/ Health

Are changes to the care home sector on the horizon?

Care homes

The Competition and Markets Authority has reached the midpoint of its year-long review of the care home market and published its interim findings. So are changes afoot for care homes?

There are a whole host of problems that people have come up against when they or their loved ones have dealt with care homes. We know this simply because of the stories many of you have shared with us.

Earlier this year, we asked people who had experienced a problem in a care home to share their stories with us so that we could help inform the Competition and Market Authority’s (CMA) review – and the response was incredible.

Care review

So far, we’ve gathered nearly 700 first-hand experiences from residents in care homes and people responsible for organising their relative’s care. These stories have made up the bulk of evidence for the CMA’s study.

The stories you‘ve shared have helped to uncover some real failings in the market, and once again reveal the true distress and pain this can cause people who are impacted by them.

We’ve heard people tell us that they weren’t given a contract to outline terms when their relative had to be placed in a care home.

Some have paid burdensome hefty charges upfront – one person even told us that they had to pay £10,000 before their relative could move in. And others have mentioned what a minefield it can be to find information about funding once their relative’s financial situation had changed.

So it’s safe to say, given the awful stories shared with us and the CMA, we had great expectations of the CMA findings.

CMA findings

The CMA reported that it has found some worrying signs that the care home market isn’t working as well as it should for those who require their services and support.

In particular, it found that:

  • People are genuinely struggling to make good decisions about care, due to the lack of information available, the impact of the stress and pressure people can be under at this time, or because they just find the system plainly confusing.
  • It’s a challenge to complain – many find it difficult to complain when they are so reliant on the care, but even when some do, the complaints system isn’t working well enough.
  • The future of care homes – uncertainty about the future of the sector has meant that investment for growth and improvements has been stunted in this market.

But most promising of all is that the CMA is also taking action by opening up a consumer protection case to investigate concerns that some care homes may be breaking consumer law.

Future of care

As the CMA continues with its review, we want to see it continue to take action where it’s needed.

But there are still five months to go until the regulator concludes its investigation, so there’s plenty of time for more of your voices to be heard by sharing your experiences of care homes.

Have you had experience of the care home sector? How do you think care homes could be improved for residents and their relatives?

John B says:
22 October 2017

In 2001, we had to place my father in care. He had several health issues, but primarily arthritis of the spine, which rendered him incapable of walking and, eventually, unable to stand unaided. My brother, sister and I worked full time, and my mother was unable to care for him alone. As Dad was also doubly incontinent, carer visits would not have been a practical option. We therefore made the joint decision to find a suitable nursing home, where he could be looked after and we (mom especially) could easily visit him. Dad was a very kind, polite, undemanding man, but the combination of incontinence and immobility meant he frequently requested toilet assistance. We found a place for him in a small, locally run home, but the staff were very unsympathetic to his needs and we soon moved him, this time to a larger, more modern establishment, run by a major national healthcare group. Initially, this seemed much better, but problems soon began to arise which were very upsetting to Dad and the family. The majority of care staff were good and helpful, but we had to complain on more than one occasion about the belligerence of two staff members, who were simply bullies. Dad’s clothes regularly went astray, despite being clearly labelled, and we would often find him wearing those belonging to someone else. A succession of other lesser but nonetheless annoying incidents persisted for around two years and, although we are understanding people and not predisposed to complaint, we regularly found ourselves doing exactly that. During this period, Dad’s mental state deteriorated; he was a bright, intelligent and interesting man, but he became very withdrawn and institutionalised. On my final visit to Dad, I noticed that he had drunk very little. I encouraged him to drink, but he seemed unable to do so. I reported this to the nursing sister on duty, who assured me that they would monitor him. Late the next day, I received a call from my sister to tell me that Dad had been admitted to hospital and was quickly deteriorating. Before I could reach him, I received a further call to say he had passed away, apparently due to multiple organ failure. I very strongly suspect that, had the nursing home been properly monitoring his fluid intake, Dad would have not died at that time.

As a result of that experience, the family have been determined that, if at all possible, no other loved ones will have to suffer being placed in a care/nursing home. Our own circumstances have changed, which has made this resolution more practicable. I was made redundant in 2006, which coincided with the onset of Vascular Dementia in my Mother-in-law. I moved in to care for her in 2008, followed two years later by my wife when she retired. We have looked after her 24/7 ever since. I won’t go into the details; those who have cared for dementia sufferers will understand what we have endured for the last 9 years but, despite this, I still would not subject her to the ‘care’ experience of Dad.

My own mother has also needed daily assistance and care visits in recent years and, two years ago, we moved her to sheltered accommodation. Despite the strain it places on us all, we are equally determined that she, too, will not go into ‘care.’ My brother and sister visit her on a daily basis and I go as often as I can. This, combined with visits by (thankfully good) care workers has so far enabled Mom to remain independent. We just hope and pray that her mobility does not deteriorate to the point that we cannot handle her and we are forced once more down the care/nursing home route.

