The problem nobody looks at
She is walking less. She goes to the dining room less often, holds onto furniture, shuffles. Somebody calls it deterioration, somebody else calls it fear of falling.
Before accepting that, do something almost no relative does: look at her feet. Not through a slipper — take the socks off and look. A surprising proportion of the time you will find toenails months overgrown and thickened, an ingrowing corner, a corn that hurts at every step, and slippers two sizes wrong.
This is not cosmetic. Foot pain changes how a person walks, an altered gait costs balance, and the fall is what changes everything else. In an older woman, feet are one of the very few serious problems that can be fixed with half an hour of work.
Two different things that get muddled
This distinction settles most arguments with a home, so get it straight.
Ordinary foot hygiene — washing, drying between the toes, moisturising, and cutting a normal, healthy toenail — is part of personal care. It is what the home is there to do, and it is covered by the fee. If you are told "we don't do nails", that is a policy, not a rule, and it is worth asking to see it in writing.
Podiatry is different: thickened or ingrowing nails, fungal nails, corns and hard skin, deformity, and anything at all on a diabetic foot. That is a clinical service, and homes are generally right that their staff should not be doing it.
So ask two questions rather than one: who cuts her ordinary nails and how often — and who do you call when the nails are no longer ordinary?
What has actually happened to NHS podiatry
Here is the honest picture, because a false expectation wastes months. NHS podiatry services have narrowed substantially and in most areas now prioritise feet at high risk — diabetes, peripheral arterial disease, neuropathy, existing ulceration, rheumatoid disease. Routine toenail cutting for an otherwise healthy older person is, in most places, no longer provided on the NHS.
That leaves three realistic routes, and it is worth knowing all three:
- Referral to NHS podiatry if she meets the risk criteria. If she is diabetic, this is not a favour to ask — it is the pathway, and it should include a documented foot risk assessment. Ask the GP practice covering the home to refer, and ask what risk category she has been placed in.
- Private podiatry or footcare, visiting the home. Registered podiatrists visit care homes routinely. Check registration with the professional regulator, and be clear whether you are booking a podiatrist or a foot-care assistant — both have a place, but not for the same feet.
- Voluntary and community nail-cutting services. Age UK branches and local schemes run low-cost toenail-cutting clinics in many areas, sometimes visiting. Underused, and exactly right for a healthy foot that simply needs cutting.
Diabetes changes the whole article
If she is diabetic, this stops being about comfort. In a diabetic foot, sensation is reduced: a small injury does not hurt, is not noticed, becomes infected, and the chain from there is one everyone knows. That is exactly why an annual foot check and a documented risk category exist within diabetes care.
Three things to insist on:
- Daily foot checks as part of her care, not on request.
- No improvised nail cutting and no over-the-counter corn removers. On a diabetic foot, a clumsy trim is how it starts.
- A current risk category and a named podiatry contact, with a route for urgent review if anything appears — redness, a blister, a break in the skin. Ask what the home's escalation is, because on a diabetic foot the difference between the same day and next week matters.
The slippers, which nobody checks
The most neglected part of all. Many residents spend the day in slippers bought years ago, stretched, with no fastening — or walk in socks on a smooth floor. Footwear is a documented falls factor: a fastened, well-fitting shoe with a non-slip sole and a low heel is safer than a soft slipper.
Feet change with age and with swelling: the size from ten years ago is not her size. And if she has insoles or bespoke footwear, ask when they were last reviewed — a worn or outgrown insole is worse than none.
The link to falls
If she has fallen and nobody looked at her feet and footwear in the post-fall review, that review is incomplete. Falls assessment in care homes is expected to cover this. Saying so in writing is concrete, checkable and hard to brush aside.
Six questions to ask
- Who cuts her toenails, how often, and is it included?
- Who do you call when nails are thickened or ingrowing, and how long does it take?
- Has she been referred to NHS podiatry, and what risk category is she in?
- If she is diabetic, are her feet checked daily, and what is the escalation if something appears?
- Do her shoes fit and fasten, and when were they last replaced?
- After her last fall, were her feet and footwear assessed?
If you get nowhere
Put it in writing to the manager, with the distinction between personal care and clinical podiatry set out plainly — that distinction is what unlocks most cases, because on the first point the home has no argument. If she meets the risk criteria and no referral has been made, that is a matter for the GP practice. If nobody in the home is looking at the feet of a diabetic resident, that is a clinical safety issue for the Care Quality Commission.
Where to start
On your next visit, do one thing: take her socks off and look. If the nails are pressing on the end of the slipper, or there is a red corn under the ball of the foot, you have found the reason she is walking less — and it is not inevitable decline.
If you are still choosing a home, ask how foot care is arranged and how often. Few families ask, and the answer says a great deal about the general level of attention.
If you would rather not do it alone, we can. For £69 we take down your mother's situation, look for the homes in your area that answer these questions properly, and report back what they told us, with names and dates. Start here
This article is for information and does not replace medical advice on your own situation. If she has diabetes, do not cut nails or treat corns yourself and do not use over-the-counter corn removers — ask the GP or a podiatrist. NHS podiatry eligibility differs by area and across the four nations: check locally. Curalune does not allocate beds and does not guarantee availability.
