"Very, very vegetarian": The importance of choice and control in care home living

In July and August 2022, we spoke with 16 older people living in care homes along with the relatives of 5 residents, hearing about 8 different care homes in Sheffield. We've published a report about what people told us - and the ability to make choices was one of the key topics. 

Choices are empowering

Most people felt they had no choice but to move into a care home. However, having the opportunity to choose which care home they moved to was of high importance to residents. Those who felt they had no say in this were caused more significant upset:

“I would have never chosen to come to a place like this”

Having choices in aspects of everyday living, such as food, was also significant. Some people felt staff didn't have the time to accommodate personal preferences, but others felt they did have some control over this:

“I am a vegetarian and they are great, there is always something that I can have. I am very, very vegetarian”

Making changes is a challenge

Whether the changes you want to see are large or small - from how your finances are managed to how you like your toast - it's important to feel you can speak up about the things that matter to you, especially in the place you live. However, the ability to influence changes within the care home was not an opportunity that most people felt was available to them:

“Change? That’s a leading question, you’ll get me into trouble!”

Most people we spoke to did have things they'd like to change, but there appeared to be very few opportunities for residents to feedback or make suggestions about aspects of their life in the care home. When those opportunities did occur and feedback wasn’t acted upon, it would be disappointing to those taking part:

“We get asked opinions on things but they don’t do anything about it, so there’s no point”

What else did people tell us?

• People value relationships and a sense of connection: Positive relationships with other residents and staff were highly important for a sense of connection and self-worth, particularly for those who had no available family or friends or for those in care homes who relied on agency staff.
• People want to live in an enabling environment: Whilst residents largely felt that their private rooms were adequate for their needs, most residents spoke of their wish to go outdoors and take part in activities that felt meaningful to them.
• High satisfaction with the access to healthcare at a care home: Most people reported good access to healthcare and additional services such as dentist, optician and chiropodist, whether they chose to see them or not.

What does this mean?

In some instances, both relatives and residents saw the move to the care home as a positive experience, either because the conditions were better than they had previously, or because of the high quality of the care home. For others, residency comes with a degree of resignation or upset. 

Making the change to live in a care home is an experience that needs to include the individual’s choices and decisions that will maintain their identity and independence. The role of family and friends in supporting the older person is of utmost importance, and whilst the care home staff can help facilitate many of these important relationships and connections, they also need to have the time available to undertake this effectively.

In light of these findings, we've made recommendations for improvement, and have asked local decision-makers - people who design, pay for and manage care homes - to respond to them. We'll publish their responses and the steps they plan to take to address them on our website.