/ 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.


My late second wife (we were both widowed) had to be put in a private care home: I was in my eighties and after some years of my 24/7/365 caring (she had Alzheimer’s dementia) I could not cope well enough. After a year, they sent her to the local A+E department, saying that she’d had a fall; she could not remember anything, and the medical staff could find nothing wrong. When this happened for the second time the home refused to take her back, telling me that she now needed a nursing home, not a care home. She blocked a hospital bed until I could find a suitable place. They offered no help whatever in the transfer, not even to take her back for a short time while they and I would do a search together: pure business, from the top of the organisation, and now not their problem. The help I had was from an overworked Communithy Psychiatric Nurse and my helpful but non-expert son. Both homes seemed to be adequate: ordinary staff pleasant and helpful in the home. Now 88 I feel well, but the prospect of myself being ending up in one of those places fills me with dread – perhaps even the Final Solution…

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My Mother-in-Law has been in a care home for over two years. She suffers from dementia. Although the premises are old, the staff, in the main, are caring and considerate. There are, however, issues created by the fact that the home is understaffed, These include:
1. Toileting: There are times when residents have to wait an unacceptable period of time before receiving assistance.
2. Attitude. Sometimes, one or two ‘carers’ will be verbally abusive to residents. This is absolutely unacceptable.
3. Accommodation. Mother-in-Law is 97. It took her over a year to be transferred to a larger room, although younger, fitter residents had been transferred previously.
4. Although it is essential for her outlook and well being, staff make little attempt to ensure that she drinks plenty of liquid. As a consequence, she consistently has urine infections and is not as ‘bright’ as she could be. This is despite the fact that her medical records emphasise that she MUST have plenty of liquids.
5. Gardens. This may appear to be a trivial point, but it is far from that. When we started visiting the home, the lawns and footpaths were like jungles. Flower beds were full of dead flowers, due to lack of attention. Wooden flower containers were stained and overgrown. There was no facility for a garden hose.
My wife and I totally overhauled the gardens and the residents were delighted. Money is not always the solution to problems.
6. Recreational activities. Most of the residents suffer from alzheimer’s or dementia. It is essential that time is spent providing them with stimulation. The home pays lip service to this. A comprehensive programme of activities is displayed on the main notice board. This is pure fiction. The main activities for the residents are watching TV and sleeping. Even with the TV, there is no effort to determine what specific individuals would like to watch and then organising a timetable to suit as many residents as possible. Again, a non financial solution.

Unfortunately, due to staff shortages, lack of finance and the fact that too many ‘carers’ are simply there for the (pretty) poor money, I cannot see any party with the political will to tackle this issue head on.

Fred claridge says:
15 March 2017

I think the prices they charge are scandalous I think it’s a 1000 a week ,,me and my wife are both disabled we could manage 6 weeks for that money ,so how can it possibly come to that amount,you save all your life and they take it in a matter of weeks ,hope me and my wife never have to go there you will have to drag me there

My Dad has passed away now but in his latter years he suffered with Demensure We needed a rest from caring around the clock so I found a Care Home. With in a few hours of leaving him as I thought in the capable hands of the staff who I was assured dealt with this illness daily. I got a phone call from the home to say that it was not working out as they could not cope. They had got in touch with a specialist in this field, They waiting for him to come to access my Dad. After being accessed he was moved to a hospital that took care of people with this illness. The staff there were marvelous with him. When went to see him I asked were his glasses, Watch and shaver were I was told he did not arrive with them. That is not good enough…

Too many firms have bought into these homes and then sold of the property leaving an unstable business. Councils sold or closed what were good homes. What about councils get cheaper rates than privately funded people? One price not the private person subsidising the council?

The care sector isn’t working – experience of care in one’s own home is exceedingly poor too. Underfunding is one issue and with the looming Brexit undoubtedly will be worse. Most of the care sector is supported by the EU or foreign nationals and the falling pound will make it even less attractive.

We have a National debt and deficit and will the public at large vote for a tax rise to support social care?

I would like to say that a number of years ago, my sister came with me whilst I was visiting Hastings, to visit my Aunt, who was in residential care at a Home in Hastings. Whilst in the lounge, we had the occasion to witness a carer, who roughly lifted a gentleman, and more or less threw him into a nearby
armchair, which was rather upsetting, both for us and for the gentleman concerned. This is not the way to treat people for the money they are being requested to pay, and deserve better treatment!! We did express an opinion to the Supervisor – by letter, but never seemed to hear further.

