/ Health

Forced to settle for an inadequate or poor care home? Too many are…

elderly woman

Our latest research reveals that some areas have more than half of care home beds in homes rated as ‘poor’ or ‘inadequate’. As Ann’s story shows, action is needed to confront the creaking care system now…

Ann, a supporter of our Care Needs Care Now campaign, told us about her challenging experience with her mother’s care home.

Ann’s mother was in a care home in Wiltshire for six years before she died. She was bedridden and had dementia. She needed help with eating and drinking and couldn’t ring the bell to call staff because of her condition.

Care homes don’t always care

What Ann’s mother really needed was a care home that cared. But Ann had numerous problems and concerns about her mother’s care – here she tells us about just a few of them:

‘When we had to choose a home for Mum, we visited three homes. One was like a dark warren and the room wasn’t very nice. We wouldn’t have wanted her to go there, or to the other one. Both stank to high heaven of urine. The one we chose was brighter with less of a smell, but being at the end of a corridor, she was reliant on staff who never came.

‘I worked as an auxiliary care assistant in the local hospital at the time. Luckily, my employer let me take long lunch breaks to visit Mum every lunchtime to check she was given her lunch. My sisters and I felt the need to visit daily because on two separate occasions, the staff simply forgot to give her any lunch.

‘Mum needed help with eating and drinking. She couldn’t ring the call bell because of her condition; she was reliant on the staff to ensure her needs were met without her having to ask. Her room was at the end of the corridor, so there never seemed to be any passing staff.

‘One November, when it gets dark at around 4pm, Mum was left without a working light in her room over a whole weekend, because the bulb had gone and the maintenance person was off! Staff didn’t even bring in a bedside light for her – they used the light from the en suite with the door open to change and clean her.

‘Soon after Mum moved in we noticed on several occasions an odd tablet on bedside table or the floor. Staff didn’t seem too concerned when asked about it, but they didn’t recognise the tablet either. Eventually one of the care assistants discovered that Mum had sucked the coating off the tablet and then spat it out.

‘Over the years, my family was concerned about the state of her room. There were some worrying cracks in the walls, yet nothing was done until we pointed out to one of the senior nurses that we could feel a draught through the crack. The nurse then checked to feel the draught herself – only then was the problem tackled.

‘My family felt trapped and tied to this nursing home because it was allegedly one of the best in town. We didn’t want to move Mum far away because then we wouldn’t have been able to visit so often or keep an eye on things.

‘Since Mum died, it makes me fear for my own future should I ever need a nursing home.’

Care Needs Care Now

Ann’s experience with her mother’s care will be a familiar story to many care arrangers across the country. Our latest research has found that nearly a third of local authority areas in England have one in three beds or more in poor care homes – find out what the situation looks like in your area here.

Thankfully, there are some areas where at least nine in ten care home beds are in homes rated as good or outstanding. Yet, as the demand for beds is set to outstrip the provision for care home spaces, it’s clear that more needs to be done to confront the creaking care system now.

We want the Competition and Market Authority’s care home market study to make strong recommendations to the Government to address both the current crisis and future stability of the provision of care in its upcoming Green Paper.

What’s your experience of care homes?

Does Ann’s story ring true with you? Have you found a relative’s care to be much lower in quality than you would expect – or have you been pleased with care homes you’ve encountered?

Tell us your experience below to help us build up an accurate picture of care home quality – and don’t forget to sign our campaign calling on the CMA to confront the creaking care system.

Richard says:
30 November 2017

Why is there no data on Wales? I live in Tywyn Gwynedd.

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Craig says:
30 November 2017

Could you see if you can get info on the care homes in Aberdare, South Wales please?
Thank you

Hi Richard, at the moment our campaign is focusing on analysis carried out by Which? of data released by the Care Quality Commission (CQC). CQC cover England only.

Hello Richard – the Care and Social Services Inspectorate Wales (CSSIW) don’t rate care homes in the same way as the CQC do for England (nor do the Scottish and Northern Irish care regulators), although you can read the CSSIW inspection reports on their website – http://cssiw.org.uk. You can also find care homes in your area by using the Which? Elderly Care directory of care services, which covers the whole of the UK: http://www.which.co.uk/elderly-care/care-services-directory.

