Is it just me…?

Editor in Chief, Robert Chamberlain, reflects on the latest research by Citizens Advice which blights the reputation of care home operators.

Released as we go to press, Hidden charges in care homes, published by Citizens Advice does not make pleasant reading about the care home sector. The report is based on mystery shops of 404 care homes with a geographic spread of nine regions across England and raises a number of concerns about care fee practices.

The findings make important and valid points that providers should heed but I am disappointed with the narrow context and the tone of the research. For example, it states from the outset that Citizens Advice ‘wanted to know whether there were signs that providers were taking advantage of the vulnerable positions of their consumers’.

Key charges

The report states that the large majority of the homes surveyed charged, in addition to care fees, for services such as chiropody, care staff and transport assistance, telephone calls and hairdressing. These charges varied substantially even within the same locality and the information is frequently not stated in brochures or on care home websites. In some cases, prices for these additional services are described as ‘exploitatively high’.

An example given is the cost for a care assistant to accompany a resident to an external health appointment. Of those surveyed, 31% make such charges and, though the average charge is £11.69 per hour, some charged as much as £50 per hour. The report makes no reference to difficulties with GPs who are now considering the option to stop care home visits, which is a little disappointing.

Whilst recognising that costs for personal care ‘are not unreasonable’, the researchers observe that ‘the possibility of some very high prices shows the potential of consumer detriment’.

Another concern raised relates to telephone usage. 40% of the sample charged residents for installation, as well as calls, if they wished to have a phone in their room. Additional charges relating to contents insurance for personal items, outings and entertainment are also highlighted.


Under the unfortunately-worded heading ‘Some care homes are profiting from older people’s stays in hospital’, the report delves into non-occupancy discounts. 96% of the participants stated that their care fees remained unchanged when a resident was away from the home for four weeks. The report states, ‘The result is that the large majority of (self-funding) older people who, for instance, spend four weeks in hospital, can end up paying thousands of pounds towards fees during their absence’.

I understand that, from a layperson’s view, charging in a resident’s absence must appear unfair. However, in the context of running a care business amid the current financial crisis affecting the sector, it is, I feel, justifiable. Income is limited to the number of rooms a home has, and losing fees because empty rooms cannot be re-let due to a resident’s possible return can cause financial difficulties for the business.

In stating that ‘many care homes may be profiting from the vulnerability of their primary consumer group’ the report seems a tad naïve.


Citizens Advice makes sensible recommendations to address the issues identified, including clearer public information and more thorough terms and conditions in residents’ contracts to set out what fees include and exclude. It also calls for the Competition and Markets Authority to provide guidance and for the Care Quality Commission to take action to provide greater consumer protection.

Following on from the Office of Fair Trading’s guidance on care home contracts back in 2003, there is clearly much room for improvement in this important area and Citizen Advice’s report highlights this well. It is a pity that, at times, it adopts an almost derogatory attitude to care home operators and fails to recognise the underfunding crisis that is putting great pressures on running such a business.

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