Staffing guidelines for care homes

A study commissioned by Comic Relief into preventing the abuse and neglect of older people was published in December 2013 and one of the key recommendations resulting from the study was that the government –

require health and care regulators jointly to consult with relevant interests, including commissioners, employers and resident/patient groups, to agree ‘fundamental’ and ‘expected’ standards for minimum staffing levels and to develop proposals for their implementation in both care homes and hospitals, with routine monitoring.”

Guidance on safe nurse staffing levels in hospitals has been published recently by NICE but there still appears to be no plans to address safe staffing levels in care homes.  CQC guidance requires providers to ensure that people who use services “are safe and their health and welfare needs are met by sufficient numbers of appropriate staff”.  However, commissioners have given no clear indication of what is a safe staffing level or produced any official tool for calculating appropriate staffing levels.  Unsurprisingly, we have seen an increasing number of providers being criticised for staffing levels in care homes.  The lack of guidance makes it difficult for both providers and commissioners to determine whether staffing levels in individual care homes are appropriate.

However, one of the key concerns surrounding the development of minimum staffing guidance is that a one-size-fits-all approach will not work.  The social care sector is highly complex providing care for a wide range of service users with differing needs.  Staffing levels therefore need to be assessed based on the needs of service users while also taking into account the nature of the premises and staff training requirements.

Commenting on the study, Jill Manthorpe, professor of social work at King’s College London said “It is known that staffing affects care and it is important that we get the right people with the right skills in the right place.  However, care homes are not hospitals and we should be careful not to fall into the trap of becoming mini-hospitals.”  Ms Manthorpe added “What we have got now is good evidence for hospitals that staffing ratios can affect patient outcomes but it would be complex to do the same in care homes.  We should be focusing on poor care and if you think staffing is one way to do that then great, but we should not jump on the bandwagon for guidelines without doing the research.”

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