Ratio of carers to residents in care homes?

[stanleypj]

In the nursing home where my wife Sue is a resident it is unclear to me how many carers are on duty at any one time. At weekends particularly there have been occasions when there have only been two carers on duty for 15 residents on the 'medical unit' (i.e. all the residents have medical needs).

Of course I can ask the management about this but I wanted first to have an idea about what is 'normal' or common elsewhere. I realise that the question is complicated because of the different types of home but I would be interested in any knowledge or experience people would be willing to share.

 

[nitram]

I don't think you will find any regulations about carer numbers other than they should be 'adequate'.

As you say it depends on the amount of care needed, my wife was in a nursing wing with a far higher staffing ratio so is not comparable.

I would consider only 2 carers to be inadequate, several procedures require 2 carers which would leave none free to deal with any event that may occur.

 

[stanleypj]

I would consider only 2 carers to be inadequate, several procedures require 2 carers which would leave none free to deal with any event that may occur.

Thanks nitram. I agree that this is inadequate - e.g a number of residents need hoisting if they are ever to get out bed and this can take some time. As you say, while 2 carers are doing this, the rest of the residents have no help available to them.

It's particularly important when a number of residents cannot feed themselves. Very often when no friends or family are around, meals or snacks are recorded as e.g. 3 t/spoons. It's clear that the carers do not have the time to persist nor are they able to come back a bit later and try again. Sue has lost an alarming amount of weight since she became a resident and this is one of the reasons. When she has visitors we always have to try and load her with fluids and food to try and compensate.

 

[love.dad.but..]

Dad is in a dementia nursing home with many residents bed ridden with medical needs and those like dad who are still mobile but advanced mentally or moderate stage. Day staff...2 nurses and 6 carers goes down to 5 after lunch. Night staff 1 nurse 3 carers...34 residents on the floor. I used to work childcare where I was quite rightly strictly regulated with staff child ratios. In my view elderly or nursing care home should be regulated in exactly the same way. It sounds inadequate to me for many reasons not least some residents need double handed personal care so there would go no one to deal with anything else especially an emergency. Lunchtimes are difficult even with a good amount of carers to help as in dads care home many as they decline need encouragement and help to feed, dad is now on the home's need help feeding list. I have asked that this happens and the staff had already started to do this dad would show no interest or wander off or fall asleep so they persevere although even with me feeding sometimes it is impossible for his brain to realise he is hungry or needs to eat so I would speak to the manager and insist your wife is given help when she has no visitors to help.

 

[stanleypj]

Thanks. I should have added that officially there is always a nurse on duty but they are sometimes difficult to find and sometimes even when they are in the nurses' station they are involved in paperwork and reluctant to get involved.

 

[nitram]

Have a look at:-

http://www.cqc.org.uk/content/regulation-18-staffing#full-regulation

Just looked back at my records from 4 years ago.
Normal staffing was.
24 beds, at any one time around 4 could be very short occupancy, a few days EOL.
Daytime (08.00 - 20.00) - 2 nurses, 6 carers.
Nighttime (20.00 - 08.00) - 1 nurse, 4 carers.

Occasionally an extra bank nurse on in the morning when GPs, SALT, TV nurse, .. usually visited.

Meal times were a problem although for eating very little fortified drinks could be given at any time.

 

[LYN T]

Hi Stanley,

I'm sorry to read that your concerns are ongoing-how very stressful for you and Sue's family.

Pete was not in a NH but in a residential CH; there were Dementia sufferers and mentally able, but physically frail residents. There were 15 residents and 5 carers during the day (plus the Manager/Senior) and three carers at night + Senior. Obviously, there was no Nurse but the staff were ably supported by the District nurse team and the local GP's.

I used to feed Pete his lunch but I know that the other 3 residents who needed help weren't rushed. Pete took up to an hour as he kept nodding off and 'sleeping eating', and the other residents needed gentle persuasion and time to open their mouths.On no occasion were carers prepared to give up just because of a time issue.

