4.1 In an ideal world, all residents of care homes would have made up their own minds about when the time was right to have made that move. They would have chosen their future home on the basis of clear and accurate information and after shopping around. The reality is that, in many cases, the decision to place an older person in a care home is taken by others, such as carers, relatives, friends, hospital staff, general practitioners, or social workers. The move to a care home may be at time of crisis, domestic or medical.

4.2 Of those residents surveyed by the OFT, 57% considered that they had had no choice about moving into a care home. The three most common reasons given for the lack of choice were:‘couldn’t cope on my own, illness or disability’ (43%); the ‘family had brought me, sent me’(11%); and the ‘doctor/hospital brought me here’ (10%). The main reason for what residents considered a lack of choice about moving into a particular home was that the ‘family brought me/sent me’ (39%).

4.3 Whatever the circumstances and whoever the decision maker, it is vital that there should be access to a range of accurate, consistent, and user-friendly information about residential homes and nursing homes and related issues, such as how the care of individual residents will be paid for. This chapter reviews the information gaps that exist and looks at ways of addressing them.

4.4 Where anybody feels that they require residential care, they are entitled to have their care needs assessed. Under the National Health Service and Community Care Act, local authorities in England and Wales, and in Scotland are required to carry out such assessments to decide what services need to be supplied. In Northern Ireland, the four boards that carry out both health and local authority responsibilities for health and personal social services on an integrated basis contract with 19 provider health and social services trusts. The assessment processes and the provision of community care services are, however, much the same as elsewhere in the United Kingdom.

4.5 Care assessments can involve a number of different professionals - such as hospital staff, general practitioners, social workers, and district nurses. They can also cover a wide range of issues as, for example, the medical and nursing needs of those being assessed, their ability to carry out basic daily functions, their mobility and sensory functioning, their own wishes, the views of carers, and financial issues.

4.12 The National Care Homes Association operates both a freephone advice line and a freepost service, and can supply information about such matters as financial options, local authority support and social security benefits. It can also put people in touch with a local association adviser. Other national trade associations in the care-home sector provide lists of homes in any particular part of the country enquirers are interested in, but make no recommendations about any specific establishment. Depending on the nature of the query, they direct enquirers to social services departments, voluntary groups, and other appropriate organisations.

4.16 One charity suggested that people were often very ignorant about what they should consider when choosing a care home. Its experience of advising relatives led it to conclude that many people made the critical decision with only the most skeletal information and that social workers either gave them too much information, or too little.

4.17 Since November 1995, one local citizens advice bureau has contracted with a social services department to provide an advocacy service. Two full-time advocates were engaged to represent residents at reviews held six weeks after entering a home and at annual reviews of care plans. The service was originally primarily intended for residents of residential and nursing homes funded by social services departments, but has been extended to be available by referral from relatives, carers, or self-referrals. The issues it has raised on behalf of its clients have been the provision of financial information - such as what options are available to pay fees, and what benefits are available - as well as other care-related issues. The local advice bureau has found that these matters are not always fully explained prior to admission, either to residents or to their relatives.

4.18 The key message to have emerged from the evidence given to the inquiry team was that while there is a wide range of useful data available about care homes and related matters, access to specific information of immediate relevance to particular cases may not be easy. Some commentators claimed that, when prospective residents and their relatives sought information and advice from social services departments, what was provided was not always sufficient or accurate, nor was it tailored to the circumstances of the enquirer. They told us that more information from both local authorities and care homes was required. Residents needed to be clear exactly what had been purchased and what they should expect of the chosen home.

4.19 One relatively recent source of information about individual care homes is the inspection reports compiled and published by registration and inspection units. The reports record what the inspectors found in particular homes and set out their requirements or recommendations for any improvements they feel may be necessary or desirable. Since 1994, such reports on residential homes have been open to public scrutiny at registration and inspection units and at other public places such as town halls and libraries, where copies can be made for a charge. These reports have the potential to be a valuable information tool for prospective residents.

4.23 Concerns were expressed at the absence of any standard-format list detailing what individual homes included in the fees they charged. Extra charges for such services as chiropody were often not discovered until after a resident had been admitted. Brochures varied greatly in clarity and content. Misunderstandings about what facilities and services were covered by the fees were not uncommon.

4.24 The inquiry team was told that some local authorities gave prospective residents an information booklet which itemised what services were covered by the fee and which were ‘extras’. In other areas, however, there appeared to be little information available to potential residents about what extras they might have to pay for.

4.25 The OFT carried out an analysis of brochures from 155 care homes in England and Wales, and Scotland, covering the private, voluntary, and local-authority sectors. This was not a random sample: the brochures were supplied by care homes and their trade associations in response to a direct request for this material.

4.27 The OFT inquiry team concluded that existing brochures frequently did not provide potential residents with adequate information about the level of fees and specifically what they included, what factors affected the fees and what charges were made for extras.

4.28 The Royal National Institute for the Blind estimated that there were around 200,000 older people with some measure of visual impairment living in residential homes and nursing homes. The fact that this handicap was not recognised as a disability as such and the lack of experienced staff meant that the quality of life of such residents was lower than it should have been. Self-evidently, the visually impaired did not have the same access to information as their sighted counterparts, and that information could be worthless if it was presented in a format they were unable to read. Material should be available in the medium best suited to the individual’s condition, whether in large print or braille, or on audiotape.

4.29 Those directly involved in the care-home sector encourage prospective residents (or their family, or carers) to visit the homes being considered, and most of the literature produced by private, voluntary, and public organisations also recommends visiting homes in advance. Material produced by social services departments and charities sometimes includes a helpful checklist of points to consider when making such a visit.

4.30 One care-home owner told the OFT that any written document was limited in its usefulness, and he usually advised people to visit the home and talk to the person in charge. A number of other care-home owners also brought up this last point, and further suggested that, in addition to giving enquirers as much written and verbal information as possible, prospective residents might be encouraged to stay for a day or so on a trial basis.

4.31 The OFT’s survey of residents showed that half (50%) of those questioned had ‘looked around’ the home to which they subsequently moved. The most common reason cited for having chosen a specific home was that they had liked it when they had made that preliminary visit. Reflecting that response, for the 31% of residents who had considered another home, the most common reason for not choosing the alternative was that they had not liked it when they had visited it. These results indicate that a greater emphasis should be put on the desirability of prospective residents visiting a care home than relying on the contents of the home’s brochure.