/ Health

The CMA must widen its investigation into care homes

Care homes

We’ve been investigating care home websites and contracts. We weren’t happy with what we found. Many providers weren’t upfront about charges, and some could be breaching consumer protection laws with unfair terms.

Last month, the Competition and Markets Authority (CMA) published its mid-year update of its year-long market study into the care homes market, and its findings were bleak.

But we weren’t surprised because during this time we’d been doing our own investigations into care homes. For months, people have been telling us their stories about the troubles they’ve faced while dealing with care homes, either for themselves or on behalf of a loved one.

Lacking information

While it certainly isn’t the case for everyone, many people told us that going into a care home or having to find care for a relative can be an emotional and stressful time. At these times, It’s unlikely you’d be thinking about ‘shopping around for the best deal’, but rather the most appropriate care setting.

And yet our investigations found that during a time when you need vital information to make these important decisions, such as the cost of rooms, how many staff will be available at any one point, or what the visiting rights are for family and friends, care home providers are making it needlessly difficult to find out these details.

And on analysing the small sample of care home contracts we were eventually able to get our hands on (even these were a struggle to find), we found a number of terms and conditions that could be potentially breaching consumer protection laws.

Unfair terms

The CMA has already opened up a consumer protection case to investigate whether care home providers really are breaching consumer law. But we’ve heard about the traumatic impact unfair contracts can have on people, often when they’re at their most vulnerable.

One relative of a care home resident told us:

’…the contract that we signed said that at whatever point in the month a resident dies, there will be no refund for the rest of that month. Even though we were prepared to fully clear his room that day, we never received a penny back. Upset from just losing Dad, I was not in a fit state to challenge​ this.’

Another said:

‘I paid for 1:1 care but within 24 hours I was asked to remove my husband as they could not cope with him. I had asked what would happen if they couldn’t cope and they just said, ‘Don’t worry about that’. I was not informed I may have to remove him. My GP and social services told me to report them to the Care Quality Commission as they did not give him a chance and they should not have asked me to remove him.’

Stamping out poor practice

We’re pressing the CMA to widen its investigation and take action against providers breaching consumer protection laws to stamp out poor practice and ensure people entering the care setting are properly protected.

We will continue to feed in your experiences to inform the regulator’s work, which concludes at the end of the year, so please share your story with us using our care home reporting tool.

Comments
Guest
Sharron Howard says:
17 July 2017

My 25 year old step-granddaughter who had a learning disability was placed in a respite home in 2016 which was supposed to be a temporary measure but which lasted 12 months. This home’s website advertised that all rooms were en-suite. In fact, no rooms were en-suite. It had been inspected whilst our granddaughter lived there, by the CQC and was found to be “in need of improvement”, and in breach of its licence by having 7 residents when licenced for 5. In fact in the whole 12 months nothing improved. There was no lock on our granddaughters bedroom door and she had her possessions stolen on more than 1 occassion and she had no privacy. There were only 2 bathrooms which were shared by both sexes. I of the bathrooms was out of action for several weeks. Our granddaughter was poorly fed, dirty and unkempt and we had to remove her back to our care as we had no faith in the home’s ability to care for her adequately after her major surgery. I complained to the CQC but they said they only make recommendations and it was up to the Local Authority to take action. As far as I am aware, the local authority took no action and the home remained in breach of its licence for several months after the inspection. Thus flouting any recommendations by the Inspectors.

Guest
Roger Partridge says:
17 July 2017

This story above doesn’t sound good. But I can only report good experiences when my mother lived in a home for the last 6 years of her life. Despite deteriorating quickly with dementia in her last 3 years (she died at 96) we thought the staff were excellent with her. No doubt there may have been times when not everything was 100% perfect but she became extremely challenging in her behaviour and on the whole we felt the staff did really well with her. And she wasn’t the most difficult! The staff had some very difficult old people to contend with.
The example given of payment of fees 2 weeks after a family member had died I thought was pedantic. Personally I would have accepted 2 weeks. I wouldn’t have accepted much longer and certainly no longer than a month. There must be a reasonable middle ground. I guess these periods must be defined in the original agreement but its often something that isn’t top of the list to clarify; I know we didn’t and we didn’t know what the final bill would be when Mum died. All I can remember is that it all seemed reasonable to us.

