50 residents rated their general health as good orvery good. Conversely, 12% rated their generalhealth as bad or very bad before moving in, and thesame proportion rated their general health as bador very bad at the follow-up.

Relatives’ ViewsFor those residents whose quality of life was verygood, good or neither good nor bad, their relativeswere asked a number of questions about theirexperience of placing the resident in a care home.Before the resident moved into a care home, 45%of relatives had had difficulty balancing the needs ofthe resident with those of other family members and36% had had difficulty balancing the needs of theresident and work. Following the move, 18% founddifficulty in finding the time to visit the resident andthe same proportion reported struggling with thecost of the home.

Abuse and NeglectPerceptions in a previous studyAs noted above, the recent national survey of theprevalence of abuse and neglect (O’Keeffe et al.,2007) focused on older people living in privatehouseholds, and there is no equivalent informationavailable for care homes. In a national survey ofthe perceptions of abuse of older people among thegeneral population, one-quarter reported knowingan older person who had been neglected ormistreated, and just over one-half reported that ithad occurred in a care home (Hussein et al., 2007).Poor care was the most frequently-identifiedproblem, reported by 51% of respondents, neglectand a lack of respect were reported by just over20%, physical abuse was reported by just over10%, and 5% reported financial abuse. However,the authors note that abuse is more pervasive inolder people’s own homes than in care homes andhospitals, and question whether the focus on formalcare in the media and elsewhere influencespeople’s perceptions, particularly given the degreeof satisfaction expressed by recipients of careservices.

Perceptions in present studyThe residents and relatives in the present studywere most likely to believe that some people incare homes were neglected or psychologically orphysically mistreated. However, the proportionswho believed that residents had money or otherpossessions stolen were much higher than theproportion who reported knowledge of financialabuse in the survey by Hussein et al., particularlyamong the relatives, who were likely to be moresimilar to the respondents in Hussein et al.’ssurvey. Although, as with abuse in general, mostfinancial abuse takes place in people’s own homes,there are specific concerns about financial issuesfor residents of care homes, ranging from theft tobroader issues of the loss of financial control andthe management of residents’ financial affairs(Crosby et al., 2008).

Health and Quality of Life


Conclusions

Reasons for MovingThe most important reason reported for moving intoa care home from individuals’ own homes wasphysical health. The survey of residents excludedthose who were incapable of consenting toparticipate, but a majority of relatives reported thatthe resident was a danger to themselves or others,or had mental health problems.

Other important reasons for moving into a carehome were difficulties with coping with householdtasks, mobility in the home and general upkeep. Aninability to return home from hospital or to providecontinuing support in their home were importantreasons for the residents covered in the survey ofrelatives, and for one-third of those in the survey ofresidents. Relatives identified social issues, such associal isolation, living alone and a fear orexperience of crime as somewhat more importantfactors than residents themselves.

However, a minority of residents were lessdependent. These residents were more likely tohave been single or divorced and to have beenliving in their own home as owner-occupiers. Theywere also more likely to have been living in homesproviding personal care, and to have been privatelyfunded.

Making the DecisionIn the survey of residents, the decision to move intoa care home was entirely or partially the resident’s,supported by family and friends. Family and friendsprovided the main source of help according to therelatives, but a doctor or other professional wasmore likely to be involved than in the survey ofresidents.

Improved Quality of LifeBoth residents and relatives reported improvedquality of life following the move into a care home.Relatives reported that quality of life changed frombad or very bad to very good or good for asubstantial number of residents.

Experiences MainlyExceeded ExpectationsResidents’ experiences of day-to-day life in thehome tended to be higher than their initialexpectations, with the majority (over 80%) indicatingthat they had a say in most aspects of their dailylife. However, fewer had control over whether theycould lock their bedroom on leaving it or over theheating in their bedroom, although the proportionswere higher than initially expected. Residents werealso generally satisfied with the help received fromstaff.

Despite generally favourable impressions of thehomes, both residents and relatives retained abelief that residents may be abused in care homes.While public perceptions of the relative level ofabuse in care homes and private households maybe influenced by media and other reports, it is ofconcern that a higher proportion of residents in thefollow-up survey stated that residents may bepsychologically or physically abused, whilesubstantially higher proportions of relatives in thefollow-up stated that some residents may havemoney or other possessions stolen, since theseviews may have been affected by their experiencesof living in or visiting a home.

