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What can we learn from undercover care home visits?

Care home

How do you distinguish between a good and bad care home? We sent a team of experts undercover to assess six residential and nursing homes and then give us their advice on what to look for choosing a care home.

If I asked you to describe a bad hotel, you wouldn’t have too much trouble: we’ve all been to hotels with uncomfortable beds, terrible breakfasts and night-time disturbances from more sociable guests. Whereas a good hotel experience can make us misty-eyed years later.

Similarly, a good or bad hospital experience probably isn’t too hard to describe.

But when it comes to care homes, it’s not so easy. So many factors are at play, and one person’s idea of a cosy, homely environment can be another’s chaotic mess.

Choosing a care home isn’t straightforward

Almost half of those we surveyed who had arranged care told us they found it difficult to get a reliable picture of what potential homes were actually like to live in. Some 20% said that brochures and websites failed to give an accurate picture, and 9% said they felt that homes were dishonest about what they can offer.

We try and make sense of the things we can enumerate: what does the regulator’s inspection report say? What do we smell when we walk in? Are there tempting menus and engaging activity programmes?

Of course, all of these factors make up different pieces of the puzzle, but things get more complicated when you start considering more subtle differences between homes.

For example, staff wearing a uniform may appear competent, but on the other hand, staff in their own unique clothes may indicate a home that values the personalities that its staff bring to your relative’s care.

And what about a home that scraps the activities programme but involves its residents in everyday life – from an ex-chef peeling the spuds to a retired DIY enthusiast helping the handyman put together an Ikea flat-pack? This could turn out to be a rare gem.

Undercover experts investigate…

To find out about what you should be looking for when viewing a home, we sent three experts to six residential and nursing homes, posing as relatives looking for a care home for their mum. As an expert panel, they then analysed all the undercover recordings, and gave their conclusions.

The quality of visits varied to a shocking degree. Care home viewings play a vital part in a difficult and life-changing decision for relatives, yet two of the six pre-arranged visits had been forgotten by the home staff.

On another visit, there were no chairs in the office used for speaking to visitors. Here’s what one of our experts told us:

‘We had to stand. I was holding a coat, bag and notepad and managed to drop everything at one point. I did wonder if this might have triggered her finding us chairs or another space – but it didn’t! It felt like she really wanted me out.’

A good home will ask lots of questions about your relative and their needs. But in four of our six visits this was not the case. One inspector told us:

‘There was a strong focus on things like the bathrooms and equipment… stressing locked cupboards and safety. Not as much on what was really important to me – my mum’s quality of life.’

Our experts were asked very little on the phone before they visited and as a result concluded that relatives could potentially waste a lot of time in visiting unsuitable homes.

How do you find the right care home?

Our panel recommended using all your senses when you visit – from what you see (for example, do residents look happy, well cared-for and relaxed rather than slumped asleep?) to what you hear (chatter and laughter rather than shouting and the persistent ringing of call bells?).

As our experts explained, a good care home will be keen to find out what your relative’s individual needs are when you visit. Make a note of what questions they ask you and how much time they spend assessing your relative’s needs – compared to how much time is spent on a general sales patter.

Find a care home

How easy have you found it to judge a care home? What would you recommend to others when choosing a care home?

Comments

When my mother had been in hospital for three months with her Alzheimer’s the hospital rightly thought she should move into a care home, so I started my search. Fortunately I have a friend who had worked in care homes and offered to visit with me and shortlist a few. But the hospital discharge team didn’t like this.
“We can recommend one for you. There is no point taking your friend” they said.
“Well”, I replied “I prefer to chose my own and if I were buying a car and I had a mechanic friend, it would make sense to take him with me and get his view, no?”
“But Barry – your mother is not a car” was the Discharge Officer’s astonishing reply.
You get the feeling this thoroughly unprofessional bunch were attempting to cover something up. Now I wonder what that might be…….. oh yes – the care system is in pieces.