We have been scarred by my father’s treatment. There has to be a sea-change , to not only ensure higher standards for care/nursing homes are established and met and many more places made available , but we also have to be realistic and recognise the immense cost to the nation of such care in an ageing population. There should be a parallel campaign to encourage and support care at home, as my family are now doing. We are in a very fortunate position, insomuch that four family members are now retired and we can afford to care for my mother and mother-in-law, both in terms of time and finance. The paltry Attendance Allowance and Carer’s Allowance help, but would be no substitute for salary, were we still working. There also has to be a cultural shift; I’m afraid far too many elderly people are viewed as an encumbrance by those who should love and care for them. We are all too ready to expect others to take on our responsibilities.

Jan P says:
23 November 2017

My husband suffered from Dementia and, at first, we coped with the help of an excellent company providing carers in the home for which we were happy to pay. He also attended a local Day Centre – also excellent. When we could no longer cope with him at home, we were lucky that there was a vacancy in a Care Home only a short drive away. I have nothing but praise for the home and the care he received until his death in August. As we had savings, I had to finance his care myself. My only slight annoyance was the fact that I was, to a certain extent, subsidising the care of those whose fees were paid for by Social Services. During the whole of his time in the home he was treated with respect and was obviously content there. During his last few weeks, he was constantly checked on by the care staff ( and even the cleaner! ) whose patience seemed never-ending. I am horrified by the experiences of other people.
I think that the whole system needs a good overhaul. There is a great discrepancy in standards and advice. So much depends on where you live and the care my husband received should be available to all.

I would just like to say following the first gentlemans comments, that after having worked as an agency care assistant that I have personally witnessed how bad they can be & to be honest that’s even the ones that look good to the untrained eye. Everywhere I have been, they work on skeleton staff to cut back costs. Carers are paid diabolical money & can work 12 & 15 hr shifts. You can get home at 11pm & be up at 5am next morning. Carers are skilled, they have to be to put up with how there job treats them, unless they have a very good heart, & oddles of patience, they are mostly trained to some nvq level so why does the pay not reflect this. My grandfather of nearly 101 years, passed last year & I never let him go in a care home until a few months before he died. I always reckoned that when you saw 3 members of staff with 40 odd rooms what the ratio was. I am so pleased. I would hand on heart personally not recommend it to anyone. I guess; if you ask any carers if they would want to be a resident of a care home you will get your answer. But by the will of God I will ensure that all the people I love would not end up in one. It would be cheaper to pay for a carer to be in a person’s home from 8am till 8pm or something? Regarding emi care, they really need to employ a lot more carers on those wards, you need it to be able to handle the situations that arise on those wards. To put it bluntly, I only ever worked at 1 care home that I would recommend, & i used to go to a lot of different places on a daily basis.

Very sorry to learn that Barnet is bottom of the ratings table. Have the CQC any views on this? My wife was well cared for at Clovelly House in North Finchley for about two years, and on the strength of this her sister followed. While frail and physically disabled she is still completely compos and is well contented

My Mother-in-Law spent several years in a Council run Care home – Weaver’s Court – in Diss, South Norfolk, with 24 hour help on call.
She had her own 4 room flatlet, with pull cord alarm points in every room.
She also had (although she had to pay for installation and all calls) her own telephone.
Her rooms opened out into a small, private, garden area.
She had to provide her own breakfast, her Lunch was cooked and served to her in the communal Dining Room and the produced fresh sandwiches which Residents could purchase for their tea. Naturally my wife obtained all the cereal and other food and groceries for her.
My wife, and my wife’s sister, had no complaints whatsoever about the care provided to their mother.

I know that residential home, John, and have heard very good reports about it. It’s actually operated by Norse Care which is a trading subsidiary of Norfolk County Council. They run about 20 highly-regarded homes throughout the County, so it can be done.

I cared for my mother for many years before very reluctantly moving her from her own home to a care home. I visited my mother every day both at home and whilst in two different care homes and in two temporary homes whilst we were on holiday.

My conclusion is that if you do not have a relative close by, residents are at risk from the main cause of problems – poor management that is not held to account, rather than lack of funding. Like a failing school the cause is a weak head teacher not a shortage of exercise books and pencils. The same school can be turned round by a change of leadership in the same building, with the same teachers and the same children, yet often the “failed institution” is closed down and the building abandoned as if it is the building itself that is at fault.

This is what happened to us; the care home concerned, that we helped close, is still empty after three years . There were plenty of staff – many were temporarily contracted at great expense but arrived at the home and stood around doing nothing waiting to be told what to do. My mother was left in bed with the window open and room temperature below 60 degrees Fahrenheit because the cleaner was told that the window had to be opened for airing after cleaning. We complained, but the manager still left other residents in the same situation until we complained on their behalf. There were many other issues – too many to list.

