• 22 January 2019
  • 9 min read

How my career as a Care Home Manager has evolved

  • Liam Palmer
    Registered Home Manager

Registered manager and author, Liam, shares with us his experience as a care home manager. This blog is split into 2, starting with a year into his care home manager job and then three years in.

'Like being touched by an angel, you are never the same, often with a greater humanity and respect for life.'

Part 1 – 1 year in

It has been a year since I moved to a private care provider working with older people after working as a senior manager in a large private hospital and 6 months since I took up the reins of a 79 bed residential home.

I was equally excited and apprehensive about the move and the possibilities for working in this sector.

I had never considered "care" before - my thoughts influenced by a jumble sale in an old peoples home as a child, seeing a few people with Alzheimers in a hospital and then of course the scare stories in the media of neglect and what sounded like a scary place to work.

How I reacted to seeing people with dementia

When I took up the reins of my first home, I saw those suffering with dementia and went to see them every day - for a while my heart sunk, I am a big-hearted person and have a sweet spot for older people but still, the reality and tragedy of their pain and loss hit me hard, I wondered, did I have enough heart to love these people every day, keep pushing for the very best for them?

After a few months, these people came alive to me, we started to get to know each other even if no words were shared, we have our jokes, smiles, habits - I became the "young man with the big smile - always smiling" according to several of these lovely older ladies that stay with us.

I am happy with that - if my smile gives them happiness, well it is not much, but it is something.

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Precious memories

Several precious memories of my work in care over the last year come from 2 particular residents; One who told me about her husband of 50 years - "best man I ever met, never a cross word, he made me laugh" she was still praising him years after he passed.

She had dementia - was her memory being overly sentimental I wondered?

I got to know her a bit - she was a remarkable lady and I think she was telling the truth.

What an inspiration - to live in such a way that your wife still praises you after you passed - amazing lady!

I hope to visit her in Cambridge next week.

Secondly, a lady in my dementia unit said "You are very handsome and you are lovely, I am not just saying that, I really mean it" she said looking in my eyes.

She said that "Your mother must be so proud of you." Whether it is true is irrelevant, at that moment, this lady meant it, said it with such conviction.

I could have cried. Nicest thing anyone had ever said to me.

A precious moment.

There are times where the risks inherent in the role of care home manager can be pressing, it is by no means a job for the faint-hearted but with a degree of autonomy as registered manager and the help and support of a great staff team, nearly anything is possible.

Part 2 – 3 years in

'These last 2 years have given me space to reflect on the vissitudes of the care sector, as a manager, consultant, author and coach to other home managers.'

I penned my original article entitled "Care Home Manager - best job in the world" 2 years ago.

These last 2 years have given me space to reflect on the vissitudes of the care sector, as a manager, consultant, author and coach to other home managers.

I thought it would be interesting to reflect on that initial glow.

CQC Inspection and how it impacts the Care Home Manager

Like comparing an engaged couple to those married, it is experience that often provides the richest insights; there are 3 main forces that have changed the care landscape from 2 years ago – the CQC regulation is far more stringent.

On some levels this is good and depending on the operator, can also mean a real sense of stress / job insecurity at others.

This is due to (in many instances) the outcome of the inspection becoming the sole criterion for a job well done by the registered manager, a myopic focus at best.

The second force is of course the financial pressure – from the minimum wage increase and where contractors for publicly funded residents refuse to accept these cost of care increases.

This brings greater financial pressure, with declining profit margins.

This means care home operators are less attractive investments, making it more difficult to refinance / raise finance at good rates.

How the Nursing shortage affects Care Homes

The third force (for nursing homes) is a chronic shortage of nurses (which this site has discussed before) which has several effects – it puts intolerable pressure on contracted nurses when a home runs mainly on agency nurses.

It massively increases costs – nursing homes need a minimum of qualified nurses at all times, otherwise the home is in breach.

This is an issue that takes some years to resolve through training more nurses.

In my view, whatever happens operationally is a reflection of the governance, staffing structures and values and culture of the leadership of the organisation.

I have written much about the importance of strong leadership at a home level- taking charge, developing teams but now I turn my focus to the design of the support structures to make care great and pay its way.

How to cope with challenges

There are 2 proactive approaches to take when the going gets tough.

One is a call to rethink some of the paradigms, to re-engineer some of our tasks, paperwork, governance.

It is a call to be better.

This is the higher view.

I know you can guess where is going!

Yes, the other call is to simply strip out cost and often reduce quality.

Some examples from other managers taking the cost reduction road are simply to delayer the organisation.

The impact of this will depend on how these layers contributed to the registered manager maintaining quality / managing risk.

Where the layers did contribute, quality may go down and risks increase.

The exceptions are where there has been a comparable investment to redefine IT, information systems to offset this loss of human capital.

Maybe it is necessary, but for those who have put our hearts into our work, it can be a SAD turn.

As for radical re-engineering, I haven’t heard of a Dyson / Stelios / Steve Jobs equivalent in care.

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Paralysis of investment in the Care Home sector

Obviously the south-east has the greatest demand for high end care homes with the relative cost of houses meaning it is more affordable.

These South East specific operators are not immune to these forces but cossetted somewhat by strong private resident demand.

I remember a former mentor of mine who used to run private hospitals, he said that as the organisation faced daunting financial pressures, it was time to move out, then come back another time, when it is more financially robust.

I didn’t fully grasp what my mentor meant. I see now that he foresaw a reduction of quality where resources are not in place to sustainably balance customer expectations, quality with staff support.

On the outside very little is changed but there will be a paralysis of investment and opportunity with risk and a possible shift to a blame based / more political culture.

It doesn’t hurt to identify the season, summer has turned to winter.

It WILL pass.

In the meantime, I have moved my attention to more integrated healthcare models which are delivering more positive resident experiences right now.

More good leadership is needed - but there are already positive stories

Regardless of these pressures, the times are a call to leadership.

Those of you who have read my articles are familiar with this call.

I make no apology for repeating myself.

It does not cost money to prioritise the resident, to focus on service, value. It does not cost to move our focus from a good inspection to instead a well-run home, which will naturally have a good inspection.

These are still many, many wonderful homes run by smart operators who pay well, treat their staff well, have a good governance model and supportive culture, even despite these storms.

Care is a wonderful place to work. Often thankless and exhausting but to touch another person, to share their life, their last few years is a treasure that cannot be bought.

I have that treasure – it changed my life.

Made my life richer, more meaningful. Like being touched by an angel, you are never the same, often with a greater humanity and respect for life.

I only wish there was a greater focus on empathy within senior management. In my view, the sector doesn’t need more skilled cost cutters or tough generals but rather more compassionate and entrepreneurial leaders.

Care Home Manager – best job in the world?

In many instances, still YES.

What now?

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About the author

  • Liam Palmer
    Registered Home Manager

Liam Palmer is the author of 2 books on raising quality standards in care homes through developing leadership skills. The 2nd is called "Leadership Secrets of Care Home Managers” inspired by several meetings with the Chief Inspector of the regulator, the CQC. Liam has been fortunate to work as a senior manager across many healthcare brands including a large private hospital, a large retirement village and medium to large care homes in the private sector and 3rd sector.

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  • Liam Palmer
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About the author

  • Liam Palmer
    Registered Home Manager

Liam Palmer is the author of 2 books on raising quality standards in care homes through developing leadership skills. The 2nd is called "Leadership Secrets of Care Home Managers” inspired by several meetings with the Chief Inspector of the regulator, the CQC. Liam has been fortunate to work as a senior manager across many healthcare brands including a large private hospital, a large retirement village and medium to large care homes in the private sector and 3rd sector.