/ 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.

Dave says:
17 March 2017

Yes , of course there are bad and poor care homes . My problem is that we are only told about these and not the good caring ones . We can end up with a distorted view . Bad news sells far more newspapers than good news . I AM NOT suggesting the bad ones should be covered up . All I seek is a more balanced playing field . The same goes for just about everything going .

Dave Boyd says:
17 March 2017

Yes , of course there are bad and poor care homes . My problem is that we are only told about these and not the good caring ones . We can end up with a distorted view . Bad news sells far more newspapers than good news . I AM NOT suggesting the bad ones should be covered up . All I seek is a more balanced playing field . The same goes for just about everything going .

My father had to go into a care home because he started to wander away from home. I thoroughly investigated several care homes before choosing one that seemed suitable. I visited Dad weekly. It was fine for a while but then things started to slip. New clothes that I took in for Dad disappeared. Old clothes were clearly washed with bleach because they had bleached areas all over them and looked and smelled appalling. After a while Dad was moved from the original bedroom room allocated to a different room without telling me, and his personal photos and memorabilia were not moved with him until I complained. This was very disorientating for him. I decided to move him as his well being was suffering. With help from the local authorities I chose another care home that again seemed suitable when I first visited. Again all was well for a while but then I got a call at work to say Dad had been taken to hospital because he had had a fall. When I got to the hospital the doctor said to me: “How could you let your father get in this terrible state!!!!” He and his underclothes were dirty and he was bruised. On being returned to the home Dad refused to let any of the staff touch him and I formed the impression that he had probably not fallen but had been dropped by them. I therefore moved him yet again to a small private nursing home which turned out to be all one could wish for. Clean, caring, they reported to me personally about his wellbeing at each of my weekly visits, asked me to provide new clothes etc as necessary and phoned me if they had queries. Dad was happy there and stayed there until he died some 3 years later. I could not praise that care home highly enough. They all came to his funeral.

The first two care homes were eye openers for me – all was made to appear well on the surface but they did not provide what they promised in reality and were on the edge of being cruel. I have put into my will that I do not, under any circumstances, wish to go into a care home if and when the time comes. I would rather take pills than experience what my Dad went through.

Choosing a care home can be fraught with difficulties, especially for lay people. There are so many different things that have to be taken into account, it is very easy to forget to ask questions about some aspects of a care home’s services.
A few years ago, while working for Gloucestershire Older Persons Association, I helped Gloucestershire Rural Community Council produce a simple check-list for prospective residents, or their families, just to help them go through a systematic process for selecting a care home.

As a manager of a small family run care home I’m shocked and saddened to read some of the comments. There seems to be a lack of respect and communication from alot of homes. People should always be treated as customers who are paying for a service and have every right to expect that the service provided should be personal and of a high quality. My advice to people looking for care is visit as many as you can, ask questions, ask for written information and tour the home. Speak to GP’s & nurses as they often know the homes well. The home should provide a guide/handbook with a complaints procedure, which explains charges, notice periods, how often fees are increased etc. If you have any difficulty with any of this then contact the CQC and let them know about it.

Why dont you high light the campaigne you running abt bob and blackie…..and the attrocious way they are being tryin to throw out a very elderly man cos face dont fit do something with the care home that has issued him eviction notice bloody appaling..they shld b put out of bussiness or barred from running care homes in full.

Barbara says:
17 March 2017

Dear Team,
I am pleased that eventually the CQC have discovered failings in the Care Home system in Bradford and Airedale Trust Area; My husband was a Patient in One Hospital, and one rehabilitation setting and 2 Nursing Homes within the area, and each of them with the exception of one have been found by me to have failings. Mainly insufficent staff covering the 24hours , care of very dependant patients.
In two of the settings, they were incapable of admimistrating correct medications on time.
On several occasions I discovered this myself, on numerous visits to see him at different times of the day.
I did care for my husband for 3years at Home, prior to his admission to hospital, in My 2015.
The CQC have since found failings since his death in 2015Oct in all the settings he was cared for in the Community.

I have just spent 6 months in a nursing home waiting for a care package before I could return to my home! The staff at the nursing home were very young but also very kind and in one respect well trained as a testimony to how kind they were 6 of the staff have become my friends on Facebook and regularly keep in touch with me to see how I am? The only problem from my perspective is thus at 58 im a divorced father of a 12 year old boy and was the youngest resident; nursing homes are used to taking much older residents and many of them either have senile dementia or are heading that way and the staff occasionally slipped into auto pilot and treated me accordingly which upset me​? In addition some of the staff had problems with English or lacked basic common sense on one occasion I childishly told a Romanian lady that I was having a heart attack her reply was to smile and say ‘here’s your sandwich my dear’ her reply to every question? The management didn’t appreciate a man with a mind of his own but all in all they ALL made my stay a good one! Thanks Culm Valley Care Centre Cullompton, Devon 7/10

Broken hearted says:
17 March 2017

My grandpa had to go into a nursing home due to the families work commitments. They took a large deposit and even though the local authority payed towards his care we had to top up tge fees. They basically put him in a chair in front of a tv that was the extent of the activities. Thankfully our family would take him for day trips and to our house for Christmas and new year. The home still charged us the 2 weeks over the festive period as his belongings were still there. When we took him on holiday we still had to pay the fees. When he sadly passed away the home hit the family with a large cancellation bill. Staying in the nursing home the fees used all the savings plus the family had to top them up. You shouldn’t have to pay a cancellation fee because your loved one died. They care about money not the people in their care.

