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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.

Anne Marie Robb says:
14 July 2017

Please stop contacting me you are now harassing me 21/6 this year I became 65 3 birthday cards 15 text messages (that I don’t agree with) what does a bloody card cost ??? Now 4 messages from which about bloody care homes . I live on my own (my husband died 14 yrs ago) I still work because off all the bloody scams I have had with the internet. I help people who is going to help me now ??? WHICH ??? Don’t think so please cancel my subscription and stop sending me these bloody emails about care homes I have already answered 3 today

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I completely endorse what Duncan has said. What you do need is a really effective SPAM blocker but if I could pick up on one point: you say you have already “answered three today”. That’s possibly part of the problem.

The unpleasant individuals who send out SPAM send it out to everyone and anyone, but when they get a response they know you’re reading it and they therefore target you all the more. It’s best never, ever to respond to emails you don’t want.

We too were paying for an ensuite room so that FIL could have a shower. After he was ill he wasn’t able to shower at home. We were told he could have one when he moved into the home and it was one of the things that we “sold” to him as a positive thing about moving . However having asked several times he never had a single shower in all the time that he was there – and I still feel bad about it. The care homes generally suffer from a lack of staff – a lack of experienced staff in particular – and they will take every opportunity they can to reduce the amount of work and therefore the number of staff necessary. This also included using a wheelchair to push him into the ensuite and to the dining room down the corridor rather than following him while he walked using his frame to save staff time. This meant that he had no exercise at all. The staff here were lovely but not enough of them and they were not putting enough effort in to do more.

My Aunt had all her jewellery stolen, and some of her clothes. We were too upset to worry about it at the time.

My Mum was in a care home that took all her money, then kicked her out, when they were supposed to leave her £16,000. Warrington Social Services were very good, and put her in a better place. Only thing wrong with that was that there were two people who had been sacked for theft elsewhere working there!

When I moved down south, Warrington Council allowed me to move Mum with me to a home local to my new house. I was very pleased with the care she had there, although when she died, the new clothes I gave her as a Christmas present were all missing.

Donna Gregory says:
15 July 2017

I have not delt with it personaly but many years ago my grandad had a fall at home after assement said unsafe to go home. He was moved into a private care home where he had a anthor fall but my grandad said they had dropped him should have been 2-1 due to him being very tall and about 16 stone . The home tried to say he had brittle bones and dementia both ruled out by the hospital. The investigation found poor record keeping and the care work assting him had been given a/l the next day but never returned unable to be traced. He had a 6hr operation to repair a broken hip but died in hospital from septacimia. He was in hospital 12 wks when he passed away the home were informed. When they went to collect my grandads things thinking they would have to clear the room. They found all his belongs had been put in black bags as the room had been used by some one else since he had been taken into hospital. They were given a bill for 12wks for the room and a settlement charge for holding a place when they had already had an income for the room so had not lost money due to him being in hospital and the home was at full capacity so had he lived there was no place any way . I know they had meetings with a socilter but were told did not think they had a case only for the care issues and still had to pay the bill any way i know that the home closed not long after.

Whilst my involvement in care homes is limited, from what I keep hearing is things are much the same as before.
In the late 1980s/early 1990s Thatcher launched private nursing homes which came under the umbrella of the NHS and later the Local Authorities.

A handbook was published as guidance to potential Home owners – NAHA Hand book. In it were minimum floor areas for residents; these were flawed and irresponsibly taken from the then Hospital Building Notes. These areas were not qualified as were in Hospital Building Notes 38 & 1.

The Chairman of the then NHA – a manager of a Heath Authority in Liverpool – was notified of this error but refused to issue any corrections. That is the reason many patients were/are packed in like sardines with the all too familiar sight of patients sat round a room almost shoulder to shoulder with nothing to do but watch TV.

The original Hospital Building Note 1 stated the notes were based on the principle that patients would have a maximum stay of 6 months. Where they were expected to have a longer stay then additional space would be required to store more personal items and accommodate some personal furnishings; plus out door recreational space should be provided. This is the first error of the NAHA [later NAHAT} handbook failed – there was no recognition of these provisions.

