/ 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?


” 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.”

Without addressing the long term future of legislation in the market any businessman would avoid this area completely. Higher regulations and perpetual criticism will ultimately force the closure of many and the cost of providing falling back on the family or Councils.

I hope CMA are allowed to think radically to improve the concept. What has been written so far is fair and does make the point that most residents are treated fairly.

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Hi Duncan, we know how much of an emotive subject this can be – having reviewed the near 700 first-hand experiences of care, we feel that we’ve just seen the tip of the iceberg too. I’m sorry to hear that you’ve suffered yourself, please do let me know if there’s something we can do to help you here.

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I appreciate your honesty, Duncan. I hope you that are getting the support you need now, but if you’d like speak with me or any of the convo team, do drop us an email at conversation.comments@which.co.uk

Nothing much mentioned about the joint fraudulent behaviour by the care homes and local authority whereby self funders are charged more by the care home to enable the local authority to pay less

bp says:
21 June 2017

spot on too many private care homes run for profit and not for care of people’s loved ones

All concerned are playing games around the edge of the matter. There are just too many vested interests in this major problem which will overtake all other problems that the country faces. Considering recent suggestions which have been made by Politicians most of which are unacceptable to the public and are riddled with unfairness to one or other parts of our Society. The function of both the NHS and Care are driving staff into a hopeless situation which is worsening by the day.
Joint non political All party discussions are required.
A discussion paper presented to the said parties by independent bodies involved in all aspects of the caring industry to be devoid of all political comments, should be totally discussed. All concerned to be locked in a room for months, if necessary. Total Blue Sky thinking is required, no ideas barred, no suggestions ignored, no matter how way out.
A major rethink on how these two Bodies should be run or merged MUST be produced.
Great Britain thought, discussed and produced the NHS from scratch. If we could do this in 1948 then we can do what is required today. What we do not require is Labour via Conservatives arguing which ideas are the best or worse!!!!!! We need a solution and no one cares whose idea is best just come up with the thoughts and agree on a finished solution.
It is an absolute certainty that the present Health arrangement in all it’s disguises cannot continue for much longer. It MUST be evident to all concerned that we are near to breaking point. Let us get a grip before it is too late. We require just one strong individual to take the whole problem by the scruff of its neck and come up with a solution.
You can shout “Costing” but lets get a system in place first and then consider the cost. If extra taxation is required to fund then so be it, but for Gods sake keep the Politics out of the whole discussion.
It’s not solely about money.
Any current MP who does not believe that this is a crisis of monumental proportion should knock on doors and see what the views of their constituents really are when they are unable to get a doctors appointment for three weeks or spend hours in the A&E, most of their visits being because they are unable to see their GP. The problem commences at the bottom and continues to the top. The spiral has to be squared and this means a complete change of our systems for young and old.

privately owned care homes are just another way to make as much money as possible ,not all but a great number of them ,why are many owned by large companies who all about making money ,they keep buying more ,it must be a money making thing, large companies have to keep their shareholders happy

The important things about care home provision are care standards and monitoring to ensure conformity. The Care Quality Commission has improved its performance but I don’t get the impression it is ahead of the game and leading instead of chasing. Since local authorities no longer have the resources [and possibly not the competence] to run care homes they all seem to be private companies or run by charitable or not-for-profit organisations. This is not necessarily a bad thing provided they are competently run and meet the relevant standards. Obviously, privately-owned care homes have to make a profit to repay the shareholders who have invested their money in them and to invest in further developments. If investment is artificially constrained then quality care provision will be jeopardised.

Many care home residents like being in private care homes if they are run to high professional standards. Obviously they have to be able to afford the fees but a goody minority of the elderly population seem to have the means to reside in such establishments. One of the things they are paying for is exclusivity so that all the other residents are self-funding and not placed there by a local authority that has bought a block of placements.

