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  1. #1
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    Care Home - Staff Ratios??

    Hi All,

    Does anyone have knowledge of the recommended staff to dementia sufferer ratio at specialist dementia care homes?? I have looked online and can't find anything for the UK. The US state ideally around 1 carer to 5 residents with dementia. My mum's current care home is causing me some concern on this part, and before I ask them (and whenever I ask them anything they go on the defensive) I thought I would try here instead.

    Thanks.
     

  2. #2
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    In my wife's home, which specialises in advanced dementia, there are normally 2 carers per 6 residents during the day.

    The home has around 20 residents with some respite beds.

    The staff may be re-balanced according to need. There are four 'houses' at the home, with 6 beds in each. When necessary, one of the two staff assigned to a house may be loaned to another, for a short period.

    The nurses also pitch in if needed, as does the care home manager.

    All hands to the pumps when necessary.
    Bruce

    I'm still a Carer.

    "I don't suppose I'll see you much more. We had lovely times. I love you very much." Jan's words, October 2000

    "You'll take care of my daughter, won't you?" an ailing mother's words, 2013

    "I always thought you were thick" an ailing mother's words to me, 2013. How right you are….
     

  3. #3
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    There are no defined staff-to-resident ratios.

    Each care home is required to provide sufficient numbers of suitably trained and capable staff to meet the needs of their residents. The number of residents changes, as do the demands/needs of those residents.

    Have you posed this question to the Care Quality Commission (CQC)? They are the only ones to answer your question.

    Try their helpline on 03000 616161.

    And please let us know how the CQC answers your question.
     

  4. #4
    Hi Macca,

    You may find it useful to look at this thread.

    http://forum.alzheimers.org.uk/showt...ht=staff+ratio

    I've spoken to a couple of care home managers and can confirm that there are 'recommendations' and 'guidelines' and these unfortunately vary. Not much help to the end user.

    Perhaps you could take a good look at the Care Quality Commission inspection report(s) for the home to see if there were any shortfalls? If the home is not addressing these issues then it may give you more weight.

    http://www.cqc.org.uk/registeredserv...uicksearch.asp

    Sorry you are having problems and unfortunately you are not alone. I have real concerns about the ratio's at care homes and how they cope.

    Kind Regards
    Craig
    Volunteer Moderator since 2003 (now retired) - PLEASE be mindful and respectful; everything you post on Talking Point is viewed by people with dementia as well as carers. My father died from Alzheimer's - April 2012.
     

  5. #5
    I think the question you should be asking is how much time do they actually spend with each resident.
    At my mums home i found out they were only allowed to spend 20 minutes with them at meal times if assisting
    Makes you wonder what happens if it takes longer to feed them.
    Simon
    just a son who cared for his mum
    My mum on people treating her like she was stupid! "Just because I have memory problems it dose not make me stupid"
     

  6. #6
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    Thanks

    Thanks for all your replies - I have read the links and have checked out the report for our care home - it appears that the home is keeping to the recommended ratios (half a senior and two carers per 15 residents).

    I do find it incredible that I can be sat in a room with 10 residents and there's not a carer in sight because they are off doing other things.

    I cannot understand why there aren't some national minimum standards in this regard. A privately run nursery looking after pre-school kids and babies has to adhere to ratios, so why don't dementia care homes? Absolutely ridiculous.
     

  7. #7
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    incredible that I can be sat in a room with 10 residents and there's not a carer in sight because they are off doing other things
    I also have this worry - although generally if I hassle enough someone does come through. If there is an emergency or the requirments of 'nursing care' residents is high, then the staff ratio does seem too tight. The other side is, what a waste of carer if one has to sit in a room full of sleepy residents who do not need help. I am happy as long as someone checks frequently that all is well. When I am there I think they expect me to raise the alarm bell when necessary
    Jan
    Former Carer and Volunteer Moderator

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  8. #8
    I do find it incredible that I can be sat in a room with 10 residents and there's not a carer in sight because they are off doing other things.
    Macca and Becky, this worries me too

    In dads previous home they had cctv in the shared room, and if the room was empty someone in the office would keep and eye on things. But I was told the rule was that a members of staff must be in the room at all times. Again, not sure if that is just guidelines or the law.

    On visiting dad's new nursing home I was assured that a member of staff would be in each of the shared areas at all times. I visit pretty regularly and more often than not no staff in the shared rooms (there are two on the dementia floor). It worries me and I have brought it up a few times. Always told that staff may be attending to an emergency situation.

    You've reminded me to bring it up with the manager, perhaps a little more officially.

    Some of the residents are at high risk of falling. This definitely ties in with staff ratios in my opinion. The staff at the home (like at so many homes) seems to struggle with the workload.

