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.
Its the responsibility of the manager to determine appropiate staffing levels. Its our problem when the homes start making a loss because they cant afford the level of staffing most poeple would call barely satisfactory.
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.
Our dementia care home is for very advanced dementia, the worst cases in the county. People who are rarely self aware and often violent. So yes over standard rather than substandard.
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!
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It only has one lounge so that all residents can be together and staff arent spread too thin. They need constant attention when not in their rooms so it was decided when the home was built to only have one lounge area, though we are expanding it as it is rather too crowded for the current level of residents!
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.
We have some self funders though im not hugely involved in the funding aspect at this time. Typically self funders pay similair fees to those on NHS CHC or full PCT funding, sometimes less sometimes more. I wouldn't say their subsidising.
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.
Varies a lot over the 3 homes. I'm concerned one of our homes is likely to making a loss or barely breaking even which is a real concern for the residents not just us as we cant keep a home running if its not making money. The others are making i would expect 5-15% profits which is abyssmal to fair. Care may come first but if the home cant afford the level of care residents may want that's not something we can help a great deal. Of course not providing the level of care they need is illegal so if thats an issue complain to the CQC.
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.
Well thats over double what our residents pay so in your case I cant imagine a great excuse for neglect. Poor management I would guess. My comments are more aimed at homes who receive under 500 per resident.
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.
I do believe we provide enough care for all residents. At least our managers tell us that and we have no complaints from residents or families. But I'm finding it hard to believe we can sustain that care without going bunkrupt in some of our homes and yes we are beginning to try gaining more funding from the NHS and LA as opposed to relying on large private fees.
It's disgusting that anyone has to make profit out of the elderly frail. In my opinion all elderly care should be funded by the LA. Staff should be paid according to their dedication and training should be ongoing. Any 'profit' from the system should be ploughed straight back in to increase ratios.
A career in elderly care should be something to be proud of, just as child care is.
It's disgusting that it is regarded as a job to do when there is nothing else on offer. Adequate salary and training with incentives is the way foreward, surely?
Making a profit is what business's do. If you can find a public care home for your relative than they wont be aiming to make a profit off them, otherwise thats kind of a silly thing to say. Since care homes have been privatised the point of them is that they can afford to provide a much better service than public care homes, but if theyre not making profits there will be no further investment so poorer quality of care.
A career in elderly care is something most people are proud of. I cant imagine many people would work in it if they weren't proud of what they do. Being physically assualted every day is certainly not my cup of tea.
I agree that the LA and NHS should fully fund all residents, but they dont and they wont so no point arguing that one.
Also staff do have ongoing training. Pretty sure thats a legal requirement too. As for increasing wages, higher wages = less care or higher fees.
I think there is definitely a place for some private, smaller, owned care homes and as long as they are providing great care they are necessary to provide a variety and choice of homes. Of course if the owners were peeling off the profits and the residents not being cared for that would be totally wrong.
That is exactly the point.
What about those who can’t? Does that make their loved ones any less deserving than those who CAN afford?
This is why I get annoyed that LA's and the NHS try to limit how much they pay for residents and herd them into the cheaper care homes, often illegaly.
but it makes my blood boil to think that CARE is about shareholders rather than stakeholders
Firstly as mentioned if residents dont receive the care they need chances are the CQC will shut them down as is happening an awful lot. Secondly it's less about shareholders and more about providing an incentive for people to invest money needed to improve the level of care. Its a win-win situation.
Ultimately if you're spending over £1000 a week for care and still receiving inadequate care thats clearly an issue. If your relative is fully funded by NHS or LA and you know that theyre only paying £500 or under, or your private fees are £500 or under, bear in mind there is a chance the home doesn't have the money to provide more care. Though asking for information never hurts. And there is nothing the manager can really do to get more money so I wouldn't expect them to take complaints too kindly when theyre likely frustrated themselves over the situation.
