/ 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.

Comments

First of all I would not want to go into a care home as it would be worse for me with infections and the same applies to having a carer who goes from one sick patient to another carrying infections with them. There is also a lot of cruelty going on in care homes and to have all my belongings taken from me to go into a care home no thanks.

My later departed Brother was in a care home and the first one he was put in he did not like and had an attempt on his life so he ended back in hospital and was placed in a different home, but he was charged a lot because other residents in there paid nothing so some had to pay for those who paid nothing. He also did not have any on-suite washing or toilet facility and the room was very small. It is very wrong when some have to pay more to keep others who pay nothing.

Heather says:
18 March 2017

Yes, when I was looking for a care home for my Mum I asked about the fees. I was told ÂŁ290 for KCC (paid for) people, ÂŁ415 for private residents. When I queried the difference with the manager she tried to say ‘you get 24 hr care …’ but had to admit that everyone got 24hr care. It was just that people with savings have to pay extra to make up for the fact that Kent County Council refuse to pay more.
Now that KCC have closed several of the homes that they ran (uneconomic they say!) things are getting even worse and really difficult to find a good home with vacancies.
My friend has a Nan in a home for dementia sufferers. They are so short staffed at weekends that when she asked for Nan’s pads to be changed she was given a pad and told to do it herself as they were so busy.

anatoli says:
16 March 2017

The recent news item concerning Dementia patients in nursing homes has been raised by a family member. They say it unfair for them to be ‘treated’ by staff not trained to do so. This has been known for many months and is obviously widespread as the news is now in the public domain. It reminds me of the ‘Gulags’…!

I am a security consultant with over 40 years experience and am very concerned that security is not of much concern to care homes or the CQC. I know this as I have attended care homes after a CQC inspection which has graded the care home as “Good” when I have found the very basic security as poor. CCTV, Access Control, Key control, alarms, etc not fit for purpose and staff reluctant to report incidents due to fear of reprisals. Care homes at night are very vulnerable as there is only minimal staff on duty reliant on a security system that will not protect them or the occupants who pay huge sums of money to be protected. I am of the opinion that there is a huge loophole in the system which the CQC has not addressed.

Julia says:
16 March 2017

Private Care Homes (not all) are open to abuse. Council run care homes were among some of the best, sadly they were all closed down. As usual how rich you are depends on the specialist care you need, no money no special care! In a way to force families to take on elderly, they hack away at their lifetime savings and force the sale of their homes for their upkeep. (Its wrong.) As someone who is ill and having to look after someone who was dying, going through many treatments nearly killed me, I screamed out for help, any help, then one Thursday I managed to secure help, even the next day my relative was going to go into Trinity for respite, a full week. That next morning I received the call, the carer secured the day before found them dead. Care homes are not care homes anymore, they are just money factories, sometimes with abuse put upon patients. State run should be the only care homes we have, people may be safer.

I was involved with too aunts and my father. Both the aunts were in the south of England. One was in a home were most of the patients were shall we say not aware of what was going on. Aunt was local and had visitors but was well looked after. Other Aunt was in a home managed by a hunting friend which was fine. My father became blind and his 3rd wife was unable to look after him. He was a doctor and quite reconciled to his situation. We moved him to a home close to us run as a farm but instead of cows they changed to humans and were very well looked after. He became bed bound and we had to move him to a nursing home, He liked company and shared a room which he liked. He reacted adversely to a morphine injection and was admitted to Hospital, He was kept there a little longer than usual but was very alive brain wise and a few days later did not wake up after his afternoon nap.

It would seem looking after animals is good training for a care home. Chester Zoo does an excellent job.

Get your reseachers to do a study of Arclid a former hospital in Cheshire between Sandbach and Congleton which looked after elderly people in Mid Cheshire 20 or more years ago.

My father had to go into a home because of my own illness and inability to care for him properly. He was happy there, my grandchildren were able to pop in to see him on their way home from school, which was good for all of them. My disappointment was concerning his personal property after he died. they wouldn’t reply to my queries, and I never was able to have his property, this included items personal to him and my mum, so would have been of no value to anyone else. This particular home was run by our local council, the actual care couldn’t be faulted. Unfortunately it’s now been closed and demolished, another victim of cut backs. Council run Day Centres, respite care, and full time care homes, to my knowledge have always been well run. The private sector, because they’re run for profit, seem at times to cut corners, and ignore much of the real care their residents should be entitled to, this is evident in the regular reports in local, and also National papers. For families to have to resort to the use of hidden cameras when they suspect their loved ones aren’t being treated with care and respect shows that regulations and inspections must be tightened up to protect those who can’t speak up for themselves.