In the area I lived many years ago, but still have an interest, the hospital authorities have closed and are trying all the time to close other cottages hospitals; my question is “Why can’t the premises be used as ‘Care Homes’ and/or for use as places for the so-called bed blockers to go, so that hospital beds can be released to other persons having a greater need. These Cottage Hospitals are dotted about the counties, and would in so many cases mean that relatives would be nearer their loved ones.Easier for visiting. and less costly.The occupants of these places would not need the attention of highly qualified nurses either. A saving all round.

I was fortunate to be able to meet my mothers wishes to ensure she was cared for at home and not to be put into a care home. I had the most fantastic care agency who went that extra mile to ensure that she was the most important person and her needs and wishes were met. She died at home having received love and kindness from everyone.

In contrast I have visited care homes and talked to people who have had to place relatives in care homes and it really is a bit like the curates egg good in places and bad in others. The good ones excell in the care and facilities that they provide but some are just an extension of the old geriatric wards where people sat round the wall all day and only moved for poor quality meals. Iv seen the early to bed early to rise regime and the holistic approach to care where there is a choice and there is no pressure. At the end of the day these people are paying for a service and they should be the primary focus and not finance. If care is underfunded then so is the quality of the care provided, Iv seen personnel from care homes shopping in supermarkets at the end of sthe day looking for reduced products and buying the cheapest items to give to residents. I went into one home where Sunday lunch consisted of chicken roll reheated but you can bet your bottom dollar that it would only appear as chicken on the menu available for inspection.

Whilst I agree that it is not easy to provide everything in what is in the end a mini institution but it is at the end of the day a persons home first and foremost and not Faulty Towers !

MARY says:
15 March 2017

My mother had care in her own home but the company we used could not look after a dog my sister and I had no end of fall out with them medication missed out many times we use to have to go at medication times to check it was been done correctly my mI’m had eye problems and they would often go to put drops in the wrong eye they was been paid my mum for this totally shocking constant change of staff young girls on zero hours we managed my mum on our own in the end sadly she is no longer with us but worked hard all her life more care is needed to look after our elderly they deserve dignity if you don’t like the job dont do it and please don’t mention the elderly who have suffered much worse beaten abused anyone who does thus should go to jail at once maybe then others would not do this terrible crime I also think the public should be able to walk in any care home to Def what’s going on the only way to detect what our poor old folk are putting up with its just scandalous and should never be allowed to happen sorry I have gone on but it really annoys me when the defenceless are ill treated.

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As a 73 year old it frightens me to think that I could land up in a care home.
My mother in law (who was bedridden) was in a care home and my wife and I visited her every day.
The place was dark and dingy, Smelly and poorly lit.
Within a couple of weeks she was admitted to hospital ( and they are not at their cleanest these days) where she was happy until the day that she passed.

The closure of council run homes has been a disaster pushing people into private care homes which are expensive. Care home owners don’t run care homes out of the kindness of their hearts, they are in it for money so you either pay a fortunate for care which doesn’t guarantee the type of care the residents need or deserve or pay a bit less for a cheaper home where the standard of care and nutrition is often compromised. I’m sure there are good care homes but most are just God’s (or whatever deity you believe in) waiting rooms where patients have a poor quality of life. Pay for staff is low so sometimes care home staff have a high turnover, some carers don’t deserve the title because they don’t show respect or understanding for people when they are most vulnerable and a few “carers” are just cruel. Some just do the best they can with little support from the owner but it must be soul destroying.

I have a friend who worked as a carer and she told me that the owners told their staff to buy food that was coming to the end of the “use by date” so was cheaper with no care for their nutritional needs or individual preferences. Because the residents had so little but the basics she would take in sweets for them and would do their hair and paint the ladies’ nails just to give them a little boost. What was disgraceful was that when visits were being made by the council the owners were told when it would take place so the owners had time to make things look good. Visits should be unannounced to ensure that best practice is followed.