Guest
Norman Taylor says:
19 July 2017

When my mother decided it was time for her to go into a retirement home, she was 90 at the time, we looked around at a few places. I would point out that this was in Australia. We looked at a few private places but found that their costs were inflated to the extreme and also that the homes that were closed down by the government were the privately run retirement homes.
Our local council ran a ‘ not for profit’ home provided for the local residents. My mother decided to enrol in this home. It is called Amaroo Gardens. It was taken over by another not for profit business and the care given literally doubled overnight. Excellent conditions and care.
The initial cost for this was A$ 175,000 which was put into trust for the upkeep of the home, i.e.: gardens, building maintenance. $7500 was taken on a yearly basis from the money in the trust fund. The costs for my mother on a weekly basis was taken from her pension. Her pension also included a living away from home allowance, so her pension on a fortnightly basis was a bit over A$840. Only a monthly basis, after all daily/ weekly costs were deducted, my mother still had approximately A$200 a month left in her pension account.
The care given at Amaroo was excellent and nothing was a problem. Their activities were all voluntary on a daily basis and this give the retirement home a brilliant ‘vibe’ that you could feel when you walked into the home. My mother was in the dementia ward even though she was not that badly affected, unlike some of them. The dementia section had 14 rooms for this type of resident. The main building had 80 rooms for the normal resident, and it also had 4 outside units for married couples. It was a large complex.
When my mother passed away after 4 years in Amaroo Gardens I received a rebate from the initial trust fund of A$ 155,000. Needless to say, there is a large waiting list for enrolment into this retirement home. The company that owns and runs the home has four other businesses built on the same methods and procedures. They are audited twice a year and get very good results from these audits. Many private homes do not get the results that Amaroo Gardens does.
It’s unfortunate that there is no similar setup here in the U.K. Amaroo Gardens is subsidised by the government to offset some operating costs. The private homes receive no government funding or subsidies because of the inflated costs of the business.
Perhaps this has been a bit long winded but it will give you an idea of how a respectable and recommended retirement home should be run.

Regards
G Norman Taylor.
Lasswade, Mid Lothian.

Guest
nora thompson says:
24 July 2017

My sister was in a care home from October 2015 to April 2016 when she died suddenly and unexpectedly. We were not told her condition had deteriorated until I received a call saying she had died. Her care was unacceptable – she was a big lady with severe mobility issues. She did not have toilet facilities in her room and often didn’t manage to get to the toilet without having an accident. Staff were told to monitor her hourly but this was never done and she ended up with unexplained bruising to her head. She deteriorated rapidly in the home and if we had had a choice she would never have been placed there. Quality of staff left a lot to be desired but I understand that wages are low so maybe won’t attract the best available which should definitely be addressed. Other staff were exemplary but only worked on alternate days so care was hit and miss

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Guest

There is an Inquest on into the cause of death of Miss Mary H. Lycett. She was allowed to come off a hydro bath seat onto a hard floor and fractured her pelvic bone on 21/01/17. She died six weeks later. She would have been 81 years old on 15/03/17, eleven days after she died.

[Sorry johncfberg, your comment has been edited to align with our Community Guidelines. Thanks, mods]

Guest
julie says:
4 October 2017

i used to work in care homes as a proper carer i loved the service users but some of the staff really did not care it would really upset me someting drastically needs to be done if it wasnt for their generation our generation would not be here

Guest
Myra Bowman says:
4 October 2017

My little Poodle is a Pets As Therapy dog. This means that we go into care homes for the elderly. In North Devon we went into five. Now we live in Plymouth we go into one large one which is enough for the dog as she herself is elderly. I have only seen good practice by the care staff in all of these homes and the majority of residents all seem happy. These homes are open to suggestions and are happy places.

I have had experience of a care home in Watford, Herts. about 15 years ago where my mother-in-law went that unfortunately was not so good. Some care staff practiced bedroom bullying as well as admin staff not notifying relatives when a resident become very ill. I knew one very good staff member at this home who left because of the poor practices there. This home was taken over by BUPA and although there were improvements, care for the dying was not so good. The staff did not seem to have proper knowledge in this area. (I have qualifications in Social Care and Death and Dying so feel able to make objective comments)

