/ 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?

tina says:
22 June 2017

A radical approach should be taken, starting with assisted housing, where occupants are facing yearly increases in rent but it would appear that most providers are cutting costs by not providing 24 hours in house wardens. The level of assistance has shrunk to morning calls to each residence (not in person) and a 24 hour call button. If the level of care in this area was returned to live-in warden cover as was usual a decade ago then people could benefit from remaining independent for longer.
Next there should be a tier system in the provision of care homes so that those requiring less care could be housed together with provision of enough care and stimulation to keep them healthier for longer and pay less for their care. Those requiring a higher level of nursing care should be housed in homes where this care is provided and staff are fully trained to meet their needs, obviously at increased cost. There should be separate care homes for dementia patients staffed by fully qualified carers where their needs can also be met in full.
I advocate this idea from experience, someone close to me could have remained in sheltered accommodation much longer than they did had the live-in warden provision not been removed and replaced with a morning call and office hours warden care and 24 hours call button. During their subsequent move to a care home they became very isolated as they were still mentally very active but most of the residents were suffering with dementia. During their eighteen month stay they were routinely subjected to uninvited visits into their room by some of these residents, in various states of undress and one night they were physically removed from their bed sustaining a serious arm injury. This happened in a care home with an excellent rating, a fantastic local reputation and a majority of caring, well trained staff at a cost to the patient of £2, 500 per month.

Agree with Tina- low level care, more affordable and helping people to stay independent longer makes sense. Why did sheltered housing seem to disappear? The support staff can focus on limited service need with the advantage of a lot of clients near to each other instead of having to spend a lot of their badly paid time getting from one house to another.

Finola Moss says:
22 June 2017

The old are the new gold mine for US Venture Capital, which already owns half of the institutions where the autistic and learning disabled are encaged, each earning on average £4,500 per week.

This is why there is such an altzeimer/loneliness awareness push financed by government to harvest cashcows.

The placements are enforced by the Court of protection and the residents get no choice and they or their family no rights over care.

There is no check on amount of medication used, CQC have no teeth, no one can complain, so perfect business model.

The only oversight is an Adult Services Manager employed by the LA Commissioners of the Care who would make their LA boss liable if they found the services inadequate.

For more details of the billions being made and to be made as they start small, and then are bought up by ever bigger boys google finolamoss and read my blog.

This comment was removed at the request of the user

Care is expensive & poorly provided. This is because dementia is considered by Government/NHS to be social issue & not an illness. Therefore care for patients with dementia must be paid for, whilst that for people with say cancer, is free.

As raised already, local authorities use their position to reduce the cost of care to them. If they pull out completely, care homes fail. They have an unfair monopoly of the market.

As a result, a local authority (LA) will pay £575 per week for an £800 room. The impact being that my father in law (Edgar), in the identical neighbouring room, must pay almost £1000 per week. He is directly funding LA care, as are all private patients. This is not fair on him & is causing him real harm.

Once Edgar money runs out, which will be very soon as he is also funding the LA, the care home will ask for a financial top up, as they also cannot afford for everyone to be on the £575 LA rate. As we do not have a spare £425 per week, he will most likely be kicked out of his home yet again: Where we will put him then is anyone’s guess. We are seriously considering leaving him on the street. The system treats our most vulnerable like rubbish to be thrown on the street.

Edgar has in fact already been forced to move home only 4 weeks ago, because the home he was in could not afford to employ specialist staff to care for his failing health & the Health Trust believed that his health was not poor enough to justify financial assistance. His doctor thought that it was, the local NHS Trust mental health team thought that it was, his careers thought that it was, but the NHS assessor did not agree.

As the home could no longer afford to employ specialist staff to care for Edgar, notice was served & he was forced to move within 2 weeks!! Our most vulnerable elderly people, literally thrown onto the street. Edgarwas thrown out of his home because most residents are now paying the LA rate of £575 per week & the home cannot afford specialist dementia care at this rate.