This arrangement cannot work for all and the problem that has arisen is that local authorities are having to beat down the cost of placements to the point where the operation is not covering its costs. In those situations the quality of care and standard of provision are bound to suffer and the experience for residents will be diminished. It is a valid criticism that self-funding residents are having to pay considerably more than the state-funded residents for a care experience that is unsatisfactory for them. The pressure placed on the care home staff by these conflicts also diminishes the quality of experience for all. Unlike with the NHS, where I do not consider throwing more money into the bottomless pit is necessarily the answer, in the case of social care I think it very much is the answer so that there is enough incentive to operate high-standard care homes for all sections of the community, that good staff wages and long-term futures attract people with the right motivation, qualifications and willingness to develop their professional skills, that care establishments are maintained to high standards for safety, hygiene and welfare, and that managements are driven by the needs of residents rather than by the constant need to cut costs and reduce quality.

Sophie Peterson says:
21 June 2017

It all boils down to money – we should bring the homes back into council ownership and pay people properly but even more important is to have much better home care provision so that more of the elderly can stay in their own homes.
Why is it that outsourcing everything is seen as the holy grail – can’t the state run something equally well without there being a profit motive?
And we should all be prepared to pay more tax to fund it – we will all be old at some point – but society seems to expect Scandinavian levels of care but only pay American level of tax – it just won’t add up…..

I have no objection to councils running residential homes again so long as they can do it as well as, or better than, the best alternatives – and that is where I am doubtful. Most councils closed their care homes a long time before economic stringency forced them to do so and that was because they could not run them properly. Institutionalised behaviours were prevalent, there was an anonymity about them, management was remote and unsympathetic to the differences between individual homes, and residents were moved around between them like stock in a warehouse. For historical reasons, many of the homes were a long way from the community backgrounds of the residents so they felt isolated. There were, of course, very good examples as well but, basically, the doctrinaire municipal approach is not well suited to good social care. Local authorities appeared to be indifferent to prolonging and enriching the lives of the residents because they operated on a restricted waiting list principle where reducing the waiting time was an important consideration.In a private home, continuation of income is the driving force, whereas in the state sector cutting the losses is more powerful.

TonyF says:
21 June 2017

Care-homes are regarded by many politicians as objects simply to be devolved to the private sector, germane to their generic long-term intentions for the NHS and for social care. They do not want to spend more than a certain percentage of GDP on the NHS, social care and care-homes, so we are where we are now.

The private sector has to regard them as business opportunities because of the capital involved, and expenses of employing and supervising staff. They are in business, with shareholders to respond to as first priority.

Accepting these realities relegates those in need of care-homes (and their relatives) as pawns in a chess-game of priorities other than those of attending to their needs.

The first step to improving care-homes can only be in adjusting the attitudes of politicians to focus primarily on the needs of those requiring care-home accommodation. We have seen their priorities when it comes to contrasting attitudes in budgeting for refurbishing the Houses of Parliament with that of refurbishing council-run apartment blocks like Grenfell. The recent manifesto U-turns on social care funding by seizing homes to pay bills tell a similar story.

Tony Papard says:
21 June 2017

The Head Office of my mother’s Nursing Home took a huge lump sum out of her bank account just two days after she passed away. I’d paid the deposit for her funeral that day from her bank account, and if I hadn’t noticed this unauthorized debit from the Nursing Home her account would have been overdrawn or her funeral would have been canceled. I had received no warning that this money would be taken out by the Nursing Home. In the event my brother had to put £1000 into the account so her funeral could go ahead and the account didn’t go into overdraft. The payment the Nursing Home took was incorrect, and they eventually had to refund most of it. It took a threat from my mother’s bank to take the money from the Nursing Home bank account before they actually refunded the money they had taken.

Gerry says:
21 June 2017

When my aunt died, I cleared her room the same day. But Barchester still charged us over £1000 for an extra week, craftily sneaking it into the final bill a few weeks later and hoping that we wouldn’t notice: close inspection revealed the final care date being seven days later than was actually the case.

When challenged, they just pointed to an item buried in the small print of the terms and conditions. That was way back in 2009, so I shudder to think how much they are charging today…

This should be outlawed. I don’t believe care homes incur any significant additional costs after a room is vacated (it certainly hadn’t been redecorated / refurbished before she moved in), and even if they do, these costs should be factored in to the normal weekly rates. Charging a fee after a resident has died is just a trick to make the weekly rates seem lower than they really are.

