Report cover image - Man looks out of window

Most people, when faced with choosing a care home, will be venturing into unknown territory.

However, we know that the decision about which care home to move to can be made all the more difficult as people frequently lack the information about what to look for. This is a considerable problem for a sector which is viewed negatively by the public, often because of a perceived risk of abuse and neglect.

It is the responsibility of care home providers and public bodies to improve the information they provide to older people and their families. We want to see a common approach to measuring quality in care homes that works in the interests of providers and the public too.

Older people and their families take the decision to move into a care home very seriously. It is time that we all supported them to make the best decision they can.

As part of this research project we have developed 10 care home quality indicators to provide everyone looking for information on care homes with the help they need to make more confident choices about where to live.

Findings

  • The quality of care in residential care is persistently variable – 2 in 5 (41%) of nursing homes are rated ‘inadequate’ or ‘require improvement’, and a quarter (26%) of care homes are similarly below standard by the care regulator the Care Quality Commission (CQC).
     
  • There are gaps in what the residential care sector knows about quality and how it communicates what it knows. The National Audit Office said it believes the CQC doesn’t have access to routine information on adult social care good enough to trigger inspections.
     
  • Public perceptions of care homes can be very negative, driven in part by concerns about the risk of abuse. Just over half (52%) of British adults believe that abuse and neglect in care homes is common.
     
  • The care homes sector – unlike the NHS – doesn’t even have a sector-wide staff survey, meaning it misses opportunities to ask staff whether they would recommend the place they work as a place for relatives to receive care or whether they have witness abuse or neglect.
     
  • Focus groups we ran highlight how people have low awareness of existing sources of information on care homes – and when information is available, they often struggle to trust it.
     
  • There are significant gaps in the information care homes provide directly about their own services, according to our mystery shopping exercise. From a sample of 100, 2 in 5 care homes were unable to provide ‘good’ or ‘satisfactory’ answers to all of our six basic questions.

Recommendations

  • The Department of Health should demonstrate the same level of policy leadership on the issue of transparency and reporting performance in social care as it does for the NHS.
     
  • The CQC should work with the Department of Health and others to agree a single, shared view of safety and quality in care homes and an agreed set of core indicators (a minimum data set) to be collected by all care homes.
     
  • The Competition and Markets Authority should conduct a full market review of the care home sector. (The CMA announced their review in December 2016)
     
  • The Department of Health should commission a Social Care Staff survey similar to the NHS Staff Survey to establish if staff would recommend the provider they work for to a family member or friend and establish the extent of neglect and abuse in care homes.
     
  • The government needs to respond to the recent challenge set by the CQC and avoid adult social care reaching a ‘tipping point;’ where quality, funding and capacity continue to deteriorate.