As Edgar is privately funded, he receives no assistance choosing a new care home. We are not care professionals, but we must make that choice for him. If Edgar was state funded, he would have a social worker & lots of assistance, but not if he is privately funded. Edgar is just financial burden that no-one cares about.

The system is broken. It fails our most vulnerable. We know how much our government cares for people with dementia (Dementia tax). They do not care, they do not treat dementia as an illness, they treat it as a burden & are not worried that people with dementia are literally moved around from home to home as objects.
People with dementia are our most vulnerable, with possibly the most distressing illness anyone can have.

I am ashamed to be living in a country where our most vulnerable, including Edgar, are treated like this. It is inhumane. He lost his home a few weeks ago & will loose it again within 12 months. Something must be done very quickly to stop this inhumane system.

A friend of mine who is in a care home often has to wait up to 20 minutes to be taken to the lavatory. She is paying over £1,000 . pound a week for this “service “

I did voluntary work within the voluntary system as a lay assessor. My main reason for becoming a Lay Assessor, was to understand how nursing homes and care homes function. I did have some training on identifying what should and should not be within that home. The way that it worked was that I would meet the officer and visit together, this was social services. I went to the first residential home and was allowed to chat with the residents. I found that some of the residents were truely engaging and quite happy to tell me about the home, is what they did and what they liked the most. I went around the home and used the toilet. There is front of me was a notice above the wash basin saying PLEASE DO NOT LEAN ON THIS SINK IT IS LOOSE?. Othere than that the home seemed to be OK. I brought this to the attention of the Officer that was present. The next home I attended was another Care Home, I found the residents quite happy, that was until they brought to my attention, 1} that there were only playing skitles that day because the Social Services were visiting. 2} Outside the home there was a bus depot, with buses running back and fore. I asked the few residents did they ever go outside, the reply was no, only when there was an outing, they then played bowls, one resident said, we all said that Social Services must be coming today, they have the bowls out. I then had to go to management and explain what I saw , I explained what I had been told by the residents, I then said what I had seen and heard, did I have some backlash, I was threatened with the law, the officer from Social Services did nothing to defend me. But I had told them honestly. I was absolutely appalled. Even after being grilled I still said what I had seen, I WAS ASKED WHO SAID THIS TO YOU, I WOULD NOT SAY. I was afraid that they the home was going to sue me. I never ever went back and would not even if they paid me a fortune, I did not get paid any expenses for travelling. I could say a lot more but I do not want to upset anyone.

Recently, my Mum died with Alzheimer’s, aged 98 . She received good care in her care home- physically and emotionally, but hours were empty of Mental stimulation. Visiting my house, she could still chop an onion better than I, and tie a knot with just one hand… Great muscle-memory.
The care home asked her if she’d like to place the napkins on the tables, but as she needed reminding before each meal, that soon stopped. When care staff are allocated 5.3mins per ‘client’ per day, there’s no time for such niceties. I’d like to see a simple gym installed!
A high flying pal of mine, having seen her own intellectually brilliant mother decline and die in a care home, has already started looking into Dignitas. ‘I am not putting on my daughter what I had to do and the sense of hopelessness about the way the system operates,’ she vows. She has decided that 85 is a good age to end it all.

When I complained to the local hospital that they were using care homes that had very poor ratings, failing three out of the five inspection criteria and “Requires Improvement”
The hospital replied – “Whilst the CQC inspection reports may reveal that improvements are needed, that in itself would not be enough to halt our use of a particular home unless we were advised by Adult Social Care to do so. Indeed it should be acknowledged that a home deemed as needing improvement should be given opportunity to make those improvements as long as safety is not comprised” In other words putting Care Homes first rather than patients!

