As any inspector knows, a good indicator of the quality of care provided in a care home is staff turnover. Regulatory alarm bells should be chiming if staff turnover is frequent (as indeed should no change over a long period, which ups the possibility of institutionalised practice or, worse still, a collusive regime). It is disruptive, prevents residents from building up relationships and has a demoralising effect.
Everyday work with older people with dementia is physically demanding, fraught with risk and poorly paid. So, it’s little wonder that many staff choose not to stick around or end up taking time off sick.
One of the not-for-profit service provider C-I-C’s care homes in the North West, Longmoor Lodge, a 38-bed care home for people with dementia, typified the difficulties faced. “The home had a huge recruitment problem and was using large numbers of agency staff,” recalls manager Helen Cook who was brought in last year. “We were taking people on and they’d last a week or two.”
Keen to make a positive start, Cook held informal one-to-one discussions with each member of staff. “I suppose that told people about my standards and expectations and it gave them the opportunity to speak to me as well.”
One of her tasks is to supervise the home’s refurbishment programme. “This is important as it’s not only better for residents who are having a say in the colour schemes and so on, it makes it a nicer place to work in as well. We’ve got new equipment – for example, hoists and specialist chairs and beds – all of which makes life easier for staff,” she says.
Cook also increased the training programme in the home: “We have moving and handling more regularly, and we have people doing NVQs. Long-serving staff had been overlooked for training. But there are lots of courses available – C-I-C is a big organisation with its own training department – and if we can involve staff in lots of different things it keeps them interested in their jobs. “
The refurbishment will create an office-cum-training room with easy chairs and a library of information. “And we’ll give staff time to go in there and read up on something because it all helps the residents in the end, and provides a break from the physical side of caring,” says Cook.
Longmoor Lodge was a nursing home but is now dual-registered (providing nursing and residential care). This led to the creation of team leader posts. “Staff already here wanted to apply so that gave them the incentive to work hard and not go off sick; but we appointed from outside as well. It’s good to keep staff but it’s also good to have fresh people in as they can encourage long-serving staff to change,” she says.
Revitalising the keyworker system (where a member of staff takes special responsibility for the welfare of a particular resident) also helped. “I’d say to people: ‘You’re her keyworker and I want you to take pride in it.’ And I’d say, ‘That room looks absolutely fantastic and that lady looks beautiful today and I can see that you’ve done a lot with her.’ A bit of praise goes a long way,” smiles Cook.
As well as vacancies, the home had familiar sickness problems. “I did a return-to-work interview with every member of staff each time they were off sick. And if there was a problem then we’d try to resolve it. We’d talk about changing shifts, possibly going onto nights, anything that would help the individual to come into work when they should be in. This did lead to staff leaving – not through disciplinary action but of their own accord.”
An incentive scheme is also helping. Says Cook: “At the end of each month everyone who hasn’t been late or lost a day to sickness goes into a draw for a £50 voucher. And people have taken a real interest in that.”
And while things seem to be working – “We’ve taken on several new staff and, so far so good, they have stayed” – there’s no resting on laurels: “We will have an open day once the refurbishment has been completed.” It seems that this Cook’s open approach to management is anything but half-baked.
Name: Helen Cook
Job: Care home manager
Qualifications: Registered general nurse; BA healthcare management; diploma specialising in care of older people
Last job: Care home manager
First job: Waitress
- Value your staff and include them in decision-making
- Hold regular one-to-one sessions with staff
- Things change all the time so training is as valid for long-serving staff as for new ones
- Take on staff with a history of poor attendance and give them a chance to prove themselves
- Long-term staff know everything there is to know so they don’t need training or refresher courses