/ Health

Why is good care so difficult to find?

Moving someone into a care home can be a difficult decision. That difficulty is only compounded when faced with the struggle of finding good care that suits that person’s needs. Fred Horley joins us to share his difficulties with finding good care for his wife, Joan.

In October 2015, my wife Joan, aged 83, was placed into a care home by a hospital for respite care. This was following treatment for a fractured right leg. Sadly, Joan’s experience in that care home was far from satisfactory.

Care home failings

My wife had specific requirements of no load bearing on the fractured limb. She had a commode in her room and needed assistance with getting out of bed to use it.

Often she was left waiting for more than 30 minutes after activating an emergency alarm before help eventually came for her. On a number of occasions, one at 1.15am, Joan used her mobile phone to call me at home to ask me to ring the home and ask them to respond to her emergency activation of the alarm.

On another occasion after waiting three-quarters of an hour after activating the emergency call button she tried to get out of bed and fell, banging her head on the stone floor. She lay on the floor, in the dark, for about an hour shouting for help and banging on the floor. It was later discovered that the emergency alarm system was not working.

My wife was often woken at around 8am but wasn’t served a hot drink or breakfast until 9.45am. And in the 15 days she was in the home she was assisted with showering only once.

At no point was Joan’s care plan ever discussed with her and she was never given the opportunity to participate in any form of activities.

We decided to remove her from the home as soon as possible and reported Joan’s experience to the relevant authorities. But we felt helpless and concerned for the other residents at the home.

A caring home

The authorities carried out a risk assessment of our home in turning our downstairs dining room into a bedroom. They provided all the necessary equipment for Joan to be cared for at home by carers and family.

With Joan now comfortable at home I was able to look into who was responsible for overseeing care homes provision and discovered the Care Quality Commission (CQC).

I found that in November 2014 the CQC carried out an inspection of the care home and concluded that it required improvement in three out of the five assessment criteria. The overall grading it was given was ‘Requires Improvement’.

The CQC had carried out further inspections and eventually put the home into ‘special measures’. And at its last inspection, in April 2017, the home still required improvement in two out of the five inspection criteria.

In the nearly two years since Joan was at that home it still ‘requires improvement’ and despite this, it’s still able to take on new residents.

Care needs care now

Many elderly patients don’t have friends or relatives who are able to make enquiries or complaints on their behalf. It shouldn’t be a struggle to find good care.

From my own extensive research and Joan’s experience I’m well placed to determine the best home for my own care should I need it.

For me, it will be one that meets the five CQC care criteria and is rated as good or outstanding. But homes in Plymouth that would meet these criteria are difficult to come by, expensive and have few vacancies.

That’s why I’m standing with Which? as they launch their campaign to confront the problems in the care home system.

Join me. Sign Which?’s petition to put care into the care system today.

This is a guest contribution by Fred Horley. All views expressed here are Fred’s own and not necessarily also shared by Which?

Have you had a similar experience to Fred and Joan? Do you worry about finding good care?

Comments

I wish we would stop using the term “The cost of care and the cost of care homes” its not the cost its what we are CHARGED.
Example, you but a cauliflower 75p a care home buys a cauliflower £3.50

They can justify why everything cost so much until the cows come home but elderly vulnerable people are being robbed!, its theft of the elderly. If everything cost so much and its what the establishments have to pay how come those that actually do the real work of caring for the elderly (and it is not a nice job!) are paid pitifully for what they are expected to do??

Pay out a fortune for pretty, expensive, posh furnishing and fittings but the people who are going to do the work give them as little as is human possible!

Get it right real care, happy well paid staff, cared for residents and no profit out of this for anybody,
we do not expect our schools, hospitals or the army to be profit making establishments why should a service that is vital be mainly geared around greed and money making?

Every penny spent on building, furnishing and supplying a care homes or care providers should be scrutinised and made accountable, I pay 75p for my cauliflower so should the care home.

I am not a paid carer nor have been. But I clear up urine, faeces, I put someone to bed, I get them up I help bath them and dress them, I help them eat, I do their washing, I change the damp soiled bed each day, I do their paperwork and commerce I take that person to endless medical appointments, the dentist, the optician the podiatrist, the hairdresser.
I maintain the car the garden the house, oh and I work.
I do it for FREE
For the care home to do a smaller fraction of this £5,000 a month please? (In Essex)

I AM NOT A CARER I am a wife.

