Choosing a care home, caring and all those calls

My father returns home from hospital after a month - in the end bundled out with indecent haste. As with every transition a host of phone calls ensue - to the GP, stoma nurses, social services.

Even with a care package in place he struggles, physically weaker and mentally overwhelmed. Thankfully the care assistants who come in the morning and evening are excellent - warm, friendly, caring and reliably on time. Nevertheless we don't feel confident leaving him so a 24/7 daughter rota is set up. The GP, stoma nurses, carers come and go. But his mood is dark, he questions the point of living, he didn't want the stoma and will never be able to deal with it, he has a log of worries as long as your arm. The grey skies behind all this are that he is bereaved, despite our presence he feels alone, her chair is empty, her side of the bed after 60 years, unoccupied. Her absence is deeply felt.

I offer him to stay in my house but there's so many stairs. In the end he decides he wants to go into a care home for a month's convalescence. We, his daughters, are running out of road, our work and family responsibilities are tugging at our sleeves. He is too weak to visit so I start the internet search for a local home, with a 'good' CQC rating, which looks nice in the pictures and has ensuite facilities. I ring round to find out which have vacancies and fix some visits. Armed with the Independent Age guide on 'How to choose a care home' we discuss the questions he wants me to ask. Questions about personal care, visiting hours (we know they should say its his home, come and go when you like but be aware we are very busy at meal times and give us notice if you plan to come late at night). Questions about facilities, meal choices, getting snacks and drinks out of hours, activities, the availability of newspapers and books, whether a minister visits. The handling of GP registration, visits from stoma nurses etc. He wants to know how many men there are (he feels oppressed by the increasingly female domination of his age group). I'm also very aware of what I want to learn by observation - how staff talk to the residents and to each other, how busy the place is.

Armed with the list I visit 3 local care homes. The first, the cheapest and part of a small group, is promising. The room itself is lovely with a window directly onto the garden. The head of home who shows me round admits the fabric of the building and decor is a bit tired, there's only a sitting room as an alternative to his room, and only one corridor to walk along. This proves an important consideration with my father's need to get more mobile. The head of home is great, she takes a deep interest in my father, his life and interests and acknowledges the trauma of his illness. I am very encouraged by her qualities but worried about the lack of facilities. Crucially I realise the most important question for my search: is this somewhere I'd be happy leaving my father in as I return to my nice warm home?

The second home I visit is part of a well known group. The customer service on the phone is excellent but the visit is less than perfect. When I ask for the head of home on arrival I'm told she no longer works there. Since I spoke to her on the phone on Tuesday and its now Thursday her departure seems rather sudden. No one is aware of my appointment. The woman who shows me around lacks finesse. She implies a heavy handed insistence that residents attend all the activities - I point out that my father hates most of the types on activity on offer (more of this later). The empty sitting room has an upturned bowl and peanuts strewn across the floor - the home generally feels unkempt. Worst of all, whilst discussing the menu sitting in the dining room, my guide says she will introduce me to the chef and then repeatedly shouts his name at full volume. Gary doesn't appear. A few minutes later as we leave the room, we come across Gary just around the corner. Clearly he heard but didn't respond - he's in the middle of totting up his food order. I worry that if that is how she treats colleagues when there's a visitor how does she usually behave when there isn't? Unsurprisingly, its an instant no.

The final home is top end - both in fees and quality. A lovely building, lots of communal spaces, friendly professional staff, a great menu and lots of activities. All good. In the end the choice was easy and my father duly moves in. It is not perfect of course. We only see the head of home when signing the contract and paying. The lovely warm nurse who welcomes him and gives him his assessment has left a few days later, some of the activities get cancelled at short notice. But there are other nice surprises - volunteers come and support the programme of activities and local groups make use of one of the rooms. So one evening when I'm visiting a group of professional classical guitarists are practising there, it's beautiful.. The stay has the desired effect. My Dad recovers strength and health, within a few days with their encouragement he has taken on his stoma care, he eats well and exercises - both in classes and increasingly longer walks round the building, the grounds and up the street. He is less depressed, though its hard to keep his anxieties entirely at bay - I joke with him that as quickly as I can allay a fear a new one is created to take its place. Like many people his age, with not enough sleep and purpose, his mind keeps whirring generating things to worry about whether it be money, or hospital appointments.. you name it the list is endlessly refreshed.

But there are lighter moments. He goes to nearly every activity on offer including those he has had a lifelong aversion to - bingo, showtunes etc. I can only presume his desire to get his money's worth is over-riding his ambivalence. It's hugely reassuring - demonstrating motivation but my Mum would be turning in her grave. How she would've loved him to join in a game of bingo and such other diversions!

When I viewed the home I was told one of the other residents was a judge. This proves fascinating to my father who is generally rather depressed by the state of his fellow residents, many of whom are much frailer and more dependent than him, lacking the power of speech and seemingly unaware of their surroundings. 'I found the judge' he announces after a few weeks living there. 'I wasn't impressed. He wasn't a High Court judge and went the solicitors route so wasn't even a barrister.' I realise this is a sign he's returning to form!

When it comes to him returning home he is much stronger physically and mentally. Sure his suitcase of clothes is accompanied by a suitcase of anxieties about returning to an independent life and its daily routines. Inevitably, his return is followed by a string of calls and emails. Hospital appointments have to be re-scheduled or cancelled. The District Nurse scheduled to visit him in the care home never showed up, so has to be re-booked this time to visit him at home. They take a number of blood samples. The next day a new request for a further blood sample arrives! My father's GPs have de-registered him, following his temporary registration by the care home with their practice and despite letters and emails informing them that he would be coming back home. A long list is ticked off, the daughters team are on it.

Social services, care agencies and stoma nurses prove relatively easy to contact by phone or email. Hospitals still rely on letters, consultants impossible to reach. GPs are hard to catch on the phone. And we have no direct link whatsoever to the District nurses! Its hard to imagine how older people who don't have anyone to scoop up all these tasks cope. You really wouldn't design it this way if you had the choice.