Guest
Graham says:
4 October 2017

My aunt had a fall broke her collarbone was in hospital a week then moved to a step down bed in a Bupa care home the NHS used.
From day one I had to complain about the care they gave her she was very unsteady on her feet broken collarbone and she was supposed to be taken to the bathroom by two carers that was ignored and I caught them trying to make her get there unaided by using a Zimmer frame in terrible pain.
She started wetting the bed which was so out of character I pointed all this out to staff who weren’t interested I requested a doctor saw her but was told he was on holiday back next week so I asked if medical needs stopped if a doctor on leave and was told it was not my concern, three days later I went with the intention of taking her to A and E myself when miraculously a doctor appeared took one look at her and called the ambulance within 48 hours she died. I feel so much like I let her down. The system is failing and needs funding now to sort the problem private companies are only interested in profit for owners/shareholders I’m sure we could bring it all back in public ownership even if it means a penny on income tax let’s give proper humane care to all.

Guest
Clive Matthews says:
4 October 2017

My partner works in a private care home. The poor pay, excessive hours and understaffing mean a high turnover of staff. The residents suffer because of this. Managers are not willing to address staffing problems as it would affect their bottom line. Until there is legislation in place to secure a minimum level of staffing, nothing will change.

Guest

People who need to be in care are still people not just objects that pay care workers wages . They all have needs, sometimes just a chat , sometimes intensive medical care but whatever they need it should be given with respect , dignity and a caring manner. In most cases they will have worked all their lives, paid their taxes for the benefit of all, it is now their turn to benefit and I am sure that given the choice they would much rather be at home and independent but sometimes life does not work out that way. Please respect and care for them

Guest
Andrew says:
4 October 2017

Care for people with dementia demonstrates an unjust society. Not only are they the victims of such a terrible disease which they and their families have to live with but they are taxed 3 times for the privilege; firstly through their tax and NI contributions (which is fair for everyone) but secondly through having to pay for their disease though astronomic care home costs, and thirdly the higher charges people with over £23K have to pay compared to ‘council paid for’ people. Cancer sufferers do not have to pay to cover their illness but dementia sufferers do (I had a parent die of each). People are being taxed on their type of illness. I would happily pay more tax in the pound to ensure that everyone gets full societal support.

Guest
Jane Groeneveld Peters says:
4 October 2017

I looked after my Dad for 14 years. Waltham Forest was inadequate and I took them to court. I’m glad I looked after Dad but appreciate not everyone was in my position to do so.
I had the backing of the brilliant Dr E Singer and Barbara out fantastic district nurse so without them I would not have had any back up.
Change it now care for those who can’t care for themselves.
Stop the abuse and neglect of vulnerable people.
Best of luck for this campaign but I doubt this government will listen, they are leaving vulnerable people without money for6 weeks regarding Universal Credit change over so how can they pay carers ?
With you all the way.

Guest
Fraser Cottington says:
4 October 2017

It is long overdue a Government faced up to the task of properly funding the social care world. Millions pay their taxes all their lives, only to have their homes taken and all their savings ransacked by local council’s social care departments to pay money hungry care homes, many of which do everything but care.
Our elderly deserve dignity, respect and above all proper, high quality care.
It is time covering care costs was taken out of the political realm and funded at source by national insurance, so everyone can receive the same level of care regardless of wealth or status.

Guest
Margaret Coles says:
4 October 2017

Hello All, apart from bringing up a large family, I worked in nursing homes of all kinds during my years of 31 to 55. I enjoyed it so very much, felt it was a privilege, I was trained thoroughly and everything was immaculate for patients and staff. I then trained in Complementary practices and now at the age of 77 years, I still take an interest in the needs of others. I am appalled at the conditions and apathy I hear of. Sincerely, Margaret.

Guest
John Vowler says:
4 October 2017

Not so long ago, and forever etched in my memory, the family decided to care for my mother-in-law in her own home and it just about broke us! (She suffered from dementia.) Care/nursing homes play a vital role in caring for the wellbeing of those who can no longer care for themselves or whose families cannot do so. Devon has recently suffered the closure of local community hospitals. This fact has put extra pressure on the large A&E Dept hospitals – our nearest is just over 30 miles away – and on all our local care homes. More are needed and they need to be real places of care staffed by well trained, compassionate, well paid professional staff! There are many first rate homes in the area, thank goodness, but there are not enough for an ageing population like ours. Yes, action is most definitely required – as it is to reverse these dreadful decisions to axe local Westcountry community hospitals!