Hospital Building Note 38 related to space requirements for three categories of patients; this is where NAHA Handbook really showed ignorance of patient needs. Few if any Nursing/residential care homes assess their patients but apply the minimum space requirements of each of the areas.

For example a mobile person will require more day/recreational space than say a bedridden patient and a disabled patient who can use a wheelchair would require the most space both in day/recreation and bedroom in order to have ease of movement. As most care homes do not just one category of patients then the minimum space requirements should have been the greatest of all three categories not the least as noted in the NAHA Handbook.

By having patients packed in like battery hens it puts stress on patients and staff which creates a bad and stressful atmosphere. Everyone is on top of each other and friction and/or depression soon sets in.

This can lead to problems of “Care Home Odor” due to again the failure to comply with HBN 38 – ALL patient areas to have minimum of 9ft ceilings unless there is mechanical ventilation. Care Homes and private hospitals have been permitted to ignore this.

I have got tired over the past many years of notifying ministers;MPs and party leaders who all have taken no notice of these basic failings.

My Mother had to go into a residential home and I was assured that even though they were not a nursing home they were equipped to deal with end of life care when the time came. However, my Mother somehow broke her ankle whilst in their care and told me and the people at the hospital she had fallen…… the home insisted she hadn’t but the doctor said such a severe break had to result from a fall…. things went downhill from there and the hospital was informed they wouldn’t take her back because they could no longer meet her needs. It was left to the hospital to inform me. I asked the home manager why her needs could not be met and was informed that as she was now “less mobile” she would be “too needy” and that they could not have someone in their care who kept telling people she had fallen when she had not . My Mother upon being told she couldn’t go back to the home refused any more treatment for her long standing conditions and died a week later…..

Doreen Kinnear says:
15 July 2017

I worked in a care home for a year in 2009/2010 as a housekeeper, supervising the cleaning and laundry requirements for 50 residents. During my time with the home the turnover of domestic staff was huge, we were supposed to have a staff of 6 and had an allocation of almost 200 cleaning hours per week, when the home was short if care staff they used the cleaning staff (all of whom were required to be trained as care assistants as well as domestics) before commencing their employment which on many occasions I was left with only myself plus 1 person to clean 50 rooms which were mostly en-suite as well as day lounges, dining rooms, corridors and treatment rooms whist I tried to do laundry, including bedding for 50 residents. I complained every day, but was told on many occasions to ‘just get on with it.’ After being in this extremely stressful position for a year, knowing that the residents were not getting the standards of cleanliness and infection control necessary my own health began to suffer and I found another job. I was also bullied by the manager and administrator of the home after I questioned what was happening to the budget for the remaining 130 hours of domestic staffing that were unused each week? Also on one occasion I found a resident alone in a treatment room, with an unlocked drugs cupboard. I left my full time position for a job which guaranteed just 4 hours of work each week, as I was desperate to get out. After I left I reported what I had witnessed to the relevant body, who did an ‘announced inspection’ which to my thinking was of no use whatsoever.

Loss of dignity, by removal of clothing and not allowing to dress, appropriation of private property and neglect of health needs are all within my experience of a local authority run home.

