/ 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.


From people I know in Care Homes and from what I read in the media, I am extremely concerned that should I go into a care home (I’m now 75) I will be paying between 40% and 50% more as a “self funder” than others who are funded by the Councils. I regard that being expected to pay so much extra amounts to a form of tax. I have paid so many forms of tax over the years, including that on my savings and I think its completely unfair to have to pay this “covert” tax.

One of the difficulties with this line of discussion is that a home that has no state-funded residents would probably have to charge even more because the local authority guaranteed income stream and ability to take up all available placements underpins the economics of the home.

Frank says:
31 March 2017

My Mother in Law recently spent two weeks in Respite Care to enable my Wife and I to have a holiday abroad. The care was excellent and I have no complaints about the staff at the Care Home. However, to get a respite care place required the assistance of the Local MSP and Local councillors. Without prior notification to the local Community, Respite Care Places at various Council run Care Homes are being used to discharge elderly patients from Hospital to avoid bed blocking. However, the result of this decision has ensured there are very few if any places in council run Care Homes for Respite Care. This will only become a major issue as families request respite care for elderly relatives during the next few weeks when families organise their Summer Holidays.

Kirstie says:
31 March 2017

I don’t have any experience of care homes either for the elderly or for looked after children, however I was reading about malnutrition and was disturbed to discover how high the statistics were for malnutrition in our care homes at both ends of the spectrum. Surely if someone is in care one of the priorities of a carer should be to ensure those in their care have sufficient nutrition to keep them healthy both in body and mind. I hope this is one of the issues that will be addressed.

Bob says:
31 March 2017

I visited an elderly friend in a care home in Hampton Hill several times, but never saw any activities organised for the residents. They were just left in front of a TV, or allowed to wander around. It was really sad to see people driven to an early grave by boredom.

I am in sheltered “bedsit” place on a mixed estate and the manager here is very careing,but!!!It is run by westminster council`s “city west home`s,here we hit problems,well?have you heard of laying lino over carpet,???The lino already here was old..with paint all over as well as grime,stringee round the sides,with a slit from north to south,will not remove as it cost money because of the asbestos tiles under,but some broken tiles showing as the lino worn a way there, after a big fight i got it sorted??]]I suffer from “c.o.p.d”ventilation is very bad,with no heaters on![[the room has hot water pipes under the floor ect]]windows closed [due to scaffolding next to my window,but there are four holes drill in to the window frame,i have overhead fan`s i installed thank goodness,but is hot at night[[75f ]]last night]]and the management and [some] staff act as if we are freeloading ,yet we are paying their salery. But councillors will tell you they care and they think housing is important!!!!!! The list is very long, sorr if i sound moanie but there are others there who nothing much is being done because have no fight left in them.your`s faithfully g.m.fraser

I put my Mum in a Nursing home in 2005. Because she had been in an EMI home and had a fall this was mandatory and she was going stay there till her end.
I was away from home when some boorish ass from the nursing home rang me on my mobile demanding payment.
DD took some organising in those days; these days I could have done it on a smartphone. Such was his attitude only concern for my mum’s welfare stopped me from tearing him apart on the phone. I subsequently recovered the fees paid via a solicitor though sadly these were recovered from the NHS not from the care home. Apparently, when she left EMI care they were legally responsible for her.
Though I am comfortably off the thought of falling into the hands of these vultures fills me with horror. A scheme in Scotland exists whereby teams of nurses and doctors enable older people to stay in their own homes. You can see it on BBC 1 in a programme by Bill Turnbull broadcast on 31/3/17 just after 9am. It should be universal as it is many times cheaper than homes or hospitals Give the very poor quality of management in the NHS where best practice is often as isolated as Easter Island, I’m not holding my breath.
I make no apology for the language I’ve have used or for excoriating this sector the way I have. While there might be good practice it’s not widespread, and there seems to be little imagination devoted to how it might be improved.
Good luck in your efforts to improve it, you’ll need it.

Well I ask you! who has the time to sit down and watch TV at 09.00hr!!!!
This programme should be watched in the evening, when people CAN actually sit down and absorb the programme in full.

Joyce Hecks says:
31 March 2017

My husband was in a care home for about 16 months before he died. I am extremely annoyed that people who save all their lives for a comfortable retirement as he did, are then penalised when care is needed and they are forced to pay the full fees. People who have never saved in their lives get it free. Where is the justice in that?
Also when a watch that I had given to my husband went missing on his demise, (treated by the police as stolen) I was treated by the care home in a most shabby manner. It was very precious to me, but they could not care less about it.

Dear Joyce Hecks – you just beat me to it!

Joyce, I’m so pleased that I’m not the only one who feels strongly about this prejudice against those who have lived responsibly!

The greatest injustice in the Care Homes System is that those who have been prudent with their finances throughout their life, may then have to pay the full cost of their Care Home fees.
This means, typically, selling their home that they’ve worked so hard for during their life, to have a room in a Care Home.