I would like to second Richards point please, same area as well.

eileen williams says:
30 November 2017

lot of care homes are “top show” fancy settees and carpets in the foyer or public areas make it all look welcoming, but will not pay for extra staff so that the ones on duty can spend a little time with the residents instead of rushing all the time, everything you do is timed, just one extra member of staff on duty can make all the difference and residents can be given more time

Linda says:
30 November 2017

my mother was in a care home and she was abused but nothing was done and that was in a home run by churches we were to scared to say anything we also had threats made against us my husband has alzimers he is deffinately not going in a home he will be cared for at home whatever however much pressure is put on me to do so.

My wife is in a care home in Leicester, she was sent there because she needed one to one care, when originally all she needed was a community hospital. I chose this home because she spent a month there earlier, and I found the very caring. Whereas a BUPA care home would not accept her because she was a risk of falling, the hospital doctors said everyone over the age of 60 is at risk of falling.

This is something families can, in most cases, discuss before disaster strikes, making enquiries from friends and friends of friends, whose relatives are happy in a particular home, which might not necessarily be the glossiest. Bad news of one travels like wildfire. The responsibility of finding somewhere comfortable, with good nursing care, if needed, rests with them. If family members maintain they cannot make room for an ailing person in their own homes, even for a short time, quarrelling and panic tend to ensue; they rush in too soon without inspecting a home properly, grasping a vacancy anywhere when one comes up. In most cases the property occupied by the ailing person will eventually have to be sold to help pay for care, with the realisation that any inheritance will be impaired. Those who pay, are subsidising the lives of other occupants in poorer circumstances, which is good. How come that you’ve blacklisted Swindon – and on what grounds?

Richard says:
30 November 2017

I must declare, I work as a Trustee in the sector (not for profit organisation). Like many things in the country at the moment, the sector has been underfunded from the start. I do recognise many of the complaints that are made, hopefully not within my organisation. One thing i do want to say, is that when looking at care homes look beyond the “glitz”, and focus on what is important to your relative who will be resident. Much of the “glitz” is directed at you, the “sponsor”. What is important? The quality of care itself, and the support and company of others (residents and staff).

I am curious to know what you do as a Trustee Richard. Do you get paid for your work, and how much.

We know just how important it is to ask the right questions when choosing a care home and we have a checklist covering this on Which? Elderly Care. You can find it here: https://www.which.co.uk/elderly-care/housing-options/care-homes/343032-questions-to-ask-when-choosing-a-care-home.

We also have a lot of information about a care home contract: what to look for in a contract, unfair terms and what to do if there’s a problem with a contract, either before and after you’ve signed it. https://www.which.co.uk/elderly-care/housing-options/care-homes/460466-care-home-contracts

My brother-in -law is terminally ill in a very caring Hospice he is being well looked after, the problem facing the family is my sister of 81yrs. she has dementia and can’t live alone her children are doing their best to keep her in her home but this can’t go on for much longer, I hoped she could live with me but the dementia has progressed too far I’m 75yrs. with some minor health problems and I spent 48hrs. with her and realized I would not be able to care for her special needs.You hear terrible stories of abuse in care homes how do we find somewhere kind and caring for her where family can visit often ? It upsets me just considering this.

Hello Olive, you are clearly coping with a lot and I’m sorry to read about your sister. Please read our advice about choosing a care home in the Which? Elderly Care care homes guide: https://www.which.co.uk/elderly-care/housing-options/care-homes, which I hope will help you when it comes to making a decision. The Care services directory on the site will also show you which care homes are in the area where you think your sister would best like to live. You can search by post code and filter for care homes registered to give dementia care. We also include the CQC ratings and links to the full reports to give you an idea of what the care homes are like.

On the website, we also have information about respite care and explain about getting a needs assessment, which, if you haven’t asked for one already from the social services, is the best place to start. You can read about this at: https://www.which.co.uk/elderly-care/your-relatives-needs/accessing-local-authority-care-and-support/342527-getting-a-care-needs-assessment.

Trudi Mcpherson says:
30 November 2017

My mum was in a Local Authority care home. The ones we had to pick from were all depressing- stunk of urine and miserable. Mum developed lots of unexplained bruises which were all explained unsatisfactorily. Staff could never be found when needed. The only time mums room was cleaned was after she had died and BEFORE the doctor came to pronounce her death. Shameful indictment on this tick-box society.