As someone working in the care home sector I can empathise with many of the comments here- but the solution is never going to be simple. As a business, other commentators have rightly pointed out that if you do the job properly, you’ll go bust if you restrict yourself to state funded residents.
Regulation has it’s place, but over-regulation will make the business paper-work driven, rather than care driven.
Attracting good quality care staff (and keeping them) is a headache for all care homes, moreso since Brexit. Most only get the National Minimum Wage and can earn more at supermarkets, stacking shelves.
Nurses are in short supply everywhere, and will put their need to keep their registration ahead of loyalty- which is why care homes in trouble find it so hard to get good nurses, and why long hours are commonplace- 13 hour shifts and unpaid breaks.
The only way I can see to improve services will involve raising fees paid, and getting the statutory sector back into the care home business. This will cost money (from the tax-payer), and unless wages go up significantly for the lowest paid, won’t address the staff shortage.
Other possible options could include improving local ownership, and making increasing use of Charities such as Dementia Friends and Age Concern to help with the non-clinical side of care, such as activities, trips etc.

I have experience of care homes from both sides- as the child of a parent being well taken care of in one, and as an employee of another. It has brought an interesting and enlightening perspective, providing me with a greater understanding of the challenges that are faced by the staff in both. There is one issue that I don’t see raised often and that is the lack of sick pay for staff. There is no onus on the employer to provide this and there is then only Statutory Sick Pay- which gives nothing for the first 3 days and is not enough for anyone to live on, especially those with families to support. I have seen time and time again staff who are caring for vulnerable people come into work when they are ill, simply because they cannot afford to do otherwise. They put those in their care at risk, but they balance that decision with being able to put food on the table and so they have little choice. The employer in the home I work in is a large and extremely wealthy company whose bottom line is profit and their shareholders above all else. Care is good, because the staff care, but I am of the firm belief that it should be a legal requirement that a company providing care for vulnerable people should HAVE to provide sick pay for every employee. This benefits everyone in the long run.

Staffing costs are, in my view, at the epicentre of the problems.
Carers are overworked, underpaid and largely undervalued.
A common theme among carers working , or who have worked, in care homes is that they do not get enough time (and sometimes support) to do their jobs properly: to spend time feeding, bathing, responding immediately to calls, etc. Largely because of staff shortages, the ones that are present are asked to work long hours often without sufficient breaks just to ‘keep things going’. Many quit because they do not want to be party to the neglect and abuse they are required to participate in. Virtually all interactions with older people require time and, especially when dementia is present, extreme patience. It is very difficult to be patient when tired and rushed. And it is very difficult to be understanding when dog tired with the relentlessness of all that a person with dementia can generate. I don’t know what staff-turnover levels are, but I wouldn’t be surprised if it’s quite high.
Other gripes among carers are zero-hour contracts and the absence of holiday and sick pay.
Besides unhappy working conditions for carers, a major factor is low pay. Many good and experienced carers look for positions in the private-home sector, which pays roughly double. A look at the websites of the placement agencies and the likes of Gumtree, where freelancers also advertise, show there is not a shortage of carers.
Care homes, like any business, expect to have enough regular income to provide a good service and make a profit on investment. They cannot raise their fees to cover better staffing levels without risking heavy losses or going bust, especially when a large proportion of their clients’ fees is paid by their local council . Council funding calls the tune; across the board it keeps the entire industry running at shoe-string level.
My view is based on talking with and listening to the experiences of the many carers who helped me in the 24×7 care my late mother needed and who are currently helping me look after my husband, who has advanced dementia. I am a retired company director.

My mum died in March in a local authority sheltered housing, her body wasn’t found for over a month, despite other residents raising concerns. A smell in the corridor was noticed however this was masked over by additional air freshness. The postman noticed that the mailbox was full and eventually raised the alarm. Due to the state of her body they were unable to identify how she died. For the last 6 months I have been trying to come to terms with this event, the council have never spoke to me or addressed the failures that clearly occurred. Infact at the inquest i found the sheltered housing manager to be somewhat hostile towards me. I want to do something about this, so that no one else has to go through the same. Interesting another man died in another sheltered home under the same council a few weeks later and wasn’t found for a few weeks. Any advice on action I could look take much appreciated, or anyone else that has been in this situation that wants to raise awareness, please reach out.