Trevor – Is there any way of contacting and reporting your findings to your friends next-of-kin who could not legally be denied visiting access, and make sure they go armed with a hidden camera for evidence.

Log onto the Age UK for some very good advice on how to proceed. . Their email address is as follows:

http://www.ageuk.org – How to complain about a care home.
or
http://www.which.co.uk – How to complain about a care home.

Christine Waugh says:
1 October 2018

Having worked in the care sector for many years I have found it mind boggling how these care providers Barchester health care to name but one of many How can they be quoted on the stock exchange and pay dividends to shareholders????
Is this why care is suffering ??? Profit for shareholders instead of ploughing money in to their business and paying their staff properly
The government needs to step in and put a cap on Care profits and make a strong legal case that companies who invest in care should Care!!!!!

Much as I agree with you Christine , its never going to happen as many government ministers are for full privatisation of the NHS . Its been announced that many NHS staff in the mental health section of the NHS are leaving in droves due to low wages which will get worse when Brexit takes place . Look out for calls to get the USA to take over the NHS .

many government ministers are for full privatisation of the NHS“. I don’t think there has been any agreement that this is the case, duncan. 🙂

Malcolm-The government has been in talks with hedge funds for a start and also they plan to sell off real estate belonging to the NHS its been ongoing for a year now QUOTE -The British Medical Association called for the Government to act, with the union’s head Mark Porter saying the move “shows how desperately the health service needs more funding”. read

And shadow health secretary Jonathan Ashworth said it was “shocking” that NHS leaders were in negotiations with hedge fund bosses.

“Theresa May has refused to respond to the needs of crumbling hospitals, ageing equipment or provide the necessary investment in community facilities,“ he added.Clive Peedell, a consultant clinical oncologist and co-founder of the National Health Action Party, said: “How can it be cheaper to borrow from hedge funds rather than fund directly from Treasury? NHS finances are desperate.”

Doctors leaders have accused the Government of a conspiracy to create a crisis in hospitals in order to usher in the back-door privatisation of the NHS.

The British Medical Association passed a motion claiming ministers are using plans launched last year, ostensibly as a means to reform over-spending facilities, as a front for selling off the health service.

They fuelled the row by also accusing political leaders of “scapegoating” doctors as a means of “distracting the public from and under-funded service”.
http://www.theweek.co.uk/nhs/63360/the-pros-and-cons-of-privatising-the-nhs

. . . and in any case, adult social care is not a function of the NHS.

[This comment is in response to Malcolm’s above querying the alleged attitude of government ministers to privatisation of the NHS]

All care homes not owned by councils, social housing providers or charities have private shareholders who have put the money up to acquire or build the establishments and to continue to invest in them. They are entitled to a return on their investment just as people look for a decent interest rate on their savings.

As a privately-owned company, not a public limited company [PLC], Barchester is not quoted on the stock exchange; it is largely owned by Irish investors and has been put up for sale.

In most companies only a minority portion of the overall profit is distributed to shareholders with the rest being reinvested in the business. The one thing that would not be helpful in the care home sector is for companies to run out of money and to collapse. In general, Barchester caters for self-funding residents and has a low ratio of local authority placements.

I don’t know what the pay rates are like in companies like Barchester but they have to pay the minimum wage. Moreover, to be able to recruit enough staff to provide the level of care and safety required by the Care Quality Commission they must pay the going rate or a little better.

That’s not about care homes, Duncan, so it’s off-topic. It’s also speculation so not evidence of any government policy.

And not evidence of the course of government policy when it involves real government officials John ? Many want care homes back into government control but it shows the dogma of it never happening.

I have supported, and proposed in these Conversations, a progressive government or municipal takeover of the care homes that take local authority placements.

We are still awaiting a promised government Green Paper on the future funding of adult social care. It will be interesting to see what proposals for care provision and organisation it contains. That will be the only valid indicator of this government’s policy approach.

Green Papers are only exploratory documents and things included can be hastily withdrawn or altered to suit the feedback. What survives goes into a White Paper which is real government policy but has no guarantee of implementation in the form of an Act of Parliament. Governments that want to be trusted tend to stick with the contents of White Papers however, but a general election can blow everything off course.

I see no merit in spending tax payers’ money on taking over the care homes that only take self-funding residents unless as premises they fill a shortfall or a geographical gap in provision.