I believe that Care Home fees for those who have to pay can cost, typically, ÂŁ50,000 per annum.

In the next room in the same Care Home, is the so-called ‘scrounger’ – someone who may never have worked in their life, and contributes little to their care, except perhaps that they may lose much of their Benefits…….such benefits having been paid for anyway by the person in the next room who has had to sell their family home for the right to be there!!

These people have made no effort to be prudent with their money – expecting AS OF RIGHT that “The Government” will have to take care of me!!

I’m incensed by this blatant prejudice against those who have taken responsibility for their lives, in favour of those who have always expected that “someone else will pay!”

We all understand the cost of caring for those in Care Homes, who may have no other alternative but to be there, but many of our Nation’s problems could be solved by severely reducing the ÂŁ14 BILLION [?]pounds sent in Overseas Aid to countries who don’t need it!

Please tell me how “fair” this Care System can possibly be?

Gerry says:
31 March 2017

There’s a further aspect to this, that doesn’t seem to have been mentioned. Local councils get a “bulk discount” for sending paid-for people to care homes, which the owners then claim doesn’t cover the full costs. To make up their profits, they then charge extra to those residents forced to burn up their savings to pay the charges. Since this discussion is for the Competition and Markets Authority, it’s something that needs to be brought to the fore – and a stop put to it.

I am hoping that the CMA will give very full consideration to this aspect Gerry because it is a serious inequity in the system. It is particularly unfair because people who have indeed had to burn up all their savings and asset values cannot, when their funds run out, necessarily become local authority paid-for residents in the same establishments.

I looked after my mother 5yrs until she died if I wanted to go on holiday we left mum in a local Care Home . we went away one year and I could not feel easy so we came home to find mum totally spaced out with the intake of drugs, I was so concerned mainly because all the others were the same . Mum came home with us at that point and we never went on holiday again , seemingly this is common practise in our area.

Chris says:
31 March 2017

I know this is a hot topic but I have been trying to find out from the Care Home, where my mother is resident, how the fees which our family pay and the fee increase which we see each year compare with fees and increases when the Local Authority pays. Has anyone managed this. Thank you.

Mum has dementia, and we are pretty satisfied with the care and support she receives in her Care Home.

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It has always seemed strange to me that at some stage it was decided that families do not need to look after their members when they get old. It becomes the states responsibility. In many societies, even primitive ones, these would seem wrong.

Obviously alms houses existed for those who had no one and were looked after by the community. Perhaps someone would do a brief history of the transfer of care from family – I assume since the 1940’s.

Politicians promise anything and everything to be elected but are incredibly shaky as to how the services are to be paid for – which I think is why we are where we are. Medicine has taken great strides in getting people to live longer but nobody has tackled the problem of paying for the upkeep.

Family care or state care?

By the way every regulation introduced etc adds to the overall costs of the nursing home of those who think the panacea is heavy regulation are merely reducing the profit or increasing the losses. It would seem to me that either there is a form of compulsory training and a year working in a home for uni students, or family members are required to complete a number of days doing similar service per week.

Expecting poorly paid and motivated strangers to look after your beloved in the way you think fit does seem incredibly optimistic. Reducing the running costs in any way might make the sector improve.

Patrick, I agree and have said the same elsewhere. Our parents make sacrifices and look after us as we grow up – often well into adulthood – out of love. We should, wherever possible, do the same for them when they need us.

Lou says:
31 March 2017

My mother was chucked out of a care home because she was a nuisance. All the other local care homes obviously got to know and wouldn’t have her either. So she had to go outside her home town which meant her elderly friends couldn’t visit and it cost me a fortune travelling, so I couldn’t go regularly. this was a few years ago. She’s died since. I am being asked for my email address even though it is supposed to be anonymous?

Judith van Dijkhuizen says:
31 March 2017

I had to rescue my aunt from a care home where she was locked up without money. No one would listen to her or her family. They took orders from her POA who wasn’t even registered. She was put there when her husband died, and wasn’t allowed to see her family for two days. How cruel is that?

My Mum who suffers with Dementia, and in a home, has been suffering with a urine infection and given antibiotics over and over again. While away my daughter got a call to say her son had been to visit his Nan and was so upset she was hallucinating seeing people not there. So on our return we shot over to Yorkshire to find Mum had fallen the night before, had few days before, threw her lamp went into other’s bedroom with scissors, We realised her hand was hurting her, so took her to the hospital, they gave a good checking over ecg, water, blood tests, found her hand was broken, her back hurting, 3+ blood in her urine, also that Mum had been given diasipan tablets because of her pain and tablet they issued this was causing the aggression. also the Doctor would like other tests done, thinking something else is wrong. and that Mum should not have been on these pills. We got the pills taken away, now the doctor is saying because of this Mum may get aggressive again, yet the 2 days she has been off the pills she had been fine, I feel she was neglected, by not being taken to the hospital the night she fell. While under the influence of pills she slept all the time so was not eating or having drinks to flush the toxins out of her body.
Now they are saying because we have halted her sedatives she will have to go into a lock up, well sorry, but through the negligence of the doctors not finding out the cause of her infection, it would not have come to this. I run a business, but shall close down and remove Mum from the home and bring her to me. I am so disgusted with the treatment. Also found out if a member of staff from the home took her to hospital we would be charged ÂŁ15 an hour. We ended up taking Mum and had to stay overnight which we did not think we would be doing, until we saw the state she was in. The staff are great with her, she had them laughing and joking when she is fit.