Eason the middle of reporting my experience of a local Care hom in which I am no longer staying. And suddenly all my report disappeared. And I can no longer find it to carry on the details

Margaret says:
13 October 2017

I am one of the lucky ones, my mother has been in two care homes. The first was closed because of problems with the building. After visiting 10 care homes I found a second where she is now which is extremely good as well. However the company closing the first home were absolutely rubbish at providing support with finding another home – they provided a list of local homes with no phone numbers, furthermore they made no effort to keep places open in their other care homes for those about to be displaced! They knew the closure was in the pipeline for some time! Additionally the local council tried to enforce their own choices, I argued about the number I had visited but agreed to look at the three they recommended; one I had already visited and two had QCC strikes against them. When I spoke to the social worker about this she had no idea!
I do visit often and have a very good relationship with the staff and I know this helps. However the care staff feel extremely sorry for those who don’t have visitors. Yes there are staff who are better than others but they work extremely hard doing a job many, many people don’t want to do. Yes I do know what it’s like as I cared for my mother at home before making the decision about a cae home.
Finally a political point – Brexit will exacerbate the problem we have; the majority of all staff; carers, nurses, cleaners, cooks and laundry staff are either EU or non EU immigrants.

From my own experience having visited my mother on a daily basis, I am convinced that care home managers – in regard to the quality of care provided for the elderly – are the last people to be trusted with ensuring that even reasonable standards of care are maintained. The families of residents are frequently afraid to speak out through an
undeniable fear of what might happen to their loved after those who carried out the investigation have left.
Former staff would be the most reliable source for collecting information, although rarely will they come forward in the belief that any adverse revelation might reflect on their own future employment. My view is that the inspections of these homes should be unannounced and that no area be excluded. If such enforcement is already in existence the public might reasonably ask why the standard of care in many homes is so wanting in compassion.From my own experience having visited my mother on a daily basis, I am convinced that care home managers – in regard to the quality of care provided for the elderly – are the last people to be trusted with ensuring that even reasonable standards of care are maintained. The families of residents are frequently afraid to speak out through an
undeniable fear of what might happen to their loved after those who carried out the investigation have left.
Former staff would be the most reliable source for collecting information, although rarely will they come forward in the belief that any adverse revelation might reflect on their own future employment. My view is that the inspections of these homes should be unannounced and that no area be excluded. If such enforcement is already in existence the public might reasonably ask why the standard of care in many homes is so wanting in compassion.From my own experience having visited my mother on a daily basis, I am convinced that care home managers – in regard to the quality of care provided for the elderly – are the last people to be trusted with ensuring that even reasonable standards of care are maintained. The families of residents are frequently afraid to speak out through an
undeniable fear of what might happen to their loved after those who carried out the investigation have left.
Former staff would be the most reliable source for collecting information, although rarely will they come forward in the belief that any adverse revelation might reflect on their own future employment. My view is that the inspections of these homes should be unannounced and that no area be excluded. If such enforcement is already in existence the public might reasonably ask why the standard of care in many homes is so wanting in compassion.

With the threatened loss of beds and other services from our local Hospitals, I and many of my peers are very worried for the future of our local Health Services. To me it would be a total disservice to the Communities if the Hospitals were sold for Housing Development, so much money has and is still being raised by the community to provide extra facilities.
An alternative could be :-

To keep the present Out Patient Clinics in these Hospitals. (appropriate buildings in other areas)
Then the remainder of the Hospital could easily be converted to Special Sheltered Housing accommodation for those who cannot totally look after themselves and require daily Care visits, with Bedroom and W.C. FACILITIES’ Plus a ‘between’ rooms for Patients en route to their homes after Hospitalisation. Residents would prepare their own Breakfast and Tea.

