This nursing home evaluation checklist is intended to assist you make informed choices when placing a relative into an Australian aged care home.

As with any major decision-making process, finding the right nursing home is a staged (step-by-step) process. But making these emotionally charged decisions can make it extremely difficult to focus and really understand the process and making the right decisions.

Online reviews and ratings

Be especially careful of aged care ratings websites which on the surface, appear as professional and authoritive websites on providing reviews to the public.  It may well be that some of these websites may be run by dedicated individuals who want to make a real difference in aged care, however others may be more profit-driven and focussed. 

To be able to evaluate any service properly, people need more than just some superficial "star rating" with a short comment, from a limited number of individuals.  In all cases, we would suggest you check to see who is running the site (names, company/private, etc), importantly, any links to industry; the funding and payment arrangements for aged care listings, and whether any of this information is made publicly available. If this information is not publicly available, then what else is being hidden? 

  • Related: Care home PR – secrets revealed! - "... Never before has it been so absolutely vital for your care home’s listing ... to be super-charged with 'good news' stories ..."

Information and where to find it

Due to the recent Machinery of Government changes, the Ageing and Aged Care functions and activities of the portfolio transferred back from the Department of Social Services, to the Department of Health as of 30 September 2015. As a result, some of the links to content may not yet be fully transferred to the Department of Health.

The following are the official Government websites that contain information on aged services in Australia:

  1. MyAgedCare: www.myagedcare.gov.au
    Basic information about aged care services include contact and location, accommodation pricing and status of home - and not much else: Service finder - Aged care homes; Service finder - Home care
  2. Department of Social Services: www.dss.gov.au
    Aged Care Sanctions and Notices of Non-Compliance: Information about regulatory action taken against aged care homes by the Department of Social Services.
  3. Australian Aged Care Quality Agency: www.aacqa.gov.au
    Reports: The body established by the Australian Government to accredit residential care services and home care. You can search and download accreditation reports (announced visits only).

Nursing home evaluation checklist

FAQs and nursing home information primer

Q: I can't seem to find much information about a service apart from costs and contact details (on the MyAgedCare website) - where can i go to get more information?

As the Australian government moves aged care towards a 'free-market' model and significantly reduced red tape, this seems to have impacted on their responsibilities and hindered their ability to provide useful information. Hopefully you will be proficient with Google search, or perhaps perusing independent websites springing up each week (some are independent - others not so much) by various companies that may profer small insights on life in nursing homes.

Q: What are the staff to resident ratios in aged care?

Australia has no federal legislated safe staffing ratios or mandated skills in aged care. Nurses and carers frequently report that they are not able to care for residents properly, given the conditions and time restraints imposed on them.

The Aged Care Act 1997 has little to say about staffing, with the most vital aspect of care provision summarised in just one short sentence:

  • "(b) to maintain an adequate number of appropriately skilled staff to ensure that the care needs of care recipients are met"

Source: Aged Care Act 1997 - Part 4.1 - Quality of care - 54-1 Responsibilities of approved providers - (b)

Q: In the absence of federal legislation mandating safe staffing ratios and skills in aged care, where can I find information about the staffing and skill levels in an aged care service?

You can't. Not one aged care provider (to our knowledge) publicly publishes their staff/resident ratios and skills rosters. Please do let us know if you find any different.

Q: Where can I find substantiated complaints about a service?

You can't. Family members are often shocked to learn that it is still possible for a home to breach its responsibilities as an approved provider under the Aged Care Act, have serious complaints substantiated against it - including physical or sexual assaults - and yet still manage a perfect accreditation score ... as well as avoid any public scrutiny whatsoever.

You may be reviewing a facility that's had 30 complaints upheld in the past 12 months, be the subject of police investigations for physical or sexual assault, and you'd never know.

Q: Where can i find the Agency reports outcomes to the 'unannounced visits'?

These reports are never made publicly available. No exceptions.

Q: What reports can i find of a service?

The majority of (announced) visits - are 'site audits'. These types of visits are well known and prepared for in advance at a mutually convenient time. Presently, these occur once every three years, but more recent changes (under the guise of the "Innovation Hub") indicate it may be up to five years.

Q: Are these reports the ONLY source of information I can find on any Australian government funded aged care home?

Yes.

Q: What if a non-compliance or something is found on an unannounced visit - are these results ever made publicly available?

