How to choose a care home: a practical checklist

Before you look at a single home, get clear on the type of care your parent needs. Residential homes provide personal care: help with washing, dressing, meals and medication. Nursing homes have a registered nurse on duty 24 hours a day and suit people with ongoing medical needs. If you are not sure which applies, our guide to nursing homes versus residential care explains the difference in plain terms.

Ask the local council for a care needs assessment if one has not been done. It is free, it is your parent's right, and it puts the decision about the level of care on a professional footing rather than a family guess. If your parent is living with dementia, read our guide to choosing a dementia care home as well. A diagnosis does not automatically mean a specialist unit is needed, but it does change what you look for.

Start with location. Regular visits do more for a resident's wellbeing than almost anything else, so a home that friends and family can reach easily usually beats a slightly nicer one an hour away. Think about who will visit most often and work outwards from them, not necessarily from your parent's current address.

You can browse care homes by area or search for homes near you to build a first list. Aim for three to five serious candidates. Fewer than three and you have no real comparison. More than five and the visits blur together.

A little desk research saves wasted trips. For homes in England, read each home's inspection report on cqc.org.uk, and note the inspection date as well as the rating, because ratings can be years old. Our guide to CQC ratings explains how to read a report in ten minutes.

Then phone each home. You will learn a surprising amount from how the call is handled. A warm, unhurried person who answers questions straight is a good early sign. On the call, cover the essentials:

• Do they have a room available, or a realistic waiting time?
• Can they meet your parent's specific needs, including any nursing or dementia care?
• What are the weekly fees, and what do they include? Our guide to care home fees covers what to ask.
• Is there a trial period? Many homes offer four to six weeks.
• Can you visit at a time that suits you, including over a mealtime?

Trust your senses. The first ten minutes tell you a great deal. Do staff greet residents by name? Do they crouch down to talk to someone in a chair, or talk over their heads? Is there any laughter in the building? Are call bells answered, or left ringing?

Smell matters. Every care home has the occasional accident, but a persistent smell of urine suggests understaffing or poor cleaning. Try to see a mealtime. Food is a highlight of the day for many residents, and mealtimes show you how staff and residents actually interact when nobody is putting on a show for a visitor.

Look at the residents themselves. Are they dressed, clean and comfortable? Are people engaged in something, or sitting in silence in front of a television? A quiet lounge is not a bad sign on its own, but a whole home with no signs of life during the day is worth questioning. Useful questions to ask the manager:

• How many staff are on duty during the day and at night, and how much agency staff do you use?
• What is your staff turnover like? Long-serving staff are one of the best signs of a good home.
• What activities happened this week? Ask to see the plan, not just hear about it.
• Which GP covers the home, and what happens when a resident becomes unwell?
• Can residents get up, eat and go to bed when they choose?
• How do you involve families in care planning and reviews?
• What happens if my parent's needs increase?

No home is perfect, and one wobble is a prompt for more questions rather than a verdict. Several of these together, though, are a reason to walk away, however convenient the location or attractive the building:

• You are discouraged from visiting unannounced, or from seeing certain areas.
• A persistent smell of urine, or residents who look unkempt or ignored.
• Staff who do not interact with residents, or who talk about them as if they were not there.
• Vague answers about staffing levels, turnover or fees.
• A recent rating of Inadequate, or repeated Requires improvement ratings with no sign of change.
• Pressure to sign quickly or pay a large deposit before you are ready.

Write down your impressions on the same day as each visit, because they fade fast. Score every home against the same short list of criteria: quality of care, warmth of staff, location, cost, and how your parent felt about it. Then go back to your strongest one or two at a different time of day, ideally unannounced, before you decide.

Do not let a beautiful lobby make the decision. Furnishings are the easiest thing for an operator to buy. Warm, consistent staff are the hardest, and they are what your parent will live with every day. As you narrow things down, you can look up care providers to see who runs each home on your list, since the same operator often runs several homes with a similar culture.

Involve your parent at every stage you can. Bring them on visits if possible, or take photos and short videos if not. Their sense of a place matters more than yours. A home that ticks all your boxes but feels wrong to them will make settling in much harder.

If your parent has dementia or finds big decisions overwhelming, involve them in the choices they can still make: which of two homes, which belongings to take, which room. Small choices preserve dignity. If they are reluctant about the whole idea, that is normal, not a failure. Take it slowly, involve their GP or a trusted friend, and return to the conversation rather than forcing it. When the decision is made, our guide to moving into a care home covers the move itself and the settling-in weeks.