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Staffing in Irish Nursing Homes

This article was contributed by Tim O'Connor, Consultant, BDO Simpson Xavier.

It is well documented that effective long-term care for the elderly requires specific skills provided by trained dedicated staff. However, far too often it is presumed by Irish society that these skills are present and available in abundance.

Despite the rapid growth in the Irish Nursing Home Sector in recent years, the industry as a whole is currently faced with a chronic shortage of healthcare workers. This shortage in supply has been on-going for sometime now and represents a key challenge to all operators both in guaranteeing adequate standards of care and ensuring the viability of their business as well.

This worrying trend of staff shortages is likely to worsen even further. Stimulated by an ageing population and the availability of capital allowances there has been significant development in the nursing home sector. Nursing home capacity has increased by 18.5% during the last 2 years. All these new homes need to be staffed and finding suitable staff in a tight market is a key challenge.

The threat to the industry as well as each and every nursing home operator is that these shortages exist over the entire spectrum of staffing positions. Many operators, particularly those located in more isolated areas have in recent years struggled to fill not only direct care positions, but other roles such as administration, cooking and domestic staff which are increasingly more difficult to fill on a permanent basis.

This has led to an increased reliance on non-national staff to bridge the gap between supply and demand for staffing requirements in the State. In 2005 alone, An Bord Altranais (The Nursing Board) registered over 3,000 non-national nurses from 49 countries while the Department of Enterprise,Trade and Employment issues more than 2,500 work permits to medical and nursing staff.

In the current market, the problem for many operators of providing adequate care in light of chronic shortages is that the legislation is particularly vague in providing support to operators on what are acceptable levels of staffing in nursing homes. Article 10(5)(d) of the regulations (Nursing Home [Care and Welfare] Regulations, 1993) require that a "sufficient number of competent staff are on duty at all times having regard to the number of persons maintained therein and the nature and extent of their dependency".

In light of these vague provisions, the challenge facing you as a nursing home operator is to conduct manpower planning to ensure the permanent availability of suitably qualified personnel to match the needs of your residents.

So, How Do I Effectively Plan my Manpower Needs to Ensure the Highest Levels of Care?

Our experience of working with nursing home operators has shown us that the key to effectively managing your staffing requirements is to realistically and critically evaluate the supply and demand for staff in your home and strike an efficient and sustainable balance.

Estimating the Type & Number of Staff Required

The first step for operators in addressing their manpower needs is to critically evaluate the number of each category of healthcare worker based on the particular needs of residents.While the staffing needs will vary greatly depending on the particular levels of care required, a range of guidelines on minimum staffing levels are provided by health authorities and representative associations to provide guidance.

+According to recent research conducted by the HSE Western Area and supported by the INHO, the minimum staffing requirements equates to a recommended 2.4 direct care hours per resident per day with direct care staff to resident ratio recommendations of:

  • Morning (8.00am-2.00pm): 1 staff to 8 residents.
  • Afternoon & Evening (2.00pm-8.00pm): 1 staff to 7 residents.
  • Night (8.00pm-8.00am): 1 staff to 15 residents

The INHO recommended support staff levels are:

  • Housekeeping: Minimum 6 hrs.
  • Laundry: Minimum 5 hrs.
  • Catering: Minimum of one chef and one assistant per day.
  • Maintenance: A dedicated maintenance officer.

As stressed above, these minimum standards will vary considerably depending on the particular levels of dependency and care needed in your particular home. The key steps in clearly defining your staffing needs is to breakdown the particular direct care and indirect care needs per resident daily based on particular dependency and the above guidelines. Once this analysis has been conducted, a collective weekly staffing level can be accurately established which will both facilitate the determination of how staff will be supplied and ensure maximum utilisation of staffing resources in a market characterised by staff shortages and increasing costs.

As a representative body the INHO have called for improvements in overall standards in the nursing home sector. This may result in increased staffing requirements, which can only be filled by a mixture of national and non-national staff, with the likelihood of a greater reliance being placed on non-national staff.

Attract and Retain Staff

Once the appropriate staffing requirements have clearly been determined and broken down into the specific skill-sets required and specific numbers of nursing home staff, the next key step in efficiently managing your manpower is to attract and retain key staff. Attracting and retaining the right staff is not only essential in ensuring the adequacy of care in your home but becomes even more critical in an environment which is characterised by chronic shortages.

Your responsibility as a Nursing Home operator is to create a working environment which is not only attractive to work in but also allows employees to build and develop their careers.

Some key initiatives in attracting and retaining the right staff include:

  • Developing a reputation as a good place to work.
  • Ensuring staff have the opportunities to further develop their skill-set through a range of training opportunities.

Conclusion

The Nursing Home sector has undergone significant expansion and change in recent years. However, despite this rapid growth, one of the key challenges to continued expansion and effective operation of the sector is a chronic shortage of healthcare workers. The worrying reality for many operators is that the relative legislation and provisions are unhelpfully vague and provide little guidance and support.

In light of the current market shortages and lack of legislative guidance, the key for you as a nursing home operator is to effectively strike a balance between the particular care demands of your home and the current supply of suitable healthcare workers in the market. Conducting regular manpower exercises allows you to effectively utilise your staffing resources to ensure both adequate care at all times and optimal staff efficiencies.

BDO Simpson Xavier is one of Ireland's leading advisors to growing entrepreneurial businesses. The firm has, through its consulting department, developed extensive experience in the nursing home sector, providing both operational and strategic review services. In recent times, the firm has expanded its product offering to the sector and can now provide detailed advice and assistance with regard to new funding and business models.

Should you require further information on BDO Simpson Xavier, or on how we may be able to assist you and your business, please contact Tim O'Connor: email: connor@bdosx.ie or telephone 01 4700373.

  • Providing staff with competitive wage levels when compared to national levels.
  • Providing relevant overtime schemes.
  • Ensuring adequate levels of staff are provided at all times to ensure staff resources are never stretched too thinly.
  • Providing staff with opportunities to further develop their career.
  • Providing staff with a clean and safe work environment.

While it is essential for nursing home operators to ensure efficient management of their cost base in light of the ever-increasing competitive market, it is equally important to realise the potential costs to both the level of care and operational performance of regular staff vacancies.