My mother had Alzheimer’s and a decision was made by the family to keep her at home because she was a wonderful mother and we couldn’t envisage her being in a care home where she could be mistreated. She had day care one day a week to give my dad and sister respite because looking after someone with dementia is really difficult and even though we all helped look after my mother we could go home at the end of the day. One of the homes my mother went to was, in the main, a residential home, but who occasionally would take someone during the day. It was run by caring people who did their very best for the residents. They treated the residents like family members and even when someone was at the end of life and bed ridden they were moved to a bedroom on the ground floor and the door to their room was left open so they could be see everybody and be a part of their day. The staff were lovely. Unfortunately on the days that my mother refused to leave the house they didn’t get paid even though it was not their fault. Prior to my mum going to the care home one day a week she attended council run day centres. The first Council run day centre was hopeless. It was a five minute car journey from her home which was ideal. We made sure they were aware how restless my mum was, they said it was fine but after my mum had been there a short while the manager came back off holiday and said that because one of the other dementia sufferers had a tendency to be violent that if my mum went up to him he could hit her. We felt they just couldn’t be bothered to deal with someone who liked to wonder round the room and chat to people despite us making it clear that was what my mum did, they just wanted people who sat in a chair for hours staring into space. My mother was then sent to another day centre miles away with other people being picked up on the way which meant they could be travelling for an hour or more both ways which my mum found really distressing so we called a halt to it which is when she went to the residential care home for her day care, she was so much happier.

The whole care system is a shambles, families being asked to pay huge amounts of money with no guarantee their family member will be looked after in a safe and caring environment. I do think it is unfair that someone who has worked hard to put a roof over their head has to pay for their care and someone who may not have been so careful with money lives in the same homes and pays nothing but that is said with the knowledge that many of those who don’t pay for their care earned so little in their lives that they could only dream of owning their own home. That paying residents are charged considerably more than the council pays for fully funded residents is wrong. Making money out of someone’s frailty just seems wrong. As the fifth richest country in the world we can afford to look after the most vulnerable in society including children and that our government choses not do so is a national disgrace. If tax avoidance and all the other dodges were dealt with there would be funds to pay for social care in all it’s myriad forms.

The creeping privatisation of the NHS will only add to the problems. Nursing homes will call ambulances for almost any reason when proper staffing with nurses and carers with an on call doctor would stop needless hospital admissions. We need a joined up system with proper funding not the piecemeal situation we are in made worse by outsourcing.

Apologies for length of my post but we need a cross party solution to this, no more point scoring.

MARY says:
15 March 2017

This is not just care homes it’s care in the persons home that’s also failing I just feel so sorry for the old people who have no one looking out for them they must have to suffer in silence how terrible we all are for allowing this to carry on

My husband and I supported an elderly friend (95 yrs old) and his wife, also elderly, when the husband went into care. He had vascular dementia. He was admitted to a local care home for, we understood, two weeks respite while they found him a permanent placement elsewhere. The home in question had failed its recent CQC inspection, “requiring improvement in all areas”. The home was filthy, ants were crawling everywhere (even through the biscuits and sugar on the tables). When attention was drawn to it they were told, crossly, “we know!” At no time was his wife told that the placement was to be made permanent, although at one meeting my husband attended, it became clear that they were trying to get our friend to say that he wanted to stay because he liked it there. The same question was asked under various guises, until they got the answer they were looking for – viz – “d’you like it here S….?” “No! I want to go home!” How would you like to stay here, S….?” “Look – I’m up in the trees!” (the room was on the first floor) “What do you like about it here, S…..?” “I want to go to (name of another home)”. “What do you think of it here, S…?” “S’all right – I suppose”. THAT was the answer written down. The meeting notes were the given to his wife, later on, who didn’t know she was signing her agreement to his remaining there.

His wife visited almost every day: two buses and a long walk for an eighty-year old lady. She frequently found him in other people’s clothes and other’s shoes, without socks. (All his property had been named on admission). Sometimes he was in bed, partly covered by a sheet, the door wide open. His razor and personal care things went missing, as did many clothes. Requests to have them found were ignored. The whole place stank of ammonia. A bag of urine had been shoved into his bedside cupboard and left there.

He had been a big man, but in a very few months was reduced to a bag of bones. We were advised to seek an advocate who would speak for him, and we tried to begin a CHC application. Neither went anywhere. Eventually after many days of refusing food and liquid he was admitted to hospital, as an emergency, in such a bad state he was close to death. His wife happened to turn up at the same time as he was being put into an ambulance. No one had been detailed to let her know. When asked why not, she was told “well, we knew you’d be along later”. He was so dehydrated the paramedics were not able to get a needle in him to take blood. After excellent nursing care he was admitted to a nursing home/hospice through the hospital, which also arranged for him to have the CHC applied (probably because it was known he wouldn’t last long from the lung cancer that had just been discovered). He was lovingly cared for in the remaining few weeks of his life and died at the end of January 2017.

