/ Health

Care homes are failing – but is it too hard to complain?

Portrait of an old man

Our undercover actors living in four care homes discovered many problems with the quality of care. So how can relatives know what’s going on – and how easy is it to complain when you suspect the worst?

Imagine the scene: you believe that the management in your relative’s care home is sub-standard. You decide to complain, but that complaint has to be made to the management.

As someone who writes about healthcare for a living, I know that it’s important to complain when things aren’t right. But as a relative I can totally understand why people might feel uncomfortable doing it.

I’ve had three grandparents in care homes. I saw my parents struggle over a number of years with trying to get numerous problems sorted.

Don’t get me wrong – most staff were brilliant and did their very best – but it’s very stressful when you feel like you’re the only person sticking up for a vulnerable relative. And you may worry that, if you raise any concerns, it’s your relative who will bear the brunt of any staff disquiet when you’re not there.

Which? investigates care homes

Our recent investigation put actors into four care homes to spend a week living as ‘residents’. They raised lots of worrying concerns in the four homes, as well as some good practice.

These included problems of poor nutrition, lack of activity and poor staff communication and skill, and even potential abuse by a staff member in one home. It made me wonder whether relatives knew about what was going on, and felt too inhibited to speak up, or hadn’t been taken seriously when they did?

Here the actors tell us about their experiences during their week undercover:

Where to go for help

The regulator in England, the Care Quality Commission, doesn’t have a remit to investigate individual complaints although it encourages relatives and residents to feed back direct.

If your relative is funded by the council, or if it’s about an abuse or ‘safeguarding’ issue, you can get the council involved. But if you’re paying for your own placement, your complaint will normally have to go direct to the provider.

The good news is that – since October last year – if you’re not satisfied with the home’s investigation, you can go to the Local Government Ombudsman and they can investigate your complaint. But you can normally only do this once you’ve complained to the home.

I’m concerned that the need to go direct to the home may put many relatives off making their views known, fearful of the consequences. I hope that the opportunity to go to the ombudsman if the complaint isn’t handled properly will make relatives feel more secure raising concerns – but what do you think?

What are your experiences – good and bad – of the quality of care in homes? Have you had difficulties making your complaint heard or have staff been open to discussing your concerns?

Comments
T O'Neill says:
3 February 2019

The problems are huge – being threatened with your disabled relative losing their place and being forced to move because we went to safeguarding over a longstanding overheating problem, care plan not being followed resulting in a foreseeable incident for which he got wrongly convicted ( and was later quashed), carehome “losing records” but not explaining which ones, council carrying out a poor investigation and the ombudsman refusing to investigate, i’s all too easy for them all to cover up what’s happened in Coventry but it will now be exposed publicly as we have no alternative

T O,Neil I despise any cover up of old -frail- sick human beings being treated despicably for the expediency of any organisation be it government- big business or any social group purporting to “help ” people while making all sorts of excuses while coining it in.

Its time some real help was given in this country not swift cover-ups by refusing relatives the means of gathering evidence against the evil perpetrators ,refusing them entry under false pretenses by saying they are “disruptive ” etc . I hope they can tell me how disruptive is the early death of a relative due to ill care . Then they have the brass-neck to outlay financial charges to the same relatives who were blocked from saving the relatives life.

Dont look to me to accept the status quo which seems to be- Old -Frail-ill ? “Drain on society ” etc .

Its time this country really cared –for human life. I will never let down those in need of help.

I read the care home problems in Coventry T O,Neil pretty bad.
Even those trying to stay out of them but severely handicapped read-
https://www.theguardian.com/society/2018/mar/27/disabled-people-independent-living-care-homes

The Guardian article is very distressing and highlights the difficulty local social services authorities are having in providing suitable care for people with multiple disabilities and conditions who need specialist, round-the-clock, care. Pushing younger people with full mental capacity into care homes or nursing homes designed and staffed for the elderly is not a satisfactory answer, . . . but what is?

It’s no good just wringing our hands and deploring the care standards in homes; we have to find a workable solution.

Are there enough places of a suitable kind? Are there enough specialist nurses and carers to provide the support and attention needed? Is it feasible to maintain people in their own homes rather than in specialist units, especially those with complex needs? Given that the cost of specialist 24-hour 7-days-a-week support for one individual could equate to the cost of caring for ten or more elderly residents in a care home, what does society feel is the priority order for financial allocations? Are there any predictions of demand and need that can help with the planning and provision of suitable resources, including nurse and carer training, special apparatus and adaptations, and bespoke accommodation? Can individual local authorities really make these judgments when they might have responsibility for only a very small number of clients with such complex requirements? Does the Department of Health & Social Care have any policies or guidance that would help? Why do none of the well-known charities and care organisations participate in these discussions?