When the Local Council convened a meeting because of so many complaints, the second in command of the very large company that operated the home, and still operate many homes, gave her seat up to someone and left the room never to return.

In contrast the next home my mother stayed in was excellent – a caring responsible manager that interacted with her staff and listened and acted on any comments made.

It has to be said that the CQC has changed – at one time if you made a complaint it was just dismissed with comments like “you are the first one to complain – we will talk to someone when we next visit..” but did nothing and refused to register a formal complaint. At least now they do record complaints.

My recommendation is for relations of residents if possible to get together to form a “monitoring” group to share concerns and apply pressure when needed. Care homes are no different to many other institutions – hospitals, doctors surgeries, domiciliary care companies – they all have the best of intentions but need honest feedback and action to work as they should.

With my mother’s dementia getting worse, we managed to get her a room in St Augustine’s in Alderstone. As a catholic this suited her as she always thought she could walk to church where she lived (a distance of a mile+). The care home, staffed mostly by Spanish nationals, many were nuns, was exceptionally good. The overall impression was a focused and caring staff. I would recommend the home.

My wife went into a local care home for two weeks having suffered a broken leg. The building and facilities looked wonderful but the care was dire. In the whole of the fortnight her bed sheets were not changed and she had to make the bed herself. The food was minimal -an example of an evening meal was cabbage and potato soup followed by two fish fingers and a small jelly. She decided to leave a day early as she had been left to her own devices for much of the time ,even having to demand that her blood pressure be taken as the staff had been requested to do twice a day.No staff member was in evidence when she left to enquire why she was doing so. A shocking and very expensive experience.

If HMG stopped giving money to foreign governments who do not need any at all or never reaches the intended people and spent that money on looking after the elderly instead that would go part way to solving the problem of elderly care look after our own people first but international reputation is more important than looking after its own people

A. Cater. says:
30 November 2017

First and foremost – I know that smaller owner c*m manager run care homes, the owner being a skilled experienced nurse, trained not only in General Nursing but also in Mental Health is far superior – provides true loving skilled care in all it’s dimensions, they take a personal pride in their home ,nurses who have had years of experience as Ward Managers -have a bank of staff (their own staff) who cover the home – not agency staff who are not familiar with the residents needs in their entirety – They save money by not having to employ a manager and so earn a decent living.

The majority of home owners. Not all.

People who have no idea of caring for the elderly, have no skills in caring for the elderly, just buy / build care homes, they then employ a manager and mostly just focus on their income expenditure and profits. The manager is not able to make financial decisions – this has to be referred to the owner. Can he/she just make decision re. staffing budget, just decide to take on extra staff when needed, order equipment, buy quality food, decorate replace furniture carpets – spend and create a beautiful soulful garden — – spend more money on varied entertainment to suit each resident’s likes and needs. I could go on but I think you get the picture.

When the home inspectors state “When I need a home for my father/mother I hope that I can find a place like yours. When there is a waiting list, when you never need to advertise a vacancy – you will indeed have found a special home.

Retired home owner/manager for 21 years – and lived above “The Shop”.!


colin McEachran says:
30 November 2017

The ex-chair of Beild Housing association in Scotland told me last night that 21 of their care homes in Scotland are going to have to close because of lack of government support and funding!!!.
add Scotland to your campaign.

David Leadbeater says:
6 December 2017

Myself and wife (T/a Kim & Dave Valentine) for the last 12 yrs have performd music therapy for the x mlitary and elderly and it is such a delightful job and very rewarding to say the least!! However, it is literallly standard practice…from our experience that there is just not enough staff to do their jobs correctly and safely! (This also breaks the rules legally). It is more than a crying shame for our elderly who have done so much and gone through so much to be treated this way. This underfunded system is already broken and we feel very sorry for alot of the hard working staff we see doing their utmost but often failing these old people as they dont have the correct support and numbers etc. Its all very sad for the residents and staff alike!!!
It’s no wonder they love to sing, dance, smile & laugh when we entertain, we are always humbled and blessed every day K & D xx

It seems that the disgraceful practice that non-funded residents of care homes have to pay more in fees than fully funded residents (their fees paid by the local authority) has been swept under the carpet and therefore will likely continue.

The costs of doing this are discussed in the CMA report https://www.gov.uk/government/publications/care-homes-market-study-summary-of-final-report/care-homes-market-study-summary-of-final-report
Where does the money required come from? Additional taxes, increased council tax, or an equivalent reduction somewhere else?