It’s just so dreadful that we now have to worry and stress about our own care when we are in need.
My mother now 93 with dementia and still living at home.
This is a huge worry to me
We are now old also and in ill health.
My every moment is spent caring and checking on the carers that do come in allowed 30 mins three times a day to do meals.
Sometimes they don’t turn up communication is very poor and I employ my own cleaners and shoppers there is extremely little for them to do and they don’t even get that correct.
I am in contact with the CQC
As I fear for people that have nobody to care or speak for them.
One day I know it will be us
A daunting thing

After my 3rd wife who had been an operating Theatre Nurse was struck by a heart attack and stroke i was forced to place her into a care home but i was not happy with her care and i complained to the manager.

I worked in an MI care home for several years. The pay was appalling and the staff quality reflected this. Some of the carers cared, other spent as much time as possible having ‘fag’ breaks and had little interaction with the residents. The more severely affected were left to sleep the day away and were only taken to the toilet at meal times and only changed if soiled as incontinence pads were rationed.
I have visited friends in car homes and one had an overpowering smell. Another had rooms little more than boxes with no room for personal effects. One had blood splatters on the ceiling over the bed, a dirty sink and stained tea pots. The costs are prohibitive and the good sized rooms with garden access cost more than most people can afford.
The council offloading its responsibility of care has left us in the hands of businesses who need to make a profit to pay salary and maintenance bills etc. The welfare of residents is the first thing that suffers so only the rich can afford anything like decent care-for everyone else its barely adequate!

Anne Henshaw says:
18 March 2017

Oh my days I have been into some homes where the acrid smell of stale urine as actually burnt my eyes and made me nauseous . Totally unacceptable .

We were very lucky. When my mum insisted she was unhappy in the home, we were able to take her back to her own home, and be with her in the last days of her life. The staff were caring, but they were so short staffed they couldn’t respond to my mum when she called to them. At night, they put her into incontinence pants, even though she had never been incontinent before, and she had to wet herself, because no one could hear her calling. I have come to know a few women who work as carers. They are all good people, but it seems like it’s standard practice now, regardless of whether they are incontinent, to put older people in care, into incontinence pants.

Catherine says:
16 March 2017

My mother had Alzheimers for over 11 years and died in May 2016. We kept her at home as long as possible but she had to spend the last 8 years of her life in a care home in Northern Ireland as we could no longer look after her at home. The home was run by a Christian denomination and my mother received very good care there. Family concerns were acted upon . However, we as a family also took an active part in her care – at least one of us visited her every day and we actively participated in events run by the home for our mother. The home was clean and well run and the staff were caring and professional. I count some of the staff as friends now. The staff themselves often said that they wished they had more time to spend talking to their patients as they were continually under pressure. However, according to the RQIA, the levels of staffing were sufficient in the home.

I believe 3 things would lead to improvements in the care home sector:
Better staffing levels
Better pay and recognition for care assistants who carry out a sometimes very difficult job
The involvement of families in the care of their loved ones – I know this is not always geographically possible but families cannot relinquish all responsibility to the care home. We must compliment their care with an active involvement in the life of the home as it is now our loved one’s home.

Clare says:
16 March 2017

My mother had Parkinsons and as she deteriorated it was impossible to get acknowledgement and thereby understanding eg when she experienced swallowing problems and when her neck muscles would not support her head at times. It was not proactively managed. It was not really ‘managed’ at all rather ignored. I would keep raising my concerns but professionals within the care centre and nhs closed their eyes to this. When I raised concerns at hospital appointments I was told the care centre had not informed of any concerns. I still am upset three years on as to how my mother’s final last few years and in particular the last year was managed. There are many excellent charities like Parkinsons that can be contacted by professionals. I contacted them but if a family member is ignored and made to feel invisible it makes the task of getting further understanding help and compassionate informed care virtually impossible.

