/ Health, Home & Energy

Is the care home sector working well?

elderly care

The Competition and Markets Authority is undertaking a thorough review of the care home sector to make sure it works in the best interests of those who rely on it, as Douglas Cooper of the CMA explains.

We launched our market study in December last year to look at issues affecting the 430,000 older people in care and nursing homes across the UK.

As part of this study, we’re looking at a range of issues including:

  • How people find the experience of choosing a care home
  • How care homes compete to attract residents
  • How well care homes are complying with their obligations under consumer law
  • Whether the current regulation and complaints systems give residents adequate protection

We want to be sure that the care homes sector is working well for residents and their families.

Home to care home

Care homes can provide a safe, warm and caring environment for older people to be looked after when they’re no longer able to cope at home.

But choosing a care home is a big decision, which often needs to be taken in stressful or upsetting circumstances, and can have a huge financial impact on families.

In particular, we want to know that residents and their families can get the information they need, when they need it, that they understand any contracts they sign once a home is chosen, and that they are treated fairly by the home during the time they need it.

We’re also looking very closely at reports of potentially unfair practices and contract terms being used by some care homes.

We will assess how widespread these concerns are, how they’re affecting residents, and whether they are likely to breach consumer law.

Playing fair

We’re now a few months into our study and have already received a wealth of useful information and well-informed opinions.

We’ve heard from consumer groups and charities about various concerns around potentially unfair practices and contract terms being used by some care homes, including:

  • Hidden charges where residents face additional fees for services they didn’t know weren’t covered within the weekly fees. Examples might include charges for accompanying residents to medical appointments or entertainment.
  • Fees being increased at very short notice and without clear explanation.
  • Care home residents being charged large deposits/upfront payments without being clear what these cover.
  • Unreasonably long notice periods to leave the home.
  • Residents in receipt of local authority funding being asked directly for top-up payments for additional services by the care home, but it may not always be clear what they are being charged for.

We’re also looking at complaints and redress systems to assess whether these work effectively for residents and their families or if they are difficult to use and deter people from complaining, for example through fear of retaliation against them.

We’re taking a detailed look into how common these practices are.

We haven’t yet formed any view about whether they break any consumer law or other regulations.

But if we do find there are problems, we can take action, including launching enforcement cases or making recommendations for changes in the rules that protect residents and their families.

Help needed

We want to gather further information and that’s why we welcome the launch of the Which? care home reporting tool, where your comments will be treated confidentially.

We want to hear about the experiences of residents and their families who feel they may have been treated unfairly by a care home.

This will feed into our study and help inform our conclusions when we publish our final report by the end of the year. We’ll also be ready to publish our interim report in May this year.

This is a guest contribution by Douglas Cooper of the CMA. All views expressed here are the CMA’s and not necessarily those shared by Which?.

What’s your experience of the care home sector? Have you or an older relative/friend ever been treated unfairly by a care home’s practice, contract or complaints procedure? Or, if you’ve ever worked in the sector, what sort of problems did you encounter?

If you’d like to share sensitive personal experiences in the comments below, please choose to do so using an alias, and omit anything identifiable.


As a retired geriatrician, Care Homes have been underfunded for years. Recent cutbacks in Council funding is seriously damaging the care for the vulnerable adults in Homes and the commercial survival of the establishments, whose owners have to cut costs of meals & services to survive. This has major, adverse effects on sick, frail elderly patients in hospital who need a place in a Home. It is essential that central government acts immediately with sufficient funding to resolve this appalling crisis

G.A.H. says:
15 March 2017

You`re experience of care home owners is obviously very limited , the monies that residents pay for their care compared to the actual costs of the care received is very disproportionate. I worked within care homes for adults with learning difficulties for 8 years and I will say , and did say to one of my managers, that I would not let them look after my dog let alone a relative of mine . The amount of money that care home owners receive for care is very reasonable , the amount they actually spend on their residents is minimal. Cash & Carry cheapest produce is all I ever saw and items were only replaced when either they were very worn out or a relative complained , as for visiting Dr`s they were in and out without the bat of an eyelid. Complaint made against a manager for manhandling a resident , in a no restraint home, nothing done and this manager continued to work in care , she was a bully with staff and residents. The whole care industry is littered with rotten apples .

