Care Home - Staff Ratios??

[TinaT]

I wonder why the standards in children's care homes have to be met, staff ratios have to be met, protection issues have to be met, leisure activities and space to move around have to be met, nutritional standards have to be met: yet care home provision is left to 'market forces'

All children recieve free education up to a certain age. The state/society/all of us accept responsibility for this and this is considered a right which we pay for out of our taxes. Our elderly/dementia population have paid for fifty years or more into society. What rights and responsibilities does the state/society/us accept for these people?

We are coming into the 'Pudsy week' where celebrities excert us all to give money for our disadvantaged children. Would it be a pipe dream to expect the same level of concern for the older, severely disadvantaged adult?

What is the difference between a vulnerable child's welfare and and a vulnerable elderly person's welfare?

xxTinaT

 

[JPG1]

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.

There's never an excuse for neglect.

It makes no difference whether a resident is paying £250 a week or £1000 a week.

Care means care. Not neglect.

And it wasn't just poor management, Doug. It was a whole host of systems that were not provided by the care provider, by the manager, by the deputy manager, by the nursing staff, by the GP, by the Local Authority, by CSCI/CQC .... not just poor management. And the biggest weakness? The care provider who was too mean to pay for even the basic requirements in the nursing section. Greedy care provider - not residents.

I wouldn't say their subsidising

If the self-funders have needs that are far less than those in receipt of NHS CHC, they are definitely subsidising. If their needs are the same, they should all be assessed for fully-funded NHS CHC a.s.a.p.

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.

A care home that doesn't provide the kind of care residents want - and need and think they are paying for - shouldn't call itself a care home and shouldn't accept vulnerable elderly residents who need care.

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

It's not silly at all.

I agree that the LA and NHS should fully fund all residents, but they dont and they wont so no point arguing that one.

There's every point arguing that one. Isn't that what the great debate is all about at present, and who knows, if at the end of that great debate the decision is made that care for the elderly should be funded by an increase in taxation, the arguing will have achieved a result. The elderly have worked and paid taxes and National Insurance contributions all their working lives.

Of course if the owners were peeling off the profits and the residents not being cared for that would be totally wrong.

Some are!!

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.

Now that really does make my blood boil. Can you send me a PM listing all those LAs and PCTs herding residents illegally into cheaper care homes, because they are limiting how much they pay?

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.

Only paying £500 a week? Only? That's £26,000 per annum - far more than most of the vulnerable elderly residents have ever earned in several years! But over a lifetime, many have scrimped and saved, gone without luxuries, never had any shares in anything. So they deserve a dividend at the end of their life, especially if paying £26,000 for care.

The National Minimum Standards are supposed to be met by any care home that registers with the CQC. The care provider sets the fees - not the resident. I get the feeling we're all being hoodwinked, especially if a care home can claim to be a care home even though it knows it's not providing decent care.

What is the difference between a vulnerable child's welfare and and a vulnerable elderly person's welfare?

There shouldn't be a difference.

We need a Trading Standards for care. We don't have one at present.

 

[TinaT]

Quote

We need a Trading Standards for care. We don't have one at present

I looked on the websites to see what the inspections had said about some local care homes and then visited them. I had to sit on a few care home car parks in floods of tears and feeling physically sick at the terrible standards I saw.

I did send detailed complaint to both the homes and the then CSKY (or whatever they were called). These homes were re inspected 9 months later and given the same 3 star rating I had previously been beguiled by!

We must, must, must have a much higher expectation of what should be the norm surely!

Now I read that even that poor standard of inspection is to go. How can we let this happen??

We may as well go back to Victorian times and call the care homes for the poor by the name 'Workhouse' if standard of care is to be judged by how much one can pay for care!

xxTinaT

 

[Otto]

Quote
We may as well go back to Victorian times and call the care homes for the poor by the name 'Workhouse' if standard of care is to be judged by how much one can pay for care!
xxTinaT

Not sure about comparing to the 'Workhouse', I would use the word 'Asylum' for some of the dementia care homes I have visited. And the staff appeared to be suffering as much as the 'inmates'.

