/ 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
Glynis Elliott says:
19 April 2011

My Mother lived in three different care homes. The first two were horrible and I ended up moving her in short spaces of time as I couldn´t bear for her to live in such conditions. However, the third was wonderful and I can always remember her saying to me that she was happy there.

My Grandad was in a care home for the last 2 years of his life. From a brain tumour, he developed alzheimers, went deaf and blind, and wouldn’t really know what day it was.

The staff at his care home in Rugby were absolutely fantastic. Grandad wasn’t happy because all his independence had gone and he could barely understand what was going on, but the team certainly gave him as good a last few years as possible and I thank them for that.

Like in any industry, there are always “bad eggs”, don’t forget, people who are in a care home really don’t want to be there and in my experience are hungry for attention. This is perhaps why genuine complaints are often pushed under the carpet. Not that they should be, it’s just very hard to differentiate in this particular field

L T Fowler-Stevens says:
19 April 2011

The problem about this otherwise valuable investigation is that no information is provided about the status of the homes investigated. Are they, like the Abbeyfield Kent Society where I work, entirely charitable and 100% not-for-profit, or are they corner-cutting cash generators out to make money from the vulnerability of elderly frail people, many with dementia-related conditions.

The Abbeyfield standards are internationally recognised as a guarantee of good, high quality care: sadly, people reading your investigation may believe that we are all tarred with the same brush. We are not.

Jane says:
21 April 2011

To the lady who works for Abbeyfield. My comments have highlighted the care she had there that was second to none and there is no reason why all care homes shouldn’t be the same. It is greed and lack of respect for the elderly that lays open this sort of treatment.

gerald says:
16 July 2011

Whilst I have no doubt with regards to the quality of care that Abbeyfield deliver I do take issue with the way the lady tries to mislead the public by saying they are charitable, unless I am mistaken they charge for their services just like everyone else, staff get paid for their work just like everyone else and they have to cover their costs just like everyone else. There is just then the dirty profit element which these people always quote , well if this lady realy understood bookkeeping shewould know that this element can easily be maximised or minised in a number of ways such as Directors (other titles allowed) salaries so lets not kid ourselves so called chairities and voluntary organisations have to operate as a business and I do not know of any who carry out their service “free of charge” If there are such organisations about perhaps somenone would enlighten me and the Public.

Lars G Petersson says:
19 April 2011

I worked for eight years in several British nursing homes. I have made serious complaints about two. CQC and social services have not even bothered to investigate. I have evidence of abuse and neglect but nobody seems to be interested. Read here and make up your own mind. http://www.larsgpetersson.com/care-homes/

[parts of this comment were removed by moderators]

My mother has been in four care homes. She suffers with Alzheimer’s and has had this for approximately 13 years. The last home she was in was so awful that I decided to move her. I tried talking to the manageress but she was the problem, so nothing changed. The home was run by two doctors who did not visit very often. The manageress was brilliant at pulling the wool over anyone’s eyes including social services. I found when they went to check on my mum, they would only talk to the manageress and took everything she told them to be gospel and wrote it all down as she said. What a complete waste of time.
When I tried to move my mum she lied to social services and got them investigating it and I found I was investigated! I had to attend an interview with three people – luckily I’d written to the social worker, when she was doing an inspection of mum, stating my fears and had said in my letter not to pass on my comments to the manageress as I was so worried about her treatment towards my mum. That luckily made them believe me.
They told me they believed my mum was ok but as relations between me and the manageress had broken down they would approve my mum being moved! Can you believe the system in this country?!
My mum was being half starved in the home, not properly looked after, no entertainment – apart from a musical cd being played in the mornings, if she was lucky and for this she was being charged £725 per week. These owners are ripping off the elderly and should be shot in my opinion along with manageresses who lie through their teeth and can get away with it.
All this drove me to attempting suicide as I felt I’d failed my mum so much.

sarah says:
23 March 2012

so sorry to read this. I am going through the same thing with a 2 hours meeting with social services, i feel exactly the same, abuse and neglect is taking place and we as loved ones are worried to the point of taking your own life, i can relate to those thoughts. i glad glared out nad frowned upon becuase they know it is me who has complained. others have also come forward but becuase i was the first it is me who is getting it. The system stinks! we have cared for my father at home for 12 years until i ended up having a pulmonary embolism and spinal problem. He is in a home not recevied his cancer treatment injections for 6 monthes even though i was told he had, had grade 3 bedsores,etc and when a place came up with a 2 year waiting list for it , sw couldnt get it to panel in 5 weeks, with me doing the running around. Its all a farce!