Disgraceful I’m really sorry.

Although my 33 year old son is not technically in a care home, he receives 24 hour care including waking night staff in a supported tenancy shared with 4 other young people with complex needs. Maintaining the standard of care provision and recruiting and retaining staff able to deliver what is
effectively nursing care for the pittance carers earn and in the face of continued cuts to services has been and remains a constant battle.

My mum was an inpatient in a mental health hospital in Leicester, prior to this I cared for her for many years. She was admitted with a fall to Leicester royal infirmary while still an inpatient. She refused to go back and alternative accommodation had to be found for her. I couldnt have he back home as her behaviour had become unmanageable plus I had two young children. It was supposed to be respite for both her leg and mental health. We were offered a different home in Leicester. We went to look at it it seemed fine but I had no knowledge of care homes. She was taken by ambulance and we met a social worker there. Her behaviour was still eccentric and after a few days the staff told me she was hoarding things. I already knew this she had OCD amongst other afflictions. We were visiting every day but the supervisor said it would be better if we “left her to settle in for a couple of weeks”! We did as we were told. After two weeks we came back. My mum was unrecognisable, she was not talking or eating/drinking. I took her out in a wheelchair and discussed with my husband bringing her home, he agreed. The next day we had a call from the home asking us to come as my mum was very ill. When we arrived she was in bed not breathing well I held her hand and she passed away. I was mortified! I employed a solicitor and attempted to take the care home to court. I got nowhere the shutters came down and all the staff had each others backs. The solicitor said to me at least you can say we did our very best! This was over 30 years ago! I would say to people keep a close eye on the staff visit as much as you can and use your own judgement don’t be lead by what staff say it is not always in the best interest of the service user.

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Janet Dale says:
30 November 2017

After watching recent tv programmes showing both physical and mental abuse towards residents both young and old i would like to see 24 hour surveillance cameras to monitor residents and staff this would ensure the patients are getting the care they rightly deserve and the staff are providing the care that they should be providing

Peter says:
30 November 2017

Hopefully I am a long of before I have to go into one, but my Dad was in one 7 years and it has put me off with a bit of luck I might been able to end my life by the time I might have to go into one because watching some go down to the point they don’t know who there son is his is sad for every one.

Hi Peter, I can certainly understand your concern. This is why we are campaigning for change, so people don’t have to worry about their future. Thanks.

@awhittle, Alex – it is quite clear there are widely differing standards in the care home system. The Government are publishing a Green Paper next year for public consultation.That will take a long time to conclude and evaluate, let alone put into practice. Many of the problems need resolving now.

Whatever the system, run properly it will be expensive. One of the the major problems seems to be the lack of proper oversight that results in so many reports of incompetent care and abuse. A major step forward, in my view, would be a much more effective monitoring group. The CQC seem overloaded. Sorting this out with more resources, the ability to act swiftly against sub-standard homes, and the acceptance that you will generally get what you pay for might be a major step forward. But it will cost money. Taxpayers must be prepared to pay.

What would Which? propose as the solution to a better care system for the elderly? Would they like an NHS-style sector, run in conjunction with hospitals for example? Free for qualifying patients funded from national taxes? Plus a private sector where people pay the full amount? To deal with imbalance as with hospitals, should the latter also accept patients fully or partially funded by the state?

I agree with you, Malcolm, and although I think the CQC is performing better these days it is clearly missing a lot of inadequate and sub-standard service delivery. The quality of care for many residents is obviously seriously deficient. This is the problem with a periodic inspection system. We need to bear in mind, though, that there is another form of monitoring that is probably also letting residents down: many are there in placements funded largely by their local social services authority. It would not surprise me if the number and standards of checks by the councils that are paying the bills have declined considerably – their resources are also overstretched and there might not be enough management time to investigate complaints, especially if the resident has by then died. This is also letting down the council taxpayers who are not getting value for money from their purchase of care home placements. It is possible that council managers are so desperate to find places for their clients that they take the prevailing conditions as acceptable for fear of pushing up the charges or losing the facility altogether. It looks to me as though the whole system is on a knife edge and I agree that there is no time to wait for Green Papers that are likely to be kicked out of sight into the long grass.