No, they are not.

The Company: who are they?

Don't assume because the place looks like a grand hotel that your relative will be looked after.  Looks can be very deceiving.  The company will now be charged for the 24/7 care for your family member.  A bit of background checking prior will not only give you piece of mind, but also the confidence that you have make an informed choice for your loved one.

The choice you make here will have the greatest impact into your relative's care.  If the aged care provider is reputable with no known issues, fantastic - but if not, then you should think again.

The owner

  • Who actually owns the nursing home?
  • Are they listed on the stock exchange?
  • What is their classification (religious; charitable; community based; not-for-profit; for profit; local government;) 
  • Do they have previous experience?
  • Are the Directors from care or health based backgrounds?
  • Are any of the Directors under any form of investigation?
  • Are the Directors (or company) from a company overseas?

Finances

  • Checking finances of the company can provide you with a good indication of the aged care home's income and expenses.  If finances are stretched then this could have a direct impact on your relatives care as cash flow dictates general day-to-day operations of the home.

The Australian Aged Care Quality Agency (AACQA)

The majority of site visits are not made publicly available nor published.  For example, the majority of visits are unannounced, or perhaps the result of a complaint.  These reports are never made publicly available.

The Agency, as it is currently structured, has two conflicting roles - a regulatory function and an educative function.  While it is beneficial to have a co-operative body assisting aged-care homes improve the quality of care provided, it can be problematic when that body also performs a monitoring and assessing role and publishes the results of those assessments within the aged-care market place.  Such a conflict of interest cannot be sustained and acts against the well-being of frail people in residential care.

  • When was the last AACQA inspection? What was the report findings?

Note:    You should be able to request previous copies of (cyclical pre-announced visits) site audit reports - even though the current report findings seem to be only ever published.

  • Has the operating company ever had any significant issues with AACQA?  (You may need to seek independent sources for this information, as the Agency does not make this information publicly available.)
  • What is the full history of the home and company with AACQA?
  • How many times has AACQA visited the home and what was the purpose/reasons for those visits?

Tip: Only a small handful of reports are ever made publicly available - the majority of those visits are performed as part of the accreditation 3 yearly life-cycle (this may be changing to 5 or more years).  These visits are the result of pre-announced visits, often at the request of the nursing home, at a convenient time, after the homes may have spent weeks/months preparing. 

They tell us that the nursing home knows what it is supposed to do but gives no information about what happens on the other 1,093 days of the cycle. They are of little value to a community, anxious about those who lack motivation to provide quality care.

As an example of the type of information collected and published, the Care Quality Commission in the UK has a much more progressive model where much more information is made publicly available.

The *nursing home

Now called 'residential aged care facilities or RACFs' - as nurses and in many cases, 'nursing' has been removed.

These are some of the things that perhaps you wouldn't think to ask or look for when embarking on choosing a nursing home - or perhaps even, take for granted and wish you had of checked after the cooling off period.

Health and safety

  • Ask to see a brief report of the Health and Safety report of the home. This is a good indicator with regards to not only incidents that have taken place but also incidents against clients and incidents of clients against staff. Use this report as part of your report and is a very important aspect.

Courts, State Tribunals and staff

  • Are there any incidents of the staff taking the home to court? If so and for what reason?

Additional checks

It is worthwhile checking the following websites to see if any issues have been noticed with the perspective home and operating company.

The bedroom

The bedroom is a critical component in your relative's care as they will spend a large majority of their time in their bedroom. The room has to be fit for purpose, clean, safe, tidy, comfortable and welcoming.

  • The room you are being shown today for you relative is it a show room? Or the actual room your relative will live in?
  • Can you see the actual room? How often is the room cleaned?
  • How many panic alarms are in the room?
  • Can the panic alarms be easily accessed by your relative?
  • If shared, do curtains provide privacy?

Bedroom, furnishings and equipment

  • Is the bed sturdy and damage free?
  • What mattress will be used? (Normal, Memory Free, Nursing Mattress) ; Will my allergies be taken into consideration?
  • Are the floor matt alarms clean, working and not showing signs of damage?
  • Lockable safe for possessions and who has access?
  • Wardrobes and cupboards space for your relative's clothes?
  • Is the bedroom lockable and who else has access to the room?
  • Does the carpet smell, or show signs of excrement stains or urine stains?
  • Does the carpet shows signs of bleaching effect to remove stains?
  • When you walk on the carpet does it feel sticky?
  • Ask how often the carpets are replaced?
  • Are the carpets fire retardant?
  • Check if it is clean under the bedside tables.
  • Are bedrooms large enough for equipment - eg, wheel chair, hoist or machines, TV, etc.

