By Debbie le Quesne

Posts Tagged ‘residential homes

The haves and have-nots: Bizarre economics of care

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The UK care home sector is losing managers and failing to replace them, that was what LaingBuisson was telling the media more than 12 months ago. And guess what, it’s not changed today.

The shrinking pool of talent for the top jobs with providers of elderly care is driving manager salaries to new heights.

In the latest data I have to hand it says new-build homes are offering in excess of £60,000 a year for managers.

That means with the additional costs of National Insurance employer contributions, pension payments and other sweeteners, the source cost for providers is rapidly approaching £100,000, and a bonus scheme can easily tip this even higher.

Of course, we wouldn’t expect to see these figures being paid amongst many of our members and it’s not because they are mean employers. It’s a simple case of economics: There’s just not enough money in the pot as the region is too poor.

It’s a fact that many of the lager corporates operate in much more affluent areas than the West Midlands and unlike many here, their main trench of income is from private payers. Most of my members survive on council-funded placements and it’s their primary source of income.

Austerity measures is seeing the industry becoming increasingly polarised – the haves and have-nots.

In May last year, according to LaingBuisson Recruitment co-founder James Rumfitt, the residential care sector as a whole was struggling to find managers of competence.

I am not surprised.

According to the healthcare consultant’s Care Home Pay Survey – second edition, the average care home manager salaries at the beginning of 2015 were up 4.2 per cent above the previous year.

This was incredible 49 per cent higher than salaries seen a decade ago. Compared to an increase of just 24 per cent in median full-time employee earnings in the UK economy as a whole, it’s an eye-watering hike.

Isn’t it odd, the general care market is in turmoil, yet the economic dynamics of a shortage of good managers, pushes up their salaries at the top end of care provision. Supply and demand are hard masters.

While there will always be those who can afford private care payments and thus fund very generous salaries for the elite operators, there will be many more people receiving care on local authority rates only. Their care providers, where pay rates remain anchored to the Living Wage, will not have the privilege of top-ups to fund such salary extravagance..

But I must say this: The care I have seen in some of our struggling homes has been exemplary. Plush surroundings, teas on the terrace, matching furnishings and expensive, oak flooring, does not necessarily equate to excellence in care.

What is it about never judging a book by its cover . . .



Guilty until proved innocent – how the law works with residential care

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The care industry is getting very twitchy over the new raft of regulatory demands and possible inspection outcomes that can now be deemed criminal offences.

High levels of corporate accountability that could end in the courts have racked up insurance policy bills and according to Caring Times editor Geoff Hodgson’s blog insurers seem to “rank care homes with paragliding and rodeo work.”

At odds with all of the UK justice system, the biggest problem is that provider are assumed guilty until they can prove their innocence.

Geoff point out, quite rightly, that we rarely hear much of lack of accountability of the public agencies involved in the investigation of safeguarding incidents.

Let me quote this incident he highlights in his blog: “In a letter published in the June issue of Caring Times, Paul Simic of the Lancashire Care Association recounts the sorry saga of Palatine Lodge in Burnley where a patient died in early 2012.

“The home had been cleared of any fault by the Coroner, the police, CQC and the local authority, but as a consequence of the safeguarding investigation, all the residents were moved and the proprietor of the home, its reputation in tatters, was compelled to sell the business at a substantial loss.

“In his letter Mr Simic asks: ‘How can it be that all this time on – with what happened to the other residents, to the proprietor, to the manager, to the staff, to any family and friends of Mrs A who also may have had to travel this unhappy road to the Coroner’s verdict – that no fault is found in a provider with an established good name, those who made such consequential judgments en route are subject to no independent review or scrutiny or consequence?

‘Where is the justice or fairness in this instance? Without the right checks and balances in place, the SME provider sector is too easily a secondary level victim.’”

I know too of another case where a male career was accused anonymously of sexual assault with a client in a nursing home. A massive, often hostile, police inquiry followed. The carer was suspended for months, his domestic life fell apart, the home’s manager was devastated and the owners distraught. Outcome: No case to answer – the letter believed to be sent by a former disgruntled employee.

Issues of a legal nature in safeguarding sometimes have catastrophic consequences, which, as these cases show, are not always fair.