The person to whom you responded is a doctor and most likely an owner or former owner of a Home, finding a way to deceive the public, seeming to think that all readers have no common sense or know logic. It makes no sense that budget cuts cause owners to cut back on meals and services since each resident or patient’s care is paid for in full. These are not Local Authority Homes which are given a fixed budget but have to cope with whatever numbers are thrown upon them. No one without the funding would be admitted in one of these Homes. The private nature of these Homes is the reason there is controversy because the Quality Care Standards Commission could easily redress it were they government owned.

Whilst local authorities persist in piling millions into unsustainable defined benefit pension schemes, I cannot accept that they are short of funds.

I think they should do a lot more to help the elderly residents because they deserve. More help than they get from this government the way they are treated for me is not at all agreeable

I have had the unfortunate dilemma of visiting two separate care homes they were both terribley run by untrained staff and bully management.i complained to manager and told I could be stopped visiting.

The pressure on all medical services has dramatically increased due to an ever increasing aged and immigrant population. Many hospital beds are taken by the elderly who would be better served in a care home and thus release the beds.

Investment in more Care Homes with qualifiesd staff would help.

Mrs M Spector says:
15 March 2017

I am already getting terrified at the thought of going into a care home. My dread of having to sit aimlessly in a row of chairs fills me with dread. Having had to deal with a couple of care homes for my Uncle and although they were private and expensive, I do not want to end up in one as he was surrounded by people with dementia and had no-one to talk to. I have no-one in this Country to keep a tag on me to see if I am being treated properly and it seems this is needed. I would welcome a strict code of practice being enforced which does not seem to be applied nowadays as hee is so much abuse of the elderly.

My late wife’s father & mother were in a care home. Her mother then needed nursing care. Despite both having lived together for over 60 years they were going to ‘ship her off’ to a nursing home some 30 miles away. We were having none of it. We then contacted our local MLA, arranged a meeting with the head of the authorities and the outcome was a place was found for her in the local town which facilitated my late wife’s father to visit her on a daily basis by taxi (paid by us). Moral of the story – don’t take no for an answer, fight your corner on behalf of your parents and with help from your local politician hopefully achieve success.

Nice one, my always question is do they care, I think not your father in law I doubt was even considered by those making the decision, the one thing they do not to is care even though the money is coming in.

There are more and more east european carers employed in the UK who don’t understand English.
Care companies don’t employ, as required, Quality professionals to ensure standards.
They don’t employ auditors to check standards, procedures and other legislation.
The Care Quality Commission don’t employ IRCA auditors or professionally qualified CQI Quality managers.

CQC audits and inspections are pitiful.

Ingrid Lee says:
15 March 2017

Why has no-one investigated the astronomical costs? How are they justified? They’re just a licence to print money.

I’d rather die than go into a care home.

The big problem is individual funding and that for Care Homes so much so the whole system of health & social care is not fit for purpose as the Government defrauds us of our inheritance, allowing Doctors to not take the hippocratic oath, they appear to be the enemy . If you suffer Alzheimers rather than cancer you get treated differently especially in hospital and this starts early regarding the delaying of access regarding diagnosis of multi chronic conditions when trying to function independently .If solo this can be a problem regarding safety , as well as for the carers too .Why did my Late Father have to call the ambulance 10x when he couldn’t pick her up and it was stroke/TIA not acknowledged ,and still they refused to take her in .
I have just seen medical care home note from Doctors & Dentists & the workers there explaining to my Mother who didn’t know me or what they had for breakfast, what to do .Is this why abuse occurs as it is only me with educational background that could assess the cognitive. Her cognition had gone and they thought she was following the TV because she smiled sweetly agreeing with everyone.She couldn’t speak This all connects up with policies & procedures that discriminate .She didn’t know where she was so why assess her as average .Only at last count when may be considered a risk & danger to herself they assessed correctly when should have been when first got DLA With Father as Carer as social services & GP refused to assist / I was having similar problems with what I know now to be heart failure symptons .What is on hospital appointment forms Watchful Waiting ?? I was even targeted out of employment when not given antibiotics for disability & who was my MP ? Jeremy Corbyn no less !What is going on?