Heating and cooling

  • Where is the heating in the room and location of the controls; 
  • Does it cost any extra to use the heating?
  • Where is the air conditioning in the room and location of the controls; 
  • Importantly, does the air conditioning and/or heating work?
  • Does it cost any extra to use the air-conditioning unit?

Fire safety, sprinklers and fire exits

  • Does the home have fire safety sprinklers installed?
  • If your relative is restrictive in movement, how long would it take to get to the nearest Fire Exit? Can a member of staff show you that the Fire Exits fully work?
  • Can a member of staff show you the outside Fire Exits and are fully operational and safe?
  • Can the fire exits accommodate immobile resident's on their wheeler/beds? (is it wide enough to wheel residents out if need be in an emergency)

Cleaning, housekeeping and staff

  • What is the minimum level of cleaning staff needed to maintain standard?
  • If shortages of staff, do you take in outside cleaning staff?
  • Do the cleaning staff perform any other duties? (eg, feeding residents, caring duties, etc.)

Laundry

  • Will your relatives clothes have name tags in them? Who will cover this cost?
  • Who will cover the cost of replacement clothes due to Laundry Damage? How often will your relatives Laundry be cleaned?

Bedroom rotation policy

  • How often are existing clients moved to different rooms?
  • A large rotation policy could indicate profit driven moves based on income derived from new clients. The obvious factor is that continuously moving an individual from room to room will have an impact on their mental state and awareness to their surroundings.

Communications:  internet, telephone sockets, mobile phone reception

  • Will the room have Internet facilities so that your loved one can go online and keep their social circle continuing? 
  • If so, is this an "extra"?  How much?
  • Will the rooms have a telephone point or dect phone so that your relative can make phone calls in private?
  • Is there mobile phone reception in the room?

Aged Care home insurance

  • Will your personal valuable be insured whilst living at the Care Home?
  • Is there an excess on the policy?
  • Who would pay the excess?

Personalisation

  • Can you have personal pictures put up on the walls?
  • Can your relative have their own furniture in their room?
  • Can your relative use his or her own bedding?

What else to look for:

  • Wall, skirting & door frame damage from medical beds being moved.
  • Sink areas especially tap heads, look for lime scale which would show regular cleaning or not. Exposed heating pipes without cladding.
  • Any electrical aspects such as loose lights or plug sockets damaged. Damage to the bedroom door from medical beds or wheelchairs. Faded wallpaper & and paint.
  • Windows with curtains that work.
  • General signs of neglect in the bedroom.
  • Access to outdoor (safe) areas?

Care and services - what's included / extra charges?

Specifically, request if there are any charges for the items below, and how much:

  • Telephone - is the connection and phone supplied, or is this extra? How much?
  • LCD screen in room - included or additional charge?
  • Personal bar fridge?
  • Safe / digital for keepsakes
  • Individual climate control air conditioning - how much?
  • Access to DVD library?
  • Access to internet - what type and how much?
  • Cost of prescriptions - pharmacy / chemist costs?
  • Are pads rationed (per day usage)? (are they readily available or kept under 'lock and key')

Care and services - what's included?

Important: You need to check the residential aged care "agreement", or "information handbook" to understand what additional fees will be charged, however, the facility is obliged by law to provide you with the following:

Source: Quality Aged Care Principles 2014
Schedule 1—Care and services for residential care services
Part 1—Hotel services—to be provided for all care recipients who need them

Item

Column 1
Service

Column 2
Content

1.1

Administration

General operation of the residential care service, including documentation relating to care recipients.

1.2

Maintenance of buildings and grounds

Adequately maintained buildings and grounds.

1.3

Accommodation

Utilities such as electricity and water.

1.4

Furnishings

Bedside lockers, chairs with arms, containers for personal laundry, dining, lounge and recreational furnishings, draw‑screens (for shared rooms), wardrobe space and towel rails.
Excludes furnishings a care recipient chooses to provide.