Geoff quotes 
“All are punished,” – the Duke in Romeo and Juliet after the lovers’ joint demise’ and notes well it’s not so in the safeguarding scenario. I have a quote to add here too: “The law is an ass” – Charles Dickens (Oliver Twist).

Care sector investment: Big really is beautiful

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Big is beautiful, or so the saying goes. Looking at the research from care industry investment gurus Frank Knight, healthcare is now considered a core property asset attracting monies from the UK and overseas.

According to the FK bulletin “appetite for care homes in largely local authority areas is improving” with investors increasingly considering this addition for portfolios.

Let me quote: “Investors are targeting a distinct range of properties based on asset size. Typically, the Asia-Pacific funds and US REITs are seeking large lot-sizes, such as hospitals and care home portfolios, priced between £100m and £1bn, while UK and Middle Eastern institutions are targeting care homes and surgeries between £25m and £250m.

“Forward funded pre-let agreements have been prominent among the specialist Healthcare funds such as MedicX, with lot sizes typically between £5m and £10m.”

Indeed, millions of pounds of investment material seem to be required. But it’s the millions values that are getting the attention and most of our smaller residential care settings are being left out in the cold, attracting little or no fiscal lifts.

With total returns of 5.6% in 2013, healthcare underperformed All Property (10.7%), reflecting the strong revival of investor interest for core property sectors (i.e. Retail, Industrial, Offices).

However, Healthcare property continues to outperform the wider UK commercial property market over the longer term, recording average annual total returns of 5.5% p.a. between 2007 and 2013, compared with only 1.5% p.a. for All UK Property, according to figures in the FK report.

FK adds that the care home sector is also a growing part of the market with the rise in user demand for elderly care a key driver for .

Let me quote some more: “The key trends which will impact the sector in the future include not only the expansion of the elderly population (the number of over-85s in the UK will increase by 85% by 2030, according to forecasts from Experian), but also changes in health and dependency levels of the very elderly. This, and the fact that up to 80% of the UK’s care home stock is arguably below ‘institutional’ quality, also provides a clear case for investment in future-proofed care facilities.”

There’s a common thread emerging for all of these investor opportunities and it involves larger than normal businesses – essentially, corporates. Think big! Very big!

I’m heartened that the care property forecast remains strong and although negative Press has clearly eroded the confidence of the public, according to the report, it “is not expected to dent investor enthusiasm for prime healthcare investments.”

It stands to reason that increased investor appetite for bigger fish should up values of smaller operations. Sadly, however, I don’t think this is the case. Investors reading the FK report should be aware that the local authority market in the West Midlands presents steep fiscal challenges as many homes are just too small to sustain quality care services at local authority rates.


CQC penalty notices and why we should have a measured response

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The Care Quality Commission has this year been busy issuing penalty notices over breaches in conditions of registration.

Most services have to have a registered manager as ‘part of the deal’ in being operationally compliant.

And sometimes there is good, compelling evidence why sometimes care businesses are without a registered boss.

Often, as staff move onwards and upwards, the vacancies are hard to plug. Getting the right person on deck is paramount to both the smooth running and general ambience of the service – but it all takes time

There’s some great advice in the latest edition of the Brunswicks’ Care Review, a great source of legal updates and mostly presented in a way all of us can understand.

It appears that editor Keith Lewin has had a bulging postbag relating to the penalties issue and he offers some wise words in response.

Firstly, “a penalty notice can only be applied with a care provider’s agreement.”

He advises that those with recruiting issues should be “slow to accept” them. In such circumstances and providing there is good documented evidence, a penalty notice is not an appropriate response.

He also goes on to explain the industry-wide and direct consequences of acceptance.

I quote: “There are consequences for individual care providers of meek acceptance; first, there is the beginning of a record of non-compliance which CQC will undoubtedly refer to in more formal penalty situations, for example, when before a court or tribunal.

“That said, there is a more wide-spread consequence for all care providers when many accept the penalty. It is this – that the regulator becomes convinced that in order to drive change in the sector, first change the rules, then tell people about those changes, provide a period of grace for people to become compliant, at the end of which give inspectors the stick of issuing penalty notices to send a message to all care providers by making an example of the few.”

