“No one cared”: Care home inspectors on what they have witnessed

Across Europe, there are regulatory bodies tasked with ensuring that care homes meet minimum standards. This involves inspecting the premises, the living conditions, and the quality of care provided to residents. As part of our investigation on the for-profit elder care industry in Europe, our journalists spoke with several inspectors from these regulatory bodies. Despite regional differences, there were some common tropes: understaffed regulators, overworked employees and sometimes, questionable quality of care. Here is what three of them had to say.

*Edited excerpts from interviews. Some sources requested anonymity.

Giuseppe Greco, Italy

Greco is the chairman of the Turin Local Health Authority Supervisory Commission (ASL). Like in Germany, all care homes are supposed to be inspected at least once a year. But Greco says that this is not feasible.

“We are asked to ensure that 100 per cent of the facilities are checked once a year. How can you do that: I’m responsible for 400 care homes, which means I’d have to check two a day in one year, and I’m also responsible for checking the new facilities that are opening. Is that possible?”

However, thanks to DGR 27, a regional law enacted in December 2020, local health authorities are now required to submit plans for improved inspection, allowing for the capacity to hire 10 doctors who can participate in the checks. This makes Greco optimistic.

“I hope to have at least one hygienist doctor with me full time, along with two administrators. We should be four (at the moment we are two), to which the various specialists may be added, according to need, but also according to their available time”.

Former care home inspector (Anonymous), Germany

In Germany, the supervision of care homes is regulated by the state. Care homes are supposed to be inspected once a year by a team comprising of professional health care workers, including doctors, nurses and hygienists. Among other things, these unannounced inspections check for the quality of care in the homes. The inspector we spoke with used to work at the home supervision authority of Bavaria and quit because the circumstances were frustrating.

Inspections were supposed to happen once a month.

“We had many homes in the district. Of the homes that we knew well, we delayed the inspections for longer. Instead of 12 months, there were 15 or 18 months between two inspections. We visited the worst homes once a year. But we did not manage to go there more often.”
Follow-ups did not always show positive improvements. 

“We always followed up on complaints, but we often did not manage to check the deficiencies again. We assumed that the deficiencies would be corrected. When we came back a year later, everything was the same.”

The quality of care differed among facilities.

“The bigger the provider was, the worse the homes were run. The smaller the home was, the better and more pleasant it was for the residents.”

And staff motivation was often a problem.

“The nursing staff must be motivated. The bigger the company or the home, the more people didn’t care what they did. I thought to myself at the time, then they should go to a factory and work with boxes and not with people. If I work with people, I have to want to. I have to treat them the way I want to be treated.”

The interviewee no longer works in the field of home supervision. When asked why, this was her response:

“I don’t think the elderly deserve to be treated like that. Nobody deserves that. But I was broken by it. What I saw there and what I found lacking there and then the following year it was the same again. And nobody cared. No one cared.”

Former care home inspector, France

The interviewee is a member of the Confédération Générale du Travail (CGT), a national French trade union. Until 2017, he worked as a care home inspector in Hauts-de-Seine, France’s wealthiest department covering the Western suburbs of Paris. In France, inspections are done by the local public health agencies (ARS). Today, he coordinates inspectors on behalf of his trade union.

A strike by care workers and CGT trade unionists outside a care facility operated by Korian. April 2021, Paris. Credit: Axelle de Russé

“To put it clearly, there has always been a lack of staff in the management of care homes, the number of establishments has not decreased. The needs are there — we need to take care of our old people. On the other hand, the number of staff on the ARS has decreased by 16 per cent in ten years. They are decreasing while the needs in the field are increasingly high.”

For instance, in the Ile de France region, there were 100 inspection agents in 2010. Today, that number is at 70, even though the number of homes has increased.

Since 2018, France no longer has national-level objectives for care home inspections. The issue is no longer a state priority like it used to be. With more regional-level measures, there is less consistency across the country.

“The inspections that we have been able to carry out show that in the private sector, the staff is often less qualified. Many times we noticed that all the care assistants were paid less than what they were given in comparison to other establishments. They were cutting back on personnel, on training, and we often noticed that the caregivers were not up to date with their training. They did not have the same objectives — they had to make a profit. This had repercussions on human resources, [focusing on] the highest margins, and the pressure put on these agents was much higher.”