Start with the care, not the building
Most families start by looking at photographs. It is understandable, and it is the wrong order. A beautiful home that is not registered for the care someone will need in eighteen months means a second move at the worst possible time. Get the care category right first, then compare the homes that qualify.
- 01Establish the care type needed now. Residential, nursing, dementia, respite or palliative. A local authority care needs assessment is free, and it is the clearest way to settle this.
- 02Ask what is likely in two years. If needs are progressing, a home registered for both residential and nursing care avoids a future move.
- 03Set a realistic radius. A home ten minutes from a daughter's door gets visited several times a week. One forty minutes away gets visited at weekends. Visit frequency is the single biggest predictor of how settled someone becomes.
- 04Check the money before you fall in love with a home. Work out the weekly contribution using our care home costs guide so your shortlist is affordable from the start.
- 05Shortlist three to five homes, no more. Beyond five, families stop comparing and start drowning.
How to read Care Inspectorate grades properly
Every care home in Scotland is regulated by the Care Inspectorate and graded on a six-point scale. The grades are published free at careinspectorate.com, along with the full inspection report.
| Grade | Meaning | How to read it |
|---|---|---|
| 6 - Excellent | Outstanding, sector-leading | Rare. Worth reading the report to see what the inspector singled out. |
| 5 - Very good | Major strengths | A strong, well-run home. Most good homes sit at 4 or 5. |
| 4 - Good | Important strengths, minor areas to improve | Perfectly respectable. Read what the minor areas were. |
| 3 - Adequate | Strengths just outweigh weaknesses | Worth a conversation. Ask what has changed since the inspection and what the improvement plan looks like. |
| 2 - Weak | Significant weaknesses | Ask the manager to talk you through the findings, the action taken and the timescales. |
| 1 - Unsatisfactory | Major weaknesses, urgent action required | Ask for the documents: the full inspection report, the improvement plan, any requirements and their deadlines, and the most recent progress update. |
Check the grades for each of the four themes rather than the headline. A home can be strong on care and support but weaker on the setting, which may matter a great deal or hardly at all depending on the person. Also look at carehome.co.uk reviews for the family perspective, while remembering that review sites over-represent both the delighted and the aggrieved.
What to notice on a visit
Visit at least twice, and make one of those visits at a busier time of day - late afternoon is revealing, because that is when homes are at their busiest. Brochures and show rooms tell you about the marketing budget. These things tell you about the care.
- Do staff talk with residents or about them in front of them?
- Does anyone greet residents by name in passing, including staff who are not on care duty?
- What does it smell like at 4pm, not at 11am?
- Are residents dressed as individuals, with their own clothes, jewellery and hairstyles?
- Is anyone doing anything, or is a television on to an empty room?
- How many call bells are ringing, and how long do they ring for?
- Are bedrooms personalised with photographs, furniture and possessions?
- Do residents look like they have been outside recently, and can they get outside independently?
- Ask a member of care staff how long they have worked there. High turnover is the most reliable warning sign in the sector.
- Eat a meal there if you are offered one, and look at what is being served to residents who need help eating.
If the person going into care is able to visit, take them. Their reaction in the first ten minutes is usually more accurate than a fortnight of family deliberation. If they cannot visit, ask whether the home will send a manager to meet them where they are - a home that will not is telling you something.
The questions worth asking
Group your questions so you can compare answers across homes rather than collecting impressions.
- Care. What is your staff-to-resident ratio on days and nights? How many staff are agency? Who leads care planning, and how often is a plan reviewed? What happens when needs increase - can you keep the person, and at what point would you not be able to?
- The team. Ask the manager how long colleagues have been at the home. Length of service tells you a great deal about how a home is run. Here at Meallmore we have colleagues who have been with us since the very beginning, and our managers are always happy to introduce you to them.
- Health. Which GP practice covers the home? How quickly can a GP or district nurse attend? How do you manage medication, falls and hospital admissions? What is your approach to end-of-life care?
- Daily life. What does a typical Tuesday look like? Can someone get up and go to bed when they choose? What happens for people who do not enjoy group activities? Can residents keep pets, drink alcohol, have a key to their room?
- Food. Are meals cooked on site? Can I see this week's menu? What happens if someone dislikes what is served, or eats at unusual hours? How are texture-modified diets handled?
- Family. What are your visiting arrangements? Can we join for meals? How and how often will you update us? Who do we call at 9pm on a Sunday? How do you handle complaints, and can I see your complaints policy?
- Money. What is the weekly fee for this specific room and this level of care? What is excluded? When and how are fees reviewed? What notice period applies on both sides? What happens if funding circumstances change?
Warning signs and reassuring signs
| Worth a second look | Reassuring |
|---|---|
| Difficulty arranging a second visit at a time that suits you | Open invitation to come back at different times of day, including at meals |
| Manager changed three times in two years | A manager who has been there for years and is known by residents |
| Heavy agency staffing | Named key workers and low turnover |
| Vague answers on fees and extras | A written fee schedule and a clear extras list |
| Residents seated in a ring around a television | Small groups, varied activity, people moving about |
| Unwilling to discuss a past inspection finding | Straightforward account of what was found and what changed |
None of these is disqualifying on its own. A home may be heavily reliant on agency staff because a flu outbreak hit last week, and a new manager may be exactly what a home needed. What matters is whether you get a straight answer when you ask.
Making the decision, and what happens next
- 01Compare your shortlist on a single sheet: care types, grades, weekly fee, distance, and your own gut score out of ten.
- 02Involve the person going into care in whatever way they can manage, even if the decision ultimately rests with the family.
- 03Ask for a pre-admission assessment. A good home will want to meet the person before agreeing a placement, and will decline if they cannot meet their needs.
- 04Read the contract properly, particularly fee reviews, notice periods, and what happens if needs change or funding changes.
- 05Agree a moving-in plan: what furniture and possessions come, who visits in week one, and who is the named contact at the home.