The abode of the service user


I’ve now visited nine care homes in search of kindness, safety and comfort for my nonagenarian mum, should her nursing needs increase beyond daily carer visits to her house. Researching these places, it quickly became clear that any such organisation is deemed to benefit from a cute name. The industry has a fondness for sea and water (‘ocean’, ‘marine’, ‘aquarius’); old-fashioned notions of comfort (‘lodge’, ‘villa’, ‘gables’); flowers, trees and foliage (‘rose’, ‘willows’, ‘beeches’, ‘oaks’, ‘meadows’), and that old jewel, an efficient combination of everyone’s favourite nurse and a melodious bird (‘nightingale’).

These are applied, like good luck charms, to Victorian terrace knock-throughs, bland eighties boxes and adapted council offices, regardless of pertinence. The delightful story that these names help to tell is, of course, all part of the sales game. Their printed brochures feature a nicely illustrated and designed front section written in warm and friendly copy which refers to the institution as a care home. Read on to the back of the brochure where the font is bog-standard and the text is in legalese, and the home becomes ‘the abode of the service user’.

I also found major disparities between a home’s CQC inspection report - the government’s attempt to grade quality of care - and its actual day-to-day performance. Visiting one that rated ‘Good’ on all five service thresholds, I nearly gagged when the front door opened onto a smell of faeces, onions and bleach. Windows dripped with condensation, wet nets lay smacked across the glass. The tour introduced me to further delights: dirty laundry in piles on every corridor floor at 4pm; toppling paperwork in a makeshift office next to food prep in the kitchen; rows of silent elderly women in winged seats backed up along the walls of each communal room, eyes glazed or heads lolling as if already dead - what, no ‘fun activities, talks and events’?

You could say that none of these observations amount to reduced quality of care. Or that most of the ‘guests’ have been through a war so will have suffered far worse. But if they’d known this is how it would end they’d probably have surrendered to the Germans. Care was not a word my tour guide seemed to understand properly when she tugged me by the arm into a cupboard and informed me that a room would become available very soon: the man we’d just passed was packing up his mother’s things. This was explained to me in mime and loud whispers. I’m not squeamish about death itself - we all know where a care home residency leads - but she may as well have run a finger across her throat.

How much does it cost to live your last days in such a place? It’s noticeable that practically all care home websites choose not to display their charges, and instead take refuge in the claim that fees are customised to the individual so a conversation needs to be had. Yeah, I know this one from broadband providers, and even those greedy corporates realised they were better off stating an average price and letting people tailor their own tariff online. But care homes appear to be doing so well from our increasingly ageing population that there is no need for transparency - the ball is not only in their court but also unlikely to be thrown back this century.

By 2025, the 85+ population is predicted to reach 36% growth and nearly all two million of the poor buggers will need a home care service or a residential care home. Children either no longer want to be full-time carers for their elderly parents (yes, I’m one of them), or are simply unable to provide the expert nursing needed by people in their eighties and nineties who tend to have complex, compounded illnesses. Of course, no-one wants crap care for their relatives. But do you/they have the funds for something better? Do they have any funds at all, trusting instead that the state will look after them?

I’ve only been checking out private care homes in the south-east costing less than £1K a week, the same ones in which people with no collateral are housed by local councils. They are the bottom end of the market. More salubrious joints charging up to £4K a week (and no doubt more if you access the dark web of the affluent) do exist. They have award-winning tactile gardens and rooms filled with natural light, plentiful staffing and daily hydrotherapy sessions. They are for the minority. The majority of us will wind up in a poky room overlooking the bins, breathing stale air, eating cold fish fingers and watching re-runs of Lovejoy. This is not an exaggeration - I saw someone’s beloved grandad living this nightmare just a few weeks ago.

One way out of this is for everyone, across the board, to pay more NI proportional to income, which can be used to streamline and raise the standards of services. We all enter a public hospital expecting a certain level of training, behaviour and treatment. The rules are set to accommodate both rich and poor, irrespective of what they have paid in to the system. Elderly care needs to be subjected to the same principle. But since any government that tries to enact such change would make itself so unpopular as to lose the vote, it might - like the NHS first time around - take something as disruptive as war for the nation to agree to it.