Which, whilst it is important to review nursing homes, and expose the bad ones, some balance has to be found, there are some great homes. My mum was brought up in a convent in Ireland, and was mistreated badly. To us as a family her ending her life in a home was the worse thing that might happen.

However, her illness (Vascular Dementia) meant this was the only option, and we were so lucky. We found a nursing home, that was so caring and loving, that cared for and respected the patient and the family and friends, you could visit when you liked, nothing was hidden, the whole team of staff were open and honest.

Both my Sister and I, counted our blessing that we had found such a good home, and one that our Mum was happy in, she passed away loved and still missed by us, but with her dignity intact, safe & happy to the end.

Yes, there might be bad homes and they should be closed, but sadly and this is from someone that loves and supports the NHS, the care of older people in the NHS is very poor in some places too. Our Mum was not treated with diginity nor respect on her last two visits to hospital before going to the home, although at her point of need previous to that, the hospital had been superb, saving her life and giving excellent care.

Barbara says:
21 April 2011

I was the sole carer for my Aunt who died last year at the age of 98. The last 18 months of her life was spent in a care home. She was really well cared for, the food was excellent, and activities abounded for those able to participate. Including computing, wee games, exercise, quizzes, and numerous days out in a mini bus owned by the home. It is a Methodist home, but my Aunt was funded by the local authority. We looked around other care homes to send her to, and were not happy with what we saw. people with zombie like expressions sitting staring into space, and often an all pervading smell of urine. My Aunt was lucky she had kind, considerate, and compassionate care for her last year. Others are not so lucky. Steps should be taken to bring all care homes up the the standard of care she enjoyed.

Jane says:
21 April 2011

My Mum was in a care/residential home in Taunton. For the time she was there, which was about 3 years, she was treated wonderfully. Even when she suddenly became ill and it was apparent that she was sadly going to die the care home staff insisted that she stay with them for those few last days.
They were unbelievably kind and caring all through her stay but when it mattered most they went beyond that.

Judith says:
21 April 2011

I tried to look after my aunt for six months, but the strain of dealing with somebody with dementia was too much for me, so I found her a nursing home which was recommended by two different people. At first the care was OK, and the residents seemed to be taken out quite regularly, but in the last year this has tailed off. My aunt has also deteriorated mentally and doesn’t eat (she seems to not know what to do with the plate of food in front of her) and won’t always take her medication. Because there are, in my view, too few staff, they do not have the time to spend coaxing her to finish her meal or take her pills. I was also slightly angered by the fact that several times I have been to see her and she is wearing second hand clothes. She is a fee paying patient, and does not need to be given other people’s cast-offs. The clothes she had when she went in seem to have disappeared – a fresh pack of underwear were never seen again after I took them in. I know it is a difficult job, and I couldn’t do it for the world, but if they are going to charge nearly £3,000 a month, I feel she is entitled to better service.

My mother passed on last year, after serious mobility problems, deafness and steadily increasing dimentia. She had been in a care home for the last 15 months of her life, all her savings were consumed by care-home and council charges and she died with nothing left to her name.

As much as the overworked staff tried to care for her I do not think that she really got the level of care that I would have wished for. In particular, I often arrived to hear her calling out that she wanted the toilet but with no staff responding or to be found. As for the clothing that we provided, I’m just glad that she was not aware enough to detect that the clothes in which she was partially dressed were not hers.

But, much worse than this, she was admitted to hospital on a couple of occasions. And there her care was abysmal. Regularly, food was ‘plonked’ on a table out of her reach and unable to feed herself until I arrived at visiting hours. Drink was supplied in a cup when a ‘feeding beaker’ or drinking straw and sombody to help her was needed.

I just feel so anxious that when I get to the same stage as my mother, that I should be subjected to the same indignities or that my family should have to go through what I have had to suffer.