My wife moved into a private care home in Lincolnshire some four months ago. She is self funding at around ÂŁ36K per annum, which is a severe drain on our modest assets. However, her room and facilities are adequate and care by the staff is exceptional. The home accommodates twenty one, or, two residents and the staff outnumber these and work in only two, exhausting shifts. The food is necessarily, quite plain, very well cooked and presented. More than half of the residents suffer from dementia and around a third are wheelchair bound. I spend between fifteen and twenty hours each week with my wife during which I have not heard a raised voice, or sharp word from any member of staff towards a resident. And when a resident uses the sound signalling system to indicate a requirement for assistance, the call is answered without delay. All residents are treated equally irrespective of whether self funding, assisted or totally supported by the government. Having read many bad reports of care homes, I realise that we are most fortunate to have found this one, almost by default. It is one of a group of, I think, 29, with headquarters in the West Midlands.

Selinaclair says:
17 March 2017

Reconsidering how disabled and very I’ll the clients in care homes are it should manirty for fully trained specailist nursing staff to look after their requirements. Also cafe staff already employed should be trained part time for a degree in learning difficulty adult and child nursing. So everybody can have a healthy safe comfortable enjoyable experience

Andrew Ludford says:
17 March 2017

I visited my Gran in a home she chose herself in the sixties, lovely caring place, plenty staff. Recently visited a neighbour, posher home, less staff and costs a fortune, they tell you it”s because they have medical people on site. They don’t. On call if they were honest. The high charges are to pay the shareholders, they are their to profit and asset strip. Care homes should be non profit and overseen by local government operating a well thought out UK system that will cope well into the future.

Pauline Beattie says:
17 March 2017

My father-in-law developed Alzeimer’s and he went into a brand new home which undertook to look after him for the rest of his life. There were some dementia-trained staff, but these were costly and ultimately the family was asked to make other arrangements for him as they could not cope with him. This was very distressing, particularly for my mother-in-law who had bought a new flat opposite the Home so that she could visit him on a daily basis. We were all upset and disappointed that the home had not kept their undertaking.

[Sorry, your comment has been edited as it breached our Community Guidelines https://conversation.which.co.uk/commenting-guidelines/. Thanks, mods.]

I’m 78 and my wife 77, having read about claimed Care Home, their press suggests they are anything but,
infact they appear to be concentration camps for the elderly, although free of the Gas, other more modern methods are available from the chemical cosh, to the care homes helpful doctor.

The rights of the elderly are not policed and many home are in the control of foreign doctors. Even in the NHS Hospital the treatment is of the elderly is at best second to thirdclass. I ofcourse refer to the lower end of the Care Market. Which suffers class discrimination right to the end.

I therefore believe cyanide tablets give a better option. To suggest the Care Council or what ever it is called already knows what is taking place, or it hears, sees and speaks no evil of the system it is charges with regulating. There is only care and humanity at a price few can afford. So although citizens have been funding care all their working lives, the system will demand fund until the elderly achieve poverty. The system is faced with ever increasing demand caused by migrantsn and as demand increases so does the cost/profit ration of service.

Anonymous says:
17 March 2017

A case of dementia care – The care my father received in his 1st care home, located in Aylesbury was initially quite good, however as the working conditions for the front line staff deteriorated, (overtime with no increase in the basic minimum hourly rate, being called in at short notice to cover for sick or absent care workers, no structured daily programme) Staff morale dropped considerably. This lead to resignations and increased sick leave with the result that agency workers were called in to cover for shortage of regular care staff. As far as my father was concerned this meant there was no continuity with respect to the people who dressed him and washed him on a daily basis. The result of this was that when confronted by people who he did not know and did not know him, my father became fearful and often times he did not co-operate or he simply resisted being undressed and having his intimate parts washed. He became withdrawn and reluctant to become involved with care home activities. In fact because of staff shortages the social activities of the care home were curtailed, and for my father the days consisted of being subjected to regimented routines that were designed more for the management of the home than for the interests of the people who lived there.

Thankfully I was able to find a small independent private home for a very similar price, a home where care workers were respected and treated well. My father adapted very quickly to his new home and spent the last 12 months of his life in a place where he was respected and cared for in a warm and loving environment. I visited some 14 different care homes before I found one that I felt would give the safe and caring environment that he needed.