Click this link to sign the petition:

My petition:

Make continuous care assessment & social services provision relate to 1st DLA .

From the 1st DLA make it a requirement that MPs monitor & intervene with LAs in the social services and medical provision overall in the community, hospitals and care homes . Carers are of a certain age & disability themselves are supported according to need not means.

Make maladministrating by LAs & missing hospital, GP records a crime .This is after checking their funding is fair, relating to numbers. There needs to be total monitoring,with MPs overseeing, not lawyers using the unqualified ,or MPs staff working independently on remits from undemocratic LAs. Convention is used by administrative staff to avoid workload not overseen. Make sure there is discretion. Maybe this is where Lords could help ?As many are ethical remembering when times were fairer. .

Click this link to sign the petition:

Petition: Make continuous care assessment & social services provision relate to 1st DLA .
From the 1st DLA make it a requirement that MPs monitor & intervene with LAs in the social services and medical provision overall in the community, hospitals…

Penny says:
15 March 2017

We had to admit my grandmother to a nursing home many years ago as she had dementia and there was no one who could care for her at home. We visited a few and found one that we thought was suitable to her needs. Unfortunately, the care home was negligent in not putting proper security measures in place and my grandmother let herself out. On one occassion we had the police knock on the door asking if my mum had a missings person… mum told the police that her mother was in a nursing home and no she had nothing to report. As the policeman walked back to his car, mum looked and saw my grandmother sitting in the back of the car… the nursing home didn’t report her missing…. On another occassion my grandmother let herself out again, this time it was a wet and cold December, wearing only her slippers and no warm coat. She was found dead under some workmans materials two days later. The lack of care given to old people scares me…. there needs to be a regulations and regular monitoring of these homes.

Linda says:
15 March 2017

Why are they not reviewing day centres especially those for people with dementia?

It is an undisputed fact that self-funders are subsidising council funded residents. What is more, there is no protection in law for self-funders from being over charged. In most cases the option of going elsewhere is not feasible. This exploitation of a vulnerable group of people is unacceptable in a fair society. There needs to be an independent organisation, backed by legislation, charged with ensuring Care Home companies and Councils do not take advantage of those who are able to pay for themselves, but are unable to ensure they pay a fair and reasonable price for their care.

I have been involved in the development and use of resident and staff-reported outcome measures over the past 5 years in about 400 care homes. These measure resident need and experience of care in a way that is very quick and easy to do (see http://www.r-outcomes.com). It rather surprising how few care homes have quality control systems in place to monitor need and experience on a routine basis.

This is an important and well-founded review and it should be a valuable exercise when completed.

To help the Conversation along it would be useful to have a reminder of what people are entitled to [or not] from their local authority, whether any assistance, either practical or financial, is available once people are in a private establishment, and what happens with respect to residents of private homes when their money runs out.

While my mother-in-law was living in her own house she received quite a lot of day-care assistance and support. She was worried that if she sold her house and occupied a home she would get much less support. We never found out as she unfortunately died from a fall in her own home. Her daily care worker did not report the fact when she could not get an answer at the door and it was a few days before we found out. Bad things can happen everywhere.

Hi John – on Which? Elderly Care you can find information about local authority provision here: http://bit.ly/2nskYZt

I think that by a ‘private establishment’ you mean those people who are self-funders? Again, we have information on this subject in our ‘Self-funding a care home’ article: http://bit.ly/2nsCcG0. This page includes advice on what happens if someone runs out of money when living in a care home.

