national care standards: care homes for older people: revised november 2007

12-19 Day-to-day life

12 Lifestyle - social, cultural and religious belief or faith
13 Eating well
14 Keeping well - healthcare
15 Keeping well - medication
16 Private life
17 Daily life
18 Staying in touch
19 Support and care in dying and death

Day-to-day life

Introduction to standards 12 to 19

The standards in this section focus on the ways in which the service promotes your general health and wellbeing. They are an important means of making sure that your quality of life is maintained or improved, and that you feel part of the everyday activities that are going on around you.

Lifestyle - social, cultural and religious belief or faith

You do not have to alter your values and beliefs in order to receive a service. The principle of valuing diversity means that you are accepted and valued for who you are. The legislation which outlaws discrimination has influenced all the care standards, and the standards in this section make it clear that you can continue to live your life in keeping with your own social, cultural or religious beliefs or faith when you are in the care home.

Eating well

Good, nutritious food and drink are important in keeping and improving your health. Individual choices of food and drink vary, as do dietary needs. Enjoying your food and having your own needs and choices met is an important part of the quality of day-to-day life.

Keeping well

Keeping healthy or regaining your health are important to your wellbeing and quality of life. You have a right to have your health needs met and to have support in using the full range of healthcare services. You also have a right to have your medication arranged efficiently and safely.

Private life

How you spend your day is up to you. You do not have to be with other people all the time. Staff will respect your wish to be on your own. You can entertain your friends and relatives in your own room.

Daily life

Living in a care home, you continue to be very much part of your own community, and to enjoy normal daily life.

Staying in touch

People may use different languages or methods of communication for a variety of reasons. As a result, they may have difficulty in making themselves understood. However, being able to communicate is an essential part of letting staff know what your needs are and playing an active part in the life of the care home.

Support and care in dying and death

The staff at the home should care sensitively for people who are dying, with extra services brought in if they are needed. The staff should handle each person's death with dignity and sensitivity, in line with their spirituality, culture and faith, and those of their family.

Friends, relatives and carers outside the care home also need help and support at these times. They should be welcome to visit the care home while the person is being cared for, and after his or her death, as part of their grieving process.

Lifestyle - social, cultural and religious belief or faith
Standard 12

Your social, cultural and religious belief or faith are known and respected. You are able to live your life in keeping with these beliefs.

1 Staff make sure they are properly informed about the implications for you and others of your social, cultural and religious belief or faith.

2 You are given the opportunity and support you may need to practise your beliefs, including keeping in touch with your faith community.

3 Your holy days and festivals, birthdays and personal anniversaries are recognised and ways found to make sure you can observe these as you choose.

4 The social events, entertainment and activities provided by the care home will be organised so that you can join in if you want to.

Eating well
Standard 13

Your meals are varied and nutritious. They reflect your food preferences and any special dietary needs. They are well prepared and cooked and attractively presented.

1 Catering and care staff get to know your food choices and preferences, including ethnic, cultural and faith ones. Any special diet (for example, vegetarian, low fat or high protein) is recorded in your personal plan.

2 You are offered a daily menu that reflects your preferences. The menu varies regularly according to your comments and will always contain fresh fruit and vegetables.

3 You have a choice of cooked breakfast and choices in courses in your midday and evening meals.

4 Meals are nutritionally balanced for your dietary needs, for example, if you are diabetic or have poor kidney function.

5 You can have snacks and hot and cold drinks whenever you like.

6 If you are unable to say if you are getting enough to eat or drink, staff will keep an eye on this for you. If there are concerns, staff will explain them to you or your representative. With your agreement, staff will take any action needed, such as seeking advice from a dietician or your GP.

7 Your meals are well prepared and presented. All food handling follows good food hygiene practices.

8 You are free to eat your meals wherever you like, for example in your own room or in the dining room. You can eat them in your own time.

9 You must be able to eat and enjoy your food. If you need any help to do so (for example, a liquidised diet, adapted cutlery or crockery, or help from a staff member), staff will arrange this for you.

10 Staff will regularly review anything that may affect your ability to eat or drink, such as your dental health. They will arrange for you to get advice.

Keeping well - healthcare
Standard 14

You are confident that the staff know your healthcare needs and arrange to meet them in a way that suits you best.

1 You continue to be registered with your usual GP and dentist. If this is not possible, staff will help you to register as quickly as possible with a new GP and dentist of your choice from those providing services in the area of the home.

2 If you have been receiving community healthcare services (for example, physiotherapy, chiropody or advice on your diet) and still need them, you will continue to receive them in the home. Otherwise the staff will make new arrangements for you.

3 During your first week in the home, and at least every six months after that, you will receive a full assessment to find out all your healthcare needs, and the staff will ensure that these needs are met. Staff will record all assessments and reviews of your healthcare needs.

4 If your review shows that you need health advice from a speech therapist, dentist, GP, dietician or someone else, staff will arrange this for you and help you to follow any advice you have been given.

5 You can see your GP or other healthcare professional in private.

6 You can be confident that the provider is aware of your nutritional state and will, with your agreement, arrange for this to be regularly assessed and reviewed. This assessment will take account of any changes in your health.

7 You will have opportunities to take part in physical activities in, or outside, the home. If you cannot go out of the home, you will be able to take part in physical activities arranged by the staff that aim to help you maintain your physical independence and ability.

8 You can expect staff to be aware of issues around the assessment and management of any symptoms you may have, including pain, and how to access any specialist services.

9 If you become ill or your health is not improving, either physically or emotionally, you know that the staff will contact your doctor or other relevant healthcare team member, if you cannot do so yourself. Where necessary, your personal plan will be reviewed.

