Compare care homes on what actually matters
Almost everything that is easy to compare between care homes — the décor, the garden, the smell of the foyer, the rating on the door — is a weak predictor of the care someone will receive. Almost everything that predicts it well is harder to see and has to be asked for.
Why the tour tells you so little
A care home tour is a sales process, conducted by someone good at it, along a route chosen for the purpose, at a time of day when the home is at its best. That is not a criticism. Every home does it, and a home that could not present itself well would worry you more.
The trouble is that families then compare homes on what the tour showed them, which is buildings. And buildings are the part of a care home that matters least.
What determines whether someone is well cared for is whether there are enough staff on at four in the afternoon, whether those staff have been there long enough to know the residents, and whether the manager is still in post in a year. None of that is visible on a Tuesday morning walk-round.
- How many care staff are on shift at 8am, 4pm and 10pm?
- How much agency cover was used in the last month?
- How long has the registered manager been in post?
- What is staff turnover over the past year?
- What happens overnight, and who is awake?
- How is a resident’s deterioration handled, with an example?
How to run the comparison
Roughly a fortnight of work, done in this order, will tell you more than a month of visits done in another.
Start from the assessment, not the shortlist
Write down the needs that have actually been assessed — nursing, mobility, cognition, night-time, behaviour. Every subsequent question is “can this home evidence that it meets this?”
Screen on paper first
Read the most recent inspection report for each home in full, not the rating. Note the date, the manager’s name, and anything at all about staffing levels or recruitment.
Visit, and ask the staffing questions
Take the questions with you written down. Ask them of the manager, and then ask a care assistant the same thing in a corridor. Where the answers differ, believe the corridor.
Go back, unannounced, at a different hour
Late afternoon is the most revealing time in most homes. So is a weekend. If a home objects to a second visit, that is itself a finding.
Read the contract before you decide
Notice periods, what is included, how fees rise, what happens if needs change, what is payable after a death. This is where the difference between two homes is largest and least visible.
Then compare, on your own criteria
Not on which one you liked. On which one can evidence that it meets the assessed needs, keeps its staff, and has a contract you would sign twice.
The things worth comparing, in rough order
Staffing and turnover
Numbers on shift, agency use, how long the team has been there, whether the manager is registered and settled. This dominates everything else.
Whether it can meet the needs
Not in principle — with evidence. Ask what it does for someone with these specific needs today, and ask to be told about a resident it could not keep.
Nursing cover
If nursing is needed: how many registered nurses, at what times, and what happens at night. This also determines whether NHS-funded Nursing Care applies.
The contract
Notice, extras, fee increases, liability of the signatory, what happens if funding changes. Boring, and the part most likely to cost you.
Location and visiting
Not sentiment — frequency. The single biggest protective factor for a resident is people turning up often, and that depends on how easy it is to get there.
The feel of it, last
It does matter. Are residents up, dressed and doing something? Do staff use names? Is anyone sitting alone in a corridor? Just do not let it outweigh the six above.
The funding questions that belong here, not later
Choosing a home and working out who pays for it are treated by most families as two separate exercises, done in that order. Done in that order, the second one usually goes badly.
If a nursing home is on the shortlist, that is a signal in itself: it means someone has judged that registered nursing input is needed, and that is precisely the territory in which NHS Continuing Healthcare should at least be screened. Once a private contract is signed and fees are flowing, the question gets very much harder to raise.
And if a top-up is being mentioned, the time to ask which affordable alternative was offered is before you choose, not after.
- Has anyone completed a Continuing Healthcare Checklist?
- If nursing is needed, is NHS-funded Nursing Care in the quoted fee?
- Is a top-up being requested, and what was the affordable alternative?
- Is the placement being treated as permanent, or a short stay?
- What is the fee for a self-funder compared with the council rate?
- What happens to the fee when capital falls below £23,250?
Questions about comparing care homes
Is a CQC rating a reliable guide?
It is a useful starting point and a poor finishing point. A rating is a snapshot of one inspection, and homes change — particularly when the registered manager changes. Read the report rather than the headline, look at the date, and pay attention to anything said about staffing.
What is the single best predictor of good care?
Staff. Specifically, how many there are, how long they have been there, and how much agency cover is used. A home with a stable team will usually give better care than a newer, smarter home with high turnover, and it is the question homes are least keen to answer precisely.
How many homes should we look at?
Three is usually enough to calibrate, and more than five stops being useful. What matters more is seeing at least one of them twice, at a different time of day, ideally unannounced.
Residential or nursing — how do we know which?
It should follow from the assessed needs, not from what is available. A nursing home has registered nurses on site; a residential home does not. If a nursing home is being recommended, that is also a signal that NHS funding questions should have been asked.
Should we tell them we are self-funding?
You will usually be asked. Be aware that fees quoted to self-funders are frequently higher than the rate the council pays for the same room, and that the price is more negotiable than most families realise — particularly for a longer commitment or a room that has been empty.
What should we ask that nobody thinks to ask?
“What happens when their needs increase?” A home that will give notice in eighteen months when someone becomes less mobile is not a home you want to move into now. Ask what the home has done for a resident whose needs grew, and ask for an actual example.
Score two homes against each other
Five questions comparing Home A and Home B. No email, nothing stored. The result says which is ahead, on what, and what you still need to find out.
Take it further
The care home visit kit
What to look for on the day, and what to ask while you are there.
Home care, live-in or a care home?
Whether a home is the right answer at all.
Should the NHS be paying?
Ask this before you sign anything, not after.
Care needs assessment
The document every comparison should start from.
You don’t need to know which service you need.
Just tell us what’s happening.
No pressure. No care-provider commissions. Just a conversation about what may help.Independent · no commission from any care provider · fees published
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