Police stations have ‘official visitors’ to check and report on the conditions for those in custody. It’s not a solution but might be a good idea to introduce a ‘people’s representative’ into the situation and start to change the culture.

There is no doubt that funding for the provision of elderly care has to be dramatically increased and it is no good the government thinking that the sale of people’s houses and surrendering all their assets will cover the position. The country will not accept an unfair basis of supporting care and in any case it would quite quickly throw up perverse consequences. A lot of local authorities need to think much harder about how they can make more money available for care provision by making cuts in lower priority services – its no good just blaming the government. The government also needs to look at all of its expenditure and see whether it’s got its priorities right: Defence? Higher education? Tax credits? Indiscriminate benefits and concessions? Lottery funding? – I include that because I increasingly get the impression they are scratching around looking for good causes to throw money at.

There are good care homes that fit the requirements that Gill describes below, but they are expensive and probably not used by local councils. To provide that standard of amenity and provision in every establishment would probably require an overall 50% increase in funding, or more. A combination of economies and higher taxes will be necessary and then a massive investment in training and qualifications and the standards of management. Enabling local authorities to build new care homes again and staff them properly probably has to be part of the picture.

Hi malcolm, we recognise that there’s no hard and fast solution right now, our primary focus has been getting the regulator to recognise the problems are bigger than it initially thought. This will ensure that when reforms are being discussed, the problems in the current system can be properly addressed so that people can get the care they need, now and in the future

There is clearly going to be a need for a big recruitment, training and qualification process to be set in train. Work should be started now on that so that we have the right numbers and right skill-sets ready for essential development of the quality of care provided to a higher and consistent standard. I would expect this to require the longest lead-in time for whatever emerges from the political reaction.

Private companies will only want to run care homes that are profitable. The fees will need to be adequate to allow for proper qualified staffing and management. To allow “ordinary” people to access these homes may well require subsidy. If the state, or local authorities, run care homes the profit incentive disappears but the majority of the costs will still be there.

The whole “industry”, whether public or private, must be properly and regularly regulated and I see this as the key to a future acceptable system – ensuring that staff and premises are adequate at worst. I would like to see the “public” care homes placed under the NHS, nationally funded, working in conjunction with local hospitals and GPs as, eventually, most residents will require medical assistance.

If there are sufficient decent state care homes in the market then those who enter private care homes should self-fund. Only if places were not locally available should a subsidised place in a private home be used. The dilemma will be how “public” care is funded by those with some “wealth”; inevitably I suspect means testing is one way to determine eligibility. Given the.state of the nation’s finances then assets would need to be used, but the house should not be included, if a partner, spouse or dependent family members were in occupation, unless it were more than a given value for the region.

As with other medical care I see no easy solution and don’t put forward proposals with great confidence but, if we are to get a better care system operating, we have to start with some discussion points. Just a “something must be done” approach is not sufficient; we have to discuss the “something”.

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At the moment, of course, care home provision is already a largely private operation. The question now is whether it should revert to being a public service. Personally I think it should, with certain provisos. I think there is a strong case for charitable and voluntary organisations to run care homes as their record seems to be generally good and I think they attract the right kind of staff and have high standards, and some of them are prepared to deal with difficult cases that the private sector will not touch. I have some reservations about the municipal sector because I think it is too prone to political interference and meddling by inexpert councillors. It also has a poor record of good financial management. However, the past is not always the best guide to the future and if the right standards are laid down and the establishments are subject to external assessment and inspection I think the quality of care could be excellent. As regards to the NHS, I think it has enough on its plate running hospitals, specialist units, primary care, and the other optical, dental and medical services, and ambulance services, etc.

There is a role for private sector provision if the same approach is used as in the private hospital sector which appears to be successful in taking pressure of the state sector and providing additional capacity when needed. This contributes to making the NHS more efficient overall even if the marginal cost of treatment in a private hospital is higher than in a public hospital. There would either be much idle capacity in personnel and premises or longer waiting lists if the NHS was not able to take up external capacity to balance the service when necesary. Care home provision does not require the same degree of expertise and flexibility as the hospital sector and would probably benefit from a regional organisation structure with strong governing bodies ensuring consistently high standards.

