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The problems facing care homes in recruiting and retaining staff are pushing the sector ever deeper in to crisis, writes Alan Jamieson.

There must have been a time when carers chose to work in residential and nursing homes because they wanted to help people rather than accept better paid and easier jobs in offices or supermarkets. Now, owners and managers are finding it increasingly difficult to persuade anyone to take up a job in homes, particularly those that cater for older people.

This is reaching a crisis point. Some of the evidence lies in the employment sections of local newspapers, where care homes  advertise every week for cooks, catering assistants, carers, care workers, nurses, night staff, day staff, cleaners. There is a constant and apparently insatiable demand. Some of the advertisements for nursing staff are close to hysterical because managers just can’t get applicants.

Other evidence of high demand and dwindling supply comes from interviews with recruitment agencies and owners of residential and nursing homes. Invariably, they refer to wide searches for staff, a high turnover of catering and cleaning staff, and the importance of offering additional benefits such as pension and travel contributions to bolster the basic pay of nurses and carers. For example, Eugene Huntley, owner of a Cornish care home, says: “I advertised regularly and interviewed 22 people for a part-time carer’s job before I found a suitable person.” Nearer London, the situation worsens. Wendy Stallwood, manager of a Buckinghamshire home, says: “We have to offer wages above shops, supermarkets, community services, leisure centres - if we didn’t, we’d get no applicants.”

And of course demand keeps increasing. Department of Health figures estimate that out of a population of nearly 60 million in 2005 more than 20 per cent will be over pensionable age. DoH statistics reveal that there are more than 800,000 people in NHS, voluntary and private nursing and residential homes, hostels and hospitals,¹ and the department estimates that demand will increase at the rate of 3 per cent a year, depending on the availability of homes and the public’s response. The official policy is, of course, to persuade people to stay in their own homes if at all possible, but the preferred option for many older people is to be looked after in a home. Yet in 2001 there was a fall of 3 per cent in the number of beds in these homes.

We know why there is fall in supply, because care homes have closed for a number of reasons relating to rising costs. The impact of the Care Standards Act 2000 is yet to be fully felt but managers are worried about the extra costs it generates. Jim Harris, manager of a Scottish home, says: “The minimum standards, admirable though they are, and we are very confident of meeting them, will increase costs. To take only one example - health and safety - inspectors will be looking at premises, property, equipment and materials, and they will expect all staff to be fully aware of all the safety implications of every job they do.” No one suggests that health and safety have been neglected but every home has to demonstrate planning, implementation and review of the health and personal care sections of the standards - along with the other six sections.

Care homes’ costs continue to escalate for wages, maintenance, equipment, food and other items too, but it’s the training costs that have everyone worried. The act requires training in five specified areas as part of the induction process to take place within the first six weeks of employment. Next comes the foundation programme with a planned pathway to qualifications.² By 2005 the - by then merged - National Care Standards Commission will require a minimum of 50 per cent of care staff to be trained to national vocational qualification level 2 or equivalent.

The commission was asked what proportion of care workers now have this qualification. The commission gave a guess of 5 per cent, some way off the 50 per cent anticipated within three years. For an owner or manager there are two main problems here. A manager has to plan and provide the training and assess each worker’s progress, while the owner will have to bear the formidable costs of providing this training and assessment. As Huntley says: “We put a lot of effort - and money - into training and all staff are working towards NVQ level 2 or higher levels, but I know of homes where the costs and the administration needed seem like thunderclouds on the horizon.” As for recruitment, all managers consulted in this survey say that training requirements will make things harder because some workers are resistant to training and to being formally assessed on the job.

Another problem is nurse shortages. The Royal College of Nursing says that by 2004, 94,000 nurses will have left the service, and the government admits there is a shortage of 22,000 nurses.³ This leaves a gap within three years of 116,000 nurses. Among the organisations likely to feel the chill wind will be care homes for older people. Nurses are able to choose widely to work in NHS and private hospitals, or for agencies and other providers, and they have to be specially dedicated or have some special interest to volunteer to work in nursing homes.

The picture is not any brighter for care workers. Local newspapers have many jobs advertised in residential homes: the rates range from £5.60 an hour for cooks, £5 for night care workers, £5.20 for weekday carers and £6.20 for weekend support staff. To attract carers into homes, owners have to be prepared to pay above rates offered by other local employers. Stallwood says: “If we offered these rates, no one would apply. We have to pay £1 to £2 an hour more than basic rates.” Nevertheless, the fact is that care homes are searching for suitable people, paying them modest wages, and asking for professional and sympathetic care for clients who need a lot of help, all to be done in competition with commercial rivals. This problem is now a crisis.

Recruitment itself can be difficult, according to inquiries we made of recruitment agencies, and home managers. Although over 90 per cent of staff live locally, “local” can mean a 10 or 15 mile radius, so managers must offer a travel contribution, and obviously advertising adds to costs.

As for nurses, there is a wider catchment, and several agencies concentrate their efforts on recruiting from overseas. Russell Prince of Eurosite says that their target zones are the Middle East and Asia, while Charles Kelly of Bison Management says that 90 per cent of his placements come from the Philippines where the quality of training and of motivation is very high. As demand continues to rise, more nursing staff are expected to be recruited from New Zealand, Australia, Zimbabwe and India.

So what can be done, especially when the act comes fully into force, as owners will have to provide staffing figures and explain why their retention rate is low or unstable? High retention rates are generally found in homes where the atmosphere of the care home (and the company that runs it) is impressive; namely a friendly and considerate management, where residents are happy, the environment of the home is pleasant to work in, and health and safety and training are taken seriously. Then there is the practical help such as flexible working hours, above-average rates of pay, holiday entitlements honoured, help with travel costs, equipment that works, and clothing allowances.

These all carry extra costs, of course, but are essential if the current recruitment and retention problem is to be sensibly faced and solved. If not, that current 3 per cent fall in the number of available beds is going to increase.

Alan Jamieson is a consultant dealing with employment and recruitment matters. He is a former director of the Careers Research and Advisory Centre, Cambridge

References

¹ Department of Health, Statistical Bulletins: Hospital and Community Health Services, 1991-2001 and Statistics for General Medical Practitioners, 1991-2001, DoH. See website www.doh.gov.uk/public/stats3.htm

² The Standards and the Regulations can be downloaded from the NCSC website or Department of Health, website on www.doh.gov.uk/ncsc/consult.htm

³ The Royal College of Nursing, Labour Market Review, RCN, 2002