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I agree with you, Gerry; that is a very unsatisfactory practice and should be deemed to be an unfair contractual condition and therefore void – the date of death is unpredictable [he says with no hint of irony] and should not incur a penalty. Perhaps it has never been tested in law.

I had been of the opinion that Barchester Group was one of the better private care homes operators. I am a member of a local organisation that has its meetings in the library of a Barchester home and I must say I have formed a very favourable impression of the quality and the amenities of the establishment and the apparent contentment of the residents [with an eye on our own futures perhaps].

Gerry says:
21 June 2017

Yes, I fear that other operators are probably far worse. But I was never really happy with them: I could never relax and be fully confident that everything was being managed pro-actively. For example, the emergency pull cord was often coiled up and placed out of reach rather than being left extending down to floor level. (My concerns weren’t just academic: when still living at home she had fallen and broken her hip. Fortunately I found her in time because the phone wasn’t answered.)

I was also conflicted about a member of staff who was deaf; you could be understood only if you faced her directly and spoke very clearly and distinctly. I didn’t complain because I really hate to discriminate against a person with a disability, but I was worried that my aunt (who had early signs of dementia) would not be heard if calling for help, especially after they adopted a ‘closed door’ policy for residents’ rooms.

Another concern was that the corridor doors were locked in the evenings and overnight and could be released only via a secret code: there was no panic button. There was no escape if a problem hadn’t triggered the fire alarm and released the doors, e.g. being cornered or assaulted by an intruder or a disturbed resident.

The saddest memory I have of the place is having to lie to my widowed aunt that her engagement and wedding rings were being stored in the safe for security. The truth was that they had vanished soon after she arrived and were never seen again.

I have had little experience, good or bad, with care homes. I was visiting a care home when a friend was on holiday and found that her father, who was in his 90s, had fallen and lain on the floor for a time before he was able to drag himself onto his chair and call for help using a handset on the table. When I arrived, he said that no-one had turned up. Even then, it took be long enough to get him attended to, and I learned that he had fallen several times recently. That was in an immaculate and expensive nursing/care home. Surely he could have been issued with a call button to put on his wrist and asked not to attempt to stand up unless someone was on hand.

None of us relish the thought of going into a care home but we do need our care homes to be run safely and effectively. I’m very grateful that Which? is keeping us aware of developments. To me, care of the elderly is more important than letting subscribers know which toasters perform best.

Some years ago my mum was in a Southern Cross care home. One Tuesday I got a letter from Southern Cross accusing me of being £7K in arrears with her care home fees. They wanted the money by Friday that week. My mothers solicitor paid her fees, after I forwarded the invoice, from my mother’s funds. I informed my mother’s solicitor of this claim, she was able to prove all bills were paid up to date, but she charged £250 for doing so. I sent the bill to Southern Cross, but they would only pay £100 of the bill. I thought it was just a genuine error. But, on visiting the home, the relatives of other residents said they had received similar letters. All had paid their bills. To my knowledge they got away with it. Disgusting.

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And was anybody ever charged with corruption? . . . . No, I didn’t think so.

I personally think we all need a long hard think about care for the elderly, the baby boomer generation are just coming into the elderly age bracket, and their are loads of us, I think that there should be a flat rate which Government takes out of your wage packet every month say £25-30, automatically like Tax and NI, so at least we dont have to see care home funding via Councils being cut by all Governments, no-one realised we would be living until our 90s or 100s, so Im afraid we have to contribute. If you die young then whatever contributions you have made into the fund then goes to pay towards your funeral

I agree with you, Debbie. As a ‘baby boomer’ myself I have been conscious of the implications for a long time and hopefully have taken appropriate measures for later life, but what I have provided might not be enough and other unforeseen complications could arise. It would not surprise me if many other ‘baby boomers’ while being aware of the outlook have done nothing to support themselves in the future and, in the absence of state support, will become destitute.

The government will probably say that it has not actually cut the money that local authorities can spend on social care and point to additional sums that councils have been allowed to levy as part of the Council Tax, but that ignores the fact that for many years the amount of Council Tax increase has been severely restricted each year such that it was no longer enough to maintain services at a standstill level. It will argue that it is up to local councils to decide how to manage their priorities within the funds available, which is true, but it explains why public libraries and trading standards – to name but two services – have been cut to the bone; the resources released are still not enough to provide a decent social care programme.

