Nursing Care Homes in the UK

Factual Questions
1

In my experience in the US, among chronically ill people (such as myself) and among most health care professionals (such as nurses), nursing homes have a reputation here for delivering poor care. Infections are common due to sanitary violations. Nurses and support staff are very overworked. An example: Several people on life support equipment recently died in a nursing home in my area because the nurses and respiratory therapists failed to respond to ventilator and pulse oxymeter alarms. The nurses I know say that the nurse:patient is something like 1:40 for LPNs at night, 2:40 for LPNS during the day.

Anyway…to the question I have: What is the general opinion of nursing homes and nursing care in the UK? Are the homes privately-owned and for-profit?

Thanks in advance!

2

Yes, they are private and for profit. Staff are frequently immigrants and on minimum wages and the quality is highly variable.

Nursing homes are subject to inspection and some have been closed down as the rules have been tightened but there are still some where the care is sub standard by any measure. There are, of course, many excellent ones as well, but they don’t attract publicity.

The whole problem is one that successive governments have shelved for years. There is state help for the fees, depending on the patient’s assets and income - if they own a house, for example, they will probably have to sell it and use the money before the state will help.

For many people, my mother was one, it is a far better option to stay in their own homes with visiting help. Of course, over here, the NHS will provide the necessary medical care - it’s just the day-to-day stuff that has to be paid for.

3

They are largely private - about 85% of places are in private homes, I recall - but not necessarily profit-making; many of the private places are in homes run by non-profit agencies. There are also commercial providers of nursing home care; I don’t have any sense of the breakdown between for-profit and not-for-profit private providers. The 15% of public facilities are mostly run by local governments.

You probably need to distinguish, in the UK context, between “care homes with nursing care” (commonly called “nursing homes”) and just “care homes” (commonly called “residential homes”). My sense is that what you may be asking about is care homes with nursing care, but in the UK they are regarded as on a continuum with residential homes, and if you read something about “care homes” you may need to dig down to find out exactly what kind of home is being referred to.

In the UK both kinds of home, in both public and private versions, are regulated by central government. The Care Quality Copmmission do the job in England; there are separate agencies for Scotland, Wales and Northern Ireland. (They also regulation health care, e.g. hospitals.) They impose standards, and run an inspection and reporting regime.

I’m afraid I have no information on the detailed standards of care they impose, e.g. nurse/patient ratios. Perhaps another doper with better information will be along soon.

4

In my experience as a former care-home worker (a long time ago, but one of my sisters works in one in the same area) and my impression from TV and real-life experiences of friends in the US, this is one area where the US and UK are very similar. For example, when in Florida I visited my American friends father who was in what they called a care home because he had terminal cancer. It was funded partly by the state, I think (by way of grants rather than directly), and partly by a religious organisation.

Only a few months before that my Grandad had died in a very similar place in the UK, except we called it a hospice. A hospice is a place where some people with terminal conditions get care and treatment; a lot of the people there will die there, but not all - some are there for temporary care and will leave to go home for at least a while.

The hospices I saw in both the UK and the US were excellent and all I’ve heard makes them sound the same.

For “care homes,” they can be for older people who are somewhat ill but not terminal, nothing requring extensive medical care, or they can be for people with serious illnesses, and then they’re usually called nursing homes.

The former tend to be private, expensive and not very good even if you pay for the best, but also not terrible unless you’re very unlucky. They pay their staff very little but the staff try hard and sometimes they’re skilled beyond their job - immigrants who can’t get nursing acccreditation in the UK, for example. I think there have been scandals about care in homes in the UK too; MRSA is one of the biggest problems.

IME residents mostly suffered from having to share rooms and other institutional aspects of the home, like there was communal underwear because having to sort out each residents’ underwear, with so many changes and washes, would have been very difficult. In practice we tried to keep them separate (by knowing which room the underwear came from) but we couldn’t guarantee it. It’s dehumanising even if it’s not intended to be.

Nursing homes vary a lot and can be quite good, but do have their own problems; they’re often state-funded which increases the care standards somewhat, but they’re still provided mostly by private companies - even if they’re not profit-driven, they’re still not state-owned. My step-nan’s nursing home refused to call by her “real” name, Marge, only using the very different name on her birth certificate, which she hadn’t used since she was about 10. The excuse was that the staff couldn’t learn two names, which made me think there was no continuity of care. I don’t think they helped her Alzheimer’s by calling her by the wrong name.

Like UDS says, there are national standards for all the types of homes, but I think there are in the US too (or, rather, state standards). IME the care home (not nursing home) I worked in would be astounding on the day of the visit and not so good otherwise.

5

Those alarms are always going off. The sensors fall off, or the patient leans on them, or some other damn thing – walk through even an accute care hospital and you are surrounded by alarms going off (mostly drips, but ventilator and oxymeter too, where they are in use).

The problem of having too many alarms is a well known problem is any situation that has alarms.

6

My wife was a nurse at a UK nursing home around 1990 so this information may be stale. In general she thought that the care and patient load for her was very good. What she found disturbing was that things like hip and knee replacements just wouldn’t happen after a person got into their 70s. She even saw cases where simple things like antibiotics wouldn’t be prescribed to older patients even though it was obvious to her that they would help. She keeps in contact with some of her coworkers from back then and they say that things have gotten worse.

She now works in a rehab unit for mostly older patients in the USA. They are under-staffed, over worked, and over supervised. The patient aides are under paid and they aren’t very good because of this. Alarms do go unanswered. My wife plans on retiring soon. She says that nursing and medicine isn’t the same as when she started 38 years ago.

7

We call them hospices too, generally. I think the facilities themselves generally shy away from the term so patients don’t get into a “they sent me here to die” mindset.