1.5

Bedding

Beds and mattresses, bed linen, blankets, and absorbent or waterproof sheeting.

1.6

Cleaning services, goods and facilities

Cleanliness and tidiness of the entire residential care service.
Excludes a care recipient’s personal area if the care recipient chooses and is able to maintain this himself or herself.

1.7

Waste disposal

Safe disposal of organic and inorganic waste material.

1.8

General laundry

Heavy laundry facilities and services, and personal laundry services, including laundering of clothing that can be machine washed.
Excludes cleaning of clothing requiring dry cleaning or another special cleaning process, and personal laundry if a care recipient chooses and is able to do this himself or herself.

1.9

Toiletry goods

Bath towels, face washers, soap, toilet paper, tissues, toothpaste, toothbrushes, denture cleaning preparations, mouthwashes, moisturiser, shampoo, conditioner, shaving cream, disposable razors and deodorant.

1.10

Meals and refreshments

(a) Meals of adequate variety, quality and quantity for each care recipient, served each day at times generally acceptable to both care recipients and management, and generally consisting of 3 meals per day plus morning tea, afternoon tea and supper;
(b) Special dietary requirements, having regard to either medical need or religious or cultural observance;
(c) Food, including fruit of adequate variety, quality and quantity, and non‑alcoholic beverages, including fruit juice.

1.11

Care recipient social activities

Programs to encourage care recipients to take part in social activities that promote and protect their dignity, and to take part in community life outside the residential care service.

1.12

Emergency assistance

At least one responsible person is continuously on call and in reasonable proximity to render emergency assistance.

Source: Quality Aged Care Principles 2014
Schedule 1—Care and services for residential care services
Part 2—Care and services—to be provided for all care recipients who need them

Item

Column 1
Care or service

Column 2
Content

2.1

Daily living activities assistance

Personal assistance, including individual attention, individual supervision, and physical assistance, with the following:
(a) bathing, showering, personal hygiene and grooming;
(b) maintaining continence or managing incontinence, and using aids and appliances designed to assist continence management;
(c) eating and eating aids, and using eating utensils and eating aids (including actual feeding if necessary);
(d) dressing, undressing, and using dressing aids;
(e) moving, walking, wheelchair use, and using devices and appliances designed to aid mobility, including the fitting of artificial limbs and other personal mobility aids;
(f) communication, including to address difficulties arising from impaired hearing, sight or speech, or lack of common language (including fitting sensory communication aids), and checking hearing aid batteries and cleaning spectacles.
Excludes hairdressing.

2.2

Meals and refreshments

Special diet not normally provided.

2.3

Emotional support

Emotional support to, and supervision of, care recipients.

2.4

Treatments and procedures

Treatments and procedures that are carried out according to the instructions of a health professional or a person responsible for assessing a care recipient’s personal care needs, including supervision and physical assistance with taking medications, and ordering and reordering medications, subject to requirements of State or Territory law.
Includes bandages, dressings, swabs and saline.

2.5

Recreational therapy

Recreational activities suited to care recipients, participation in the activities, and communal recreational equipment.

2.6

Rehabilitation support

Individual therapy programs designed by health professionals that are aimed at maintaining or restoring a care recipient’s ability to perform daily tasks for himself or herself, or assisting care recipients to obtain access to such programs.

2.7

Assistance in obtaining health practitioner services

Arrangements for aural, community health, dental, medical, psychiatric and other health practitioners to visit care recipients, whether the arrangements are made by care recipients, relatives or other persons representing the interests of care recipients, or are made direct with a health practitioner.

2.8

Assistance in obtaining access to specialised therapy services

Making arrangements for speech therapists, podiatrists, occupational or physiotherapy practitioners to visit care recipients, whether the arrangements are made by care recipients, relatives or other persons representing the interests of care recipients.

2.9

Support for care recipients with cognitive impairment

Individual attention and support to care recipients with cognitive impairment (for example, dementia and behavioural disorders), including individual therapy activities and specific programs designed and carried out to prevent or manage a particular condition or behaviour and to enhance the quality of life and care for such care recipients and ongoing support (including specific encouragement) to motivate or enable such care recipients to take part in general activities of the residential care service.

The kitchen, restaurant, food, liquids & nutrition

Eating out, cooking at home, ordering a take away and having friends round for dinner are all aspects of our social life that sometimes we may take for granted.  To a larger extent, we have a say in what we would like to eat and drink on a daily basis, we know where most of the produce we consume originates from and we trust our choices.  