There should be parity when it comes to care home fees. Self funders can pay over £200 per WEEK more than local council funded residents. This was the case with my mother. Also, if you are self funding, they actually expect you to give two weeks notice when you die! Maybe that’s a little cynical, however you do have to pay for two weeks AFTER you die! Seems they need time to clean, decorate etc. the room for the new resident, and they are definitely not going to pay! However, after my mother paid in excess of £100,000 in care home fees before she was left with the basic limit (£23,500 comes to mind) she was part funded by the local council for about 2 months before she died, and they paid nothing extra after her death. Seems if you have enough clout, I.e. paying for multiple residents, you get “perks”. Sad day when our local council closed down all of their local authority care homes. Lastly, I would add that in my opinion, Alzheimer’s/Dementia is an incurable disease, requiring nursing care, and should be exempt from fees.

Why does it cost £1000 each resident per week to employ a few “carers” on minimum wage, when their time is spent between up to 20 others? £20,000 per week for, say 6 carers on minimum wage leaves an awful lot of money left for heating, maintenence, food and profit.

We were charged a whole months accommodation charges even after my father in law had died, and we’d cleared his room!

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I can easily see how running a care home properly can cost a lot of money when you take into account that it has to be staffed on shifts and rosters for 168 hours a week with cover for holidays, absences, etc. By the time the personnel administration costs and employer’s NI contributions are factored in, the average wage cost is probably around £15 per operating hour per employee [£15 x 168 = £2,520 a week]. Assuming that an average of eight employees are on duty for each hour that is over a million pounds a year [£2,520 x 8 = £20,160; multiply that by 52 = £1,048,320] required just for basic staffing before taking account of food, bed linen, cleaning, grounds and buildings maintenance, energy [hot water, space heating, lighting, cooking, etc], repairs & renewals, transport, laundry, protective clothing, other services, insurance, business rates, administration and management. I can only guess these amounts so let’s say £2 million pounds a year to operate the establishment [it might be higher]. That will require a minimum occupancy rate of at least 45 residents throughout the year at £50,000 a year each to cover expenditure and provide a profit. If local councils have negotiated a reduced rate for their placements that puts more pressure on the charges to the self-funding residents. As Duncan says, it would be most interesting to see a realistic breakdown of the operating costs for a medium-sized care home.

I would be amazed if there were 6 carers for 20 people. At least 2 on night cover, at least 3 probably 4 on each of 2 day shifts. Cleaners? Cooks? And you do have to expect some management, particularly with care plans, staff management, just running the place… And a newish care home will probably have something in the order of £1000 per room per month to pay for having built the place and maintain it. More worryingly is the idea that a local council can put in c£480 per week and expect a reasonable level of care, management and premises.

It’s obvious to me by many of the comments on here, and of my experience and of that talking to others, there are major / serious / and regular FAILINGS across the whole system. A scandle of epic proportions that a significant number of people hope, wish and activily scheme to keep the whole thing under wraps.
A bit strong some may think, no where near strong enough for others who have experienced first hand the things that go on. Now lets just say that in some homes all over the country some people have an OK situtation. I’ll stop there though, because yes its difficult to provide care to 100,000’S of Individuals with complex needs 24x7x365 but just think how you would want to be treated let alone a loved one.
So starting at the begining for me …… CQC what a total waste of time, money, and office space. If the “enforcer” the “standard setter” the Judge of Right & Wrong is clueless …. the system will never work as it should.
Eg if the food inspectors visit a Fast Food Oulet and its bad enough ….. they close it.
Of course it wouldn’t be that easy to do that in the case of a Home, but they carry on ! for months … and months, and often those paying circa £36K PA and upwards are getting a very raw deal.