The question of how much financial assistance someone gets when moving into a care home after being supported at home depends on whether or not the value of that person’s home is taken into account. There are exceptional circumstances when this isn’t the case. For more information, please see the pages relating to local authority funding for a care home: http://bit.ly/2mZO7NI

I hope this all helps.

Thank you, Emma. What you have referenced will no doubt help, but I suggested that to help this Conversation along it would have been useful to include this information in the Intro or within the comments. I am disappointed that you cannot do that.

I was expecting the information to be available to look up, and no doubt any new correspondents could also go down that road if they read all the previous comments to see if there are any useful links. But in the spirit of making these Conversation topics relevant and helpful to people, and not just an opinion gathering exercise for Which? staff, I hope you would agree that it would be more helpful to provide a summary of the background information in the first place. In my experience an informed Conversation is better than one that is purely opinionated or based on anecdotes.

I was upset when my mother had to go to a nursing home, the home didn’t keep records of injuries which occurred. Which don’t involve expense just time for the nurse in charge to record them, trouble is they think it will effect their rating. Sadly she passed away 6/5/2010

Peter Grant says:
15 March 2017

When I was looking for a suitable care home for my late father, who was classed as frail elderly in the area of Scotland where he lived – due to different criteria used between regions he was placed in a home unsuitable for him which affected his health until he was eventually moved to one that could cater for his needs – there should be a universal “check list” to make sure those individuals needing care are placed in the environment
best suited for them

Peter Grant says:
15 March 2017

I should’ve said that while in the first care home my father had some money stolen – we called in the police but unfortunately not much could be done as the person accused was no longer working at the home, it was also discovered that he had a urinary infection which I am sure he picked up there

My late father who couldn’t speak due a stroke, and wire nappies, had to go to hospital for a scan. We went with him and when we got back some 4hrs later, at 5pm they were putting everyone to bed and too busy to change my dad or give him a drink or anything!! That was in a BUPA home!!

Linda J says:
15 March 2017

Our neighbour had two strokes and when her husband died of cancer, her sons put her in a home. Although physically fit and sprightly within months they began taking her everywhere in a wheelchair to speed up the process of getting everyone to the dining room and back . Within a very short time she could hardly bear her own weight and could not walk. She became a prisoner in her chair or room and then was made to wear nappies as she would soil herself before she could attract their attention. This then led to other problems and ulcers and finally dramatic weight loss due to them not having the time to feed all the residents.

My mother was moved from a good care home to another place, against our wishes, because of her dementia. During this period she went down to a little less than six stones and had deep bed sores when my sister finally succeeded in the fight to get my mother moved to a kinder environment. The home imposed on our family was quite distance from the family who don’t drive and they had to get two buses to complete the journey. My mother would often be found with her chair pushed so close to the table on which her food was set that she was unable to get her arms out from under the table, food had congealed on her plate. (her shoulders were very painful). The staff were no where to be found, although you could track them down smoking in their own room. During the 13 years that my Mother’s dementia lasted we found her with bruises and a broken pelvis, we were told she was becoming difficult. She was in her 80’s frail and very small.

I knew someone who worked in a care home years ago, and she told me horrendous stories of malpractice.

Things like underpaid foreign workers eating the residents’ food because they couldn’t afford to feed themselves. Foreign workers unable to speak English well enough to understand basic instructions. British workers visiting on their days off to bring the residents sandwiches. Residents being made to get up at 5am and be washed in cold water against their will. Verbal abuse of residents by staff. Neglect was common. Over-use of agency staff who said the place was no worse than others they had seen. Staff afraid to complain in case they lost heir jobs. Rapid turnover of staff who sometimes complained about conditions but nothing was ever done. The home-owner lived in luxury.

This situation only exists because callous families don’t care enough about their older relatives and just dump them anywhere there is a vacancy and forget about them. People stupidly vote for governments that starve this service of funding.

I’m over 60 myself now and fear for my own future.