I sometimes wonder if we’re approaching a point where extremely unpalatable choices might have to be made. My sister in law, an exceptionally talented singer who’d performed on the same bill as the Beatles, the surviving members of which she still saw regularly, contracted Motor Neurone Disease (in her late ’70s). Watching her deteriorate over a surprisingly short period of time was distressing in itself, and her husband – fortunately in full health apart from the odd cancer – was able to look after her.

But the sheer numbers of workers who were involved in her home care was astonishing,

And this isn’t a rare case. At both ends of the age spectrum we’re committing millions of pounds and millions of man hours to maintaining the health of those who would otherwise die. Because we’re getting better at maintaining life in the premature baby, or the baby born with multiple disabilities, it’s now routinely expected that we – as a society – will do that.

The unpalatable question that has to be asked is this: with our increasingly effective medical techniques we can now maintain the lives of people suffering from the most horrendous birth defects or from the worst ravages of old age. But we, as a society do not have unlimited resources. Is it ethically right that we should do so, and is it possible to do so indefinitely and – if it isn’t – what would be the criteria for determining who is treated and for how long?

I realise these are extremely difficult questions and this is an extremely difficult subject. But perhaps we need to start considering the ramifications if we fail to even talk about them.

This may not be the right topic for this (I’ve just realised it isn’t the Lobby) so please feel free to move it elsewhere.

I can identify with Lucy Watts and her plight.

The problem is one of finance Ian. CCGs are holding ‘professional’ meetings where nearest relatives are not welcome and invited to hear the inevitable bad news where they assess every individual situation and decide a Care Plan Approach that is affordable, usually the cheapest since government social care financial cutbacks.

This approach has led to the commodification of the sick and vulnerable, is widespread across the country and the elderly are now expected to become the main carer, not only for their partners but for their disabled children also.

Morphing over to American societal —“values “.

Cost of care home residence in the USA -2016 – US government figures –

Below are some national average costs for long-term care in the United States (in 2016). Average costs for specific states are also available.

$225 a day or $6,844 per month for a semi-private room in a nursing home
$253 a day or $7,698 per month for a private room in a nursing home
$119 a day or $3,628 per month for care in an assisted living facility (for a one-bedroom unit)
$20.50 an hour for a health aide
$20 an hour for homemaker services
$68 per day for services in an adult day health care center

The cost of long-term care depends on the type and duration of care you need, the provider you use, and where you live. Costs can be affected by certain factors, such as:

Time of day. Home health and home care services, provided in two-to-four-hour blocks of time referred to as visits, are generally more expensive in the evening, on weekends, and on holidays
Extra charges for services provided beyond the basic room, food and housekeeping charges at facilities, although some may have all inclusive fees.
Variable rates in some community programs, such as adult day service, are provided at a per-day rate, but can be more based on extra events and activities
Long-term care is expensive, but there are several ways to pay for the care you may need.

Costs of Care

Costs of Care in Your State

What is Covered by Health & Disability Insurance?

What is Long-term Care Insurance?

Using Life Insurance to Pay for Long-term Care

Paying Privately

Notice the fact of taking out medical insurance , when my wife lived in the USA many Americans needed -TWO insurance policies because small print says you DONT get 100 % cover.

Medicare?-quote-
Except for the specific circumstances described below, Medicare does not pay for most long-term care services or personal care such as help with bathing or for supervision (often referred to as custodial care).
There is a lot more — in case of arguments I have downloaded all the government documents relating to it.

we, as a society do not have unlimited resources“. So we need to decide how best they are used. My view would be that the care of our population should come at the top of the list, before defence, foreign aid, for example. There seems little point in spending billions “protecting our security” when we then let those being protected suffer and die from conditions we could address – medical, care homes, social care, support for those genuinely unable to support themselves.

Wholeheartedly support your post malcolm ,couldn’t have put it better.

Tracy O'Neill says:
14 February 2019

I think that if a carehome has clearly failed the disabled person, the council should carry out a full and transparent investigation. In this case they have avoided some issues and not upheld others despite evidence, they have also not obtained evidence over ‘missing’ medical/care records – the police were apparently involved but no proof of this and police themselves don’t know anything about it and the council have assured the ombudsman that the police were involved to cover up for the carehome and their own failures. The ombudsman has relied upon incorrect info from the council in deciding not to investigate. And the poor vulnerable person has been wrongfully convicted when the carehome failed to follow his careplan and provoked him. He was later found to be unfit to stand trial. A can of wriggly worms which will soon have it’s lid blown off.