10 You will receive information about preventive healthcare (for example, screening, immunisation and regular check-ups). If you want to take part in any of these, staff will help you to do so.

11 If you have any personal care equipment you can get help and support to look after it and maintain and repair it.

Keeping well - medication
Standard 15

If you need to take medication, staff know this and there are arrangements in place for you to take your medication safely and in the way that suits you best.

1 You can choose whether to manage your own medication unless there are specific legal provisions applying to you that prevent this.

2 If you are managing your own medication, you will be given your own lockable storage to keep your medication in your room. If you need it, you will also have special storage somewhere else (for example, in a fridge) that is secure and accessible to you.

3 You can get help from the staff with ordering and collecting your prescriptions if you want or need it.

4 If you are on medication that someone else needs to administer (for example, an injection), the staff will do this in a way that recognises and respects your dignity and privacy, as set out in your personal plan.

5 If you have any questions or need advice about your medication which the staff cannot answer, they will help you to get the advice from your community pharmacist, GP or another member of the primary care team.

6 If you have your medication managed for you, you can be confident that the home has comprehensive systems in place for ordering medication and for its safe storage and administration, and for the safe disposal of unused medicines.

7 You know that any medication you receive will have been prescribed for your own use.

8 You are confident that staff will monitor your medication and the condition for which it has been prescribed. If there are any changes or concerns about the medication, including side effects, or your condition, they will seek your permission to get medical advice.

9 You are confident that the home keeps accurate, up-to-date records of all the medicines that have been ordered, taken or not taken, and disposed of.

10 If you are capable of understanding the need to take medication and what will happen if you do not do so, but you refuse to take it, staff must respect your wishes.

11 You may not understand that you need to take medication and what will happen if you do not do so. If so, there are legal powers ¹² that allow other people to give permission for you to receive treatment if it is necessary for your health and welfare. The staff will work in line with these legal powers and guidance. If you refuse to take the medication and your health is at risk if you do not take it, then and only then, will the staff consider giving you your medicine in a disguised form in line with recognised guidance. ¹³ Staff must record this in your personal plan.

12 You know that if any drugs go missing, the staff will take the necessary action to report this to the relevant authorities.

Private life
Standard 16

You have the right to a private life.

1 You have control over who goes into your room or living space, and when this happens. Your door will have a locking system that you can use but staff will be able to open it if there is an emergency.

2 You know that staff will knock on your bedroom, toilet and bathroom doors and wait for you to say that they can come in.

3 You have a lockable space for personal belongings in your own living space.

4 You can entertain visitors and friends in private, and children are made welcome.

5 You can discuss your needs in confidence and in private with whoever you choose.

6 You can make and receive phone calls in private and receive mail, including e-mails, in private, unless there are specific legal reasons to prevent this. If this is the case, staff must explain these reasons to you and record them.

7 Intimate physical care or treatment will be carried out sensitively and in private, in a way which maintains your dignity.

8 Your personal possessions will be used only by you unless you want to share their use and have given your permission.

9 Only you use your clothing and you are not expected to wear other people's clothes.

10 Staff will make sure that your clothing and personal possessions are clearly marked and properly cared for.

Daily life
Standard 17

You make choices and decisions about day-to-day aspects of your life and about how you spend your time.

1 The social events, entertainment and activities provided by the care home will be organised so that you can join in if you want to.

2 You know that the staff will explain, justify and record any limits on your independence in your personal plan and know that these will be reviewed regularly.

3 You know that the staff are trained to listen to people living in the care home.

4 You can keep up relationships with friends, relatives and carers and links with your own community. If you want, the staff will support you to do this.

5 You are free to come and go as you please, unless there are specific legal requirements which prevent this.

6 You have no restrictions placed on the time you get up or go to bed.

7 You are supported and encouraged to use local services such as hairdressers, shops and banks.

8 You have access to information about local events, facilities and activities.

9 Staff can help you to arrange meetings with visitors, and help any disabled friends and relatives into and around the building.

Staying in touch
Standard 18

You have help to use services, aids and equipment for communication if your first language is not English or if you have any other communication needs.

1 Your communication needs are regularly assessed and reviewed.

2 If you need it, the staff can help you get, and use, specialist communication equipment.

3 You are supported by your named worker or trained communication support workers, including trained interpreters.

4 You can ask family, friends, carers or other people to support your named worker and staff in communicating with you in ways that suit you and at your own pace.

5 You can prepare for important events (for example, reviews and hospital appointments) and have time to communicate your feelings, views and answers.

Support and care in dying and death
Standard 19

You are confident that the staff will be sensitive and supportive during the difficult times when someone dies.

1 You are confident that any death in the care home will be handled with dignity, sensitivity and discretion.

2 If you lose someone close to you, you will be fully supported. You will have the opportunity to say goodbye or go to the funeral if you want. The staff will be available to help and support you.

3 You can say what you want to happen and who should be informed about your physical, personal and spiritual care in dying, death and funeral arrangements. You can be confident that your wishes will be carried out.

4 Staff will discuss your preferred place of death with you and those important to you. They will make every effort to achieve your wishes.

5 The staff will ensure that your death is as free of pain as possible. You will be able to choose whether or not you wish to have someone with you when you die and who that person should be. Staff will make every effort to ensure this happens.

6 There will be somewhere for those important to you to stay with you during your last few days and hours, if that is your wish and their wish.

7 When you die, your body will be treated with dignity, sensitivity and respect, in accordance with your expressed social, cultural and religious preferences.

8 The staff will make sure that your bereaved relatives, friends and carers can spend as much time with you after your death as they need to. They will support your relatives and friends through the formal processes relating to death, such as arrangements about belongings.