We have made formal complaints to the County Council concerned. (It was a privately-run home, but with local authority beds leased out.) His widow didn’t want money, but an assurance that no-one else would suffer the way they had. We met with the CC last week. Fine words and an admission that “you have not received the best of care”. We are still awaiting the promised letter of apology.

J,N. Orme says:
15 March 2017

My late Nana was in a council run care home, she was bullied & abused by the matron. We got her out of there ASAP, years later my Mum was Manager in a care home & the inspector for the CQC was the matron that had bullied my Nana years before, needless to say we reported her but nothing was ever done.

I perform music in a local group and as such I have visited a lot of local care homes. My comment is that they may to be charging the same but there appears to be a huge difference in care and circumstances, sometimes engendered by the surroundings and sometimes by the staff. I have come away from some care homes with a very positive feeling about how the residents are supported and treated by the staff. In others I have come away with less than positive opinions. This is hardly scientific,very subjective and it may vary from day to day, but I would say it is split roughly 2/3 positive, 1/3 negative. I can usually tell from the initial conversations with managers and first visit which category the home will drop in to and I suspect the defining overall feeling of care or lack of it is connected to managers’ attitudes and how they treat their own staff and resources.

In some, the daily entertainment seems to be to place residents in front of a tv with little interaction from a minimum of staff with little proactive involvement. Others really do show the opposite, providing what appears to be a joyful and supportive environment in what are obviously sometimes very difficult conditions. However, if they can do it, so can the others and this industry seems to have been run byt too many for profit above all else for far too long.

Caroline says:
15 March 2017

I had to find a care home for my Mum as she didn’t want to go home the last time She’d been in a couple of homes before when she’d been in hospital which weren’t very good. I found one she liked (but it was a smelly one) and she never left her room so I found another one nearer me and I made sure she went with a friend for a separate opinion. I don’t know what they did to her when she was there but she wasn’t my Mum and she died soon afterwards

Pete Wag says:
15 March 2017

The Father of a friend went into a Care Home (in Essex) last year but died within a few weeks. Immediately the private care home produced a bill of ÂŁ5,000 odd ‘for admin’. The wife thought it unreasonable but the daughter did not want to query it at the time and so nothing happened – except it was paid without real query.

I’m a lecturer (Health & Social Care, Health & Safety & Public Services) and went for a job interview for our local council which was being held at a residential respite home in the community. This home is also used as a day centre where adults with special needs can take part in organised learning classes.
I was absolutely flabbergasted when I was asked to sit in a waiting area and noticed that a fire door was propped open by a large fire extinguisher ! The person who was conducting the interview (had worked for the Council in a responsible job for 25 years) had walked past it 5 times and had not batted an eyelid which made me think that the door is propped open on a daily basis and people are used to seeing it. And No, the door did not have an automatic closer on it in case of fire! They asked me in the interview was MY “Safeguarding”knowledge up to date. I had done another course the previous week.
I find this is happens VERY often – where people in VERY HIGH responsible jobs have taken theirs for granted and put others lives at risk. When they are pulled up about it they WILL DENY IT BECAUSE NO ONE WANTS TO TAKE RESPONSIBILITY.

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Denise makes a very valid point. I’ve witnessed similar breaches with it becoming part of the culture simply to accept what’s happening.

All too often it’s the culture that needs challenging. In institutions such as care homes quite poisonous cultures can arise, usually because of poor overall management. When it happens it can all too easily become an accepted norm, because the majority are seen as approving of the behaviour.

Ian makes a good point. There are other examples where many accept unsatisfactory service. For example retailers will usually turn customers away or refer them to the manufacturers, rather than consider that they have obligations under the Consumer Rights Act.

The health and welfare of vulnerable people – and their safety – should be paramount.

My mother was put into a care home by social services against my wishes and due to only 1 member of staff being on duty she had a fall and broke her femur and prior to this she used to get very upset after going to see her as she wanted me to take her home so the manager said to me that if this continues she will limit my visiting, so in conclusion I hate social services because between them and the care home, my mums life was cut short.

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