Oh Stanley, this really is not good care. It's no wonder that you are so worried.

Take care of yourself

XXXX

 

[stanleypj]

Have a look at:-

http://www.cqc.org.uk/content/regulation-18-staffing#full-regulation

Just looked back at my records from 4 years ago.
Normal staffing was.
24 beds, at any one time around 4 could be very short occupancy, a few days EOL.
Daytime (08.00 - 20.00) - 2 nurses, 6 carers.
Nighttime (20.00 - 08.00) - 1 nurse, 4 carers.

Occasionally an extra bank nurse on in the morning when GPs, SALT, TV nurse, .. usually visited.

Meal times were a problem although for eating very little fortified drinks could be given at any time.

Thanks for the link nitram. There seems to be some scope there for discussion with the management in terms of the training they provide.

I think if the CQC came in tomorrow there's a fair chance, for a number of reasons, that that the would be quite likely to find a number of issues on which the home is falling down.

 

[CeliaW]

Hello Stanley, is the home owned by a group or private individuals? If a group you might find that there is some information on their website as to what their quality standards are. If you can't find it, you can do as I did and contact their QA person as a potential client (I created a temporary email account) and enquired regarding some QA issues with a care agency and got some very useful information. You can, of course, also ask to (ideally) see their QA policies or at least the part relating to your query. xx

PS when I started referring to quality standards it had a definite beneficial impact.

Sent from my SM-T310 using Talking Point mobile app

 

[stanleypj]

Hi Stanley,

I'm sorry to read that your concerns are ongoing-how very stressful for you and Sue's family.

Pete was not in a NH but in a residential CH; there were Dementia sufferers and mentally able, but physically frail residents. There were 15 residents and 5 carers during the day (plus the Manager/Senior) and three carers at night + Senior. Obviously, there was no Nurse but the staff were ably supported by the District nurse team and the local GP's.

I used to feed Pete his lunch but I know that the other 3 residents who needed help weren't rushed. Pete took up to an hour as he kept nodding off and 'sleeping eating', and the other residents needed gentle persuasion and time to open their mouths.On no occasion were carers prepared to give up just because of a time issue.

Oh Stanley, this really is not good care. It's no wonder that you are so worried.

Take care of yourself

XXXX

Thanks Lyn. That sounds like a decent ratio. I would settle for carers who didn't give up because of the time issue! xxx

 

[Shedrech]

hi stanleypj
dad's home has 4 floors; 3 have 18 residents, 1 has 9
each of the larger floors has a senior and 2 carers during the day - dad's floor is dementia designated and they recently agreed that 2 carers wasn't really enough so at times there are 3 carers, sadly not all the time
at night there is a senior and 1 carer; again on dad's floor they are trying to have an extra carer
it's not a nursing home so no nurse in the building; the district nurse visits
there's also manager, deputy manager and admin; all dementia trained so they do add their weight in tricky situations - and a full time activities co-ordinator
sadly, there are still moments when the residents in the lounge are without a carer
no resident who needs individual help at mealtimes is left without having eaten their fill - I overhear conversations where the carers check this amongst themselves at mealtimes and designate someone to each resident who needs particular care
dad is weighed every week and one time when he was losing weight it was brought to my attention and discussed with me
best wishes

 

[stanleypj]

Hello Stanley, is the home owned by a group or private individuals? If a group you might find that there is some information on their website as to what their quality standards are. If you can't find it, you can do as I did and contact their QA person as a potential client (I created a temporary email account) and enquired regarding some QA issues with a care agency and got some very useful information. You can, of course, also ask to (ideally) see their QA policies or at least the part relating to your query. xx

PS when I started referring to quality standards it had a definite beneficial impact.

Sent from my SM-T310 using Talking Point mobile app

Thanks Celia. I will definitely ask to see their QA policy - very good idea.