Pam, Kent says:
21 April 2011

My father sadly succumbed to Alzheimer’s, at around the age of 79 which progressed rapidly. Having tried our hardest to care for him in his own home (he was widowed) it became necessary to move to residntial care. Initially a local provider (we are in a rural location) felt they could accommodate him – although not usually accepting dementia patients. Sadly the move from his own home highlighted the very level of support we had been giving, and after a few days and with less than the best support from the staff there; we were forced to sleep in his room to supervise him until, after 10 days, we managed to find a fabulous home to accommodate him a liitle further away. Classified for EMI clients, and with a Nursing EMI unit, too, we felt he could at last become settled – albeit sadly not in his own home. Whilst structurally not a ‘showcase’ the staff and manageress were second to none on the EMI unit and we were able to visit completely comforatbly at any time. I went to great lengths to write a portfolio of his past, his likes and dislikes, his many hobbies, included photos, etc.. and this was valued by the home and we frequently saw evidence of staff trying to interact with Dad(and all others) kindly and encouraging such things as art which he had enjoyed when well. Sadly, he deteriorated rapidly and suffered increasing numbers of falls (all of which we were notified of immediately, advising of any specific marks / bruises) and he was assessed in need of a move upstairs to their Nursing EMI unit. This was an altogether sadder experience, and I don’t have any answers to the issues. He was prone to falls, but still in his mind wished to be active. I had very regualr contact with the overall home manager – who had been so good; but the Nursing staff – many foreign who Dad struggled to hear or understand – seemed less personal and there were issues surrounding the use of sedation. As one of 6 siblings, it could be complicated to reach consensus on this, and as his main carer until the residential care it was heart-rending to feel so helpless as he worsened. All this took place between April and September 2007, and in early October the home called a meeting for the residents of all families and announced it was to close for refurbishment as soon as possible after the end of October!!! The manageress was actually in tears at the meeting, whereas the owners delivered the news and heard our comments with little compassion. Hence we were forced to seek a further EMI Nursing bed this time amidst ‘competition’ from other families whose relatives all neded to move at once. Yet another home was found – this time even further to travel to – however, again we were as happy as we could be with the whole sorry situation. He moved there at the end of October, and settled as well as we could have hoped. A newer, purpose-built facility, Dad was allowed to wander as much as it was safe to allow him to, and he was on the ground floor and could see squirrels and birds from his room. Sadly, a phonecall on 12th November advised that they were awaiting an ambulance as he had breathing difficulties and asked me to meet it at it’s destination hospital. As is not uncommon with dementia, something had been ingested into his lungs, and Dad survived the initial emergency but was put on ‘The Pathway To Dying’ programme in the most awful ward of the oldest wing of an NHS hospital 30 miles from our home. The theory of the care of the ‘Pathway To Dying’ (as gently explained by the admitting dotcor) was sound, and we were happy that this ‘palliative’ approach was the appropriate course, and what Dad would have wished. However, the reality of my Dad’s last few days (8 in all) in that NHS ward will never leave me. In an almost unbelieveable twist of fate, my father in law was concurrently ill with cancer during Dad’s decline with dementia, and as Dad lay in the hospital, Father-in-Law was in his last few days being cared for in the nearby hopsice. Despite being run entirely charitably, this care was second to none – as was the aftercare for the relatives. However my Dad was virtually ignored most of the time by the NOT overworked ‘nursing’ staff – who frequently stood in a gaggle at the nurses station over magazines, and it took me or other visitors to prompt them to administer any care such as changing bed, bag or position. Let alone such niceties as mouthcare or anything else. After the first 2 days, myself and Dad’s partner slept nights in a chair by his bed – just to ensure he was not left in distress. I asked repeatedly if it would be possible to move him to the Hospice, too; but was told he would not survive the journey. He died, surrounded by his family, in that NHS ward on 20th November, myself having witnessed the far more dignified end of my Father-in-law’s life at the Hospice only days before. I am sorry this is long, but it is a long, painful and relevant story. Good care IS possible, and rarely costs more in financial terms. Residential Home owners should have a look at some of the voluntary sector – such as hospices, and especially their daycare units – where so much is done with so little, but which has such a positive impact, and is based on true care. It is not rocket science – like the manageress of the lovely EMI unit Dad was in, it’s about good management, pride, teamwork, initiative, taking advice, being open to suggestion, and a job well done. I would add that my Dad paid dearly (from £600 to £880 / week) for his ‘care’ as he had worked hard all his life, and saved. He sat and lay adjacent to others funded by the Local Authority who were paying much less for exactly the same service. These issues of care for the elderly really must be addressed. One can’t help but wonder if politicians would not be acting rather differently if stories such as this were their own family experiences?

Olga says:
4 May 2011

What a sad and moving story. I am lucky enough to have two daughters who will hopefully organise a good nursing home for me. I shall direct them to this website for guidance! But one of them has no children and no partner and I worry constantly about what will happen to her in her last years.

gerald says:
5 June 2011

Good to hear that this gentleman has received good care in the independant sector care homes Sorry to hear that the daughter thinks that the fees (£600 -£800 per week) were extortionate.
If she was able to check the amount the Hospital Trust was being paid for the awful care she quotes (approx 5 to 6 times as much per week) she might appreciate how reasonable care home fees are. It just proves throwing money at a situation (as in the case of Hospitals) does not always improve care.
As a matter of interest ALL Care – Homes, Private,Voluntary, Charitable or Public charge for their services and in many cases the Private Sector are cheaper.
The determining factor of whether or not it is state funded is the wealth of the individual, means testing as it is called,is applie if the individual has a wealth of over £25,000 inc. property.
Nursing Home fees (inc. EMI) used to be exempt until recently.

