Closing Care Homes

Community Care reports that the CQC yesterday released figures stating that 42 adult care services (that would be care homes and home care agencies) have been closed over the last year following action taken by the registration authority.  A further 51 services were closed following ‘poor’ ratings.

The Guardian breaks down the figures a little more minutely. And the figures deserve examination.

Those 42 services comprised of 34 care homes and 8 agencies.

Of the ‘further 51’, that includes 39 care homes, 11 care agencies and 1 nursing agency.

The total amount of residents who have needed to move places of residence due to these closures is 1600.

How is this not a national scandal on the front page of every newspaper?

It may or may not be obvious (probably not, come to think of it) but I do haul around searches for care homes and poor practice in care homes including ones that have been forceably closed – that is active searching – and maybe 3 or 4 might have been on my radar. So that’s an awful lot of highly vulnerable people who have been subject to incredible disruption, often linked to abusive practices in these care homes that have completely slipped beneath the public radar.

The Guardian lists the reasons for these closures as being

• verbal and psychological abuse of residents;

• medicines not being managed safely, leaving people at risk of not receiving vital medication;

• lack of medical and nursing care;

• staff not legally able to work in the country;

• poor sanitary conditions;

• lack of staff training.

Unfortunately, verbal and psychological abuse of residents is always a potential danger in work with vulnerable people. Residential homes can be a rich ground for potential abuse and sometimes the ‘wrong’ people are attracted to the kinds of work which can allow for abusive power-plays. It is despicable, it should never happen, but it has and it will, unfortunately. The only way to stamp on it really is strong regulation and good management.

All the other issues though seem to point to potentially money-saving measures related to staffing –  illegal immigrants will invariably be paid a lot less than ‘legal’ employees. Poor medication management points to poor training. Training costs.

Lack of medical and nursing care? Medical and nursing care costs.

Poor sanitary conditions? Cleaning up costs.

Lack of staff training? Training costs.

Do we see a theme here?

It is a very pertinent theme as we move towards an NHS which will increasingly draw on private enterprise.

This announcement and these figures are in advance of a new regulation system that comes into place on Friday. I’m fortunate to have a very good friend working in CQC as an inspector.  We go back to when we worked together as care assistants in the same residential home. Now, that makes me feel old but I raise it only to show how strange it is where our careers take us – anyway, I use her as a sounding board about my day to day frustrations and equally have a neat little insight into some of the behind-the-scenes changes in the various regulatory bodies that have become the CQC. It sounds like a mess, to be frank.

I lost any faith in the regulatory system a while back – not because there aren’t good people working there – indeed, taking my friend as an example, I would be hard pushed to think of anyone with a higher moral compass as a practitioner and she couldn’t be more focussed on providing good outcomes but the constant flux in the system (and yes, retraction of staffing levels) does have an impact both on quality and on staff morale.

At the ‘sharp’ end we have abusive systems in residential homes which are able to rattle along without sufficient oversight and regulation because there aren’t the people to provide the level of supervision needed.

I don’t want to colour the past in roses unnecessarily. I know there were problems, certainly with the physical structures of homes but with private companies, the motivation to ‘get better’ and ‘improve’ is not sufficient to force their hands. It only occurs when the delivery is so very poor that they are actually losing money.

There was an interesting quote from Cynthia Bower, the Chief Executive of the CQC in the Guardian where she says .

“This is where we’ve been focusing our attention over the past year as we get the sector ready for a new registration system that will be even tougher when care is not up to scratch.

My ‘mole’ in the CQC would claim that this is a part of the problem – the focus on changing systems has taken people away from front line inspections and where I’d agree with her is that the desk-based inspection systems do not provide any protection to those the system is meant to protect.

I know the system is due to change but in my old fuddy-duddy way, I would say there is absolutely no replacement for spot inspections regularly, day and night, weekday and weekend, from inspectors.

A ‘good’ report one year is no more valid than a CRB check one day after it has been completed. Bad things can happen the day after an inspection takes place.

Yesterday I was talking to a family member about a problem that she raised regarding a residential home where her mother is currently placed. This is a ‘good’ residential home.

It isn’t an issue that could be termed to be ‘abusive’ but it shouts ‘poor staff training’ to me. One member of staff saying one thing can make a ‘good’ residential home ‘poor’.