Guest
Susan Squire says:
4 October 2017

My dear late Mum was transferred to respite care following a spell in hospital being treated for a urine infection. On one occasion when I visited, she was downstairs in the lounge and I wanted to leave but the staff had to open the door. I rang the bell and because the staff were upstairs, they did not come for at least 15 minutes. Imagine if this had been an emergency.
In the same place, my Mum had a fall on a Saturday evening, the night the clocks went back. The staff asked if she could wiggle her toes and she did so they told her she hadn’t broken her hip. The next morning, they made her get out of bed and walk to the sink to wash. I was not informed and only found out when I went to visit her the next day in the evening and was surprised to find her in bed. It was unlike her to complain but she had had a dreadful night and had requested pain killers. With the clocks going back she had to endure a further hour of pain. The staff said they wouldn’t call an ambulance or doctor as ‘her case was not familiar’ and would get the doctor on the Monday morning. How I wish I had called for an ambulance on the Sunday night but Mum was never one to ‘rock the boat’ and said let them get the doctor on the Monday as she didn’t want to cause any fuss.
I rang her social worker first thing on the Monday morning and asked her to make sure the doctor was called. He came at 1pm and immediately called for an ambulance. It turned out she had broken her pelvis.
We made an official complaint to the Local Authority who ran the home and this was upheld. 9 years later, I still feel angry at how she was treated and am glad the place has shut down to be replaced with housing.
I have shared this story for her sake. She was 84 years old at the time and died peacefully 4 months later in another Local Authority home where the care was fantastic, completely opposite to the other place.

Guest
Yvonne says:
4 October 2017

My mother recently passed away after 3 weeks in a local nursing care home. The care and attention she received was outstanding and the staff were very kind, helpful and supportive to her and to our family, and explained everything to us clearly. They were backed up by weekly visits from her local GP, the community nurses, and a Macmillan nurse. It made the whole process of her death a gentle and natural experience. Id like to see all care homes match these standards, and for this to be the rule rather than the exception.

Guest
Kerry Lyons says:
4 October 2017

I wouldn’t put a dog in a nursing home these days, never mind a human being.

Having looked after my grandmother for over 15 years, she was forced to go into a nursing home after being discharged from hospital while work was done to modernise her home of the past 70 years. Whilst she was in there, I watched her going from a chatty person to someone who looked frail, and rarely spoke, apart from to cry when visiting time was over. I believe she was damaged by the common nursing home strategy of medicating all dementia patients, whether they had been on these meds before or not. I found her sat in wet trousers often, as the staff preferred to put nonmobile residents in nappies rather than accord them the basic privilege of taking them to the toilet when needed. It came to a head when I visited one evening to find my gran sat in her chair in the residents lounge with food caked to her face and her eyes rolled up into their sockets. On shouting for an assistant, the nurse manager said they would put her to bed and call a doctor the next day. The news came that my gran was suffering from bronchopneumonia, and it was just a matter of days. What will always haunt me over this incident are 2 things: the fact that they had tried to feed her without noticing her eyes and how ill she was, and the fact that she never spoke again, so could not say goodbye to her family.

Guest
Marina says:
4 October 2017

I owned and ran a Care Home for 14 years. My staff were mature women who had families ,they worked part time . I employed young people to do washing up etc after school and weekends. As they got older they were trained by the other staff to do caring , by the time they left to go to university they were loving caring young
people. One of them a young man cooked the breakfast and lunch at weekends if the cook was indisposed.
My home was a happy place , the residents were treated like family. We had some great times with dementia
Residents. They were not a nuisance but a person living the rest of their lives in comfort and respect. There is no need to treat residents as though they had no feelings. They were treated as one would want to be treated if they were in the same position .

Guest
terry says:
4 October 2017

The CQC are supposed all of the companiies involved in care as well as home care and so on. The CQC audit reports are of poor quality and it appears that non qualified auditors are used. They also do not appear to have registered and qualified Qualified Assurance personnel. Care companys don’t have these either, despite regulation 17 requiring it. Check that area first which instead of rummaging in the bushes.

Guest
Margaret Johnson says:
4 October 2017

I do agree that this is something that has to be sorted out. after my experience with my father’s lack of care and seeing that nothing seems to have changed, I have come to the conclusion that I would rather commit suicide than go into a care home at least then all suffering would be over.
.

Guest
Dina says:
4 October 2017

I think that the family should get paid to look after a relative who needs care at home because the best place in my opinion is with the family. This is the best option. Honestly, many families would be able to look after their sick relatives at home if they were paid half of the price charged by care homes.