 

[stanleypj]

hi stanleypj
dad's home has 4 floors; 3 have 18 residents, 1 has 9
each of the larger floors has a senior and 2 carers during the day - dad's floor is dementia designated and they recently agreed that 2 carers wasn't really enough so at times there are 3 carers, sadly not all the time
at night there is a senior and 1 carer; again on dad's floor they are trying to have an extra carer
it's not a nursing home so no nurse in the building; the district nurse visits
there's also manager, deputy manager and admin; all dementia trained so they do add their weight in tricky situations - and a full time activities co-ordinator
sadly, there are still moments when the residents in the lounge are without a carer
no resident who needs individual help at mealtimes is left without having eaten their fill - I overhear conversations where the carers check this amongst themselves at mealtimes and designate someone to each resident who needs particular care
dad is weighed every week and one time when he was losing weight it was brought to my attention and discussed with me
best wishes

Thanks Shedrech. I suppose this illustrates that numbers are not the only problem. A lot depends on the attitudes.

 

[truth24]

Hi Stanley

Fred's home takes 35 residents. It is split into 4 lounges, according to stage (dedicated dementia residential/nursing home) each with it's own permanent team of carers. There are 9/10 residents in his lounge with 2 main carers and often work experience girls training too. There are always 2 nurses on duty who will help too when they are free. All staff, including kitchen, cleaning and laundry, have dementia awareness training and will 'sit' in when necessary to make sure lounges are always attended and the carers from other lounges will also cross over to help from time to time. Meal times are not rushed. In Fred's lounge, those who can still manage sit at a table for lunch while those who need help receive it patiently and with no rush. I also have to mention with pride that Fred's care team and nurses were highly acclaimed in the national awards scheme last year out of 35,000 entrants.

Sent from my SM-T813 using Talking Point mobile app

 

[lemonjuice]

Interesting all the different experiences of people.
In my mother's 48 bed home apprx half of which are post-hospital convalescence they have 2 registered nurses and 6 carers and often the manager herself helps out because she is a qualified nurse.

I know there are far more 'dependent-for-all-needs' clients than when my mother entered 5 years ago and the carers struggle to see to everyone.

 

[Angie68]

My mother is in a residential home, there are 4 corridors two of which have dementia and the others are just residential. My mom has dementia, and I was wondering what ratio there should be with carers and residents as on my mom's corridor it's 2 carers to 16 residents in the day and 1 carer on each corridor at night. Apart from district nurses that come in to see residents there are no qualified nurses. I worked in the NHS for 36 years as a support worker and find this quite unacceptable. Could anyone tell me whether this ratio of 2 - ,16 is right.

 

[TNJJ]

Hi.There isn’t a ratio for residential homes or nursing.
When I have done a night shift in a nursing home it is usually 1nurse and 3 carers for 38 people.

When it has been a residential home for nights it has been just 3 carers for 32 people..
Personally,I would say with the numbers you have provided that there is not enough staff.

What management do not take into consideration are the residents with behaviour problems (day and night) and people who are sick.Plus staff breaks.
I hope this helps you.

 

[Mouse2014]

I live in Scotland.. and had cause to lodge a complaint to the Care Inspectorate as the staff left my mum at ‘serious risk’...Which was upheld..

The CI said there is no such thing as ratio of residents to staff, it is 100percent down to the requirements of the residents at a given time..

If mot residents are 2 person jobs or end of life, clearly more staff are required so it’s down to the home to get the correct staff to do the job properly...as residents conditions get more advanced, their care requirements increase so, therefore, should staff numbers....

It always angered me that the staff seemed to be struggling, thus leaving residents ‘at risk’..

 

[Sirena]

As others have said, there is no set ratio. But 2 carers to 16 dementia residents doesn't sound enough.

There are about 40 residents at my mother's CH (residential, not nursing) and there usually seem to be 6 or 7 carers on during the day. It's hard to tell though because 3 or 4 will be in the main lounge and then there will be others in other parts of the building. I haven't seen residents kept waiting for help, carers are available and are proactive.
I don't know how many night staff there are, but the answer seems to be 'enough', as when my mother had a fall in the night a carer was able to accompany her to A&E.