Annette says:
16 March 2017

I cared for my mother for in our home for 7 years with several private care agencies calling once or twice a day for 30 mins to assist with personal care. These carers were often disrespectful in our home (brought mud in all over stair carpet refusing to remove shoes, washed my mother roughly etc).
one care home used for respite care left my disabled mother hungry, another left her on the floor for hours after a fall leading to a long hospital stay, another placed her in her disabled and partially sighted state in a room shared with a lady with obvious dementure – faeces were in the wash basin when I arrived. This home lost a support cushion and several items of clothing.
Eventually my mother entered a care home on a permanent basis as she was too disabled for me to cope – but upon several visits I found her without water in the room – I asked for some and was made to feel a nuisance. Then on a later visit I saw that my mother was ill and insisted that the doctor be called. The doctor said she was “severely dehydrated2 and sent her to hospital immediately.
Another home was found in the end which was good.

chrischips says:
16 March 2017

I have an elderly friend who is single with no immediate family nearby; who is totally at the mercy of the local care home and very vulnerable, with no one to stick up for her when arbitary decisions are made about her or her possessions…
This is a common problem for anyone in a similar situation

I knew someone in a similar situation.

Perhaps Which? can inform us who we can turn to as concerned citizens. Social services will not discuss them with anyone who is not family and when vulnerable people have no close family, someone needs to look out for them.

Is there anywhere independent of social services or the care home who can intervene to make sure their welfare and possessions are being handled in their best interests?

I agree. There ought to be a way in which a friend, neighbour or authorised safeguarding person should be able to represent the interests of those who are vulnerable, confused, without relatives, or otherwise incapable of standing up to ‘the system’. I suppose a power of attorney can achieve it but the person has to be capable enough in the first place to grant the power. A community-based legal guardian system is one possibility. The existing ‘ward of court’ arrangements in respect of children might be a pointer. Services such as that would presumably be costly. One would think that the existing duty of care owed to a resident in a care home would be sufficient protection but the evidence is that some establishments abuse their authority and do not exercise any supervision over the conduct of their staff, It seems to be that horses get much better treatment. Why?

Hi Alfa
This is a good point – it can be really tricky to know how to complain and who to go to. On Which? Elderly Care we have this page about making a complaint about a care provider, which you can find here:

http://www.which.co.uk/elderly-care/your-relatives-needs/dealing-with-unsatisfactory-care/343077-making-a-complaint-about-a-care-provider

The Care Quality Commission is responsible for the regulation of care homes in England. You can report serious issues to them. There’s more information here:
http://www.cqc.org.uk/content/report-concern-if-you-are-member-public#

Hope this helps.

Thank you for the links Emma. I hadn’t heard about the CQC before.

There have been a number of previous Which? Conversations about care homes which have also revealed many problems and difficult situations where families were left to battle against the institution. The CQC has upped its game since some those earlier reports but it has a mammoth task on its hands and finds it hard to get round all the establishments which it has a statutory duty to inspect.

I had not realised there was a “Which? Elderly Care” site before this Conversation so it has certainly been informative.

One thing that has become very apparent from the comments here, is that inspections should never be announced in advance.

It is too easy to put on an act for an inspection then revert back to a less desirable norm as soon as the inspectors have left.

My mother receives care at home for an hour a day. The career arrives at 7.00 and lets herself into my mother’s house and help my mother first thing in the morning. This is when my mother feels most vulnerable. It costs a lot of money and we use a care company to provide this service. My mother generally sees the same person for the majority of her week, but at weekends this varies. Currently we are generally pleased with this service. My mother has received a six month review by the company.

Stuart young says:
17 March 2017

My mother-in-law went into a Care home in 2010. When we viewed it the owner said they had dementia patients in a separate block and the care home looked beautiful having been recently refurbished. However when we got mum in there on the first day she had a fall. We then discovered dementia patients mixing with normal and chaos reigned. We saw residents urinating in the fireplace, naked resident sunbathing on the lounge rug. Mum was left for hours in wet clothes and dev lopped a grade three pressure sore. We found another resident in her bed and also her bed made but when we investigated we found faeces still on the sheets.
When we complained the owner got aggressive and accused us of being disruptive and questioning the carers about the activities going on in the home.
Needless to say we removed her whilst playing the theme tune on the film The Great Escape her new nursing home looked after her in the manner she should always have been and she passed away in 2013

Just over 8 years ago I put my companion into a nursing home for respite care for five days while I had a much-needed break (I had been trying to cope with 24-hour care on my own). The manager promised that she would be well cared for. However, her designated carer was unkind. He frequently left her cold and uncomfortable on the lavatory for a very long time, refusing to return when she called him. He also refused to allow her any warm clothing or slippers in the bathroom, telling her it wasn’t necessary. She had cancer and was very thin, so she was in a great deal of pain. She was very dehydrated when I collected her. There was no drink in her room and she had not been given any breakfast when I collected her at 10 am. She begged me not to place her there again. The “care” was non-existent and I believe her experience hastened her death. Eight years and four months later I still feel angry and upset that she suffered so much at the hands of so-called professionals.