We trust the choices of others, and especially with regards to professional environments such as aged care homes, we trust them to look after our relatives to the level we expect.

Diet, social eating and regular meals all play a part in our lifestyle and the same should apply to your relative in an aged care home too. Just because they may not be as mobile or mentally astute any more does not been they are not entitled to a healthy diet with regular meal times and plenty of food and fluids.  A lot of us now, would take these choices for granted - but this is an important marker of the day for many patients in nursing homes.

Ask to sit down and try out the food at different meal times

I would offer to pay for the meal, but you should at least sit down for breakfast, lunch and dinner on separate days. This will not only give you an indication of the level of food, delivery and staff interaction, but as the majority of the existing residents will be collectively together for meals time, it will also give you an indication of resident morale and behaviour.

Eating your meals

  • Meal times: sometimes residents get nothing from 5pm onwards, until 8am or later the next day - please check what the kitchen/close policy is.
  • Do you have to sit down in the dining room?
  • Can you eat your meals anywhere else besides the dining room?
  • How many one to one take place at meal times?
    (If there is a lot of clients being fed by carers then this obviously reduces the time and availability of cares to manage everyone else including your relative).

Snacks in between

  • Will the home provide snacks and drinks in between meal times?
  • What are the snacks available? Is there an additional cost?

Food budget

  • What is the daily food budget per client?
  • What does the food budget cover?

Client food storage

  • Will the aged care home provide a small section in the Kitchen Area / Pantry for your relative to store some of their own food produce? i.e. Chocolate Biscuits or favourite cheese.

Take away food

  • What is the aged care home policy on Take Away? Would your relative be allowed to order take away to be delivered to the home?

Food sources, hygiene inspection & history

  • It doesn't have to be organic but it has to be fit for purpose. Ask the aged care home to show you where they source their food?
  • Do they use produce near to "use by date" to save money?
  • I would ask the aged care home to show you the Food Hygiene Inspections

Menu choice and meal times flexibility

  • How often is the menu changed?
  • Is it varied based on existing clients needs?
  • Is it at least two main meal choices per sitting?
  • What are the times for meals?
    If left for extended periods, are the main meals placed/warmed up on a hotplate?
  • Is your relative able to have meals in their room if they wish?  Is there additional charge to this?
  • Are residents assisted with removing 'glad wrap' or similar wrap/covers on their feed and with pouring of drinks?
  • Are residents involved in menu planning? Can they request special foods? Are snacks available?
  • Does the dining room environment encourage residents to relax, socialize, and enjoy their food
  • How far is your relative’s room from the dining room?
  • Would the food still stay warm whilst in transit to your relative's room?
  • Can meals be provided at a time a resident would like or are there set times for meals?
  • Can residents have guests for meals in the dining room for an additional fee? Is there a private dining room for special events and occasions?
  • Are the helpings sufficient?
  • Packed Lunches:  If your relative is intending to have days out from the aged care home, will the aged care home provide packed lunches? If so, is there a charge or is it included in fees?

Dietary requirements

As we grow older in life sometimes our dietary requirements have to change based on medical issues or simply a change in preference, a simple choice of wishing to eat something else.

  • Is the aged care home able to adapt to changes and what are the associated costs?
  • Will the aged care home keep you informed?

Patient choice and input

The first area to investigate is whether residents are allowed to make choices about their daily routine.  Residents should be allowed to make some decisions such as when to go to bed, get up, bathe, or eat. (some restrictions concerning the routine can be expected)

(An example of not respecting patient choice or input may be: some homes make a practice of feeding residents their last meal at an early time (ie, late afternoon instead of early evening;  or, they may routinely put residents to bed at an early hour to ensure minimum staff is required for resident care during the night; or maybe residents are woken extra early to appease the shift roster and not patient choice.)

If the resident has special needs, it is important to see how the nursing home accommodates such needs

  • Is there a resident's committee and/or a family member's group?
  • Do they have regular meetings?
  • Do residents and their families feel comfortable speaking up at these meetings?
  • Can anonymous suggestions be made? (Consumer input is a requirement under the government's standards.)
  • Is the home's documentation available in the language you need? (ie, the Agreement you sign on entry to the nursing home; complaint forms; etc.)
  • Are you permitted to have your own family physician visit your loved one? (sometimes, nursing homes insist on using their own doctor, as well as their own pharmacy).
  • Are the residents and their families encouraged to have input into the quality of care?