At present the private sector has a number of unfortunate “commercial advantages” over the public sector: it can easily refuse to accept residents, it can evict residents, and it can ignore complaints or penalise those who make them. Because of the poor track record in these areas – as revealed by the CMA investigation – it has not earned the right to continue receiving substantial public funding in my opinion, especially at heavily discounted rates that means self-funding residents are subsidising publicly-funded ones. It can carry on serving the needs of people who want private care and can afford it but should not be entitled to effectively “dump” them on the state sector when they become too troublesome to handle or run out money. This does leave local authorities in the position that they will have to face up to much higher charges if they need to buy placements from the private sector. However, this does provide an incentive for expansion of the public sector and the establishment of new homes.

I still think a lot more should be done to expand and improve the home care services and sheltered housing enabling people to carry on living in their own accommodation if that is their wish and they can cope. This would take a burden off the hospital and state care home sector but running these services largely with part-time and agency staff is becoming an increasing challenge and the service delivered has many shortcomings due to the pressure it is under.

Dear John,

I have around long enough to remember when Local Authorities were the main providers of Care Homes and when the Local Area Health Authorities were the only providers of Geriatric wards . If my memory serves me well both these Authorities were well funded and yet totally unaccountable to the Public, the service provided at the time was not monitored by an independent body such as the CQC and complaints from the Public were regularly ignored .Although the Private Sector is still not perfect , I can assure you that it is miles better than these alternatives you suggest. Yes we do make a profit (even charities) we have to do that to survive in the real world, we are not allowed to make a massive loss as do the banks it appears they are more important, Bye the way was it not Labour that bailed them out? Please head the words of this report otherwise the Country will loose a very much underrated Service.

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an email showing me the error of my ways would be appreciated

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My mother was in a care home in Abergele, Wales for 10 months before she passed away in 2007. I looked at many care homes before selecting this one. In fact, generally, the care she received was pretty good. The manager was wonderful and a very strong person which, I think is what is required. However, I was not impressed with the owners when I met them and here, I think is one of the problems. Some care home owners are clearly in it for the profit and one can tell!

The carers themselves were ‘caring’ and worked hard. It was a small home and that, I think, helped a lot. It was comfortable and home-like, light and bright. It did not have the feeling of an institution at all, which I found many had. On behalf of my mum I had to contribute a certain amount to her care from her savings and I visited 3 times a week. I was still working and had to.

I would say that my biggest problems with the system were the system itself: insufficient information given to families about finances, how the system works and how to navigate the system. The whole financial system takes a long time to sort out. There is a risk assessment system for carers but that seems to be pointless as it doesn’t seem to be taken into account by anyone.

If I hadn’t had a friend who actually ran a care home else where and who told me what to look out for, I think I would have struggled even more than I did.

Unfortunately, this care home received poor reports in its care home rating in later years and has now closed.

Dear Lynn,
Thanks for having a good word for Care Homes and hinting at the real problems, I have been trying to advise people for years, unfortunately there are many people who are just politically motivated and therefore are not willing to hear any good points.
I would be grateful if you could elaborate on the system faults which you have experienced and give your views , maybe then some people might take note.

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Lesley Spink says:
30 November 2017

Something needs to be done. Our elderly need good care. Perhaps new training for staff is the answer.

The whole system requires overhauling. These homes should be homes where residents can live comfortable life & engage in life. They should be able to choose what they want to eat & what they want to do within within reasonable guidelines. They should be able to have a pet if they wish to do a hobby etc.

However working in these homes as they now stand is a thankless underpaid slog for most of the staff. Carers have to work long back breaking hours for little pay & respect from service users families & owners of homes. They are abused on a regular basis & are expected to take it. They are very short staffed & expected to provide a service with minimal staff that is impossible to do. Just as residents expect to be treated with respect so should carers be given the same right. We talk about the abuse toward residents which we should do quite rightly but we don’t talk about how badly carers are treated. Of course this isn’t always the case but talk to people who have been caring for a long time & they love their job but not the abuse that comes with it.