This comment was removed at the request of the user

duncan, the parts of the NHS we deal with a particularly good – proactive and supportive. However I agree other parts have suffered. We live longer, make greater demands, have much better and more expensive treatments available. And not the funds to cope.

The question I would ask is when such services are underfunded, where should the money come from? Diverted from elsewhere, taxes increased, or should NHS services be restricted to to more essential work?

A Convo on how money should be raised and how money should be spent might prove interesting.

Sue says:
17 March 2017

My Mum has recently gone into a care home after the hospital ‘bed-blocked’ her over the New Year (another story). She was quite poorly and after the respite and assessment care could do no more for her I made the decision to find her a space in one of the local homes in the small marked town where she lives. We did have a care package at home but for 24/7 care to keep her in her own home would have been equally as expensive as a care home. I had the choice of three but the other two aren’t so good. Social Services were not interested in helping with any of this as Mum is self funding and I even had to organize transport from the respite home to the care home myself. The social worker kept mentioning an alternative care home which has not got a good reputation locally. As a consequence of all this we are having to sell the family home which is very upsetting for Mum and me, but we have no choice. I am now trying to get Social Services to put a care order on the property incase it does not sell before her savings runs out. I cannot afford the ÂŁ450 a week top-up which will be needed as I still have a mortgage. It is all very stressful and I am exhausted by all of it. If my parents had just stayed in their council home in the 60’s, not had the vision to build their own home, then my Mum would probably be on council benefits and the Social would knocking on the door to help. I agree care has to be funded but the way it is done is totally unfair. Fortunately the care home Mum is in seems to be ok and a friend’s father had been there and they also had no issues. As it is a small market town where the home is, reputations are soon destroyed if a business is not up to standard.

People living in their own home are effectively ‘self-funders’ but nevertheless can get local authority assistance and support, and yet as soon as they enter a residential care home the interpretation of self-funding seems to turn against them completely and absolutely with a total withdrawal of support and even of recognition as a person for whom the local authority has any responsibility at all. In reality, self-funders are the saviours of the social care system and deserve much better consideration. Selling the family home might raise a substantial sum in some parts of the UK but in many other places it won’t pay care fees for more than a matter of weeks. Surely we should have a system based on needs not on outdated notions that started life in the National Assistance Board and were based solely on a person’s resources [and that only at a rock-bottom level].

Hello Sue – please see our page about self-funding a care home on the Which? Elderly Care website as it gives you ideas for how you might be able to supplement your mother’s income to pay for her care home. You can find it here:

http://www.which.co.uk/elderly-care/financing-care/financing-a-care-home/343054-self-funding-a-care-home

I do hope it helps you at this very difficult time.

There is all this talk about elderly care and care homes but what about the people who are not old and who have to be cared for. We do need to be a voice for the elderly and protect them from the horrors that go on in care homes but not everyone who needs to be cared for is old, vulnerable people, not just the elderly need equally protecting. We (My Father and I) have had to put my Mum into respite over the years, every time in a different place hoping to find one less horrible than the last. She is still a young woman but due to her having MS, we struggle with the 24 hour situation as it is just us Two who are there to support Her. She does have home care but things go wrong and it is a 24 hour situation, that alone is a fight. We sometimes have been at breaking point, especially my Dad. My Mum has been in both private and public care homes and in both varieties we saw horrific actions. Bullying, mental and physical abuse by staff. I remember the first time we put her in a home, a private home thinking it would be the best for her. We told her it would be a rest for us all and and we’d all feel strong again. Not at all, the strong will that I knew so well was gone, we saw a broken woman and we could not bring her home. She has not been the same since then, it changed Her, it changed us all. Far more needs to be done to protect people but it never will. Our loved ones are not thought of as people. It’s all about money and figures looking good on paper every time.