This article is about a hard hour: visiting a care home with a relative at home waiting on a decision. We wrote it for families, but it also serves whoever runs an institution — because these are the questions they will start hearing, and it is worth having answers.
One note of honesty upfront: we manufacture a system used in care homes. None of the questions below is about our product, and most good institutions answer them well with no technology at all.
What almost everyone asks
Single or shared room, menu, price, distance, whether there is a doctor. Necessary questions and insufficient ones: they are all about facilities and contract, the visible part and the easiest to arrange for a visit.
What decides someone's life inside is different — what happens between meals. A day has fourteen waking hours.
The twelve questions
About the day
- What are most people doing right now? Ask it while looking at the room. The best answer matches what you can see.
- How many hours a day is the television on in the common room? Not to condemn television. To understand whether it is the programme or the ambience.
- What happens between 3pm and 6pm? It is the window where agitation most often appears in people with dementia, and where the difference between institutions is largest. We have written about sundowning.
- Who does not leave their room, and why? Every institution has those residents. The good answer names them and explains; the bad answer is that there are none.
About activities
- Who plans the activities, and with what training?
- What do you do with those who do not join in? The most revealing question on the list. A plan only for those already joining in is half a plan.
- Are there individual activities, or only group ones? People with advanced dementia, hearing loss, or who simply dislike groups fall outside programmes that are group-only.
- Is it recorded what each person did? Or is the record only medication and incidents? Without a record, nobody can say in three months whether anything changed.
About family and the person
- How do you find out what this person used to enjoy? Is there a life-history conversation, or an admission form? Biography is the only thing that makes an activity personal.
- What are the visiting hours, and what happens outside them?
- How does the family in England speak to her? Half of Portuguese families have someone abroad. If the answer is "we have the phone in the lounge", that is an answer.
- Who calls me if something changes, and how quickly?
Signs that should worry you
- "We have activities every day" without being able to describe yesterday's.
- An activity plan on the wall, out of date. It says more than no plan at all.
- Everyone seated in rows facing the same direction, at any hour.
- No answer about those who do not join in.
- Technology displayed on the visit with no agreed use. True of our equipment as much as anyone's: if it is on a shelf impressing visitors, it is not being used.
About technology, frankly
If they show you equipment — virtual reality or anything else — ask three simple questions: how many sessions last month, who runs them, and where is that recorded. If there is no answer to those three, the equipment is decoration.
And the reverse is also true: a care home with no technology at all can be excellent. What distinguishes them is not equipment, it is having someone who knows the person's name, what they used to enjoy, and what they did yesterday.
In short
- The visiting hour is spent almost entirely on what matters least.
- The most revealing question is what they do with those who do not join in.
- Without a record of what each person does, nobody can prove anything — good or bad.
- Equipment with no counted sessions is decoration.
- A good care home without technology beats a bad one with it.