What concerns me deeply is that the ‘stick’ approach, he says, is “expected to be deployed more in future.”

His reasoning is to be found in the CQCs board of management papers for its meeting last week.

Let me quote some more: “Andrea Sutcliffe, Chief Inspector of Adult Social Care and Corporate Lead for Registration, reported that there was a 57% increase in the number of new registered managers in 2,439 care services which CQC targeted in a six-month period which ended in April.

“I therefore suspect that CQC management will use that statistic to drive through change in the sector at a time when care fee payments from the majority of commissioners of care, local authorities, are still exercising considerable downward pressure on care fees.

“Therefore, for the future, I expect that in matters of provider delinquency CQC will take a much less tolerant approach and that similarly, it can be expected to issue penalty notices.”

Make sure your paperwork is in order! Enjoy the weekend.

Ruling to send shockwave through the care industry

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Nestling in the columns of Brunswicks’ Care Review are details of a legal ruling that is about to see wages of some carers rocket while simultaneously providing another hurdle for hard-pressed providers.

The issue centres on whether a care worker should be paid the National Minimum Wage for ‘sleeping night duty’.

It’s an old chestnut that until now has escaped a legal precedent.

But now we have a definitive view, as expressed by the Employment Appeal Tribunal which very recently had to consider the point in Esparon (trading as Middle West Residential Care Home) v Slavikovska

The case wins a large editorial display in the Brunswicks’ publication. I quote: “In short, the decision is that a worker who undertakes sleeping nights must be paid for all of the hours ‘at work’ whether awake or sleeping.

“Care providers can be expected to have a deluge of requests for payment by workers when they become aware of the ramifications and effect of the decision.” Indeed!

The case arose because of the Home Office making it a condition of employing Ms Slavikovska that the employer paid her £7.02 per hour.

HM Revenue and Customs had previously conducted an audit of the provider and determined that staff employed on the same terms as Ms Slavikovska were being paid National Minimum Wage!

Let me quote some more, so there’s no misunderstanding: “Another decision covering this and another issue, namely, whether domiciliary workers should be paid for travel between service users came before the Employment Appeals Tribunal, although one differently constituted from that in the Slavikovska case.

“In Whittlestone v BJP Home Support Limited, Langstaff J, held that a care worker who was required to sleep-in premises in which three learning disabled adults lived in case they should need help in the night was ‘’working’ and accordingly, the NMW applied to all the hours.

“Further, and it should be of great concern to domiciliary providers, Langstaff J, also held that when travelling between assignments at the homes of a number of different service users throughout the day, that time too should be regarded as ‘time work’, to use the technical phrase, and is to be paid for at not less than the NMW.“

Editor Keith Lewin rightly says in his piece that it will “send shock waves throughout the sector.”

With that thought, I’ll bow out of the blog for the long weekend. Have a great bank holiday.

Jobs galore reveals need for social care

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More and more support is needed to care for our ageing population, either in care homes or clients’ own homes, so says the Mirror – and the world and its wife.

In fact Skills for Care estimates that “adult social care alone, which already employs 1.5 million people, will need to find nearly one million new staff within the next decade.”

The figures are scary.

All credit to the ‘red top’ article in their online job focus piece, they offer a pretty comprehensive overview of what the role of a carer involves and warns about the anti-social hours that will be on rotas.

The following breakdown gives an insight to the current marketplace needs:

At Jobcentre Plus there are 22,348 jobs, ranging from care assistants and home carers to house parents and residential wardens.

“We [The Mirror] found a health-care assistant role in Inverness (from £14,238), a night-shift care assistant in North Shields (£6.56 per hour), a registered care manager in Coventry (£22,000 to £24,000) and a residential support worker in Leeds (£7.07 to £13.80).

“At fish4jobs.co.uk there are 2,939 jobs, such as care workers in ­Leicestershire (£7.16 to £10.25), a care manager in Leek, Staffs (£23,000), a care assistant in ­Buckinghamshire (£6.81) and a care manager in Enfield, North London (£26,000).

“At jobs.communitycare.co.uk we spotted 3,380 jobs, including 2,068 working with ­children and 993 with adults.