I know it’s not fashionable and I can’t see it happening – not in the current climate – not ever, but when the staff were employed directly by the local authority, at least training, pay and conditions and supervision could be better enforced.

Of course, we can never roll back the privatisation of the care sector but it’s amazing how few lessons have been learnt from the difficulties faced. I suspect it’s because it is an aspect of people’s lives that no-one really wants to think about unless they are directly faced with it.

I suspect it is part of an ingrained fear of growing old and possibly internalised ageism which sees ‘the economically redundant’ elderly as being somehow peripheral to mainstream society and their needs, wishes, wants, desires and aspirations – even if those aspirations are about living out ones’ life with the necessary care given in a dignified and sensitive manner.

Older adults will never have the same voice as young families in drawing the attention of the exchequer.

Why aren’t we shouting about these residential homes that deliver so poorly? Why isn’t every single closure on the front page of the national newspapers? Why does no-one care about the ways we treat older adults in this society? How is this able to happen?

Money, guilt and fear, I suspect.

This is why I wanted to work with older adults initially and it remains the same ten years after qualifying. There is so much more work to be done. It can feel like swimming against a rising tide but if we don’t shout out and shout frequently, all will be lost for our futures.

10 thoughts on “Closing Care Homes

  1. Could I have your permission please to share this across some of the online forums for carers and other online websites. It is an issue like you rightly say, that should be on the front of every newspaper.

    Local to me we have just had a care home close, which was for those with dementia. It was the only one in our town. Not only have people been moved, but local family carers have lost the one place where they could apply for respite for their loved ones.

    This link may interest you , not just about care homes but about cutbacks right across the country

    Look forward to your reply

  2. Hi Rosemary,
    I’ll have a look at the forums when work allows! and you can generally assume that anything I publish here can be shared as long as it is attributed.
    I feel very strongly about quality of care in residential settings. It is the one ‘theme’ of my career that makes me rage like nothing else and I honestly can’t understand why more people aren’t angrier about it. Perhaps it’s because I started my ‘social care’ career as a care assistant in a residential home.

  3. I feel very strongly about the quality of care in residential settings too – and I’m angry about it also. My own relative died as a result of care home neglect/lack of care/abuse/inadequate staff training/ignorance/stupidity even – in a care home, run by one of the biggest ‘care’ providers in the country. There was an investigation carried out – behind closed doors, so never in the public domain – by the local authority, with CSCI (as it then was) sitting quietly in the wings, feigning interest but never once showing me that CSCI cared. The Adult Protection Coordinator was invisible too – so much for protection. But they could no longer protect my relative – who was by then dead. File it, and forget it – that’s what the local authority does with these investigations. The public has no idea what has been going on.

    A year later, and a massive improvement plan had been imposed on the home. A year later, all the appropriate ‘care systems’ and knowledge bases and staff training could be seen (on paper, at least) to be present. Too late for my relative, who had to die before the world of care cared enough. But it was deemed acceptable now for CSCI/CQC to award a ‘good’ rating to a care home which was so obviously ‘not fit for purpose’ a short while ago. Are CQC ratings not just like an MOT – valid and useful only on the day of inspection? Yet it takes about 3 months for the CQC inspection reports to appear – so by then, things could have spiralled down again.

    Three years on still, and I’m struggling to work out why so few people care. I’m still struggling to understand why this particular care home was ever allowed to open and function (albeit badly) and to receive vulnerable elderly people with dementia. The cynic in me will forever believe that the care provider sees the £££s before their eyes, sees this particular sector of the population as an easy target – after all, they can’t fight back; they don’t make demands; they can be abused so easily. And, I’m afraid I would say the same of the local authority – they claim to care, but don’t care enough.

    If my experience is anything to go by, the state of care of the elderly in the UK a disgrace.

  4. Thanks for the terrific blog; I think it is too common to damm the inspection system without recognising that things could be a whole lot worse. Spot inspections, fear of poor star ratings and the use of inspection reports by local authorities to drive purchasing decisions has been a huge motivating factor to improve quality in the sector.

    We did a press release today because the care home star ratings are being scrapped before there is any replacement. This seems short sighted and leaves the public struggling to work out how to seperate the best care homes from the worst of the worst.