Elsewhere I suggested that given the cost of care for a small proportion of the population it might be funded by private insurance contributions. My suggestion and reasoning were as follows:
“Someone can please check my numbers but it seems revealing. According to a 2011 report, the average length of stay in a care home for the over 65s was 909 days. 2.5 years. At, say, £1000 a week that costs £130 000. Government statistics show 3.2% of the population over 65 are in care homes, and the figure is fairly stable. So if all the population over 65 had saved £4160, that would have paid for the care of those 3.2% (actually, less because around a third are self payers, many of whom may have the requisite means to self fund). So if we all save £2 a week during our working life we could fund our possible need for care in old age. Is that too big a price to pay?”

It has progressively become accepted that the care of elderly people must be a public expense with as little contribution from the beneficiaries as possible. Many people strongly object to having to sell their property in order to pay for their care, but why is that so unreasonable? It isn’t in itself, but it looks unreasonable when compared with the likelihood that people who go into social care from rented accommodation are under no such obligation. I believe this is a quandary that must be addressed in order to provide a level playing field, but it is made difficult by the fact that going into a home includes both an accommodation element [including meals, laundry, etc] and a care element; if these can be split and the accommodation made the responsibility of the occupier and the care the responsibility of the state [e.g. as an alternative to NHS provision] we might start to get somewhere. If a tenant continues to live in social housing, they still have the rent to find [with or without benefit payments] and they still have to feed themselves and keep their home and clothing clean, so that expenditure could just transfer to the home care charges. If other members of the family were supporting them financially directly or indirectly it would not be unreasonable for such a commitment to continue. I believe it is also essential to disconnect the use of the principal asset, the resident’s privately-owned home, from the question of inheritance since that is clearly another bone of contention. The alternative is to rent it out and use the income to meet all or part of the care home charges.

Whether we can continue to live in our own homes until a ripe old age or whether we succumb to conditions associated with old age is, to a large degree, a matter of luck, with the age, duration and severity virtually unpredictable, so I don’t think it reasonable that the state should carry all the risk, and either private capital provision or an insurance-based fund should become part of the solution. There remains the question of how to deal properly with those who have not made any provision by either means. The Victorians used the deterrent principle to relieve the burden on the public authorities; that would be unacceptable today but without any constraints the implications for taxation at national and local levels would be overwhelming and economically unsustainable.

It is frequently suggested that it would be better all round if adult residential care was effectively nationalised and retuned to local authority provision. Personally I think there is a role for local authority provision, and there are still a number of county councils and other authorities that run their own care homes either by themselves or in partnership with a commercial, or quasi-commercial or charitable, partner. But we should not overlook the facts that in previous times (a) local authorities were not the only providers and there were many independent and privately-run care homes within a whole range of quality levels, and (b) local authorities were very much providers of last resort offering a fairly basic standard of provision and meeting the need of only a tiny percentage of the people eligible for such a service. ‘Nationalising’ adult residential care would be an extremely expensive solution and although profits would be stripped out of the system there is no guarantee that the same revenue would not be lost due to inefficiencies, poor management, and wasteful practicies.

Providing care homes free on the “state” would be nice if we could, as a nation, afford it; it looks like £15 bn a year to me. It isn’t “free” because the taxpayer will fund it. That seems to equate to about £550 per year for each person in work.

The problem with who is subsidised runs through society. Some are paid not to work by those who do. Some pay “full price” for their accommodation and help others do not. It is the way a caring society works. So those with wealth will be asked to pay for their late-life care, and to help fund those without. The reasons people cannot or do not work, or who have not accumulated wealth, are immaterial. It might seem unfair to some, until you find yourself in the same position.

I used to work as a sheltered housing manager and we had a few members of staff whom had worked in council care homes, these where very much highly trained, well qualified staff whom found they could not work in private care homes as they had watched the way they had forced local councils to close down the state run homes, they told me the way they just ‘Popped up’ and offered a cheaper alternative to council controlled homes, the council trying to save cash saw this and the flow of elderly in need of care started to dry up at the council controlled homes, at first it was the casual staff then the senior members where enticed to work in the private homes for what looked like better working less red tape and they had flexibility to choose one nearer to their homes, when the staffing was reduced and the lack of patients the council controlled places where in effect closed down and staff relocated, hence sheltered housing staff was a main occupation listening to them they talked about the training they had and responsibilities and qualifications they had earned it was in my opinion that they had loved their jobs, now after the homes where closed amazingly the pricing went up, and up in the private homes, and the council in its efficient ways had sold off the equipment for pennies ( a lot went to the private homes) then sold the land for housing, now years down the line councils cannot support the costs of the elderly to stay in care homes so they bed block the hospitals, I feel that the council ours was labour controlled was hoodwinked and they have cost the taxpayers millions on a plan to save 100’s the responsibility of elderly care should be passed to the NHS to control they might be able to open up the old cottage hospitals they closed down who’s purpose was to look after the elderly in their own community……