I had to place my husband in a nursing home in Oct 17 due to Alzeimers I was given the sales pitch of care & consideration by a new Manager that was going to turn the home round I believed and trusted them, my husbands challenging behaviour was within their experience they had been trained to deal with it they informed me. Two weeks later my husband had been assaulted by a permanent male carer who ripped his trousers off him, dragged him down a corridor, threw him against a lift and pinned him against the wall, he was so badly bruised, there were three witnesses who gave statements to the police but apparently their statements differed a bit and their was no cctv to back it up and my husband was unable to say what happened. The Police would not follow it through as the witness evidence alone was not strong enough to withstand testing in court. The man had already been suspended on a previous occasion but had to be allowed back. This time the home have dismissed him but he is still out there and probably looking for a new job in caring. He accepts his manner is direct and could have been misinterpreted by his colleagues and somebody else must have caused all those terrible bruises on my husband. My Husband is 86, has advanced Alzeiemers and prostrate cancer. I feel so guilty that I placed him in such a bad situation. Safeguard, the CQC, and Social Services are all involved but he will be able to get a job in care again. How do you stop these people? without getting yourself in trouble.

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Beryl says:
20 January 2018

Duncan I love your attitude.

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Duncan, that came from another Beryl, honest. (Different avatar) Sorry to disappoint.

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No worries Duncan, those of us who are used to your strong retorts know that it’s mostly a load of Lucas hot air 🙂 I hope you are feeling better 🙂

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I think most of us know exactly where you are coming from Duncan and I think the regular contributors are coming from exactly the same place, the difference being most of us manage to keep our emotions under wraps, and in doing so, come up with some really positive solutions.

There is a very popular book written by Daniel Goleman called Emotional Intelligence which I think you might benefit by and which explains the importance of keeping ones emotions under control without being labelled PC.

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Hi Duncan – I’m a Scot too and I feel very upset when I see examples of selfishness and greed. What I learned at a young age is that if you adopt an aggressive stance you are likely to be seen as having lost the argument.

I would like us to focus attention on those care homes where problems are known to exist. One of my concerns is that family and friends may be unwilling to report concerns in case this impacts on the future treatment of residents. In one case I wanted a friend to report a case where I found her father had fallen and injured themselves, but none of the staff would attend promptly because they were responsible for a different wing.

I wish I could contribute more to this important topic but it’s several years since I last visited anyone in a care system and have no friends or family in care and those friends with elderly parents in care have not mentioned any problem other than the high cost of care.

I want to see attention focused on those care homes where deficiencies have been identified, so that they can be closed down if problems are not addressed promptly.

Duncan, my sister-in-law hails from Oban, now living in Vancouver, and she is one of the nicest people I know and we still have regular chats on the phone, and one of our most prolific and respected regulars is also Scottish.

This last exchange has once again taken us away from the original topic and the conversation has once again switched its attention onto Duncan and away from the unfortunate victims in both England and Scotland’s care homes. Let’s now return to the original topic and focus on ways in which we can improve the care system in the whole of the United Kingdom.

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c wooley says:
20 January 2018

I’ve experienced these kinds of goings on with my aunties and uncles, its a constant battle with governments on how and ware they spend our money, billions of pounds given to other countries and unnecessary projects like the high speed rail from Edinburgh to London in which they claim will cost 50 million pounds, when the dream turns to reality it will be double that amount. my point is todays tax payer and people who are in these homes are being forgotten.

Do’nt like Care Homes,when my mother became unable to cope for herself I took her home to live with me.I look at it this way —-when I was young and unable to look after myself, my mother cared for me so it only seems natural to me that one returns the favour. Just one mans thought

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CQC have a form on their website where you can (anonymously if you wish) report poor or good care:
https://www.cqc.org.uk/share-your-experience-finder?referer=promoblock. Maybe if this were better publicised to all who use care homes malpractice could be dealt with more promptly?

• If you have been awarded a CQC rating (outstanding, good, requires improvement or inadequate) you must display it in each and every premises where a regulated activity is being delivered, in your main place of business and on your website(s) if you have any, where people will be sure to see it. This is a legal requirement from 1 April 2015.
• Your ratings must be displayed at the premises where your service is being provided unless you are delivering care to someone in their own home.

I would like to see residents and their family/ friends encouraged to provide an annual assessment of the care facility they use that would guide the CQC and local authority in prioritising inspections. Maybe Which? could push for this?

