Why are care homes not full?

Given the current state of bed blocking in the NHS it would be easy to think that some of the cause could be put down to the availability of beds in care homes. But according to a new Laing Buisson report market-defining report, Care Homes for Older People it says care home occupancy is lower than previously thought with people being turned away from services due to staffing shortages and providers not being able to cover additional costs.

The Care Homes for Older People report says care home occupancy stands at 85%, which is lower than previously thought, and calls for ways of levering “latent provision” back into use.

William Laing, report author and data director at Laing Buisson, said: “These findings call for a realignment of how we think about how future demand for care home places will be met.

“Ally this to the predictions for demand based on proximity to end of life rather than age, where we have adopted the methodology originally proposed by the Brookings Institute in the USA, and the issues the market faces are more manageable and resolvable.”

The report throws new light on care home supply and demand, reporting that net capacity rose by 900 beds in the year to March 2018, which the majority of this gain being driven by nursing homes.

Laing Buisson also highlights the contrasting fortunes of self-pay and state-pay focused providers.

William said: “Where state-pay prevails, there continues to be significant pressure on providers’ prices and margins from council and CCG commissioners, putting into question the sustainability of the model.

“Where self-pay prevails, the sector remains robust and the private pay funding model, based on liquidation of owner-occupied property value, looks likely to remain sustainable for at least the next three decades, so long as there is no collapse in property values.

“The importance of this to the market as a whole is reflected in the fees paid by ‘pure’ self-payers who account for 52% of the market by value but only 45% by volume.”

New information from CQC reports has led to a reappraisal of the impending ‘care home crisis’. Laing Buisson has collated and analysed the data from individual care home reports and these show that overall occupancy of care homes is lower than previously thought, at about 85% when measured as occupied beds as a percentage of registered beds.

William Laing, report author and Data Director at Laing Buisson said:

“If the new information is correct, and we have no reason to doubt that it is, it sheds a whole new light on the balance between demand and supply for care homes. Derived from CQC inspection reports, it shows that the aggregate numbers of residents as a percentage of registered beds are, at 85%, much lower than the widely accepted occupancy benchmark of about 90%. At the same time, there seems to be a lot more ‘latent provision’ – mothballed capacity where the care home provider has chosen not to admit residents to full capacity, for example because they don’t want to incur additional staff or other costs.

“This shifts the whole debate. Rather than looking at care home occupancy levels being close to their practical maximum, commissioners might want to look at whatever levers they have to bring the ‘latent provision’ back into use.”

It also casts a new complexion on the impact of openings and closures and, in addition, there appears to have been a reversal in recent trends in the year to March 2018. During this period, net capacity has risen by around 900 beds, with a greater part of this gain coming in registered nursing homes, allaying fears that capacity is being lost.

William Laing remarked further:

“These findings call for a realignment of how we think about how future demand for care home places will be met. Ally this to the predictions for demand based on proximity to end of life rather than age, where we have adopted the methodology originally proposed by the Brookings Institute in the USA, and the issues the market faces are more manageable and resolvable.”

Some of the reasons for lower capacity

Elderly people are being turned away from care homes with spare beds because of staff shortages, analysis suggests. Shortages are arising because managers are leaving beds, or in some cases entire floors, units or homes, empty of residents.

“The number of registered but unavailable beds is much greater than previously thought,” the research said. In some cases, it adds, managers “take a conscious decision not to admit residents to full capacity, usually for staffing reasons, either because they cannot recruit the staff or, more likely, the additional revenue from occupied beds is insufficient to justify incurring additional staffing and other costs.”


The Laing Buisson report market-defining report, Care Homes for Older People throws doubt on the assertion that care homes will struggle because they will reach their full capacity. The analysis based upon CQC information shows they are only operating at 85% capacity rather than previously thought 90%.

It is a sign of the times that some providers are choosing not to admit residents because of recruitment difficulties, or additional revenue from occupied beds is insufficient to justify incurring additional staffing and other costs.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy


MP wants cameras in care homes to be made compulsory

Conservative MP Dominic Grieve is pushing for a new law; making cameras compulsory in care homes.

The MP for Beaconsfield wants a new CCTV law to be one of the first issues debated by MPs when Parliament returns this September. He will apply for a debate in Parliament and intends to argue his case for a law that would make it a requirement for all care homes to install recording equipment.