I agree with you Tracy, but I am curious to know what involvement the Care Quality Commission has had in the case you are referring to. The Commission is the official inspecting and regulating body and should have carried out a full inquiry and taken corrective action if justified. The Council has a role as well if it is, as a customer, placing residents in the care home and should certainly investigate any allegations of maltreatment or performance failure since they are responsible for their client’s welfare.

Tracy O'Neill says:
11 March 2019

The CQC were contacted on several occasions and took the view that if there was a problem the parents should report it to the carehome as a complaint. When we did this the carehome threatened on several occasions to give notice and finally gave notice to the council when the parents went to safeguarding about a year-long problem which was affecting the disabled son. The carehome also refused to respond to a complaint by the parents and when the son made a complaint he was stitched up like a kipper.

Gerald says:
22 March 2019

Hi John
The Government has set up The “Safeguarding” system which covers all forms of Abuse and is administered by the County Councils , in my opinion this system would be more suitable than the CQC, it surprises me that more people do not use it,I can only assume that more people have not heard of it.

I expect one of the obstacles to what you suggest is that in many cases the county council [or other social services authority] might have a conflict of interest by virtue of also being the placing authority.

Hi John,
When it comes to the Public Sector you could be correct but I can assure you when it comes to the Private Sector they have no reservations whatsoever , personally I have always welcomed any and all inspections as along as the are constructive and lessons are learnt and rectified.

The two are intrinsically linked as many privately owned care homes rely on social service placement funding to keep them afloat.

Unfortunately social service placements now also include B&Bs which are regarded as ‘safe places’ by Borough Councils, a requirement for all NHS hospital discharges to prevent bed blocking and a loophole used as a way of dealing with government SS cutbacks.

The role of the social worker has now split between health and accommodation to ensure outsourced patients receive appropriate medication whilst awaiting a suitable placement, many of whom will relapse ending up back in hospital; altogether a false economy costing the NHS thousands of unnecessary pounds.

More privately run care homes are now closing, unable to maintain the high standard imposed by the CQC and their reliance upon financial support from strap cashed Borough and County Councils.

Gerald says:
19 April 2019

Dear Beryl,
It used to be far simpler when the Nhs themselves made placements direct to “ Nursing “ Homes which they were responsible for ensuring proper Nursing care .With the involvement of the Local Authorities the placements are now made by the LAs but the funding comes from the NHS , very confusing as you say. If you compare the cost of a stayin the hospital and compare like for like care in a properly registered Nursing Home you will be amazed at the savingwith very little ,if any difference in quality of care. No brainier as ,they sa, but politics has a say which as usual doesn’t revolve around common sense

Duncan
Does this statement apply to Gosport Hospital ??

They are also Providers, which also has a conflict of interest, I suggest. Can you imagine what conflicts of interest are in play when one looks at the joint funding project being carried by the NHS and the Public Sector, John, the mind boggles the more one is aware, I can assure you.

Well Beryl,
In the light of the recent news with regards to Four Seasons demise, this problem is to be even more of an Head ache .
I wonder how some people who resent the Private Sector “making a profit” can explain how the largest Group in the UK , supposedly making massive profits and paying so little tax can possibly find itself in such a mess ?
I have been in business now over 50 years and I cannot make any sense in this situation.

Why O why do you keep referring to America Duncan ,the English system is not comparable, why don’t you refer to Australia or Canada or maybe just concentrate on sorting our problem out with constructive ideas

Bye the way :
Have you had time to look at the Four Seasons problem? I can’t wait to hear how you explain how such a large Group is in such financial difficulties when ,according to you , they are making millions in profit? Any good business person knows that Bank Loans must be dealt with, particularly when they are as large as. £500,000,000.Only state funded systems can rely on being continuously baled out. One never knows the present Government might help out , don’t hold your breath.

As long as it doesn’t support the Private Sector at the same time eh Duncan.

Duncan is currently not contributing Gerald. I hope he does return – he contributed useful and interesting posts – much of the time.

Thanks for the info malcolm, I hope he returns soon ,his comments on the 4 Seasons mess would be interesting. I would also like his his view on the Gosport Hospital incidents which are now once again being investigated by the Police.

Care UK is also seemingly in an unhealthy financial state, despite being profitable and paying its CE £900k. It seems to stem from the private equity group taking interest charges of up to 9.75% plus 16% on preference shares, according to Private Eye. I am naive enough to wonder what is the point of these investors of driving such companies, like Four Seasons, into administration by such tactics.

At last malcolm someone has seen the light, who really is making the profits ?
maybe Duncan can enlighten us ?

It appears that funding for such large concerns is only forthcoming from overseas banks and they tend to be notoriously expensive.
Chief execs. all over the World of any size of Company are highly paid but usually they have to earn their Salaries, shareholders will have to make their own judgements in this case.