 

[Margaret W]

I assumed that Doug was distinguishing between 2 homes which are purely for the elderly with no significant other issues (standard) and 1 home for dementia sufferers. I don't find it strange that the former should have several lounges if the majority of residents are not needing constant supervision, but dementia residents are more likely to need supervision, which would be very difficult if they were in 5 different lounges, their own rooms, or on the loo. Admittedly 37 residents would seem to warrant at least two rooms, but in my mother's home the second large room was converted to a permanent dining room to save staff the great difficulty of moving tables and residents around at mealtimes.

As to care homes making profits, I have no personal experience, but a fellow accountant whose firm audits some of the private limited company groups of care home providers told me that they really do struggle to make any profit at all in some of their homes, the reason being that local authority limits are so low and they are forced to compete with other homes who provide much more basic services. I can't prove or disprove this, but I viewed one care home for my mum that only took LA clients, and it was abysmal. The manager looked at me astonished when I asked about activities, trips out etc. None of the rooms had en-suite facilities and the place was dark and dingy. Another whose fees were "reasonable" said they sometimes took the residents for a walk round the outside of the building.

I've just done a quick spreadsheet of income and expenditure for mum's home, with much guesswork, and it just about breaks even.

Mum's care home had lots of faults, most of them to do with high turnover of staff (including the manager - had she not died in a tragic car accident, the place would be fantastic by now), but they did at least try to provide a home from home.

Margaret

 

[Doug]

If the self-funders have needs that are far less than those in receipt of NHS CHC, they are definitely subsidising. If their needs are the same, they should all be assessed for fully-funded NHS CHC a.s.a.p.

So few people receive CHC thats not really the point. A good number of self funders do so because they dont want SS involved, because dealing with them is a horrifying experience. Its nothing to do with the level of care they need.

A care home that doesn't provide the kind of care residents want - and need and think they are paying for - shouldn't call itself a care home and shouldn't accept vulnerable elderly residents who need care.

What people think they need, what they actually need and what theyre paying for or having paid for by another party is rarely the same thing.

There's every point arguing that one. Isn't that what the great debate is all about at present, and who knows, if at the end of that great debate the decision is made that care for the elderly should be funded by an increase in taxation, the arguing will have achieved a result. The elderly have worked and paid taxes and National Insurance contributions all their working lives.

There is no point in me arguing that here.

Now that really does make my blood boil. Can you send me a PM listing all those LAs and PCTs herding residents illegally into cheaper care homes, because they are limiting how much they pay?

Every single one? LA's have the right to set a limit for how much they would prefer to pay for a certain level of care. What they actually do is a set a flat rate for every level of care that theyre required to pay and refuse to go above it in 99% of cases. Due to this a care home that is able to provide a far better quality of care because they have higher funding is ignored by SS as being too expensive.

Only paying £500 a week? Only? That's £26,000 per annum - far more than most of the vulnerable elderly residents have ever earned in several years! But over a lifetime, many have scrimped and saved, gone without luxuries, never had any shares in anything. So they deserve a dividend at the end of their life, especially if paying £26,000 for care.

They may never have earned that much but they've also never required 24 hour social and nursing care I would assume. Luckily most people get help in paying for that, unfortunately mots of those authorities "helping" are incredibly cheap with no concern for the residents they are responsible for.

The National Minimum Standards are supposed to be met by any care home that registers with the CQC. The care provider sets the fees - not the resident. I get the feeling we're all being hoodwinked, especially if a care home can claim to be a care home even though it knows it's not providing decent care.

Care homes are regularly shut down for not meeting those standards. If your home is still up it likely meets those standards. Care providers either take fees set by the LA or from local competition, or charge slightly higher for those self funding to maximise the level of care they can afford to offer.

but I viewed one care home for my mum that only took LA clients, and it was abysmal.

This doesn't surprise me. Your whole post is exactly what I mean though I'm not sure if that is reassuring or incredibly worrying.
I will say every care home manager I personally know is incredibly passionate about their work, far more than I can begin to understand, and does the absolute best with what they have. We're also quite lucky that our owner is overly generous and doesn't bat an eyelid at spending £15,000 on a lounge and doesn't limit capital expenditure (i.e. allows the managers to do whatever renovations they desire).