  5. I have worked in the same care home for well over ten years and am proud to work there. I would rate the care as excellent and I leave every working day with a clear conscience. It is one of a small group of homes scattered across the UK

    However, I am not as naive to think that my care home is representative of most care homes. I think the bigger the group – the more remote the care is.
    The horror stories I hear from agency carers make me cringe.

    “Why aren’t we shouting about these residential homes that deliver so poorly? Why isn’t every single closure on the front page of the national newspapers? Why does no-one care about the ways we treat older adults in society? How is this able to happen?”

    Totally agree in that it is a disgrace.

    Mine own thoughts would be that a home found to be offering poor care should have to declare same on a CQC notice on the door – only removed when standards had been vastly improved.

    All homes should operate on a CQC led traffic light system rating care given – and this would be required to be front door displayed.

    All homes – whether stand-alone or part of a group – if found to be wanting – should have all new admittances blocked until standards were raised. This meaning every home in a group – as this would make distant directors at head office sit up and take notice!

    Employment laws in care homes should be relaxed in the sense that it is almost impossible to sack a member of staff who actually has no caring instincts – unless gross misconduct applies.

    All GPs and visiting health professionals who have concerns regarding care in a particular home should air these with the manager and if no improvement is noted – should report said home to the CQC.

    The only way we can effect change is to speak out!

  6. Great post cb. Speaking for myself, the reason that I chose to look after my mum was because I was afraid of what might happen to her if I put her in one. I had been part of a local organisation that visited homes and I had seen at first hand what a curate’s egg the system was. I remember with one home in particular that had been good and passed to new owners. A couple of years ago we went up to have a look (with the idea that maybe Mum might be ok in it) and the first thing that we saw was a resident going past in dirty trousers. We decided not to go ahead after that. Is it alright if I link to this?

  7. I find it appalling the treatment of our elderly neighbours have to endure due to severe lapses in the system.

    I understand that CQC has to make a stance and in dire instances close care facilities. But the problem you have already highlighted is that most of these homes are run as a commercial enterprise, meaning the company closes the home to save costs of remedial work and the residents are forced to be moved.

    My own viewpoint is that the provider should be enforced to correct the deficiencies as well as punished and not allowed the easy route out of their responsibilities by closing the home unless they are prepared to wind up all their home care business.

    They may think again about taking the easy route to improve their own problems or opt out of the care business altogether and leave room for people who actually care and want to provide the care & facilities.

  8. You make good points, and the situation should be seen as scandalous.

    I agree with you fully about the need for physical inspection as well as desk-based assessments. The other aspect of this that’s worth thinking about is the structure of the agency itself. An an overarching body I suspect the CQC is too unfocused on any particular area to be able to do the kinds of things that really force change.

    For example when the Mental Health Act Commission operated it was headed by people who were highly respected in the field and who were more than capable of generating public debate. I don’t doubt the capable people are still there but the ability to report in ways that attract public/media/political attention seems to have been lost by folding it into the CQC. Plus, the detailed reporting the MHAC did in its biennial reports was incredibly valuable and has been lost.

    I’d also point out that the Prison Inspectorate, which I’m more familiar with, has a formidable reputation (even though not everything they recommend gets done) and is able to command extensive press coverage for its reports and sometimes put ministers in embarrassing situations. And it’s successfully survived attempts to tone it down. Most of the inspections are announced and prisons have some time to prepare, which can be helpful in making sure all the relevant documentation is to hand and relevant people on site. Sure, prison governors have tried tricks like transferring troublesome prisoners elsewhere during the inspection but when that happened it got detected and caused a major furore. Plus a few each year are unannounced. And then there are the thematic inspections (such as on prisoner suicides) which have become major academic and policy documents in their own right. I can’t imagine their work would be done in anything like the same detail or with the same effectiveness if they became a part of some larger inspectorate.

  9. Jonvagg – Thanks for sharing that information about the Prison Inspectorate – I didn’t know that. And I agree that it’s an awful shame the MHAC was integrated into the CQC as they did a fine job.
    From what I understand from within the CQC, the health services have completely monopolised all their systems and the care side is seen as ‘less important’. That makes me very sad.

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