Poor care home staff retention can lead to Special Measures

Helen Fuller, Managing Director at Care 4 Quality, discusses the shortage in care home staff and how a positive working environment can boost staff retention…

Research has shown that rising numbers of care homes do not have enough staff to meet people’s needs efficiently (as was the case in 72% of ‘special measures’ care providers analysed); and this is becoming a growing problem. There are of course, multiple reasons for this but the likelihood is, more residential homes are providing care and support for individuals with greater physical and psychological complexities and longevity than ever before.

What were historically, fairly localised issues around recruiting care home staff, have now escalated to a national level with many care and support staff still being paid the minimum wage for what is a very physically challenging and emotionally demanding vocation. More worryingly, care managers are constantly tasked with weighing up the level of dependency versus the availability and financial implications of recruiting extra care home staff. The problem is, right now there is no legislation from the regulator in terms of what constitutes safe staffing, which leaves this wide open to interpretation and exploitation.

So many factors impact staffing requirements

Whilst some care operators argue that set ratios are too prescriptive, on the flipside, the result of having no clear quantifiable system means that induvial interpretation as to what safe staffing actually looks like is very ambiguous and lacks consistency. Although there are a number of recognised tools available to help calculate dependency and quality staffing levels, there are so many other factors that can affect the staffing requirement in a care home.

Everything from the building layout, the layout of converted buildings, the mix of available staff skill set to the team dynamics in terms of strength and weakness, will all affect the cohesion and effectiveness of a care team. Increased financial constraint also means that care homes have to be more imaginative when assessing and reviewing their staffing levels.

Current trends to manage staffing include using other resources such as volunteers, apprenticeships and management time to fulfil the dependency need however, this does present its own risks certainly around limiting the amount of contingency that can be built into staffing rotas.  It also begs the question: what sustainable staffing options do care homes have in place for the future?

Developing a sustainable empowered workforce

The care sector can only develop a sustainable and empowered future workforce by supporting staff in a positive working environment, with appropriate training, which supports their continuous professional development as well as managing staff mental health and wellbeing.  Essentially this is about caring for those who care for others.

Reports confirm that a large majority of care workers and one in two care managers, are over the age of 50 years and predictions of a staff shortage is estimated by 2028. As such, care providers must start to formulate plans to foster a robust staffing environment of continuous development and career progression within their workforce. Supporting and encouraging staff to specialise in and champion various areas of the care industry will help to strengthen the quality of service provision while empowering staff to take ownership and to develop their own vocational pathway. 

It is also imperative for care homes to be able to justify incremental increases in their fee rates and to have the courage to challenge where necessary. Being consistent in special costing requests from Local Authorities and commissioners will make this sustainable longer term.  Creating a robust and quantifiable dependency framework that evidences the direct correlation between individual resident complexity/dependency and staff time, can go some way to supporting this.

Mind the gap

Care provision is such an exciting and challenging sector, one that is ever evolving and totally adaptable. From changing regulations to change of regulator and inspection methods, not to mention changing consumer demand, many care providers have had to diversify their services to even remain viable in the marketplace.

Reviewing future sustainable options for safer staffing is an extension of the need for change in the sector.  Yet this is a sector to be celebrated in a positive light. Much of the care home headlines are focused on everything that is ‘wrong’ with the industry. Safe staffing matters and there are ways to improve this, it doesn’t seem right that this is open to individual interpretation, the gap is too wide.

The sector should work to keep the emphasis on the positive side of care, ensuring that there are enough staff to meet the needs of those receiving care, but also as a welcome support to staff within teams.  The unique sense of team satisfaction gained through supporting people in a person-centred way, helps goals and achievements come to life in a real and meaningful way.

*Research carried out by R.Drury, S.Bawden, R.Dowson-Wallace, H.Fuller (Care 4 Quality Ltd) Analysis of Inadequate CQC published reports between October 2018 – March 2019.