 

[Soapy]

I'm a carer in a nursing home where the 1st floor is for the elderly with general nursing needs and the ground floor is purpose built for dementia sufferers. I love my job, particularly when I work downstairs. However, as hard as I try, I feel that the care provided is not always adequate.
Staffing levels are always an issue, and whenever I try to discuss this with my managers, they always 'go on the defensive' and find excuses for the lack of staff or how some staff are expected to work harder than others. I was once told that because I am only nineteen, I am "inexperienced and un-organised". I know this is not the case as I have worked there for over a year and am currently studying for an NVQ in social care. I also take pride in knowing that I am an efficient worker as I often receive praise from residents family members and other colleagues. We have a high staff turnover rate which doesn't help, but staff feel under appreciated and are tired of pulling more weight than they should, and they get frustrated about our working conditions with only 30mins break in a 12 hour shift, so look for jobs elsewhere. The residents pay from £650 a week so should receive good care, but I often feel that I have no time to carry out tasks properly when we are understaffed, which makes me stressed.
I really got frustrated the other day when I was left to work downstairs as the only carer with 16 high dependency dementia patients on a 13.25 hour shift. I am only paid the national minimum wage, so the home should be able to afford a suitable amount of staff. I am told that ideally the home aims to have a 1:4 staff to resident ratio, but this is rarely the case. I read earlier that it is the care home provider's legal responsibility to provide appropriate staff:resident ratio's, but I do not think this is always being achieved and I struggle to care for the vulnerable adults in the way I think they deserve. The nurses do their best to phone around and call in staff on their days off when we are short, but it is not really their responsibility to cover shifts, and the staff are getting more reluctant to come into work as it is a daily occurrence that they are asked, and they never receive any appreciation for coming in. Any advice?

 

[mermaid22002]

care home staff ratio

most homes have a ratio of 1-5 , but if someones behaviour is intense or problematic then they may need some additional one to one support

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.

 

[jenniferpa]

I should point out that with the exception of the last two posts this thread this is fairly old thread so posters should bear this in mind when responding.

 

[Aromajoan]

Staffing levels at Care Homes

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.

Hello Macca
I have been looking at the care ratios as well for dementia sufferers and it seems there are many different ideas of what is acceptable, however my local Alzheimer's group suggest 1 care worker to 4 residents. My mother is in a home that provide 1.5 care workers to 10 residents although they say 2 care workers to 10. They just have one member of staff that 'floats' between the two units, 20 residents in total. I visit my mother every day and can say from my observations, the staffing is inadequate and a number of the care workers agree, however, to stand up to their management gets them no where. Perhaps a campaign through the Alzheimer's Society asking relatives of people in care homes to be more vigilant about staffing ratios and to keep raising their concerns as we have, with the Care Quality Commission and local Social Services may help?
Having spent a great deal of time trying to sort personal issues out over this I have come to the conclusion that relatives should not necessarily be swayed by care home companies providing care homes that look like 4 star hotels with ensuites for their loved ones. This is purely aesthetic and you can be lulled into thinking this is the right type of environment but drilling down on a day to day basis let's not forget this is a business venture and the up keep has to be paid for somehow?
We need a site that allows us as residents' relatives to give our own views on the care offered at care homes. Unless you know someone who has a loved one in a home and they are completely happy with the home it is not until you are stuck asking all these questions whilst the person you love takes the brunt of the inadequacies you have unearthed whether that be, too lower staff ration, not enough mental stimulation, inadequate communication or willing and able but poorly trained staff!
I know there are some very good care homes around and some wonderful care workers who would no doubt welcome something concrete that would help to put an end to what I believe are double standards in this area.

 

[rockyhippo]

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.

who are you trying to kid SS nor the NHS pay anything towards my fathers care he has no savings yet not only are the taking his State pension but his small private pension he paid into from work circa £180 PER MONTH 50% of which my mother is entitled to but they have told her she cannot have any of it. The council by the way is *name removed*.

 

[hortenzia]

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.

I never heard somebody to confirm the staff ratio.In the nursing homes the staff now is reduced to 1< 10.

 

[deegto]

Ratio of 33-1 at night!!!

My daughter works caring for elderly dementia care patients at night. Concerned at her reports of being left in sole charge repeatedly I encouraged her to talk to her supervisor - particularly after a new resident moved in who has a care statement indicating 3-1 care and she still had sole charge. Her supervisor very firmly stated that the night time ratio for carers to patient is THIRTY THREE PATIENTS PER CARER!!! What if one resident falls or needs personal care, then another person is distressed or needs help? If someone dies? Becomes violent? Makes claims of abuse by the carer? Neither the carer nor the resident is protected. Can anyone advise please?