Day to day living, social and recreation

An integral part of daily existence is activities and social interaction.  Without a purpose, without something to do a person’s ability to function is severely effected. So if you get bored when you have nothing to do, imagine what it is like for a person to live in a Care Home with nothing to do except meal times?

Social and recreational activities are important - some facilities attitude of 'activities' may simply be limited to placing your loved one in a wheelchair, dumped in a room facing a television, or lined up in a hallway.

Look for notices or posters within the Care Home advertising or displaying activities. Again just because it is listed does not mean they take place. An unannounced visit by yourself on activity days would show whether they are actually taking place or not.

Ask the Care Home what daily activities take place then come back another day and see if they are actually taking place or not. Things to look and ask for would be (this list is not exhaustive and is just to give you an idea):

  • Day Trips
  • Excursions
  • Social support from outside
  • Newspapers and magazines
  • In House Activities (examples) Bingo
  • Film club

Social and recreational activities

  • What kinds of group/individual recreational activities are offered and who schedules them?
  • Is there a full-time diversional therapist? (These should have a certificate and be trained for the job - cost-cutting measures can lead to untrained recreation officers fulfilling this role)
  • Is there an organised activities program with a posted daily schedule of events?
  • Do volunteers and family members come into the facility to participate/conduct programs?
  • Does the facility schedule trips or go to other events off premises?
  • Do residents participate in activities outside of the facility in the neighboring community?
  • Are the resident activity (social) areas appropriate and desirable to the prospective resident?
  • Are there supplies for social activities/hobbies (games, cards, crafts, computers, gardening)?
  • Are religious services held on the premises or arrangements made for nearby services?
  • Are there fitness facilities, as well as regularly scheduled exercise classes?
  • Does the nursing home create a sense of community by allowing residents to participate in certain activities or perform simple chores for the group as a whole?
  • Does the facility have a garden and allow residents who can participate in gardening activities?
  • Does the facility have pets? Who is responsible for their care?
  • Does the facility encourage "Pet Therapy" visitations?

Visitor policy

  • What is the visitor policy with regards to seeing your relative? (access, etc.)

Outside communication

  • Will you relative have access to a phone, internet or mobile phone to contact you?
  • Can you relative have their mail/post delivered to the Care Home?

Trial stay

  • Is it possible for your relative to have a trial stay to see if they will look their new surroundings and feel at home there?

Residents meetings

  • Is there a committee or regular meetings between the Care Home and the residents to talk about ongoing care and any concerns raised - and importantly, are they independent of the nursing home?

Slush fund

Is there somewhere safe and accountable spending for your relative to have spending money for day to day items such as newspapers, alcohol, cigarettes and general day to day purchases.  

  • Will the aged care facility provide regular printed statements of your relatives purchases?
  • Who is in charge of client spending?

Aged care staff

This is critical, as staff have a direct impact on your relative's daily care.  Staff morale, overworked, underpaid and multi job function will have a negative impact.  Positive staff in a good job role will have a positive effect on your relatives care.

Many people are shocked to learn there are no laws in place to ensure a safe number of staff (or minimum skills) to residents in Australian nursing homes.  In comparison, kindergartens and hospitals, also cater for people with different levels of need in different locations have these basic protections in place. 

The term "care" implies there is a person-to-person relationship between the carer and the one being cared for. There is a limit to how many people can be cared for by one staff member at the same time. It is essential that a safe mandated staff/resident ratios and skills be introduced in aged care.

One of the problems is in the employment of poorly qualified, poorly trained 'hands-on' staff who are responsible for the day-to-day care of residents with very high support and nursing needs.  Residents from non-English speaking families also experience communication problems – for example, frail aged Italian residents need to be able to tell their carers their issues and problems.

One can only imagine what it must be like to be old and frail and not to be able to communicate your needs to the people caring for you.