Margaret Hulse says:
31 March 2017

My mum was in a care home where she was shouted at by the carers, was left on her own for hours with no carers around. Fell out of her chair and was found on the floor by another residents wife. Had her gold chain removed from her neck and a ring from her finger.. was very poorly and was left in a chair until we demanded an ambulance be called.. Also our mum was able to walk with the aid of a Zimmer frame and was able to ask for the toilet, but because she was left for long periods on her own with no one to take her to the toilet she became incontinent within a couple of weeks of being in the home… Also because she was left in a chair all the time she was unable to even stand let alone walk.. The carers lifted all the residents by having one carers at either side and putting their arm under each arm of the resident and their other arms used to lift the residents legs, then they would lift them from a wheelchair and bang them down into arm chairs.. This was very upsetting for the residents and also for us as a family to witness. I reported it to the manager along with every other complaint but nothing changed. When we ordered our mum needed to go in hospital we then decided we couldn’t possibly let her go back there and reported everything to social services.. They arranged a meeting and the manager of the care home attended, and told a pack of lies.. The meeting was only to last half an hour, and we had a tape that we recorded our mum telling us that the carers shouted at her and said she was disgusting because she had an accident in her bed in the night.. Our mum was crying when she was telling us about the carers shouting in her face. We then received a letter from social services stating that everything was inconclusive due to our mum having dementia, so no more was done.. Our mum could have a normal conversation with us some days and knew everything even though she had dementia, she was a gentle kind lady that was loved by everyone who knew her.. Sadly we lost our mum three years ago, but the way she was treated, and the way all the other residents were treated will stay with us forever..

Patricia says:
31 March 2017

I once worked for a Care Provider and after a year I experienced Constructive Dismissal.
I worked full time, 12 hour shifts and tried to gain a different post to reduce the shifts/hours as I did not wish to leave, but I was given no option and needed to leave. I was exploited while working there, and have been stalked and managed ever since. I consulted the Police but had not enough evidence to make a case.
I consulted a Lawyer, but he advised to have no further contact with them, and it was too late to bring a case. This has affected my life and my career ever since, yet can do nothing about it. I could not afford to employ a lawyer, and therefore have never been able to have closure on this.

Jill Watkins says:
31 March 2017

My husband had a week in a care home whilst I had a cataract operation. He found it incredibly noisy (so did I) and he felt he was bullied.

John Skeer says:
31 March 2017

Following a stroke, my90yr. old mother needed care. I found a room at in a home in Faversham,Kent. At the first interview the owner treated me with tea on silver ware,informing me that she took residents out for coffee and many other nice things.However, it soon turned out not to be true as did a lot else. My mother was still quite mobile at the time, but if she wanted to stretch her legs,she was made to go and sit down again, there was no freedom. I found her more than once quite upset at not having her knickers on. They lost her teeth and a few days later came up with some that were not hers insisting that they were saying they had found them under her bed. At afternoon tea there was just one biscuit whether she liked or not. From the top down, they had little concern for the welfare of the residents.

Regards, John Skeer

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Alan Smith says:
1 April 2017

I can relate to your concerns , Care homes is about profit , minimum wages for carers. Arogant managers . and totally disrespect the clients in their care . I worked as a carer in care home and the staff spoke very nastily about the clients , even to go as far as talking about their private parts . Its a nasty atmosphere to live out your last few years , When family visit its all loads of smiles and little treats.
What the elderly need is a little time and chat about how they was before they got old . to be told they are loved . See me as a person not a sick old man / woman .
I bet the biscuits was cheap as they can get , tea rather than coffee and very small cups. Its not good enough

I’m sorry to see that the questionnaire only refers to the current time. One of the most difficult times is when your relative is dying, and I would have liked to make some comments about this in respect of my late mother. Given that most if not all care home residents are only going to die there, our experience was that getting information and expressing our wishes was anything but easy. For example while pain relief was guaranteed (with morphine), who got this and when was anything but clear. Indeed most questions about medication met with answers that differed on each occasion. When residents are suffering from dementia one feels even more protective, and yet there was very little reassurance

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These are indeed heart-rending reports of care home treatment, and it is awful to realise that they probably represent just a small percentage of the terrible times experienced by all those who have already passed away. Despite all the promises and inspections I am not convinced that things are getting substantially better – and the post-war boom generation is yet to enter the picture.