Since this time I have met many people who have experienced similar problems; front-line carers who are paid a basic minimum wage, with little or no structured career path and often from Africa or Eastern Europe. The quality of care they provide is generally very high, as many come from strong, faith based communities, however the lack of respect that they often receive contributes to a high turnover of staff in some care homes, which for dementia patients such as my father, can be extremely disturbing.

The beauty of this review is that it is being undertaken by the Competition and Markets Authority which is completely independent of the care home sector and can take an objective and impartial look at the commissioning side, the delivery side, and the regulatory angles, with the professed aim “to make sure it works in the best interests of those who rely on it”. Hopefully this will put the Care Quality Commission under the spotlight as well since many of the testimonies reported here make you wonder whether the CQC has its eye on the ball at all. It looks to me that finance is one of the biggest problems but there is also a major difficulty in attracting sufficient staff with the necessary training and motivation to do what many would regard as extremely unpleasant, albeit potentially rewarding, work. Staff recruitment and retention must be key difficulties for many establishments.

The question has been raised about whether the commercial nature of many care homes militates against the sort of care and provision that could make a big difference to the quality of the residents’ experience. It surprises me that so many of the operating companies seem to see the homes as cash generators first and foremost. There is long-term business here since the population’s needs are not going to go away, and indeed are growing faster than new provision is coming into service, so it seems perverse for companies to put those business opportunities at risk by bad practices and poor management. I suspect that the local authorities who purchase placements are trying to drive too hard a bargain because of their lack of funding so homes in some areas are being squeezed beyond endurance which has adverse consequences for the residents. I feel that there is a role for more charity-operated, or not-for-profit, provision to raise standards and generate more trust in the system. Nevertheless, quality care and caring staff still have to be paid for and despite numerous references to high fees and charges I cannot see much hope of any significant reductions, indeed the opposite is more likely.

To the extent that more investment in social care will relieve the NHS of a number of its problems, it would be a better place for the government to spend any tax bonuses that come our way following our departure from the EU. Provided, of course, that the NHS does not just go out and fill the capacity released in response to other lower priority demands. This is where a comprehensive combined review of health and social care policies and priorities needs to be undertaken [but not one that drags on for years] along the lines already suggested by Malcolm.

I think all care homes providers, should be made `NON-FOR-PROFIT`, BY LAW.. To care for all people should not be there to make profit for private companies, at the experience of the people who need taking care of. How we has a society have let this get this far down the line, where profit,(COMES 1ST) rules over care, THAT NOW COMES AS(2ND place). When there is a inspection due at any and all care facilities, that is the only time 100% care is provides by these private companies, with the right amount of staff on and proper service is seen to be given, until the inspectors then leave these places , then it converts to extreme poverty service given, at the experience of the people needing the service. Making all homes non-for-profit service , run as a one home service provider, with the staff running these facilities, own and make the management choices , to give the people of this help they need and if the do make a profit, maybe 10 % to cover inflation costs every year, and special extra help for days out and entertainment. That sounds like a good start to just giving the basic service care to the people who deserve nothing less.

Judith says:
17 March 2017

Self-funding residents are charged higher fees for the same care provision than those levied on local authorities. This seems inherently unfair, as the self-funding residents appear to be subsidising local authorities.

That is exactly what is happening, Judith. Because the local authorities are in a position to commission a large number of placements, and have a reliable payment history, they are in a strong negotiating position to achieve lower fees. In homes where they have a large number, or a majority, of residents they are also able to influence the care regime, standards, quality, and staffing levels. Self-funding residents are not only subsidising local authority placements but are experiencing a lower quality of care as a result. There should be no secrecy over the amount charged to local authorities on the specious grounds that it is “commercially confidential”.

An alternative point of view is that without the local authority ‘base-load’ of residents many care homes would struggle to stay in existence. In the absence of better information it is impossible to get to the truth. I hope the CMA will be able to penetrate further and see how the care home market is really working.

It took quite a few visits to care homes in the Wallingford area before I found a care home for my mother in 2008 that I felt happy with. Fortunately they had a space in a respite care room, which was extended, until my mother died 8 months later. Combe House in Streatly Oxon were fabulous. Not sure the others would have had the same level of caring , aside from the practical care necessary.

I was horrified when a friend of mine had to find a care home for his wife who suffered from severe dementia and had become violent , she was placed in a Care home on the reccomendation of the loal council who said the Home could cope with her condition, A day or so later he was contacted by the Local Police who had been called to the Home by the Management as they could not cope with his wife and had arrested his wife and she was in a cell in handcuffs and could he collect her, He did so and eventually she was found another home but she was kept sedated for the rest of her life and died in the home a couple of years later – a very sad story.