I briefly touched on this topic a while ago and must admit to being a little reluctant again to relive my own personal experience in which I found myself in the midst of what amounted to an extremely painful and difficult situation involving the care of a close relative suffering from mental health issues. Some of the awful details have been explicitly and concisely portrayed in the many postings here, most of which I am all too familiar with, but I finally took the matter into my own hands by seeking the help of a solicitor who specialized in the care of the mentally ill.

Unbelievably, the privately run care home, on the advice of the responsible consultant psychiatrist there, refused to allow the solicitor legal access to interview the patient! It was at this point I decided to take the matter further by submitting a long and comprehensive report to the local Mental Health Trust and arranged a meeting with a team of management consultants, psychiatrists, social workers, senior nurses and advocacy representation from both the care home and the hospital responsible for sending him there. It was an extremely stressful occasion to deal with single handedly but as I had already gained some inside knowledge of the care system, I was able to confront ‘the team’ with the necessary evidence which led to the immediate reinstatement of my relative back to the hospital until more suitable accommodation could be found.

It goes without saying the effect this had on my relatives mental health at the time which, at the end of the day only goes to prolong the recovery process with patients staying much longer than necessary in hospitals, taking up beds that could be made available for new admissions.

I would not wish anyone to have to go to the lengths that I did, but at least my intervention finally alerted the CQC and the relevant authorities to the inadequate care and conditions at this particular care home which eventually, I was very relieved to learn, finally resulted in its closure. The last I heard was the site had been bought by a developer who had submitted planning applications to demolish the old care home and build several luxury homes on the site.

I have worked in care, as well as having had a friend who was in a nursing home, who I was a guardian for. I’m afraid I have a very poor opinion of the whole system.
Virtually anyone who walks in off the street can get a job in care without any training at all. It’s a business, and profit is top priority, poor pay, shortage of staff – end result is poor service. ( I’m talking here of a church run nursing home, even the manager left due to the paring of staff and services )
This is nothing new, it’s been going on for decades, endless politicians who can talk the talk but thats as far as it goes. How many times have we read in the papers of the elderly being abused by staff in homes and a host of other atrocities due to lack of care. You only have to read through the posts here to get a sense of what its like.
I was lucky enough to be able looked after both my parents at home, one with MND and the other Heart disease, even that state care left a lot to be desired for the one with MND, in fact it was none existent, other than a free chair for my father ! My mother died in hospital and the lack of care was unbelievable, she would have had better care in a third world hovel.
It’s a very sad situation and I can’t see anything changing in the near future.

Gwynneth oakley-Smith says:
30 November 2017

I have now had to use two care homes in my local area over the course of the last seventeen years, both of which have been excellent in their care, above and beyond particularly in the case of my mother. I think building a rapport with all the staff is important and I have only ever had to make an official complaint once, and that was at the suggestion of a Team Leader.

My dad was at Kniveden in Leek, run by the government. It was closed. It was a great place. Now they are all run privately. Hardly any checks.

My mother had the best of care for over 9 years.

She lived in two different Care Homes, run by the same charity. The love and care she received were second to none and I was reassured to see that other residents, alone in the world, appeared to be as much loved and cared for as she. (Staff were not always aware that we were in the background, observing, thinking us to be focussed solely on our mum.)

My first concern was that the first Home had to close because of escalating costs as so many of the residents were mainly council-funded, as well as the building being a little unsuitable to elderly, vulnerable people. Mum’s second Home was farther away but we chose it as it was the sister Home so we took a chance on its having the same level of care. If anything, it was even better. However, unlike the privately-run Homes, it had no en-suite facilities.

If I had to chose a Care Home for a loved one again, I should be wary of those Homes that are too much like an hotel. I visited one when choosing Mum’s second Home. It is absolutely beautiful to look at, with restaurants on every floor and landscaped gardens; it is also around the corner from where I live, not 57 miles away as was her second Home, yet I felt shivers down my spine when the manager wouldn’t allow me to visit the Dementia Unit without giving her staff prior warning. Why should that ever be necessary? Alarm bells rang out.

My second concern continues to be the low level of remuneration for the staff, who work unbelievably hard and in my experience were always cheerful and welcoming. We met some wonderful, kind people through the years. It is the compassionate staff that make a Care Home a home, not the up-to-date and impressive facilities.

I wish that everyone could have our positive experience.