The second best option is to give a subsidy to pay for a carer to look after the patient in their own homes, in cases where a relative is not able to do so.

Going into care is the worst option, but is unfortunately sometimes unavoidable.

The care should be part of the NHS and provided free of charge. No ones chooses to get ill, in the same way no one chooses to be disabled and in need of care. We might all need to pay a little bit more tax or national insurance contributions to achieve this and reach old age with dignity. However, fewer people would need to go into care if more herbalists, naturopathic doctors, and homeopaths, were employed in the NHS as a first line of approach before people are put on pharmaceutical medications, often for life, with serious side effects.

Guest
Sheiila says:
4 October 2017

3 of my elderly friends experienced so-called community care. One example – lunch was a cream cracker scraped with cheese. No one would have wanted to eat it. Another 90 year old was visited at 3 pm to be fed and 11 pm to be put to bed. He had ulcerated legs amongst other things. Because of what I saw I have moved into a retirement village, which isn’t perfect but is a whole lot better than that.

Guest
Gordon. says:
4 October 2017

The majority went through a World War, rationing and long working lives and yet in this day and age,
there is no guarantee they will be cared for with respect and compassion.
In the 21st Century we are a third world nation when it comes to caring for OUR elderly.
(That is of course unless you are rich)

Guest
Steve Wright says:
4 October 2017

I have an email from Which, asking for support, based on Fred’s story. It looks legitimate but the ‘Show you care’ button links to a site on the domain ‘bsd.net’ (whichcouk.bsd.net/…) I erred on the side of caution – that it was a phishing scam – and came straight to Which site to (successfully) find Fred’s story. Surely Which are not using third party domains in their mailings. Anyone following Which’s phishing advice would ignore the email I received (which may be a pretty good genuine scam, or a poorly constructed genuine Which mailing.)

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Guest

Hi Steve, thanks for your comment and I understand your concern. The Care website does indeed include three links to separate pages where you’ll find a form to share your care story with us – these are legitimate pages that are created by us. We are hoping to include a form itself on the site so that you don’t have to click off anywhere else, we’ve just had some technical difficulties with the form styling.

We have indeed published Fred’s story in full here: https://conversation.which.co.uk/health/care-homes-provision-service-cma/

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Guest

Thanks for your response. I’ve obviously pledged my support via the website. I just wanted to ensure you were aware. 🙂

Guest
Olive Main says:
4 October 2017

I am 80 and in good health. I have done all I can to make my flat suitable if I become ill. I have a good sum available from the sale of my house and will use it if necessary to buy high quality care, either at home or in a care home. My family agree with this. I have helped them when needed rathe than them hanging on for an inheritance when they are middle aged. I see no reason why the government should be expected to provide for me unless I have a real medical condition when I would hope theNHS will oblige. My money comes entirely from my husband and I working, paying into pension s chemes from our income and still managing to live busy, fulfilled lives. This may sound pious and complacent but there are millions like me who should stop winging and spend their money to ensure a comfortable end. If we paid a proper wage and organised training for care staff and made it a proper career then homes would improve

Guest
Alexandra Heslop says:
4 October 2017

Alex

Guest
Robin Jarvis says:
4 October 2017

My father died after being admitted to Norfolk & Norwich Hospital from St Nicholas Home East Dereham Norfolk. The proximate cause of his death was his desperation, occasioned by pain and suffering from a urethral blockage, on being told that its removal was being delayed by surgical concerns with his low blood pressure without any palliative procedures being [offered or available?]. He pulled the tube out himself for relief.. subsequent complications soon led to his death, the cause of which only referenced, in effect, ‘misadventure’ or similar. No fault was ascribed, proximate nor ultimate. Clearly the ultimate cause was the fact that his urethral catheter had not been periodically changed by the carers in St Nicholas Care Home according to clinical requirements. In the ICU where I have worked this is required within every 21 days and also requires management in care homes. I know that his had not been replaced for several months prior to his difficulty passing water and the great pain he reported that led to the discovery that the tube was adhering. The home admits to no wrong doing even though this would appear to be a clear case of manslaughter along with several failings of a professional nature.

