This site is intended for health professionals only

Read the latest issue online
Winter work


What does a good care home look like?


George Coxon, author.


I will immediately confess, the question of what ‘good’ looks like always gets my hackles up. The question feels jargonistic to me and not the type of question that ordinary people might ask. Or am I being unfair?

However, within the care home sector, we do ask this of ourselves and each other. Invariably, it’s a question that can feel a little weaponised, uttered in a mildly passive aggressive accusatory way, but again, perhaps I’m being overly sensitive and defensive.

For care homes, we know there really is no single answer to this anyway. The idea behind the oft-repeated adage ‘once you’ve visited one care home, you’ve visited one care home’ is seen in similar slogans and comments, such as from our chief executive at the NMC, Andrea Sutcliffe. She often commends to us the mum test – ‘is it good enough for my mum?’ – even though no two mums have the exactly the same views on what good looks like. But I must confess, with sincerity, that I do really like the mum test as a way to embed high standards and refer to it often, and I have nothing other than great respect and high regard to Andrea, who I know well.

However, to return to the question of what a good care home does look like, I fear I may have given the impression there is no legitimate answer to this. Despite what I’ve said so far, I will chance my arm and attempt to correct myself.

My many years of walking the walk and talking the talk as a hands-on care home owner has given me a set of principles, lived experience views, values and beliefs and frontline reflections that I would like to share. I’m hopeful that reading this short piece can be of value to those with a personal or professional interest. Let’s face it, if we or any of our loved ones live long enough, a care home move will in all probability enter the equation to ensure safe and cheerful longer-term care for us all.

Knowing ‘good’ when you see it

First, it truly is a personal thing, but objective measures to start us off should be the many practical factors, for example: Where is the care home? How big is it? What atmosphere and ‘vibe’ has it got? Does it have a garden? What about staff – how good is the staff retention? Can this meet my needs of those of the person I’m looking to find a new home? And of course, is it affordable?

A personal caution from me here – don’t be too enthralled to the palatial glossy marketing on offer – it’s the ambiance, character, culture and care that really matter.

Consider what type of home is right for the person looking. Look at factors such as autonomy and independence and/or help with everyday living; the person’s future care needs. Are there good links with NHS colleagues, such as the local GP practice and visiting professionals, and what about a visiting chiropodist, hairdresser or masseur? Think about bedroom size. Can I bring my pet? Does it allow alcohol and even smoking (for those who still like a smoke now and again)?

Second, what about leadership and how visible is this? Is there a website that conveys useful important and interesting things about the home and what goes on there? Is there a good balance of entertainment and choices of how to spend time? For example, are there opportunities to do things that the person enjoys as well as relax and not be corralled about the place in a semi-institutionalised manner? Another good measure is can I get a cup of tea whenever I want one?

Listing the factors that are important to you, and being prepared for your visit with a personalised checklist is recommended.

The final set of pointers I venture to offer are reflections on what matters to care homes as much as to those looking to live in one.

We talk about four essentials:
• Occupancy – if the care home is running on several empty rooms this might raise concerns about why this is the case and how viable the service is. We say in my care homes that we want a full house of well looked after people having a great time including having lots of fun (see my article on fun-guarding published by the British Geriatrics Society).
• Workforce – we want and need a great team of staff doing the right things well, having a great time enjoying their jobs, and feeling well trained, positive and proud of the home and their roles within it.
• Reputation – a lesson we must all learn early in our career, if not our lives, and certainly in our care homes (we stand or fall by how we are talked about by others) is what those who know us say when we aren’t in the room; the comments from residents and family/loved ones and neighbours, or the professionals we work with.
• Inspection status – this is an obvious measure of any service that is subject to the care quality standards measured and determined by the Care Quality Commission. A poor inspection is a powerful indicator of what good doesn’t looks like for the curious and questioning prospective new arrival/entrant.

But a final confession – several in this short reflective piece – is to caution that, even given my self-critiquing and numerous conversations with colleagues in compiling this advice, I know that a combination of my blind spots and the inherently personal nature of what good might look like leads me to conclude that only you can actually decide what good looks like to you. To suggest that anyone else can say this for you is wrong.