Law will ‘protect carers; it’s not just a spy device’

“If a resident suffers an injury and you can show on CCTV how it happened, residents and relatives are going to be reassured.” Currently, there is no requirement for care providers to use monitoring in communal areas.

Mr Grieve, a former attorney general, said: “I think this is achievable and could become law. Seeing potential problems that exist in care environments, the arguments in favour are very strong.”

“We have large numbers of vulnerable people in care homes and we want to provide them with proper standards of care. Incidents of them being abused are scandalous.”

But he warned: “We are not going achieve this overnight, but it is something we should continue pressing for.”

“There is clearly growing anxiety about the risk of abuse, sometimes from other residents and sometimes staff, so all that seems to me to make it very valuable. It’s there to protect carers, it’s not just as a spy device.”

The use of CCTV in care homes has long been a topic for debate with some families of abuse victims calling for widespread use, claiming it is the only way to catch abuse or neglect.

Mr Grieve made his statements after hearing from campaign group Care Campaign for the Vulnerable.

Jayne Connery who founded Care Campaign for The Vulnerable is calling for CCTV to be installed in every care home following the experiences of her mother who has dementia. Ms Connery has been a carer for her mother since 2016.

‘There will always be areas which cameras do not see’

However, many have argued a CCTV law is not the solution to issues in care homes.

Gary FitzGerald, chief executive of Action on Elder Abuse has previously voiced concerns of “getting caught up in a debate about cameras when they are a symptom of the problem not the problem.”

He added: “I really think it is a red herring and it is deflecting us from the whole issue of quality of care. Cameras are not the solution. We have to force the Government to invest in social care.”

Caroline Abrahams, charity director at Age UK, recently said: “With all the media stories about abuse and neglect in care homes it can be tempting to see installing security cameras as ‘the answer’, but Age UK very much doubts this is the case.”

“For a start, there will always be areas which cameras do not see and we would not want there to be a false sense of reassurance about the care on offer to residents. More profoundly, care homes are that just that – people’s homes – and those living in them have rights to privacy and dignity just like everyone else.”

“Any use of cameras must therefore balance concerns about older people’s welfare with their right to dignity. Certainly, as a matter of principle we think that cameras should only be used with the informed consent of care home residents or their representatives.”

She added: “Above all, we need to raise the quality of care in care homes across the board and ensure that all older people, their families and staff are involved in how the care home is run and are able to raise any concerns.”


The Conservative MP Dominic Grieve is entitled to his opinion but would the installation of CCTV Cameras in care homes prevent abuse. At the heart of this debate is acceptance and recognition that a care home is the residents home, a place where they live with the right to their privacy and dignity.

Care services will always have to strike a balance between concerns about resident’s welfare along with their right to privacy and dignity. At the very least, residents and their families should be involved in any decision to use CCTV Cameras before their installation. The question needed to be asked; should we be focusing upon CCTV Cameras or more importantly improvement in quality of care?

If adult social care services raise the standards of quality of care, they will not only reduce incidents of abuse, but give the public more confidence in the services they provide and prevent the clamour for CCTV Cameras.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

Care homes often do not meet national standards of diabetes care

Diabetes care in nursing homes still remains “fragmented” and urgent steps need to be taken to restore the “health and dignity” of older people, leading experts have said.

A review of multiple studies carried out across 25 years involving service users with diabetes has slammed care home provision saying that care homes “often do not meet national standards” of diabetes care and staff training is “patchy”.

Lead author Professor Alan Sinclair, from the Foundation for Diabetes Research in Older People and University of Aston, said: “Our findings show the level of diabetes care remains fragmented which is quite worrying because figures suggest over a quarter of care home residents are believed to have the condition. Without proper management, it can lead to frailty, dependency, disability and reduced life expectancy.

“There is also the added strain on the NHS as frequent hospital admissions to treat diabetes-related complications are costly, not to mention unsettling for the patient.”

Declining diabetes health

Alongside Professor Sinclair, Professor Roger Gadsby, of Warwick Medical School, Dr Ahmed Abdelhafiz, from Rotherham General Hospital and Dr Mark Kennedy, from Corio Medical Clinic in Australia wanted to investigate what interventions had been introduced in a bd to improve care and what needed to be done to address the declining diabetes health of this vulnerable sector of people.

The findings also suggested that care homes often lack HbA1c monitoring, diabetes self-management programmes, regular exercise activities and most staff have very little knowledge of hypoglycaemia treatment.