    Kind Regards and thanks for the reminder
    Craig
    Last edited by CraigC; 07-04-2010 at 09:15 AM.
    Volunteer Moderator since 2003 (now retired) - PLEASE be mindful and respectful; everything you post on Talking Point is viewed by people with dementia as well as carers. My father died from Alzheimer's - April 2012.
     

  9. #9
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    At many, many homes, even GOOD homes, the staffing ratios are a nonsense. Even with good carer/client ratios circustances can affect efficient and effective caring. It is generally about how work is allocated, and the attitude of the carers. i have worked in homes where Senior staff know the clients well, and will allocate carers specific jobs or clients to attend to however long it may take them to do. Its a case of prioritising according to need.
    If a carer is concientious, and compassionate, and organised at thier work, then less staff are needed in real terms. However, the staff working as a team is most important, with good communication and high practice standards. I have been at homes where, despite high staffing levels, client care is neglected becasue of complacancy, poor practice, lack of communication, poor environment managment, poor supervision and lack of prioritising.
    It is a senior member of staffs role to ensure that all carers are working effectively, and that no client is neglected. There are no rules regarding staff to client ratios, apart from guidelines regarding saftey (for staff and clients).
    Simonmonty- I find it very worrying that your dear mums staff were not "allowed" to spend more than 20 minutes feeding. That is poor managemnt and poor practice.
     

  10. #10
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    Zoet,I agree with everything you have said,excellent leadership and team management skills coupled with a well trained,valued and motivated team will always shine through.

    At a recent lecture by a well respected dementia care trainer we were told that it was how the day was managed that made the difference.

    We were told to dispense with all routine and rituals.Let people get up when they want,eat when they want,sleep when they want.

    Get rid of uniforms,staff loos,separate staff dining rooms.

    Make meal times a social event with the staff as well,this gives more opportunity to help people with feeding without the stigma of being fed,apparently appetites are increased.

    We were told so much more.The speaker said that to run a home like this would not need increased staffing levels but to utilise the whole team more,even involve the admin staff at meal times.

    I realise that this type of care would not suit all but I am well and truly hooked.

    Staff had alot more time to spend just `being ` with their residents than busy `doing `.
    `As we let our own light shine we unconsciously give other people permission to do the same`

    NELSON MANDELA

     

  11. #11
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    I realise how old this post was but I was trying to find information on this myself and wanted to make a couple points of my own.
    Firstly the amount of carers you'll see does depend a lot on the layout of the home. I personally oversee 3 homes, two standard nursing homes and one dementia nursing home.
    Our dementia home has only one lounge area and you will regularly see the majority of carers in there with the majority of residents (37 residents total).
    One of our other homes on the other hand has 4 or 5 lounge areas spread throughout the home with the same number of residents and slightly fewer carers in the day due to receiving phenomonally less funding. While we're confident the home still provides a high level of care you will see fewer carers because the home is just larger and they cant be everywhere at once. As it is that home barely breaks even trying to provide that level of care because the NHS and SS absolutely refuse, most of the time unlawfully, to pay for anything more than an adequate level of care and often not enough to really fund even that much.

    So if you're finding that the level of care provided by your home is insufficient it is quite possibly because the home simply cannot afford to provide a better service. Even the NHS funded nursing care of £108 a week for patients that require regular nursing care only actually pays for less than 1.5 hours a day. This means the NHS only pay for 1 nurse per 16 nursing residents per 24 hour day and the home will make zero profit on providing that level of nursing care, providing more if its necessary costs and SS are unlikely to pay that and seem to have something against letting residents they are funding pay for it either so either the home pays the cost like ours do or they provide inadequate service at the risk of residents.

    SS are more worryingly tight with their money, in our homes refusing to pay more than £421 a week for care irrelevant of the level of care required. Considering a home will aim to keep 45% of those fees to pay other costs (such as food and all those other large bills any manager or accountant should be aware of) and make some form of profit to make running the home worthwhile, this means they provide aprox £230 for every member of staff excluding qualified nurses; this means manager, deputy manager, kitchen staff, domestic staff, maintenance staff, admin staff and anyone else including care staff. This is roughly a 50/50 split believe it or not, so £115 or so goes toward care staff who are typically paid minimum wage or just above it if they are slightly more qualified. Average of about £6 an hour, thats 19 hours a week of care per resident, around 3 hours a day or 1 care assistant per eight residents. Admittedly there is typically either a manager or deputy on during the day as well so you could say 1 per seven. Thankfully I can say our home's provide more than this, with at least 1 per six not including managers during peak times and 1 per seven not including managers the rest but as I say we cant afford it.