In addition I am very familiar, from testimony of a very close relative working in a rural Worcestershire care home for two years, that the same lack of properly managed and administered care of the elderly would appear to be endemic at the same and very much worse levels of dereliction of the duty of care on the part of the owners of these establishments. I place the finger of blame where it belongs. These homes are endemically squeezed in resource availability, operating restrictions and in all operational aspects which may lead to the incurring of expenses which may affect profitability. This is not that they would not be profitable if the property cost were limited to the depreciation charge required to maintain the property in a good state of preservation and asset value. It is because the owners require the business to be profitable at a ‘commercial’ rate of return on capital invested that is over and above the servicing costs of a mortgage that paid for the development of the property as well as the depreciation charge to maintain its asset value… and before accounting for any capital appreciation arising from the ‘holding’ of that property.

Looked at from another way.. one might argue that it is maximising the legally available ROI of the owners’ investments in these businesses which is the business with which they are concerend and upon which their attention is focussed. The people, as individuals, passing through the doors of their facility, whether working or dying, are incidental to their principle purpose as far as owner’s are concerned whatever their public protestations, and whether or not they actually believe what they say. Simply because the motivations by which the business arrangements of our society require them to act no differently.

Until all people who utilise what we call ‘capital’ are seen as, and see themselves as, providers of the service of employing capital within society for all of our mutual benefit, and see their services as no more and no less important and requiring of integrity and professional application and focus on the social importance of what they do as are the services provided by the refuse removal men, the firemen and the medical clinicians then we can expect no more from these ‘care clinicians’ who refuse to take their place in the society upon which they rely no more or less than does any other member of it.
Rob Jarvis, FRSA,

Guest
posted anonymously. says:
4 October 2017

I was a nurse for over 30 years. On occasions when I was between jobs I do occasional shifts in various homes. In most of them the unqualified staff were not adequately supervised, so they simply did things the easy way instead of the correct way. Having an easy shift was more important than doing the right thing. I would not put someone I love into any of the homes I worked in. However the best one was a Masonic Home, things were a lot better there as they spent more money on services and were not looking for a profit. Homes should be not for profit businesses .
Thrift is a good attribute and waste is bad, But not providing enough basic items like bedding, wipes and towels to do the job adequately is disgusting.
I don’t have time to list all the things I experienced. None of them were shocking but even little things matter.
Im afraid I will have to ask that this be posted anonymously.

Guest
Mr C says:
4 October 2017

The system is broke. It’s not fit for service, and as its costs money ( alot of money) the advertising standards
agency should get involved because simply “care” and “nursing care” are words that should not in my opinion be allowed to be used. Its false representation. Strong words some will say, over the top others and in some areas I might agree. However I say this because so many people pat themselves on the back, pay themselves large salaries and bonuses, the regulator does the same, and Governments DO NOTHING. Abosultely NOTHING, not a single mention today in Manchester, because today, this week, this crisis the Young ones are in the spotlight. The Old are not important (until the next election) … so things will get worse. Pay rises will rob funding even more, housing will rob money away from care, it just gets worse.
Every day every week for the next year … Thats just 365 .. personal stories should be published, in the papers, on bill boards, all over social media, in print, and as in the way of polictical parties a 3 minute slot on TV just before the news. This will highlight The woeful assistance the authorities give, the utter waste of time many of the “packages are”, the profits made and the employment records and practices of the care home owners, the sheer lack of funding and shameful practice of preventing the correct assesments for continuing heathcare, are the cause of much of this. Oh and a regulator that couldn’t run a party for 6 yrs olds. Until a wider audience get more than soundbites mentioned breifly on the news only those that have loved ones in homes will know just how bad it can be and often is.

Guest
Blanche says:
5 October 2017

I did try and share this debate on Facebook but it did not share when I clicked on the share facility even though I tried several times. I think it is an important subject so please tell me when the ‘share’ facility works.

Guest
Peter Rockcliffe says:
5 October 2017

IMHO there are two significant problems facing the Care Home Industry (because that is exactly what it is now) with private Companies putting profit before care and Local Authorities paying too little. The consequences are staffing and care quality. There are many people who work in Care Homes who are wonderful and caring but there are those who are not. Caring has to begin at the top of each organisation. The drive to meet occupancy targets suggests that the business models are skewed and lease-back of premises rather than asset ownership suggests that many Care Home Operators businesses have no value other than “vendre commerce”. Unfortunately good homes suffer from the bad reputation of poor homes. CQC has failed very many who are no longer with us and many are suffering in silence if they do not have relatives who can speak for them.