Martin Scherer says:
21 April 2011

I don’t have any experience. I just have anxiety, even fear.

Part of my fear is I don’t have the right in this country to end my life when I choose. The right to end my life in dignity. I fear people will keep me alive to earn money, or because they fear prosecution.

Don’t worry. about not dying when you want.I have often been asked if I want them to stop feeding my wife. The Gold Standard award is been undertaken by nursing homes with the intention of keeping people out of hospital and they soon stop feeding and providing fluids. All you need do is refuse food and they will start the Gold Standard procedures and you will be dead within two weeks.No one is after your money for care – all concerned just want to get rid of elderly people as quick as possible and gt them off the NHS or Social care.Best of Luck.

Lars G Petersson says:
21 April 2011

[parts of this comment were removed by moderators] was written by the moderater after my contribution on 19 April. I think it is fair to add that there was no offensive language or anything like that removed – only an appeal for ‘some’ specific people (who I shall not repeate) to help me fight this abuse. I hope the moderator will leave this untouched.

DrJ says:
21 April 2011

As a GP with plenty of experience of many different care homes, I find the stories here very depressing. I would like to express my admiration for the calmness and restraint shown by most contributors, even when my own perspective may be a little different.

But my main point is that I have no faith whatsoever in the reliability of any official assessments of care homes by the CQC or its predecessors. My colleagues and I have looked at gradings of the local homes, and they bear no resemblance to our own experiences and views.

Like most bureaucratic endeavours, the reports appear to rely far more on box-ticking exercises than anything more complicated. This is not confined to care homes: I recently read a report on the work of food hygeine inspectors revisiting establishments which had previously been criticised. One was now spotless, another far less so. However, the clean place scored poorly because they had no written record of action taken to address their failings: The evidence of the inspectors eyes came a poor second to the evidence written by the management.

I am sure that the same applies to care homes. Indeed, I know of homes which are part of large chains where the individual staff may be excellent, but the overall ethos, thanks to the management, is disjointed and chaotic, which certainly causes unnecessary work for us as GPs (I don’t mind hard work when it is needed, but unnecessary work means even less time for necessary work) and I doubt is good for the residents. Others, usually independent, get poorer reports, but I know where I would want my own elderly relatives to be cared for.

Having said that, I will say some words in defence of all care homes. The number of hoops that a home has to jump through, many of very dubious usefulness, is enormous. In particular, there is no allowance made for the application of common sense. The homes which, to me, and also to the relatives I speak to provide the best care for their residents are often those who are the ones prepared to ignore, or at least heavily bend, the rules with an application of common sense, but are sticking their neck out to do so.

Another factor in judging a care home is not always apparent to a visitors – the average degree of disability of the residents. Some homes are prepared to accept more demanding residents than others, and this will have a major effect on the overall atmosphere and environment of the home. A home which seems to provide a more positive environment may be doing so at the cost of refusing to accept some residents, yet such an approach would clearly nor be sustainable if all were to try.

I will also briefly defend Care homes compared to hospices – not that I have anything but the highest regard for hospices. The most recent figures I can find suggest that hospice beds cost around three times a care home place per day, and this was before the significant cuts that many local authorities are making the funding they will offer. Now hospices have some significant costs which care home do not, but on the other hand they have far fewer patients who suffer dementia whilst being physically very active – with all of the difficulties that that entails. Hospices work wonders in raising the great majority of their finding through donations, but this itself depends a lot on societies attitudes to charitable giving. Cancer care tends to be regarded far more highly than general care of frail elderly people – and there are far, far fewer hospice beds to fund than there are care home beds – our local hospice covering a large town and more has less than half the beds of each of several care homes within a couple of miles of the hospice. I think that it would be wonderful if all care homes had the resources that a hospice can call on, but see no sign whatsoever that society in general wishes to pay that sort of price.

Which is sad, because far more of us will end up in a care home than in a hospice…..

I have had two parents and a close family friend in care homes at different times and different places, so over a period of about 10 years I had detailed experience of four different care homes. Without fail they have all been appalling. If they were kennels or catteries they would have been closed down and the owners locked up.
The most frightening thing was that those people who should have been safeguarding the residents, social workers and such like, were clearly very much in the pockets of the operators and were desperate to cover up any problems. Probably this was because they didn’t want to have to admit they were not doing their job properly, although in some cases I’m convinced money was changing hands.