This study did not achieve the intended samplesize, and it is quite possible that the participatinghomes and respondents formed a self-selectedsample, although the comparison of the star ratingsdoes not suggest that the homes were particularlyunusual.

However, the study does suggest that the residentsand relatives that responded generally valued thecare and support provided by the homes. Theirexperiences of the homes tended to exceed theirinitial expectations and the quality of life ofresidents was often judged to have improved.

Inevitably, there were aspects of living in a homethat were less satisfactory. Residents had lesscontrol over their environment than over otheraspects of day-to-day life, and relatives reported


that residents had less say than expected in whenand who would help with their care.

Given the level of physical and cognitive frailtyamong residents, participation in activities andsocialisation with other residents were sometimesrestricted by personal circumstances. Somerelatives and residents commented on staffingissues, and expressed concern that staff weresometimes too rushed to give sufficient attention tothe residents or organise activities.

Individual respondents identified matters that couldhave had a significant effect on the comfort andwell-being of the residents, and homes shouldensure that they have the means of identifying andrectifying these.

The positive responses indicate that care homescan provide welcoming and comfortable places tolive for residents who choose to live in them, andproviders should be able to achieve the standardsof the best.


References

Charlton, A., Buckley, K. and Romanou, E. (2010)Study of Care Home Residents’ and Relatives’Expectations and Experiences. Technical Report.BMRB Social Research, London.

Crosby, G., Clark, A., Hayes, R., Jones, K. andLievesley, N. (2008) The Financial Abuse of OlderPeople: A Review from the Literature. Help theAged, London.

Darton, R., Forder, J., Bebbington, A., Netten, A.,Towers, A. and Williams, J. (2006) Analysis toSupport the Development of the Relative NeedsFormula for Older People: Final Report. PSSRUDiscussion Paper No. 2265/3. Personal SocialServices Research Unit, University of Kent,Canterbury.

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Granger, C.V., Albrecht, G.L. and Hamilton, B.B.(1979) Outcome of comprehensive medicalrehabilitation: measurement by PULSES profile andthe Barthel index. Archives of Physical Medicineand Rehabilitation, 60, 145-154.

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Hussein, S., Manthorpe, J. and Penhale, B. (2007)Public perceptions of the neglect and mistreatmentof older people: findings of a United Kingdomsurvey. Ageing and Society, 27, Part 6, 919-940.

Laing & Buisson (2010) Extra-Care Housing UKMarket Report 2010, 10th ed. Laing & Buisson,London.

Mahoney, F.I. and Barthel, D.W. (1965) Functionalevaluation: the Barthel Index. Maryland StateMedical Journal, 14, Issue 2, 61-65.

Netten, A. and Darton, R. (2003) The effect offinancial incentives and access to services on self-funded admissions to long-term care. Social Policyand Administration, 37, No. 5, 483-497.

O’Keeffe, M., Hills, A., Doyle, M., McCreadie, C.,Scholes, S., Constantine, R., Tinker, A.,Manthorpe, J., Biggs, S. and Erens, R. (2007) UKStudy of Abuse and Neglect of Older People:Prevalence Survey Report. National Centre forSocial Research, London.

Sinclair, I. (1988) Residential care for elderlypeople. In I. Sinclair (ed.) Residential Care: TheResearch Reviewed. Literature Surveyscommissioned by the Independent Review ofResidential Care. HMSO, London.

Towers, A. (2006) Control, Well-Being and theMeaning of Home in Care Homes and Extra CareHousing. PSSRU Discussion Paper No. 2342.Personal Social Services Research Unit, Universityof Kent, Canterbury.

Townsend, P. (1962) The Last Refuge: A Survey ofResidential Institutions and Homes for the Aged inEngland and Wales. Routledge & Kegan Paul,London.

NURSING HOMETHE REGISTERED NURSINGHOME ASSOCIATION

Personal Social Services Research Unit

Requests for further copiesThese should be made to the Registered Nursing Home Association, John Hewitt House,

Tunnel Lane, off Lifford Lane, Kings Norton, Birmingham B30 3JN.Telephone: 0121 451 1088. Email: [email protected]

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