“These include children and family support workers in South East England (competitive), an assistant team manager in Hampshire (£30,195 to £33,984) and home-care support workers in Cambridge (£13,500 to £15,500). We found a further 3,294 jobs at gumtree.com/homecare-jobs, ranging from a home care support worker in Bristol (£10) to a live-in carer in Oxford (£400 to £550 a week).

“At Jobs jobsgopublic.com there are 460 vacancies, while lgjobs.com has 429. The NHS has 1,354 care roles, including a care facilitator in Oxford (£25,783 to £34,530). See also carejobfinder.org/jobs, which will put you in touch with employers in your area.”

Thousands of jobs and seemingly a general poor uptake response in the industry, well at least that’s my experience. Getting the right people is never easy.

I’m left asking why so many posts are difficult to fill. The answer? Because current funding from Government that is decanted into the private sector for local authorities to purchase care is chronically poor.

That reflects in pay rates and anyone who works in the sector will know that being a carer is jolly hard graft.

There are now more than 60,000 social-care apprentices working towards nationally recognised qualifications, says the Mirror and that’s good. But the industry will need more than training ‘teasers’ to get vacancies filled.

I’m not a fan of tabloid journalism, but the Mirror has done a fair job with this piece.

Panorama: It’s a hearts and minds battle to up the game

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Andrea Sutcliffe, chief inspector of adult social care at the Care Quality Commission has waded into the Panorama debate for a second time.

Writing in the Guardian, she joins a growing chorus of voices airing their views about the terrible scenes that were beamed into our livingrooms in the ‘Behind Closed Doors: Elderly Care Exposed’ broadcast.

She writes a lot of words, but not least that the new powers in the Care Bill will afford her inspectors stronger legal powers to “take additional action.”

And she adds: “You have a chance to have your say about what we do, as we are consulting on our new approach – so please do.”

Sadly, few do have their say – bogged down in care toil, or just can’t be bothered. Quite how to break the inertia of lethargy in responding I don’t know, but I must encourage at least all of my members to contribute some comment as the new inspection models are rolled out.

Undoubtedly the Panorama programme has sparked a deal of comment from service providers, staunchly defending the good care that so many carers give. I too have added my letter of support for the thousands of unsung heroes and heroines who help on a daily basis to reform care – something that the government seems happy to decant to the private sector.

Ahead of the programme the Commission issued a statement and Ms Sutcliffe was interviewed on radio and TV. In her own Guardian piece she recalls that after the broadcast she tweeted that “no one should experience such awful care. Staff, owners, commissioners, CQC, government, society we all have a responsibility to sort.”

Indeed, we all do have a responsibility to make a difference. To do nothing is cowardice, but safe. To have a voice, backbone and conviction is what’s needed with carers and their managers.

Let me quote Ms Sutcliffe: “Every day I know our work makes a difference. An inspector shared her experience with me yesterday about a recent inspection where last year we had served a warning notice and identified necessary compliance actions for poor staffing practice.

“She told me: ‘This service has turned around and I was so pleased to find everything in place and people being treated very well. Everyone sang the praises of the service. The manager has worked hard to make this happen and it has reminded me why we do this.’

“We are not the only solution, but we are definitely part of the solution.”

And there’s the rub . . . part of the solution. CQC – love them or hate them – are the people we need to work alongside to up our game. But compliance is not an in in itself. In the Gulf conflict a new sound bite was aired: “It’s a battle of hearts and minds,” said the captains and generals.

That unfathomable, mysterious ingredient that captures our thinking and inspires vision needs to be in liberal quantities among care managers and their staff.

Strong leadership also needs to be inspirational. The new inspections promise to be rigorous and robust. They will be person-centred and “alert to warning signs.”

Undoubtedly, the Panorama report has shaken public confidence in an already-embattled care sector. With other care association leaders and industry ‘movers and shakers’ it’s my duty to try to improve public perceptions.

Part of that process is to try to increase fees paid to providers by local authorities; to deliver relevant and equipping training models; to support care businesses; to promote the real value of our carers; but none of these things in themselves will win the fight.

As I said . . . upping the game really is a battle that is initially won in hearts and minds. Be empowered, be inspired – let’s show the British public another way of caring where excellence is the default setting.