Jenny Hirst, the co-chair of the Independent Diabetes Trust (IDDT), said: “It is thought around 27 per cent of residents in care homes have diabetes. With a growing number of older people developing the condition, the need is ever more pressing to ensure there is a good standard of care for this group of vulnerable people who have complex needs.

“Older people, particularly those with diabetes, are more likely to be admitted to hospital when they are unwell. This is because diabetes can have an additional effect on the illness and the illness can impact on their diabetes.

There is a need for much better training and support so that care homes are able to support people living with diabetes

Professor Martin Green OBE, chief executive of Care England

“However, this can be often be avoided if care home staff are trained properly in how to treat diabetes, checking blood sugar levels, identifying when a person is suffering from high or low blood sugar levels and taking the necessary action, quickly and also encouraging light exercise activities.”

To help counteract these problems, the researchers have made a series of recommendations for care home staff, health professionals, diabetes organisations and policy makers to undertake constituting a ‘Call for Action’.

Professor Martin Green OBE, chief executive of Care England, said: “There is a need for much better training and support so that care homes are able to support people living with diabetes. There needs to be a training programme put in place by Health Education England, much better access to primary care services and regular and proactive monitoring of residents so that they are able to live well with their condition.

“Currently, the NHS is poor at supporting care homes and we need them to understand the residents of care homes are part of the community and should be enabled to have all the resources that would be available to people living in their own homes.”

Professor Sinclair said: “We want to see older people with diabetes who are in care home settings being given greater prominence by healthcare professionals. In addition to this, we want more focus to be given to defending the rights, health and dignity of care home residents with diabetes.

“More training for staff, introducing better interventions and encouraging a change in attitude is all going to contribute towards improved health outcomes for those with diabetes.

“Furthermore, we want international health organisations to include diabetes in care homes within their policies and guidelines. This will ensure global collaboration at a high level of influence and pave the way for an International Best Practice statement in this area.”


This review of multiple studies carried out across 25 years involving service users with diabetes highlights the continual decline in provision to address the growing problem of service users with diabetes in care homes. A solution to the problem of diabetes will not be solved by care homes alone. They will need the support of NHS and Health Education England to ensure sufficient resources are made available and staff are properly trained.

The findings of the review, entitled Failing to meet the needs of generations of care home residents with diabetes: a review of the literature and a call for action, has been published recently in the Diabetic Medicine journal.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy


A new guide for care home staff- Is my resident well?

Care home staff are being encouraged to think ‘Is my resident well?’ as part of  a new training programme to help spot the early warning signs of those they care for becoming unwell.

Most of us know that there are simple things we do everyday to look after ourselves; making sure we eat, drink plenty of fluids and taking care of our physical needs. When something isn’t quite right, we take steps to prevent it getting worse or seek medical advice.

Some people however, rely on others to ensure their basic needs are looked after and may themselves not always notice the small warning signs that they may becoming unwell.

This can often be the case for care home residents, who need extra help and support to stay well and recognise when things are not right. Within adult social care, this role is largely carried out by medically untrained care workers.

A new guide called ‘Is my resident well?’ and associated training programme is being rolled out to care homes across North West London to support these care workers.

Content of the guide

The guide contains 10 questions for carers to think about whilst providing every day care, like washing and dressing.

The 10 questions go through simple steps to check;

  • Breathing
  • Bowel habits
  • Hydration
  • Pain
  • Confusion
  • Wellbeing
  • Skin health (specifically looking out for the early signs of pressure sores).

In addition, care staff are asked to consider other things including:

  • Sepsis (infection of the blood)
  • Falls
  • Care Plans
  • Last year of life

The guide trains staff to use a simple traffic light system Red, amber and green to help staff to identify any concerns they may have and what they should do if they are concerned.

Dr Asha Katwa GP and clinical lead for the guide and training, explained: “This pocket guide is designed to provide a simple method for care workers to assess their residents.

By repeating the 10 questions during everyday interactions with the people they care for, it is hoped that care workers will be more confident in recognising some early warning signs of deterioration and be empowered to know what to do, and to get the right help when needed.”

The guide provides practical advice on what to do if someone shows signs of being unwell or deterioration and how to escalate to get the right help. It includes guidance on what to do if resident falls or is suspected of having sepsis (serious infection).

The guide also provides practical information about how to prepare to call an NHS service when requesting medical help.