What to look out for:

  • If you are quoted staff numbers, check to see that the number of staff providing direct care do not include laundry or kitchen staff.
  • Residents should be supported by staff familiar with their medical needs and other requirements.  Having a revolving door of inexperienced and unfamiliar (eg, agency) staff can be unsettling and disruptive for residents and their medical requirements.
  • Good staff leave because they don't feel valued. They just can't get the job done – and don't want to work in a situation where it is unsafe for residents and themselves;
  • There is no job satisfaction when due to pressures of time and insufficient staff, residents are rushed and prepared in the mornings, for example, sometimes missing out on proper dental hygiene, for example, just so that staff can meet their unrealistic workloads;
  • Are there enough trained Registered Nurses to supervise other staff;
  • Poor mentoring and little ongoing professional development for aged care staff;
  • Need for all staff to be able to communicate well with residents and families and to read care-plans.  For example, English language skills of some staff may be inadequate to communicate effectively with patients or their families, raising concerns as to whether they can competently read and interpret written case notes and care plans and give out medication.
  • It is essential to ask about staff/resident ratios and the facility's staff turnover rate -- eg, a low staff turnover might indicate that the staff are generally happy, and suggests that what is good for staff is ultimately good for resident care. However, the turnover rate is only one indicator - what about the staff absentee rates - especially on weekends.

Try to visit the Care Home a couple of times on different days as it should give you the widest spectrum of different staff on duty. This should show you how they operate at work on a daily basis. Try to visit unannounced so they you can catch the Care Home and Staff off guard.

Tip:  You don’t need to be a body language expert to work out issues or concerns with people. Take your time and observe how the staff interact in their surroundings.

  • Are the staff polite to clients?
  • Are the staff polite to each other?
  • How do the management talk and interact to the staff? Do the staff looked stressed out and tired?
  • Are staff members required to multitask? They have more then one job function?
  • What is the average hours worked for existing staff member?
  • How many staff work double shifts?

Staff turnover

A high staff turnover can be indicative of a highly stressed work environment and underpaid staff who can no longer cope with the conditions. The impact this could have on your relative’s care is very serious.

Tip: Keep an eye out on local newspapers and online job/career websites and see if the same type of staff/care roles are repeatedly advertised for applicants to apply for.

Staff experience

  • Ask about the senior management and how long they have been involved in care?
  • Ask how long the training is for normal care staff?
  • How long do they shadow for?
  • How much initial and ongoing training do the staff get?
  • Ask about palliative care.

Staff specialist training

  • Just because a Care Home claims to be specialised in Alzheimers, Dementia or Parkinsons, you need to ascertain what training the staff actually have had and for who long?

Support for staff

  • What support does the company provide to their own staff with regards to general well being?
  • Are the staff afforded therapy based support due to stress from the job?
  • Are the staff allowed time off work due to their own personal  bereavement?
  • Are the staff allowed time off work due to emotional issues related to work?

External employment agencies

  • Are outside agencies used to cover staff shortages?
  • If so, what companies are used? How often does this happen?
  • Are they familiar with the Care Homes general practices of operation?

Health, Medication, and Personal Care

Nursing home medical care is not a highly regarded practice area for physicians. Physicians are already unhappy with dropping Medicare and reimbursement rates for services.  Therefore, to minimise their time spent with residents, physicians may opt to provide maintenance-only care, sometimes using polypharmia (overmedicating with multiple drugs) to treat residents.

Physicians may or may not examine a resident, or may only provide a cursory exam, may even opt to simply record notes in the resident’s medical records, barely seeing the patient.  It is the reason why polypharmia is so prevalent in Nursing Homes - the prescribing of medication gives the appearance of care.

Your relative will be depending on you to evaluate the medical care he/she is receiving - making sure that his/her health stays on a path to wellness, rather than mere maintenance and continued, needless suffering. As you observe your relative’s condition and receive the medical advice given, you will quickly find that your research has prepared you to make the best decisions in preservation of your relative’s health, safety and overall well being.

The resident right-of-physician choice has been limited by some parts of the nursing home sector. For example, you may be provided with a list of physician's names from which to choose. If possible, obtain this list before your relative enters the Nursing Home, so that you have an opportunity to research each physician’s background and experience.

It would be preferable if you actually had your right of physician choice and could choose the quality of care you prefer - you may need to stand your ground on this, although, it may be difficult if your physician is geographically located far away from the Nursing Home too.   By the nursing home controlling the list of physicians, they can also control how medical care is dispensed and the services a resident will receive. To give yourself an edge (and if such a physician is available), choose your own physician.