In the 70`s my husband and I owned a very small care home registered for 8 but mainly only took in 6 as it was enough for us to care for. They were all physically and mentally capable but not looking after themselves properly. They chose whatever they wanted for breakfast, milky coffee and biscuits mid morning, 3 course meal at midday dinner with coffee/tea after, mid afternoon tea/coffee and biscuits, teatime a lighter cooked meal, fruit and cream, cae etc. evekning whatever they wanted. They were mostly capable of going for walks, had their own rooms and television plus a dining room and lounge they could use. We were classed the best in town, 1 social worker asked us to take her grandmother as she would not put her in any other and 1 person heard at her hairdressers in a different location that we had a vacancy and rang her son who was a radiologist at the hospital to ring us and ask us to save it so they could come and see us that evening. We always asked before what the person liked and disliked etc and what condition she was in. People could visit any time of the day to see them. We had large gardens with a trout pool and the ladies used to want to feed them.

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My sister is in a nursing home in Accrington and the care she gets is terrible in twelve month she’s had a fractured hip and shoulder bruised face twice the last time this week she should get one to one care but they say they can not provide it you can sit in the day room all day when I have been visiting and you wont see any body until its time for lunch or afternoon tea there is no care at all they even just put the patients biscuits on to the dirty tables when they have a cup of tea one elderly lady thought her digestive biscuit was a coaster and put her cup on it AWFULL place.

That sounds very bad for a nursing home. Have you checked the CQC inspection reports, or drawn their attention to the conditions? I would.

You can find CQC full reports on their website, and locate the home concerned here: http://www.cqc.org.uk/help-advice/help-choosing-care-services/map-service-ratings-across-england

J.Mitchell says:
21 January 2018

If the whole care system, including that of hospitals etc, is based/dependent on Government funding – they never think twice about blowing millions, billions, even trillions into waging “wars” to harm, injure and “kill” people – and only when it comes to “helping” and “caring” for people who need it, they are short of the money/funds/resourses to do it. In which case the attitude and train of thought is very clear to see. And their priorities and main objectives are plain to see too. It is mostly survival of the fittest and to hell with the rest. This is the kind of world and country we are living in.

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Best way is keep the elderly parents in their own home , as many people do in other countries, and get a reliable housekeeper or carer.

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It does not matter how many care homes you visit or how lengthy reports you write about them.The one question no-one has the answer to is …..Why hardly anybody wishes to work in a care home. Sorry but you can publish as many hard luck stories as you like ,it will not alter a thing. A have read thousands of reports letters etc.on elderly care ….but solutions, or real answers are in very short supply.

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Well my poor late mam had dementia the house she lived in she wanted to go to me and my brother she was an astute business woman if I had told her that her care would cost her 550 a week she would have not gone into a home we tried unsuccessfully to get a positive assessment but we were turned down she could not talk or interact with anybody but dementia is not an illness I don’t know why because your brain is a lot lighter than a normal brain ,the horror stories I could write a book on it you will find excellent carers everywhere you will also find some who just are not up to it in my case it was usually tit for tat like I would complain about a subject and then would get a counter complaint ,I today saw an advert posted by the home for an apprentice the wage £3.50 an hour I can see a few apprentices doing the work and then later on get rid and start some fresh ones ,I shop near the home and on meeting some of the carers in the shop they tell me that the place is not so good as it was as it’s under new management I wish any of you who has a family member with dementia and you are after nhs funding good luck get a good solicitor involved

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Duncan the government has allowed dementia to be classed has not an illness so it saves the taxpayers money the only way we can change the system is to pay more tax to be controlled by the local authority also be run by them. H as a lawyer i get fed up of rich or even well off middle class trying to get out of paying by giving there homes away when it could be used to keep them comfortable in there old age. Makes me sick if you want to inherit your parents estate then look after us.

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Two years ago I helped my best friend find a Care Home for her mother. Neither of us had been down this road before and decided to read and be guided by the CQC write-ups for homes in the relevant area – bad mistake. Having made our choices and then a short list we set about looking at the homes – well some of them I would not have put my worst enemy in (baring in mind we were there because of the good positive write the CQC had given it) we both wondered on several occasions what home they had inspected it certainly couldn’t have been the one we were standing in sometimes we just stood there eyes and mouth wide open! Unless I am advised I am no longer able to care for her there is no way my mum is going in a home.

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