Care homes are increasingly struggling to provide high quality care for residents with complex medical conditions, amid a backdrop of a severe lack of funding, equipment and staff, the Royal College of Nursing warned yesterday.
A new RCN report outlines how nurses working in care homes are facing huge challenges in providing care for people, many of whom may have been previously treated in acute hospitals.
One year on from a similar survey, the study of almost 600 nurses in England found that more than a quarter of nurses (26 per cent) stated they did not have adequate equipment and medical supplies and almost four in ten (38 per cent) of respondents reported a lack of staff to meet residents’ needs.
The survey also identified a lack of training for staff, inappropriate admissions and extreme pressure on the workforce leading to poor staff morale.
In response, the RCN sets out a nine-point plan for the government to act on.
The RCN’s report, Persistent challenges to providing quality care, also highlights the key issue of funding and admissions.
It warns that people are being admitted with more severe and complex care needs, but with inadequate funding allocated to meet these needs as both social care and Continuing Health Care (CHC) eligibility criteria are being tightened.
Tuesday’s report also found that almost half of nurses (48 per cent) said care homes are accepting residents in a bid to fill vacant places, despite the fact that they might not be able to meet their needs.
In addition, some homes have an increasing preference for self-funding residents, which would have implications for equal access to care.
One manager in a care home said: ‘There are pressures from councils and CQC to provide a “Harrods-quality service for Woolworths prices”.’
RCN General Secretary, Dr Peter Carter, said: ‘This report paints a hugely concerning picture about the many daily challenges that so many nurses in care homes face in delivering high quality care.
‘Many of these challenges are not new, but following years of underinvestment these issues have now significantly worsened.
‘When nearly two in five nurses say there are not enough nurses to meet the needs of residents, then you know that this is a worrying state of affairs.
‘Even nurses who were positive about the quality of care, felt it was delivered despite significant challenges.’
Key findings from the survey include:
Almost two fifths of nurses (38 per cent) believed that there are not enough full time registered nurses employed to meet residents’ needs – up from just 29 per cent in 2010.
More than a quarter of nurses (26 per cent) said they did not have adequate equipment and medical supplies needed for residents – up six per cent from 2010.
Many carers are often paid the minimum wage, currently just £6.08 for workers aged 21 and over, with higher wages on offer at the local supermarket.
This leads to issues of retention of staff. One staff nurse said: ‘Until carers are paid a decent wage we will be in this awful situation where it is so hard to retain good staff.’
A senior nurse added: ‘Too few staff, low staff morale, long shifts. Feel like a general dogs body, not a nurse a lot of the time. I work myself to the point of exhaustion and often come home in tears but at least I have job security.’
The RCN’s recommendations include:
Re-evaluation of how funding is allocated to cover the needs of residents in care homes;
National guidance on staffing levels and ratios for care home;
A government review of care home workforce planning and to ensure that this workforce is appropriately supported, trained, qualified and valued; and
Regulation of all healthcare assistants.
Dr Carter added: ‘Getting health and social care funding right is crucial not only for the sustainability of the social care system, but the NHS too.
‘On a daily basis nurses have to deal with the burden of repeated form filling and eligibility assessments.
‘It is nursing staff and the NHS that have to deal with the pressures of delayed transfers, referrals and confusion over who pays for what.’
l A new analysis has found that private equity takeovers lead to job losses, and estimates that buyout companies in the UK will have to refinance over the next five years to the tune of the £111 billion.
GMB, the union for members in firms impacted by private equity like AA, Southern Cross, Four Seasons Healthcare, pubcos and Boots, highlighted the latest findings in the study Private Equity Takeovers and Employment in the UK: Some Empirical Evidence by Marc Goergen, Noel O’Sullivan, and Geoff Wood.
On jobs, the study found: ‘There is a significant decrease in employment in acquired firms in the year immediately after the completion of the institutions’ buyouts compared with non-acquired firms.
‘Further analysis fails to identify any parallel or subsequent increase in firm productivity or profitability.
‘This evidence suggests that the observed downsizing has not been effective either in disciplining staff or imparting a clearer focus to activities.’
On refinancing, the GMB noted that it has been reported that General Healthcare Group (GHC), one of Britain’s largest private healthcare services provider, has around £2billion debt and that loans plummeted to deeply distressed levels.
Banking sources have been quoted saying they are likely to breach debt covenants by June.
GHC is reported to be ‘struggling with a debt burden’ as its 2006 acquisition was backed by £2bn ($3.14bn) of borrowing split between £315 million at its operating business (opco) and £1.65 billion at its property arm (propco).
Financial analysts say that an opco/propco structure, as it is commonly referred to, sees the propco’s debt serviced with rent payments from the opco.
‘It is the same model under which care homes group Southern Cross collapsed after defaulting on its debt,’ said the GMB.
Also on refinancing, commentators warned on estimates that £111bn is the amount that buyout companies in the UK will have to refinance over the next five years that ‘a flood of leveraged buyout debt onto secondary markets will drive prices down and make refinancing even harder’.
Analysts have warned that with ‘the wall of debt getting larger by the day’, defaults and bankruptcies are inevitbale.
Maria Ludkin, GMB Corporate Affairs Officer who gave evidence to Commons Treasury Select Committee on private equity in 2008 said: ‘This report on employment provides independent confirmation of what GMB has always said, which is that private equity produces financial results by reducing the payroll and using the money to reward themselves.
‘They are like vampires sucking the lifeblood out of healthy business.’
Paul Maloney, GMB National Officers for staff at AA and in pubcos, said: ‘That there is a wall of debt that cannot be refinanced and that more insolvency is likely as a result is a major cause for concern for GMB members and their families.
‘Employees, tied tenants and consumers took all of the pain for no gain as the multi-millionaire elite enriched themselves leaving behind these billions of debts that may lead to more business failures like Southern Cross.
‘GMB members at AA would like to know how debts of £4.8 billion can be repaid.
‘It is a disgrace that the tax breaks that spawned this industry have not been closed. The Chancellor should get rid of these tax breaks in the next budget.’
Justin Bowden GMB National Officer for care staff added: ‘GHC and Four Seasons are just the latest to cause concern.
‘A newspaper yesterday reported: “A raft of financial investors has made it through to a second round of bidding for Four Seasons Health Care. The company has 500 properties and cares for 25,000 elderly residents. It became Britain’s No1 operator last year after the collapse of Southern Cross — a demise some have partly attributed to past ownership by Blackstone, the private equity giant.
‘ “Among the shortlisted private equity suitors are Bain Capital, CVC, Formation Capital, and a consortium that includes Patron Capital. A firm belonging to the Hong Kong billionaire Li Ka-shing is also thought to have made it through”.
‘This story was placed by bankers trying to whip up interest in Four Seasons, which has to repay £780m by September, playing a cynical game of “pass the parcel”. GMB has seen enough of private equity in Four Seasons.’