The memory care tour: what to ask, what to look at, what to write down

Go three times, and choose two of the times yourself

Take the scheduled tour. It is useful: you see the building, you meet the person who runs it, you collect the paperwork. Then arrange two more visits at times you choose.

Go at a mealtime. Ask to eat there. You will see how many staff are in the room, whether people are being helped or waited on, whether the food is what the brochure described, and how long the meal actually takes.

Go late in the afternoon, and go at a weekend. Ask when you book: "Can I visit on a Saturday afternoon?" A place that only shows visitors mid-morning on weekdays has told you when it is at its best.

Ask directly whether unannounced visits by families are permitted once someone lives there, and what the policy is. Write the answer down word for word.

On every visit, note the same four things in the same order: how many staff you can see, what the residents are doing, what you can hear, and what you can smell. Four notes per visit, compared across three visits, is more informative than an hour of brochure.

The staffing questions, in numbers and at the hard hours

Ask for numbers, at specific times, and ask for them in writing. "Well staffed" is not an answer.

Ask what the ratio is on this unit at 3pm on a weekday, at 8pm, and at 3am. Ask how many staff are on the unit at this exact moment and how many residents. Count them yourself while you walk.

Ask about turnover in plain terms: "How many staff who worked on this unit a year ago still work here?" Ask how often agency staff are used on this unit and what happens when someone calls in sick.

Ask who the named contact for a family is, whether that person changes, and what their direct number is. Ask who is in charge of the unit at 9pm on a Sunday and how they reach a doctor.

Ask what training staff receive for this unit specifically, who provides it, how many hours, and how often it is repeated. Ask whether the training is the state minimum or more than the minimum, and by how much.

Write every number with the name of the person who gave it and the date.

The daily-life questions

The brochure describes the activities programme. The question that matters is what happens in the hours that are not on the programme, because that is most of the day.

Ask what happens between two and five in the afternoon, on a weekday, in practice. Then ask what happened yesterday between two and five. The gap between those two answers is worth noticing.

Walk the corridor and look at what people are actually doing at that moment. Note it without judgement in your book, with the time.

• What time do people get up and go to bed, and how much of that is fixed?
• What happens if someone does not want to join in — what does the unit do?
• Can residents bring their own furniture, and how much of it?
• How are clothes labelled, and who does the labelling — and how often do items go missing?
• Where can a resident go when they want to be somewhere other than their room?
• Is there outside space, is it open, and at what hours?
• What do you do about someone who prefers to be awake at night?
• How many staff are in the dining room at the evening meal?
• Can family visit at any hour, and can they eat here?
• What do you do on a resident's birthday?
• What happens when a resident is upset — who comes, and how quickly?
• Can I speak to a family member of a current resident?

The building and the routine questions

Ask about the building as a set of processes rather than as a set of features. A secure door is a feature. What happens when it opens is a process.

Ask how the unit's doors and outside space are managed, who has access, and what the procedure is when a resident goes towards an exit. Ask what happens at night, who is awake, and how the unit is checked.

Ask about the call system: how a resident calls for help, what happens if they cannot use it, and what the target response time is. Then ask what the actual average response time was last month, and whether they measure it at all.

Ask what happens when the fire alarm goes off in this unit specifically, and who evacuates whom.

Ask about rooms: private or shared, what happens if a shared arrangement does not work, whether the bathroom is en-suite, and whether there is a lock on any door. Ask what a room looks like empty — ask to see one that is not made up for viewing.

And ask the simplest question of the day: "Where would my parent's room be, and can I stand in it?"

The record and communication questions

How a unit records things, and how it tells you things, is the part of the arrangement you will live with every week.

Ask what is written down about each resident daily, who writes it, and whether the family can read it. Ask to see a blank version of that daily record.

Ask the notification questions precisely, because this is where families are most often let down. Who rings me, and how quickly, if there is a fall? If my parent is sent to hospital, who rings, and who goes with them, and does someone stay? If there is a change and I am not reachable, who is called next and in what order? Am I told about small things, or only big ones — and who decides which is which?

Ask about the administrative side of medications: who orders them, where they are stored, how a change from a doctor reaches the unit and how quickly, who checks that the change was made, and what the record of administration looks like. You are asking about process and paperwork, not about what is given.

Ask how families raise a concern, who it goes to, whether it is logged, and what happens if the answer is unsatisfactory. Ask for that complaints process in writing.

The money, the exit, and the comparison sheet

Ask the same money questions you would ask any facility: the base rate, what is billed on top, the increases in each of the last three years in writing, the notice period on both sides, and what happens if private funds run out. Take the blank agreement home and have an attorney read it before you sign.

Then ask the questions specific to this kind of unit. What would cause a resident to be asked to leave, or to move to a different part of the building? Who makes that decision and what do they base it on? How much notice would we get? Does that decision get reviewed, and by whom? Has it happened in the last year, and how often?

Ask what happens if needs change in the other direction, and whether a resident can move back.

Build one comparison sheet before the first visit: one column per unit, one row per question, plus the four observations from each of your three visits, the driving time from your house at 5pm, and the direct number of the person who answered. Fill it in in the car park, not at home.

Send the finished grid to every sibling. It converts an argument into a table.

Questions