The cost of care is eye-watering, with fees set around an average of £30,000 a year for residential care and £40,000 for nursing care. But that's just the start of it. Care homes fleece their residents for all kinds of outrageous things on top of the basic fees - taking advantage of the fact that families often have very little choice but to pay whatever they ask.
See also: Shocking cost of care means we're saving less - not more
See also: Care home prices 'jump by almost a quarter in a year, despite declining quality'
Some 41% of all care home residents have to pay for all their own care, and 12% pay for at least part of it. They are free to set their own fees, and know that residents are restricted by geography, availability and price bracket, so don't have the freedom to shop around unhampered. Once they get them into the home, of course, they are very unlikely to want to move on, so they are free to increase charges and add additional costs for services whenever they want.
Of course care homes face their own pressures. It's becoming more and more difficult to get money out of the local authority to cover the cost of care for the 37% of residents who have their care paid for. They also have rising medical and staffing costs - as the rising minimum wage affects many of them. In many cases this forces them to lean more heavily on self-payers, which is glaringly unfair on those who are left paying the bills.
Citizens Advice investigated the issue, and identified that it's often difficult to tell what is included as part of the fees. Many care homes will state that they include 'hotel costs' or 'bed and board' within the weekly fee, but will not specify what this consists of. It can therefore be difficult for potential residents to understand whether services such as transport assistance, carers, phone access and hairdressing are included.
When potential residents ask for further information, key charges, such as carer assistance and chiropody are often hard to discover - and can be incredibly expensive. Citizens Advice used the example of a weekly trip to the hospital, requiring two hours of carer time, which could cost as much as £5,200 a year.
Likewise, some will charge £30 for a haircut, £32 for chiropody (which is free from the NHS when patients can visit in person), £130 to have a phone installed, and charges of up to £15 a month just to have access to a phone.
They also highlight that unexpected charges are a major source of stress for residents. They have provided advice to residents facing unexpected costs such as a £1,000 phone bill, or unspecified entertainment charges.
Another serious problem is that care homes are hiking these fees all the time. Fees increased by an average of £900 in the previous year - a rise of 2.7%. Residents often have very little notice in order to plan for these hikes. Almost one in ten only give a week's notice of fee increases, and two thirds offer four weeks' notice or less - although one in five offer a year's notice before they hike the fees.
Most care homes don't pass on savings when residents are away for extended period of time either. Some 96% say they won't offer any discount if the resident is in hospital for four weeks. Obviously some of their overheads are fixed, so there's no saving to be passed on. However, Citizens Advice points out that things like laundry, meals, electricity and heating are variable costs, so they do save some money when a resident is absent.
What can you do?
Citizen's Advice is calling for better regulation of the industry. However, until this happens, we need to do everything we can to protect ourselves.
If you are expecting to need care for yourself or a loved one in the years to come, it is well worth doing as much advance research as possible. Get hold of information on every care home in the area you are considering, and check all the potential hidden costs. When you come to need care, your choice will be narrowed down dramatically by availability and time pressure, but at least armed with this research you'll be able to make an informed choice between the handful you can get into.
It's hardy an ideal situation, but at least it's better than making a difficult choice under pressure, without vital information on the hidden costs involved.