Chilternphil says:
21 April 2011

What is needed is an organization that achieves good standards in care homes.I believe the government has a moral and legal responsibility for these standards (not another quango with jobs for the boys). From the Private Eye regular reports it certainly appears that the quango CQC is NOT capable of delivering this.
When we had to find homes for aged parents 250 miles away from us (and the first time an emergency nursing bed on Christmas Eve) it was incredibly difficult to judge (apart from those which smelled) and extremely stressful.
We didn’t mind paying but had no easy way of judging whether this would provide compassionate care for our family. On another occasion a good care home had to close because the doors were not wide enough and they couldn’t afford the investment. So no wheelchair bound residents were inconvenienced – except for them all having to find somewhere else to live. Do legislators not understand this is what kills people in this condition – even i am not cynical enough to believe it is policy; just incompetence. I applaud all those care homes that do deliver a caring considerate service, and thankfully it was one of these that comforted the last weeks of my mother-in-laws life.

On a lighter note my mother-in-laws sister was asked to leave a Hull nursing home aged 91 as she kept reminding them of the service for which she was paying. As she will be 99 later this year I’m sure she was right.

DrJ says:
21 April 2011

“On another occasion a good care home had to close because the doors were not wide enough and they couldn’t afford the investment.”

Further to my comments above, this is a perfect example of the approach that regulators take – they love things that they can measure, average, tabulate and stratify. But do not expect any more human input into the process, and heaven forbid any inspector being allowed to apply their personal opinion after using their own five senses, such is anathema to the bureaucrat.

angiebrose says:
21 April 2011

My mother was only in a local ‘Care’ Home for 6 weeks to get back on her feet after a prolonged stay in hospital.It did the trick in as much as she hated it so much she was determined to get out as quickly as possible! They were only registered to take 2 dementia patients, but there were only 2 other people Mum could actually have a conversation with.
We made a point of checking the entertainment programme & menus beforehand, but the entertainment never appeared, and 2 fish fingers & 6 chips for tea was hardly going to build her strength up! If she asked for a glass of water to take her tablets, she was given a glass from somebody else on the table. The staff didn’t know whether it had been drunk from.
There is no way I would ever have left her there permanently, she would have been dead in weeks.

Rosemary says:
21 April 2011

My step-grandmother died in February aged 103; she had needed full nursing care for 3.5 years and the care she received at Wilton Manor Nursing Centre in Southampton was outstanding. She was always well cared for even when she was unable to communicate her needs verbally; although she was bed-ridden all that the time, she never had a bedsore! The activities co-ordinator used to stop by and have coffee with my relative, and read to her and chat to her; even though most of the time, she got no response.
Prior to that she had spent about 6 months in another nursing home in Norwich, where she was neglected as she could, at times, be aggressive. She was asked to leave because they could not cope with her.
She also spent 7 years in a residential home, Hethersett Hall near Norwich where, once again, the care was second to none.

My mum has vascular dementia and has been in two care homes. The first was poor: the staff had little insight into dementia, residents who were weeping, calling for help or flopped sideways over the arm of their chair were left unattended for long periods. The night care staff had to clean the premises and my mum was frightened of them – she had called for help in the night (her ischaemic attacks usually happened in the night.) Obviously she could not tell me what had happened, only that she was scared of them. Staff used a nickname (which they invented) for my mum. It was a shortened version of her surname and felt very disrespectful to a previously independant, intelligent and kind woman.

The second home is exemplary – staff show care and respect, are never patronising, are skilled at defusing difficult incidents and are very well trained. There are lots of optional activities (e.g. they have just got an accessible greenhouse) as they have a full time activities co-ordinator. A resident with very advanced dementia has been given a a cloth with different textured fabrics stitched to it, which she loves to stroke – brilliant, individualised care.

Both these homes got the same score from the inspectors!

I’m a member of REMAP Gwent. We are Retired Engineers Making Anything for People with disabilities where a commercial solution cannot be found. — In Newport where I live there are many council run community complexes where some of the lucky qualified elderly have their own flat. Hope it remains this way with the cut backs. Small living room, bedroom, Kitchen and Bathroom. Then community dinning and entertainment areas, always a happy atmosphere. During my many visits to these complexes I’ve found them to be a very pleasant experience indeed as I’ve never seen anything negative. Sadly this is not true when I’ve been to private complexes, not that I’ve experienced anything bad as I would think that would be hidden from me. But you can feel the different atmosphere, there is no joy in most of these places. So anyone inspecting who is up to their job should be able to detect the difference of a good or bad place with ease. RNV