Within the complex would be a Kitchen and Dining Hall for a good midday meal to be provided and a communal lounge area for Residents to socialise. A Bathroom area with walk-in Bath etc.. The flats would all have easy access to these facilities. They would be let to Single Residents on a need basis, whether they are tenants or own their property. A Proper rent would be charged, in full for those who can afford it and the Housing and Care Benefits of the time will help those not able.
Carers would visit Residents every morning and check their needs for the day.
I feel that to have Carers on hand in this way will be Health and cost effective rather than harassed Carers rushing around in cars on home visits each day, only being able to spend 15 to 20 minutes with each Client, rather than using up time and fuel each day. Also for Residents to have the company, if they wish, of others is another big Health and ‘Quality of life’ benefit.

On site, after space being allotted for car parking I would think that there would be room for several small bungalows/apartments for the elderly who would like to downsize from their family homes. This would free up family accommodation in the area.

I had experience of a similar Special Sheltered Housing scheme in Surrey, Toldene Court, my Mother lived there happily and was extremely well looked after for 3 or 4 years, Toldene was converted from a redundant School. I believe it was the first in the London Borough of Croydon of its type and I see that they have a further 5 now in the Borough, Further information can be sought on the London Borough of Croydon Website, see below.

If my proposal is of interest and you would like more information from me I will be pleased to help.

Special sheltered housing / extra care – London Borough of Croydon

Anne Wild says:
17 October 2017

I know there are significant problems but there are good homes out there too. My parents (98 & 96) are in a care home in Bedford, near my sister, who sees them almost every day (so would notice if there were problems). Although the building leaves a lot to be desired the staff are kind and caring, which is by far and away the main thing. The cost is significantly less than many others we approached, too, and although my parents are paying out of their savings and from the proceeds from selling there house (as they should – why should the tax-payer foot their bill if they can afford it? We, as offspring have no inheritance ‘rights’. Family greed makes me so cross!) many others in the home are funded by the state.

We were lucky as our mum went into a private care home called Westward Hall on the Wirral. We could afford her care and it was exceptionally good care. The staff were kind and understanding, nothing was too much trouble to them.
This should be possible in all care homes not just private ones and not just down to luck.
I would happily pay more income tax if it meant we had the same good quality establishments with the best staff and paid a decent wage.

Jean says:
My mother went into hospital care when she was 100. Visitors had to leave at lunch time and return later. They would not allow me to feed my mother although she was incapable herself and so went without food often. They took no notice of my complaints. We moved her into a residential care home where she was properly cared for and I could help when needed.

In respect to NHS contributions to nursing fees, my wife was assessed as requiring the contribution of £155.05 pw. According to the Which information this sum should be deducted from the self funding amount paid by my wife to the nursing home. The operators of the home say this is not the case and take the NHS contribution on top of the fee. Upon enquiry to Which I was referred to Care Aware, an advice charity, they say that whilst the system says that the home should deduct the NHS contribution,they rarely do and seemingly cannot be made to do so. Assuming the home did deduct the contribution there is nothing to stop the home increasing the fees to cover the deduction, as a private company they can adjust fees at any time.

Carol says:
20 October 2017

After working in the retail sector, I started working as a care assistant in a nursing home, I paid to do my NVQ in social care, then free funding became available through the government, now that has stopped, so many problems occur in the private sector due to lack of training, this all has to be paid for and nothing is for free!
It’s an underpaid job and staff mostly are hard working and get very little praise, it’s only bad press, never the
good homes getting publicity. As a member of the management team, we all know we are not perfect and things do go wrong, I always try to say thank you to the staff for doing their best, maybe the owners of care homes should take a good look at what their staff do, take on a shift or two and deal with what their staff do on a daily basis mostly on minimum wage! After all most of the people I work with do just do the job for the money, they do it because they truly care. It’s not always the care staffs fault when things go wrong, it starts from the top. I wouldn’t change my job for any other now, I might change the homes I work in, but always strive to make the homes I work in a better place where the residents are comfortable and safe with staff that are trained and care for the people in their care.