“This may sound simple,” said Dr Katwa, “But, in order to get the best help and advice when calling a GP, 111 or 999, care workers need to provide as much information about the resident as possible. Their role is vital in helping health care professionals provide the right support and advice so that decisions for their residents are made in accordance with any known wishes and care plans. In doing so, this training aims to encourage care workers to act as advocates for the residents they care for, particularly if the resident cannot communicate their needs”.

Across NW London 40 clinical staff are being trained during June on how to use the guide and provided with a training programme to go on and train care home staff and carers. The aim is to have 40 percent of care homes in NW London using the guide by the end of 2018/19.


I was impressed by the simplicity of the Is my resident well guide. It is colorful, practical and easy to follow. Given the workload of staff in adult social care services time for staff training is at a premium. It would seem because of the simplicity of the guide that it would not take a great deal of training time.

The guide would provide considerable benefits to staff, carers and service users. It would encourage staff to become more aware of the health and wellbeing of service users and alert staff to the changing needs of people in their care.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

For more information visit: www.healthiernorthwestlondon.nhs.uk

Extending the range of social activities in care homes

Although older people in care homes are offered opportunities during their day to participate in meaningful activity that promotes their health and mental wellbeing, staff are always on the lookout for new and interesting activities to engage service users. This week’s blog article brings together two new activities which readers may find of interest.

It has long been known that activity helps to sustain both physical and mental health, so it is important that older people living in care homes are able to maintain interests and have opportunities to develop new ones.

The challenges of providing good care for older people with complex needs in care home settings, as well as the culture of the care home, can result in staff prioritising practical tasks above supporting people to take part in meaningful activities. Risk management can also be an issue, with staff not feeling empowered to support people if there is an element of risk involved in activities.

Even when taking these important issues into consideration care homes can still greatly improve levels of activity for the people living there by ensuring that they have opportunities throughout the day to take part in the daily life of the home. To achieve this, staff need to know that engaging with people living in the home and encouraging activity is central to their caring role. SCIE’s film Excellence in residential settings – older people demonstrates the success of this approach in a care home. Meaningful activity can include routine personal care tasks, such as getting dressed and brushing teeth. If older people are encouraged to carry out these tasks for themselves, rather than have others do them on their behalf, it will contribute to their sense of wellbeing.

Pen pal scheme

A new initiative aiming to be the UK’s biggest pen pal scheme is to partner nursery and primary school children with care home service users of the same name.

The initiative, dubbed ‘Letters from a Namesake’, aims to bring together two different generations to share experiences and life stories.

Launched by the nations’ biggest supplier of name tags and labels for schools and care homes, My Nametags, the educational scheme aims to help develop children’s letter writing skills, while tackling loneliness among care home residents.

My Nametags are appealing for care homes in all parts of the UK to come forward and sign up if they are interested in taking part.

Lars B Andersen, Managing Director at My Nametags, said: “The way the scheme will work is we will match people and children with the same names.

“For example, a ‘Mary’ from a local nursery will be given the opportunity to write to ‘Mary’ in a residential care home and vice versa.

“No personal details will be shared as all the letters, pictures and drawings will be sent to us and passed on directly. We’re excited to be launching the scheme, and hope that it will help the local community enormously by bringing these two very different generations together.”

Care homes wishing to take part can register their interest by contacting Mynametags@energypr.co.uk or calling 01993 823 011.

Tailoring social activities to people’s choice and preferences

Organised activities contribute to the sense of community in a care home, but they aren’t for everyone. Some people prefer activities that they can pursue on their own, such as reading or listening to the radio. Other people prefer group activities, but a group activity that is enjoyable and meaningful to one person may be of no interest to another. People need a range of activities to choose from and support to maintain existing interests. The College of Occupational Therapy’s Living well through activity in care homes toolkit has plenty of ideas for building meaningful activity into the daily life of a care home and Staying involved and active from the Alzheimer’s Society provides tips on how to involve people with dementia in activities.


The importance of social activities to service users in care homes as a means of sustaining physical and mental health is well documented. Staff are always searching for new social activities. SCIE’s film Excellence in residential settings – older people, the My Nametags, educational pen pal scheme and The College of Occupational Therapy’s Living well through activity in care homes toolkit may well help to extend the range of social activities available in care homes. It must always be remembered that service user choice and preference are strong motivators towards engaging service users in social activities.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy