/ 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?


My mother was discharged into a care home after leaving hospital. The home had previously been run by the local authority and had a good reputation. Now, however, the Council had sold the home off to a private company, which immediately put up partitions to divide what had been a reasonable size bedrooms into two, instantly doubling the capacity. My mother was sleeping in what was effectively a large cupboard, only very slightly wider than the bed. There seemed to be hardly any staff on duty and my mother was visibly distressed during her stay. Fortunately I managed to get her into a better home within about two weeks. But this is what happens when care of the elderly is put in the hands of companies interested in very little else but making a profit.

c. morris says:
30 November 2017

Please can you include wales and scotland in your research

HI thanks for your feedback, I’ll be happy to pass it on to our campaigns team. This research is based on data released by the Care Quality Commission (CQC), the data is then analysed by Which? The CQC cover England only.

Sally says:
16 January 2018

And also in Northern Ireland

twice now elderly friends have had to go into care two separate stories on the same theme went in lucid bruise free ! went to visit sedated asked why in one home was told she was agitated a woman who never got angry and was the life and soul of any get together her daughter could not be bothered to care for her it sickened me and still does went to see her one day after she had been in less than a week and it looked as though the light had gone out of her soul i cried all the way home
second elderly friend who had no one but her friends has fell in the bathroom social services decided a home would be the place HOME!!!!!!!!!!! more like a concentration camp she was badly bruised i asked why i was asked who i was and then told to mind my own business i asked why she was sedated i was forced out of the door of the home by a young man who told me as i was not a relative not to come back i questioned this and he slammed the door on me one week later she died
i have told my son if i ever get to a stage where i need putting away ! to put me in the shed because i will not go into a home voluntarily and if put in one i will escape

I have recently been to a funeral of a highly respected gentleman who was in care ib the home where his niece saw a lady naked walking around the home while she visited him. this happened twice.
By comparison ABBEYFIELDS on the corner of WARWICK & ASHLEIGH roads is highly recommended. that’s where Iwould like to go.

[Sorry, your comment has been edited to align with our community guidelines https://conversation.which.co.uk/commenting-guidelines/. Thanks, mods.]

I am wondering whether there has been any study of the differences in care quality between care homes run by corporations with a number of establishments across the country or a region and those which are independent or operated as a tiny cluster. I should be interested to know whether the CQC ratings indicate whether one type of provider is consistently better than the other. With charges in the range of £600-800 a week this an important consideration. Of course, in some areas there might be little or no choice.

Until the Goverment tackles the divide between NHS and social care nothing will change. Money is wasted in hospitals by a too rapid discharge, inadequate and poorly arranged post hospital care, including care at home. The shortage of District Nurses, inadequate back up for people living at home results in early readmission. It is an expensive revolving door. The pressure on the ambulance service with ambulances queuing to take patients into A&E because of inadequate beds compounds the problem.
The problem is getting worse and throwing money at it is not the total answer. It requires a brave long term look at Care in the widest sense and how it is to be paid for.
Consistency is needed across the country and I hope that the Government has the courage to tackle the problem before the whole system breaks down.

glenys JOHN says:
23 January 2018

Yes deffinately and something MUST be done to put things right A MIRACLE

A relative placed her granny in to a care home that cost £900 per week. She derioated rapidly once in the home, she died within a few months. Not cared for properly. Her arm was found to be broken on one visit. Nobody knew how it happened or when. A male resident attacked her but nothing was done about that. Jewellery she owned disappeared as did other possessions.

Lou – Do you know if the mistreatment was reported to the Care Quality Commission or the local authority, and whether the attack and the loss of the jewellery were reported to the police?

Chris Goddard. Mr. says:
5 December 2017

Admittedly I have little experience of care homes, but as you talk of Calderdale. Of this I do have some experience. My mother in law was living with my Wife (Her Daughter) and was already diagnosed with dementia. However her dementia took the form that she forgot how to walk! And after 18 months,2years? We were forced to bring her back to the UK. The first two homes we had “earmarked” both happened to turn us away! (One of those is now rubble and 15+ houses built in its place?) But the home we settled on was one of the homes that would most certainly been on the list 5or so years earlier when I visited to service some vacuum cleaners. Smell of urine, large holes in the floor! Really dark and dank! Step forward to our first visit with Mum. It was light, bright, fragrant the residents had a hugectv to watch! Nice carpets oh it was EXCELLENT! Mums first words? Ooh, this is nice. Am I going to live in this big house? Yes Mum! With all these people, are they staying with me? Yes Mum they are! Ooh, that’s lovely! And it WAS for a further 2+years she lived there. And the home was as good then as it was when we first entered it! The staff were a good mix of older ladies and enthusiastic younger girls. Well certainly it kept Mum laughing for over two years! The only real bad mark I could award? Not to the home! But Calderdale Social Services! Some 7? 8 ? Years later? We are STILL awaiting a payment from them for Mums fees!! But the Home at Brookfoot. Excellent, 5*.

Many elderly and/or disabled people ( I am both ) receive care at home and not in a care home. Not much is said about that. Local authorities , such as mine, Camden in London, do not check daily reports written by carers in files that stay in our houses, and which nobody else reads.
Complaints about unsatisfactory service are usually ignored and I would like to be challenged on this. Authorities spend more time, and ultimately money, taking complainants round in circles hoping they eventually get tired and give up.

My wife is now in a care home with Alzheimer’s disease. A friend chose a care home for a relative by visiting over 20 homes in the area in order to choose the one he thought best. My approach was completely different. I studied the Care Inspectorate inspection reports on all nearby homes. These inspections are rigourous, in-depth and often un-announced so I believe they are a good indication of the quality of care offered by care homes. I was able to choose two, onto whose waiting lists I placed my wife. She is now in one of these two and I am very comfortable with the choice. This method of choosing a home was, at least for me, much preferable to what my friend did. (I assume there is an English equivalent to the Scottish Care Inspectorate.)

The care system is screwed starting at the very top. also there were many in local authority that should be sacked from their positions. The hell Social services allowed my father to go through for the last 4 years of his life was appalling. It’s who you know, hand shake, wink, wink. your back is my back, regardless of evidence or statements. They actually refused to look or consider evidence at secret meetings. They also came to a judgement before we even came into the room. Holding a 20 minute meeting before we were called in after held in a small hot room for one hour before that. Coming to a judgment stating. “Aw Arthur is wanting his lunch. Aren’t you hungry Arthur!” The person at the top of the table declaring I see no evidence before me today….I said you refused to see evidence put before you today” As I tried to hand photographs around the table, they were quietly put down by all on the table without being looked at or considered. I had a hand flap my evidence away “Pfffffttt!” is what I got off the at the top of the table. I complained about his shoddy meals on wheels that I put a photograph on facebook to which it went viral. A sausage roll, two and half new potatoes and a table spoon of spaghetti hoops and that was his hot meal for the day. I was threatened that from tomorrow my father who lived on his own in a rural area with dementia would no longer receive meals. I took it down just for it all to be pushed under the carpet. My father was record in his blood tests as nutrient deficient. So called family that took over his affairs because they were in charge no longer me, hit the repeat button tescos basics over and over again. dismal meals on wheels. So eventually after fighting for him for 4 solid years against everyone for him which cost me, my health, my mental health, my marriage. I had to give up to save myself and he eventually died from pneumonia, I found him. I blame his death firmly at their doorsteps.

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What does this refer to duncan?

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I was simply asking what the post about Juliana referred to, duncan, as I couldn’t see a related comment. For my information, no criticism.

…as I is many government run organisations and other large ones The workers at the bottom know more than those at the top Ask any nurse what is wrong with the NHS and they will tell you most will say the same things

If you would only stick to you compassionate side Duncan you might find you not be so “heavily criticized” I personally think you would do more good working on a Geriatric Ward in you local NHS Hospital you might achieve a more balanced view point that way

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I would like to highlight that not only are there issues with spaces and consistent quality care with elderly care homes but with other care facilities as well. I have a 29 year old daughter with a severe learning disability. My wife and i worry, that if, or when we get to the point that we are not able, or alternatively we all agree that my daughter would like her own independence, then maybe the avaiable facilities and quality of specialist care is not available for her. I am in my mid 50’s and at present it is not a major problem but i do worry for the future and what may happen when i am not here. i believe that to much government money is going abroad to assist and enhance other economies and countries and now is the time to refocus and start looking after the elderly and specifically the vulnerable at any age, and ensure they are cared for. We have the money in this country, but the powers we vote for dilute funds and give to much to others around the world.

if you or an elderly male relative have to go into hospital get it in writing and make a fuss that you refuse to be catheterized unless there is a genuine medical need. Some hospitals are now in the habit of carrying out this invasive procedure to save them time. Many perfectly able men never recover bladder control after having this inflicted on them.

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Pam Church says:
19 January 2018

Our elderly neighbour had no relatives,but had appointed a solicitor who eventually was given power of attorney. However, they were in a town some distance away and not in a position to provide practical help. He moved into a care home from hospital, suffering from a good deal of mental confusion. We had a good relationship with the solicitors but found the care home totally thrown by the fact that we were not next of kin. The high turnover of staff didn’t help. With more people living on their own, with relatives non-existent or a long way away,should care homes not have some plan in place to deal with this situation?

The deterioration in availability and the lowering of residential care standards for senior citizens are based on ONLY a monumental error that changed the course of everything good that Great Britain had and was admired by the entire world. The USA private enterprise culture embraced by the late Margaret Thatcher and compounded by the culture of managerialism her loyal follower Tony Blair, so much supported.

Essentially, privatising public services for the most vulnerable, has led to opportunistic unscrupulous individuals to make a business of care, in other words care for profit. The moral and legal duty of caring for those in the greatest need, was the advice from social, legal and economic policy academics, social sciences professionals as well as medical Drs. to all post WWII governments in order to alleviate the suffering of many afflicted by poverty, disability and a variety of ailments that affect many with advancing age. Have a look at the relatively recently repealed National Assistance Act of 1948 (the 1948 Act) and the 1946 and 1947 NHS Act. Fitting then these laws and even more fitting now with the increasing age demographic trend, middle age and Millennials population that as tax payers are owed the duty of care in the course of the next 50 yrs.

The centre of all discussions, the planning and the development of services for building a decent society was provided until the 1990s by local authorities controlled and inspected by separate inspection services all public services, accountable to the electorate, who rightly so funded those services with their taxes.

Pensions above the minimum threshold are taxed. The electorate still pay taxes. Introduce hypothecation and let the public decide by means of an annual vote, how to spend 80% of their taxes, so that the public can take responsibility for their country and allow a highly competent, honest, non political individuals coordinate with equally competent people employed by local authorities take the responsibility of leaving no one in the criminal state of neglect and abuse that has become the norm even more in the last 25 yrs.

Let it be known that since 1979, all health and social policy academics and professionals have been excluded from being the architects of what they are best at i.e. researching social and health issues and trends and forecasting the most appropriate means of investing tax payers money in the most cost and quality effective care provision and in many instances, for decades, delivering services themselves.

There is no time now for even considering doing any patch work to the devastation caused to care services in the course of the last four decades. It is essential not to reinvent the disasters of the last 40 yrs. The greatest hope is to read and reinstate the NHS, National Assistance and other post WWII laws.

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Monica Hodkinson says:
24 January 2018

Which contribution to the conversation with the government on behalf of consumers, could be to call upon all uk retired nursing, medical, social workers to register their interest in long term or short term “fostering” (even convalescence to aid the number of older people “detained” in hospital against their will and where no clinical/medical interventions are being delivered) but individuals ready for discharge, but cannot be so, due to not only care home failings, but equal failings in domiciliary care.

That register of interest to be given to a small and short term “Administrative Task Force” (six months Only to followed by a review, if registrants numbers become unmanageable). The Task is to give a URN for every expression of interest, followed by a request for submission of a cv AS WELL as details of the care and support services each of these retired professionals is proposing to provide TOGETHER with photographic evidence of the ENVIRONMENT in which the care service is to be provided in the event of being successful with compliance of all other requirements such as Criminal Records or equivalent checks, One requierement would be that minimum one older person per household and a maximum of 3. Single rooms with a shared bathroom for no more than 3 people within the proposed setting.

Once all checks and balances have been evidenced, the “Aministrators Task Force” role is to group by area all those “registered providers of “foster care” in a homely and caring “home from home” environment with 5 star ratings only allowed. The rate of pay to be exactly what the government hands over to the thousands of institutions and in such way wipe them all off the face of the earth as a victory to end the decades of “make up” given to the old asylums and workhouses of the early XX c. A.D.

It can be done, it happened very successfully in many places of the U.K. in the 1980s and 1990s only to disappear because the spirit of Westminster’s government’s NHS &Community Care Act 1990, was sabotaged by large scale providers of institutional care at such a low rates that such aggressive marketing strategy led to the “home from home” providers being seen as no value for money.

All in all the power of managerialism with executive and directorship accountants as (Finance Directors, Heads etc) apportioning a cost to everything but having NO IDEA of the VALUE of anything. These jobworths were not given the REPONSIBILTOY for establishing correlation of COST vs VALUE. Had they been given such a responsibility, one has to laugh, the people who were more relevant to forecast the current tragedy would have been and are still, are ACTIARIANS AND STATISTICIANS all on operational salaries for reporting on their findings to the government with accountants being removed from their little cosy, fat pay jobs which any last year secondary student on a work experience would do better at for one fraction of a “Finance Dorector/Head/ Executive and still be a well remunerated work experience placement.

I would be more than prepared to meet with Which? Representatives who may be asked to answer any questions from the government, one hopes very soon as something to put an end to the now “normalised attitude to suffering of older people in the UK” criminal situation.

Peter says:
30 January 2018

I have been working with the care administration sector for 9 months on transformation of the service and what surprise me is the complexity and wide variation of care packages their support. This alone is adding to the delays and costs. Moreover, no one really understands where the money goes. We need to rethink the system.

pat owen says:
31 January 2018

My 98 year old mother-in-law had to be placed in a Nursing Home in the Grimsby area and couldn’t have been better looked after. From 92 years of age she has had various ’bouts in hospital and of course prefers her independence when it is possible to offer this. However on every occasion she has been well looked after from the local Hospital Diana Princess of Wales Grimsby but the worst aspect of each and every hospital admission is being asked the huge list of questions (via Social Services) only to be told she will get no help whatsoever. Mum is a very independant individual but last time she was in a home as soon as selling her home to pay for her care fees her reaction was even if it kills me I do not want the state to look after me. What I am trying to say it’s time we brought in some type of tax to cover all these needs it should be a right not a situation that puts Mum in ‘no-mans’ land every time. At the present time we look after her washing needs and she has carers in twice a day more for our peace of mind than hers. We call and look after her shopping and hairdresser etc. We are a loving family but she feels she is a burden and would love an ideal instant heart attack (in her own words) to get her out of the situation. Surely it is a human right to be able to be looked after at her age. She has had very little in her life monetary wise and has had to be very frugal and yet if you are a person who has asked everything of the state throughout your life you get absolutely everything.

We, by we I mean the Government of the Day only care about the elderly when they want their vote. Regardless of which party is in control. We FAIL our elderly utterly in every form, from pensions for 50yrs+ working life, social care and an abject failure to offer support within healthcare. Since the early 2000’s Governments have failed to keep pensions at a level compared to Minimum Wages/Living Wage. They seem to think as you get older, YOU DO NOT MATTER – except of course, when they want your vote. We have some of the poorest Social Care in Western Europe, with very, very little being done.

My mum went into a local care home and a couple of days later apparently threw herself onto the floor. When the staff got her up they noticed her arm was dangling. They didn’t call an amblanc because a doctor was due that afternoon. Mum had a dislocated shoulder and must have been in agony.
When she came out of hospital we found her a very nice place that specialised in dementia care. We were very pleased with the new home apart from one of the residents who woke mum up with a slap round the face one morning. She was frightened of her. When mum died all her possessions were shoved in a spare room, in bags and boxes and there was a new resident in her bed. So, not only did mum have to pay for that month they were also getting money from the new resident for that month as well. Very profitable, a nice little earner as Del Boy would say.

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