    If you dont believe you or someone you know is being provided enough care I hope you're willing to fork out a lot of money to put them in a more expensive home, which many people aren't being the reason we keep our prices in line with SS. Either that or complain to your PCT till they provide more funding to the homes.
     

  12. #12
    Doug,

    Although it is interesting to see it from the accountants point of view, I do think the most relatives are concerned about safety and issues like their loved ones being left unattended where a home does not have adequate staff ratios - well that is my view. The maths is less important.

    If you dont believe you or someone you know is being provided enough care I hope you're willing to fork out a lot of money to put them in a more expensive home, which many people aren't being the reason we keep our prices in line with SS. Either that or complain to your PCT till they provide more funding to the homes.
    Sorry, and apologies if I took that the wrong way, but that does seem a bit harsh and cruel. We 'fork out' over £1000 a week for dad who is self-funded and he has been in many homes that struggle with staffing levels/ratios. If dad was not self-funded and the local authority had limits on funding etc, I would still take it directly to the manager before complaining to the PCT.

    Just my view
    Craig
    Last edited by CraigC; 05-11-2010 at 06:00 PM.
    Volunteer Moderator since 2003 (now retired) - PLEASE be mindful and respectful; everything you post on Talking Point is viewed by people with dementia as well as carers. My father died from Alzheimer's - April 2012.
     

  13. #13
    I'm not quite sure what it would have to do with the PCT in any case. Surely this (the funding provided for clients funded by social services) is a decision made by the local authority rather than the PCT?
    Jennifer

    Volunteer moderator and former long distance carer.

    “A test of a people is how it behaves toward the old. It is easy to love children. Even tyrants and dictators make a point of being fond of children. But the affection and care for the old, the incurable, the helpless are the true gold mines of a culture.”

    Abraham J. Heschel
     

  14. #14
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    Doug,

    Yes, it is interesting to see an accountant’s POV, and I was puzzled as to why a Care Home Assistant Accountant would be trying to find information on the question of care home staff ratios. I would have expected that to come already within your own areas of responsibility. No? If not, please enlighten us as to who is responsible for staff:resident ratios.

    I felt uncomfortable when you described the 3 homes that you oversee as two ‘standard’ nursing homes and one dementia nursing home. Implication being that dementia care homes are in some way sub-standard or even operating to a different standard. But I’m sure that’s not what you’re thinking. You probably meant to say that the dementia nursing home provided a standard of care way beyone the standard of .... well, just standard. I hope that's what you meant to say.

    Then, when I read that your dementia home has “only one lounge area” (with 37 residents) but that one of your other ‘standard’ homes (also with 37 residents) has 4 or 5 lounge areas .... I began to fume! Also known as steaming!

    If anything, I’d like to suggest that your ‘non-standard’ dementia care home may need more than one lounge area too – so who deemed it unnecessary? (I hope that wasn’t an accountant! )

    Do you have any self-funders in your care homes? The self-funders are subsidising not only the care home provider, but also (through no fault of their own) those who are in need of local authority funding.

    Are you able to access the balance sheet of your care home provider? Can you give us an idea of the annual profit-loss-share-balance-profile of the care home provider? It’s the legal responsibility of the care home provider (company) to ensure that the staff ratio is appropriate to the ‘needs’ of the residents. Not appropriate to the profit of the care home provider, and that’s where things may be confused.

    Yes, the PCTs are responsible for the RNCC/Funded Nursing Care Contribution, and for the full costs of those in receipt of Fully-funded Continuing Healthcare. But the self-funding resident, the part-funding resident and the SS, are responsible for the rest of the fees. And, like CraigC mentioned, we too had to ‘fork out’ close to £1000 per week. That was for sub-standard care, aka neglect, in our case. But we had no way of knowing that then, before admission.

    So, Doug, I’d like to turn your question around and put it back to you: If you don’t believe that your care home residents are being provided enough care, I hope you have challenged your (private/for profit) care home provider, and asked ‘them’ to fork out a lot of money to provide that which they are registered to provide.

    Sorry, Doug, and with apologies, but you touched a nerve. I've still got a few nerves left, but they are growing weaker by the day, as I get older and more demanding.
    Last edited by JPG1; 05-11-2010 at 09:23 PM. Reason: spelling
     

  15. #15
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    I wish my relative was given the right to pay for the best quality care available but this has been denied him!!! Sorry for butting in, I am so very upset to read all this, it's not your fault Doug, it's the fault of the system. Thanks to Macca who originally started this thread as it has rejuvenated our thinking about this issue.
    "The best of life is further on, hidden from our eye beyond the hills of time" - Sir William Mulock.
     

 

 

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