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When an individual goes into a nursing or residential home, their family usually continue to be involved in caring. At this stage people need information and advice from staff, and the Home needs to listen to family members to ensure personalised care is provided. This survey found that the majority of respondents (90%) had been consulted about their relative's needs.

This partnership between relatives and staff is essential. Good partnership can be achieved by: Homes involving families at the start of a residents stay; the provision of information; involvement in activities and encouraging to visit; key workers being introduced to relatives; and relatives being encouraged to make suggestions and if necessary highlight areas of dissatisfaction.

Visitors are important to prevent residents feeling isolated from life outside the Home. Relatives who visit regularly are well placed to ensure the needs of individuals are met, be proactive in seeking solutions to problems, and take on an advocacy role. In this study, a high proportion of respondents (83%) visited their relative at least once a week.

Care provided in Homes should be holistic and look after the social, personal, and nursing needs of residents as individuals, rather than isolating the different elements of care into separate tasks . The overwhelming majority of respondents thought the care provided by nursing and residential homes was satisfactory. In most areas of care, respondents were satisfied or very satisfied. However, common problems appear to be, wearing other residents clothes, cleanliness of clothes, levels of staffing during the night and lack of purposeful activity.

Residents in Homes are individuals and should be treated as such. Their privacy, dignity, rights and independence should be respected. It is therefore unacceptable for residents to be dressed in other residents' clothes.

In this study, over one-quarter of respondents (28%) stated their relative, on at least one occasion, had been dressed in other residents' clothes. Turnover of staff and use of agency nurses can prevent residents' needs being fully understood or social interactions between staff and residents developed. The employment of full time staff is essential for the continuity of care, particularly for less lucid residents .

While Homes are not normally perceived as lively centres of activity, places where activities can be pursued or where new interests can be developed , a co-ordinated activity programme is an essential part of Home life. Homes are required by legislation to make arrangements to provide activities for their residents . Activities are not just about playing games, but have a part in increasing self-esteem, encouraging social interactions and stimulating residents. However, older people in Homes have differing expectations and preferences of activities - some may want an active, well-organised social life, while others may prefer more privacy and resources such as a library . These differences should be respected.

Leadership from managers and enthusiasm from staff are essential for offering interesting activities, but these achieve nothing without active participation from residents. Residents should also be involved in the planning of activity programmes, and relatives encouraged to participate in the social life of the home.

This survey found that 63% of respondents thought the activity programme provided was good or satisfactory. However, areas of dissatisfaction included no programme provided, lack of variety in activities, and residents not encouraged to participate.

Residents and relatives need to be aware of how to make comments about their experience of life in the Homes, and how to suggest changes or improvements. Encouragement to exchange ideas is an aspect of quality care, empowering those who live and work in the home. Meetings between staff and residents or relatives, or setting up residents/relatives' groups are some of the possible methods of consultation .

Over half of respondents stated Homes provided opportunities for making suggestions, with a suggestion box/book being the most frequently used mechanism, particularly in nursing homes. However, suggestion boxes/books do not encourage interaction between staff and relatives or residents and the development of relatives'/residents' groups should be encouraged.

Residents who do not have relatives or whose relatives visit infrequently may feel vunerable when making suggestions or comments to staff by themeselves. Advocacy schemes to allow the views of these residents to be heard should be developed.

Homes need to foster an environment where residents, relatives and staff feel confident in making suggestions and, where appropriate, making complaints without fear of victimisation. They need to be confident that their complaints will be listened to and taken seriously.

The purpose of the complaints procedure is 'to improve the quality of life of elders in all Homes' , and all Homes are expected to publish their complaints procedure , and to inform residents and relatives how and to whom the complaint should be made . While only a small number of respondents expressed concerns with the care provided, a smaller number actually approached a member of staff. Overall, only 40% of respondents had been given a copy of the Homes complaints procedure.