Jane says:
6 November 2018

After three years of dealing with placing my mother with dementia in a care home and sorting out the financing for it I have a few points to suggest.

We are so used to the right to free education and health care that we assume the same privilege for care in old age.
The current system is not set up for this and as we all know is a horrible muddle.
As a nation we need to have a conversation about who is actually responsibile for our old age, is it to be our own or the state?
If it is the state then we need to be prepared to pay more in in NI contributions over our working life, or if our own be offered wider range of appropriate financial products that enable us to invest to meet the cost of our care.
Either way the whole system needs a total rethink and we will need to be prepared to pay more

For example at £1000 a week full time care is steep however if you work out the hourly rate, it is far less than £9 per hour which barely covers the cost of the living wage of if you had to pay to be looked after at home.
If we expect to have well qualified and professional carerers similar to education or nursing then how we meet the cost of this needs to be part of the conversation.

As a nation we need to face up to the fact that becoming old and needing to buy in care can be expensive.

Jane , what you are saying boils down to whether the public want care homes run by private enterprise or by the government , that is a political decision.
Public money should go to public care not end up in the hands of big multinationals who hold no allegiance to this country only the USA .
Its down to political dogma as the voting in the past has favoured —privatise it
the next election might be a major turning point depending on the position of other parties and you are quite right -either –Pay Up in taxes or Shut Up and accept different classes of services depending on how rich you are .

If the majority of voters are happy with their lot then nothing changes ,if not only voting one party out and another party in who will do their wishes will have any real meaning .
Those that vote on the basis of –I am voting to increase my share prices /house prices will be happy with the present system ,
those that aren’t will want change , be aware out will come —the nation “cant afford it ”
can we “afford ” the terrible treatment dished out at present and posted on Which ? and elsewhere
played down as — its only a few “moaners ” by those with a financial/political interest in the present policy ?

Jane, you are quite right. We must pay for care one way or another, either through increased taxes (or a change in the way taxes are spent), by personal saving (as we do do for our private pensions) or a combination of the two. Whether care homes are run privately or whether they are public does not avoid the fact they will cost (us) money.

Many people accumulate wealth throughout their life, particularly in property, and using such wealth to give themselves a comfortable care home life seems reasonable to me. There is this underlying resentment in some that those who have not accumulated such wealth, for whatever reason, still get access to care homes paid for by the state – and particularly by those who do pay their own fees and subsidise them. However, this is the nature of a caring society that does not abandon people in need. No more than those who pay for private healthcare should resent the rest who use the NHS. Money – wealth – is to be used. we can’t take it with us.

Robbo says:
20 November 2018

Difficult campaign this. I am not saying that the system needs funding properly and fairly, but putting caps on profit and prosecuting care homes surely mean that more of them will go bust exacerbating the problem.

Shirley Phillips says:
5 May 2019

I should like to see care homes being not for profit organisations. so that charges people in care pay are for upkeep of the home, good food and properly trained staff, who are paid, at least, the living wage. If I need care, I shall be searching for such homes or I shall have home care, from a respected home care organisation.

There are some care homes run by local authorities or charities that do not make commercial profits, but they all have to raise income in excess of their expenditure in order to survive. The accumulated surplus will not necessarily be reinvested back into the home where the income was generated, or even into the care home part of their operation at all.

In some cases the care homes that have folded were not making enough money to survive and pay the operating expenses including staff remuneration. Some companies had expanded rapidly and were not generating enough income to service the debts arising from the acquisition of other, sometimes failing, establishments. Part of the problem has been the heavily discounted charges that are paid by the placing local authorities that take up a large percentage of the places in the lower to middle bracket of provision.

Those care homes that seem to do very well, according to my observation, are those that charge high fees, provide a high quality environment, run a 4-star hotel standard of catering and facilities, never seem to have staff shortages and – obviously – attract the most affluent and always self-funding residents. Unfortunately these are out of reach of most people and local authority placements are not accepted.

The Priory was once regarded as providing a high quality environment until quite recently.

Edited to remove broken link.
AT ICUC

An alternate link to my comment today @ 18.07:

theguardian.com – Priory fined £300,000 Over Death of Girl 14 in East Sussex Hospital

BBC Panorama Crisis in Care at 21.00 – 22.00 this evening. Up to one fifth cuts in social funding in the last 9 years according to The Institute for Fiscal Studies.