After losing my income, in desperation I took a job as a carer in a well known local private luxury retirement care home. My manager told me that she hopes that I will stay, because many cannot cope with the job. That manager was the most dedicated lady doing jobs others could indeed, not do, like cleaning orifices with an utmost consideration and care. I was one that could not cope and ran off within a week with a breakdown. Not for the orifices, because my good manager was willing to be doing that for me, but because of the heartless manner in which the top management was running this business and which, in my eyes, amounted to abuse, cruelty and more. I was reprimanded not to allow residents to get attached to me. Within a day one lady considered terminal with anorexia and depression started speaking and listening to me. I was telling her about the need to live, as life is a school of lessons to be overcome to fulfil a lifetimes’ mission. By this time, she signed her bungalow over to her son who was visiting to speak with the managers and was seen smiling, even laughing with them. I tried to explain same to him, but he was not interested. That lady started asking for me and I was encouraging her to eat. Management told me that I must not allow her to favour me before other staff and that she has a right to die: I was transgressing. A retired teacher sat the whole day in her room in front of her tv with hugely swollen legs, arthritis, diabetes and open sores. She was fed tea and coffee with cream, pasta drowning in creamy cheese and other dairy products. At one of the morning staff meetings I asked why are some residents not given soya milk instead of dairy. A couple of carers quickly commented that their own joint aches eased after they moved to soya from dairy. The manager stated that soya is more expensive and after all, these people live to 80 and more, all of their lives consuming dairy, so why to change now. To reduce their suffering, I thought, but the topic was closed. A spritely little old lady, seemingly without relatives, busied herself through the establishment not causing any harm to anyone other than remaining in her long cotton nightie during the day. It was decided to section her and several police officers attended colluding with the management as they came to remove her with her being given no apparent say. This is one of the most expensive care homes in the affluent area where I live. Should I have been forced to stay there, I would have committed suicide. Whenever I pass the place, I see it as a house of horrors.

The contract states what I must do but there is no statement on the level of care I can expect in return. This means my mom who has dementia has her illness used against her to not give appropriate care. They ask once and leave her unless I complain. They have said she pulled her teeth out, this is not true, they rotted away as they were not cleaned by the home or hospital.

My mother was in a care home with dementia which I visited daily, was able to notice it was going downhill and poor CQC report. Moved her when a very desruptive resident was put in her room and she became very frightened. Social services closed the home soon after. New home was new and opened its a fanfare, ratio staff to residents excellent etc. Then that went downhill, staff cut back, lies told. My m other and others being bullied by aggressive resident, another resident died after being knocked over by another resident. Neglect, disrespect, etc I moved my mother to a consistently excellent home run by a charity. I advise anyone to visit daily if possible and vary the times, be aware, read the CQC reports , don’t accept the myth that the worse thing is to someone.

1 used to work in a residential home when the home knew that the cqc was coming low and behold we had so many staff on that day. also when showing people round in the dementia unit that has 15 residents it normally has one member of staff in the afternoon and the same at night but was told to say there was more staff. resisdents preferences was not taken into account and lots of other things. this is a private home which prides its self on its care

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Anon says:
15 July 2017

My relative was left unshaven and unwashed for days at a time. Also the family had to buy a chair for him costing thousands.

Ron McLennan says:
15 July 2017

My mother, who died in January, 2008 was effectively bullied by certain care assistants and nothing was done about it

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How about investigating why care companies do not have qualified auditors or qualified ‘quality assurance staff. The CQC are not fit for purpose yet no one checks why their checks are inadequate and amateurish

How about investigating why care companies do not have qualified auditors or qualified ‘quality assurance staff. The CQC are not fit for purpose yet no one checks why their checks are inadequate and amateurish

Jackie says:
16 July 2017

My mother-in-law clearly preferred a home in her country district that six years ago cost £700 a week. As the home had rooms for about 100 ‘guests’, most of whom ate scarcely anything, I could never find justification for SUCH high fees. However, we all loved my mother-in-law, and it was others who decided.

What really incensed me is that when she died, the youngest brother and his wife were persuaded to ‘make a donation’. They never said how much, but I feel it was about £500, to a home that charged excessively, to my mind, in the beginning. This is not a rich family, and there were five of her children and their children left to share the modest legacy. None of us begrudged paying for her last few months to be in comfort, but I just cannot see the justification for such very high fees in these places; after all, the staff generally get very low wages!

l have worked in care homes for many years, so l know about the care. Some carers go out of their way to support residents/families. Often without recognition from managers and senior staff. Pressure is often put on staff to do tasks, sometimes with very very little equipment etc. Staff hate bad carers who give them a bad name. l have seen both good and bad practises by staff, training is important but also the recognition that good staff are blamed for the bad apples. On tv everyone looks at the bad homes, yet where is the balance of the good homes doing fantastic work.

In 2002 my family and I were looking for sheltered housing for our mother she was 77 the house was too big for her and she was troubled by neighborhood children but because she had her own home she did not score enough points. So was refused accommodation anywhere else. She died when she was 78 in hospital.