I ask you to study the results of any visit to a care home, then another and another …… just look at the “cut and paste” of the reports the meaning less comments …. homes are so hot on filling forms for this and for that , the problem is about 60% of whats recorded is false/fake/made up. My mother for instance nearly always manages to be in bed at least 25 ins before they record her being so !!!
No one ever knows where a bruise came from, how she ended up with a black eye, why she has had constant UTI’s ( we have been with her for over 3hrs on many occasions and no one has come to check her, we have found her wet, for how long we wonder?) We have watched others in the home go to the toilet in the corridors, on chairs etc, staff walk by when its obvious someone needs changing … I could go on.
Of course when the CQC say they are coming all the best staff are on and they are “over staffed” just ask others .. I bet everyhome says the same, do the CQC work weekends ? early evenings? from reports I have seen I doubt it.
Oh I hear you say …. it costs such a lot to do the visits ….. and there you have it … it can never COST too much !
but you are allowed to MAKE money … thats fair…
Controversial some might say …… A recent Fire in fire in London … seems if you are poor you are not worth it ….. well add to that being Old and not Well. It’s some one elses problem …. made so by a system that protects a huge number of people earning / making a fortune out the whole debarcle.
Oh and just what is Social Care ? if you are lonely, have trouble with doing a few tasks, and want /need assistance maybe…… but Dementia is not a lazy syndrome, its an actual problem like cancer, a part of the body has failed in a big way ….. this is a medical condition …. but not treated as such.
I have already gone on too much but haven’t really covered a fraction of whats wrong.
The mutinationals that operate are no better (worse in many cases) than the single / small group operators, cheap labour, “ecouraged” to work long hrs in return for “cheap” ? rent in properties they own (no doubt financed via the business) but privately owned, ..conflict of interest as it “controls” the loyalty of those who have more than a job to loose. Actual Care is low on the daily tasks …. unless the staff are themselves the “Best” and rise above the standards set.

For years now, study after study, TV undercover program after TV undercover program, Comments via the Nursing Council, 1,000’s and 1,000’s of residents and their loved ones, letters, comments, filming, whistle blowing by staff who do walk out …… and we need another “report/study” …. Please ….. just write to everyone who has a relative in care …. and publish their letters in full giving them protection …… you will reduce many to tears in the same way as many of us feel for those whose fate was decided upon by a “committe” who patted themselves on the back for saving a few quid.


The most crucial thing is the quality of the staff – fortunately for my husband they are kind and endlessly considerate – even though they work very long hours, are overworked and the building – which is privately owned is below standard and the dishwasher has been broken for weeks.

After I had removed my Granddaughe from the care home I had carefully chosen for he because of negligence, I was informed by the Manager that they were always notified before a care inspection was due, which resulted in the negligence that ocurred, fortunately when I reported this to the local PROVA Team they swooped in and found this was the case and insisted on changes being made and notified me they now would be keeping a close eye on things. By thenI had lost all faith in the System. Social and Health authorities need to be much more diligent In overseeing the safety of our precious loved ones, these places are paid a lot of money for young people like my grandaughter who was severely disabled.

Care homes should come back under the umbrella of the NHS and should not be a profit making PRIVATE enterprise. I signed up for ‘ Cradle to Grave ‘ in 1958 and now I am being told that because I foolishly saved I now must donate my savings to the care home to pay for something I have already paid for. Whilst those that chose to spend their salary, have a life of luxury at no extra cost. Why not give me a refund since 1958 ( plus interest ) then I will willingly pay for my care.

Care homes need to be brought back under the umbrella of the NHS, They should never have been allowed to run as a profit making ‘PRIVATE ENTERPRISE ‘. I signed up to the NHS in 1958 for ‘Cradle to Grave ‘ And now I am told because I’ve saved I must pay again for my care. Those that chose to spend and not save live a life of luxury free of charge in care homes. I would willingly pay if I was given a refund from 1958 plus interest . WHY should I have to pay twice, when others do not?

I agree, care homes need to be brought back under the NHS. They should not be profit making enterprises. One thing I noticed in my mum’s care home was that at one stage, half the clothes in her wardrobe were missing, in spite of being labelled. It was all the new and nearly clothes that had gone. A search of the laundry and rm 19 , for unidentified clothing did not find any of them! After kicking up a terrific fuss, we did get a refund for the “missing” clothes. If you ask me, someone helped themselves to her clothes. You would need eyes in the back of your head. A christmas outfit we bought for her never even went on her back. It vanished. The problem is not confined to my mother, other residents have the same problem. Anything decent vanishes, even if it has been labelled.