How Care Home Managers can build occupancy whilst balancing care quality and workload for their team

Running a care home usually has fairly high fixed staffing costs - manager, deputy, admin, chef etc etc so when occupancy dips the profitability can be impacted very fast. Often, working in large care homes catering for older people there may be several unexpected vacancies over a short period. This is upsetting and also means there is a pressure to rebuild occupancy to improve the financial viability of the home whilst maintaining good care quality. Read on to find out how to approach this and do it well.

Managing levels of resident need and dependency with managing occupancy

Considering the levels of resident need and dependency is crucial for the safe and sustainable running of your home.

It is about managing risk and managing workload in order to manage the well-being of those in your care. In general, you will have a staffing ladder for your home – this is usually a sliding scale of resident numbers versus staffing hours.

There is usually the desired number and then the minimum safe number. For example, you may be scheduled to have 6 staff on (ideal), 5 staff would the minimum safe level. 4 would be unsafe.

Needs will vary so when you have a combination of residents requiring exceptional levels of support, you may not to be able to safely run the floor with less than 6.

For a floor with 20 residents, you may have a budget for 3 carers on in the morning and 3 in the afternoon.

This equates to a ratio of 6.7 carers to 1 resident (20 / 3).

Balancing the levels of resident need with staffing levels and the budget is an important skill.

Risks of (relative) high level of need in the home

Staffing ratios are only part of the story. It is also about how strong your staff teams are (depth of experience and care knowledge / mix of hard-workers / team spirit / how well they know the residents / length of service can be a factor).

You need to know your residents and staff team well. It is a judgement call.

The care team will always want residents who are generally easier and complain whatever you do but you need to understand what their actual capacity is.

Give them enough to be manageable busy and build their confidence by building the resident population carefully and thoughtfully.

Balancing needs with bed occupancy pressures

The balance here is with occupancy. So if several residents pass away, there will be pressure to rebuild occupancy.

If the residents referred to you are have high dependency, what do you do? If you take them all, the owner / regional director may be happy temporarily but if later there are more falls, complaints and staff start leaving because of an unmanageable workload, it could be that some of those admissions were not well thought through.

The registered Care Home Manager position is the responsible one.

You need to weigh all things up and make good decisions for the home, residents, families, teams and for those who oversee and audit the service.

When you can’t meet the need / how to decline

When you do an assessment, after careful consideration and liaising with your team and you conclude you can’t meet the need – you simply confirm that you can’t meet the need, briefly explaining why

Sometimes social workers and hospital discharge teams under pressure will try and influence you to clear the bed / take the person even if you have declined.

They may disagree with your reason for not accepting the resident.

You need to aware of the constraints across the social care system – be courteous, professional but as registered Home Manager, do right by your home and by your residents.

This is your legal obligation.

The owner of the home, the families, the residents, the regulator are all trusting you to do the right thing.

In the end, you need to run a service that has a good reputation, that staff are happy to work at, that manages risks responsibly and has a profile of resident that you can take care of skilfully.

If you manage quality well, in time, the reputation of the service will mean you will get referrals and fill the home.

Never underestimate the power of reputation for your Care Home. Treat every person you come in touch with as a customer, to be treated with respect and courtesy and you won’t go far wrong.

Compliments

This may seem obvious but keeping a log of compliments is evidence that the home is running well and having a positive impact with residents and families.

There is a negative bias with Care Homes at times; capturing positive feedback is a great and authentic way of countering this negativity.

Complaints, concerns and queries

Firstly, there is a distinction between complaints, concerns and queries.

I see the significance building – an unresolved query, could be later cause for concern, which if left unchecked could later become a complaint. Queries should not considered complaints.

The CQC will want to see evidence of compliments and complaints and especially a robust system for dealing with and learning from complaints

You need to adhere to your policies and experience to weigh up the distinction between what constitutes a formal complaint and what to record.

Where possible concerns, verbal complaints and queries should be dealt with immediately.

Often things logged as formal complaints are in writing / email and explain a series of points or relate to a specific incidence where needs / expectations were not met.

They will require a written response. Sometimes an investigation is appropriate with a summary of findings. Good practice is to use a form that shows what was done in response, with a follow-up and lessons learnt to prevent a recurrence.

Complaints are usually feedback and should be taken seriously and prioritised in a timely way. (For more information you can consult the Local Government and Social Care Ombudsman.) https://www.lgo.org.uk

If you do not agree with the complainants' request or assessment of problems and proposed solution, you need to politely and objectively explain why.

Remember the registered Care Home Manager is there to meet the needs of the residents and listen to any other stakeholders with relevant information to achieve that end.

You can never say you’ve got it all right, running a service is very dynamic. We need to solicit and consider feedback and adapt continuously.

Related articles and stories

• The Care Home Manager’s clinical support guide

• A Registered Care Home Manager’s guide to health and safety in residential care

• What does a Care Home Manager need to know about CQC inspections?

• The Complete Care Home Manager Career Guide

• Other articles by Liam and his Podcast series 'Care Home Quality'

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