And finally -- always follow your gut instincts. In a worst case scenario, if the nursing home physician is not cooperating, if your relative is getting worse, if you are confused - have your relative taken to the nearest hospital for outside medical evaluation under closer care conditions -- today. Don’t second-guess yourself, don’t worry what the nursing home will think - take the lead.

Remember, residents have the right to accept or reject healthcare. We employ the medical profession to borrow their expertise, not dictate what we will do. Consequently, if necessary, don’t think twice about rejecting the nursing home physician and proceed to find the emergent care you believe your relative needs.

Health and personal care

  • Am I able to view and make a copy of my mum/dad's care plan and medication regime - without resorting to a lengthy wait and FOI request to do so? (have this one written into your residential care agreement)
  • Does the facility have both short and long-term services, such as routine physical and dental/vision examinations as well as skilled nursing?
  • Are pads usage rationed per day?
  • How do staff safely administer, monitor, and assist a resident in taking medicine?
  • Does the facility's pharmacy provide delivery, consultation and review of medicines?
  • Does a staff physician visit the resident regularly (or TOO often?) for medical check ups, or can the resident his/her have own personal physician?
  • Can the facility provide a list of available services and are residents and families involved in developing the care plan/service agreement? Who provides these services/what are their qualifications?
  • Are physical, occupational, or speech therapy services available onsite? Who coordinates these services and how are they billed? (Medicare, Private cover, etc.)
  • Are staff available to provide 24-hour assistance with activities of daily living (ADLs) if needed? Activities of daily living include dressing eating, mobility, hygiene, grooming (bathing, toileting, incontinence)
    IMPORTANT:  Check to see what the staffing levels are at night.  Frail patients need assistance especially with mobility and toileting during the night to avoid falls, etc., and often these facilities do not have enough rostered on.
  • Does the residence have Alzheimer's programs, or other dementias and other specialised areas?
  • How do staff safely manage residents who might wander?
  • Are staff available to assist residents who experience memory, orientation, of judgment losses?
  • How are medical emergencies handled? Does the aged care home have a clearly stated procedure for responding to medical emergencies? Is there an arrangement with a nearby hospital?
  • What's the facility's attitude to medical visits outside?  (homes are only required to 'facilitate' these -- sometimes this can amount to no more than dumping your relative in a taxi -- whether they are competent to manage on their own at the other end is something you may need to address)
  • Are housekeeping, linen service and personal laundry included in the fees, or extra charges?
  • Does the facility provide transportation to doctors' offices, the hairdresser, shopping and other activities desired by residents and can it be arranged on short notice?
  • Are pharmacy, barber/beautician and/or physical therapy services offered on-site?

Aged Care and fee based consultants

(Nursing home location experts, Placement consultants, etc)

In our opinion the best decisions will be those you have made yourself on the basis of your own assessments after face-to-face inquiries of the kind mentioned above. However, if you feel the need for an intermediary then we suggest the following questions should be considered and put.

In all cases however, we strongly recommend you make notes about the responses to all the questions you may ask, of the Providers, the staff and the consultant. It may be weeks, months or years – perhaps never, but notes of that kind can be extremely useful if any promises turn out to be false. 

An even better alternative is to pose questions and get answers in writing. If written confirmation is resisted or not provided after you have requested, then you need to evaluate what could be the reason/s for this?

  • Please give me some background details on your experience and qualifications to act as an intermediary for me / my family member;
  • How long have you been doing this work of assisting / advising on the selection of aged care accommodation?
  • What are the services you offer?
  • Please tell me what fees are payable for your services and what can I expect;
  • Can you please assure me that you do not accept commissions or fees or other gratuities / rewards from the Providers which you recommend (get this in writing);
  • Can you inform me about the history and some of the important operational and management aspects of the delivery of the care and services by the Provider/s you recommend – like –
    • a. staff and health services;
    • b. staff to resident ratios;
    • c. if an accommodation bond is required, how the bond moneys are invested (i.e., shares, term deposits, cash management funds etc),
    • d. do you prefer not for profit or commercial Providers?
  • Can I be sure that any important complaints issues, breaches of the aged care laws and care requirements and past history of sanctions, Notices of Required Actions (NRA's), or any similar problems which have occurred, are reported to me/ my family member as a prospective resident, with information about whether they have / have not been addressed?