The Association between Staff Retention and English Care Home Quality

Allan, Stephen; Vadean, Florin

doi:10.1080/08959420.2020.1851349

Cited by 38 publications

(34 citation statements)

References 43 publications

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“…136 However, there is only a small amount of evidence for England as to the effects that staff and their employment conditions have on the quality of care homes. 148,149 This study sought to assess whether or not employment conditions and care home-level staffing factors have an impact on the quality of English care homes using a large, national data set of homes for the years 2016 to 2018. The study utilised appropriate statistical methods, including use of longitudinal data to tackle omitted variables and addressing both missing data and the potentially endogenous relationship between wages and care home quality.…”

Section: Discussionmentioning

confidence: 99%

“…141,146,147 Much of this literature is US based and focuses on clinical markers of quality or other process measures, not on final outcomes or quality of life. Previous analyses of care homes in England found that quality had a significant positive relationship with staff retention and a significant negative relationship with job vacancies 148 and that a lack of staff could lead to closure. 149 However, there is very little statistical evidence in England linking wages and training levels to care quality outcomes.…”

Section: Staff and Quality Of Carementioning

confidence: 95%

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Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study

Towers

Smith

Allan

et al. 2021

Health Serv Deliv Res

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Background Care home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 (Great Britain. The Care Act 2014. London: The Stationery Office; 2014) requires services to improve ‘well-being’, but many residents cannot self-report and are at risk of exclusion from giving their views. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is currently no equivalent way of measuring aspects of residents’ health-related quality of life. We developed new tools for measuring pain, anxiety and depression using a mixed-methods approach. We also explored the relationship between care home quality, residents’ outcomes, and the skill mix and employment conditions of the workforce who support them. Objectives The objectives were to develop and test measures of pain, anxiety and depression for residents unable to self-report; to assess the extent to which regulator quality ratings reflect residents’ care-related quality of life; and to assess the relationship between aspects of the staffing of care homes and the quality of care homes. Design This was a mixed-methods study. Setting The setting was care homes for older adults in England. Participants Care home residents participated. Results Three measures of pain, anxiety and low mood were developed and tested, using a mixed-methods approach, with 182 care home residents in 20 care homes (nursing and residential). Psychometric testing found that the measures had good construct validity. The mixed-methods approach was both feasible and necessary with this population, as the majority of residents could not self-report. Using a combined data set (n = 475 residents in 54 homes) from this study and the Measuring Outcomes in Care Homes study (Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents’ quality of life in England. Health Qual Life Outcomes 2019;17:22) we found a significant positive association between residents’ social care-related quality of life and regulator (i.e. Care Quality Commission) quality ratings. Multivariate regression revealed that homes rated ‘good/outstanding’ are associated with a 12% improvement in mean current social care-related quality of life among residents who have higher levels of dependency. Secondary data analysis of a large, national sample of care homes over time assessed the impact of staffing and employment conditions on Care Quality Commission quality ratings. Higher wages and a higher prevalence of training in both dementia and dignity-/person-centred care were positively associated with care quality, whereas high staff turnover and job vacancy rates had a significant negative association. A 10% increase in the average care worker wage increased the likelihood of a ‘good/outstanding’ rating by 7%. Limitations No care homes rated as inadequate were recruited to the study. Conclusions The most dependent residents gain the most from homes rated ‘good/outstanding’. However, measuring the needs and outcomes of these residents is challenging, as many cannot self-report. A mixed-methods approach can reduce methodological exclusion and an over-reliance on proxies. Improving working conditions and reducing staff turnover may be associated with better outcomes for residents. Future work Further work is required to explore the relationship between pain, anxiety and low mood and other indicators of care homes quality and to examine the relationship between wages, training and social care outcomes. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 19. See the NIHR Journals Library website for further project information.

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Section: Discussionmentioning

confidence: 99%

Section: Staff and Quality Of Carementioning

confidence: 95%

Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study

Towers

Smith

Allan

et al. 2021

Health Serv Deliv Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…The majority of social care workers are female (80 per cent), with a mean age of about 43, having a low level of formal qualifications, and a growing number are migrants (Gardiner and Hussein 2015). However, despite the increase in employment, care providers are reporting high turnover (27 per cent) and vacancy rates (7 per cent), providing an important challenge to the provision of good quality services (Allan and Vadean 2020; Skills for Care 2016b).…”

Section: The Long‐term Care Workforcementioning

confidence: 99%

“…Therefore, care providers lacked the flexibility of passing cost increases on to charged fees, and changes to minimum wage legislation were expected to have a noticeable impact on the sector. The main concerns were that the increase in minimum wage will have a negative effect on employment, wage distribution, wage differentials, promotion prospects, employment conditions, quality of care, market sustainability, and/or noncompliance with minimum wage regulation (Allan and Vadean 2020; Gardiner 2015a,b; Gardiner, Hussein 2015; Low Pay Commission 2016).…”

Section: Introductionmentioning

confidence: 99%

The Effects of Minimum Wage Policy on the Long‐Term Care Sector in England

Vadean

Allan

2020

Brit J Industrial Rel

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The increase in the National Minimum Wage rate in October 2015 and the introduction of the National Living Wage in April 2016 led, in a short period of time, to an aggregated increase in the wage floor of over 10 per cent for workers in England aged 25 and over. The long-term care (LTC) sector is a labour intensive, low pay sector, and as such, can be substantially affected by changes in minimum wage. We assessed the effects of this exogenous wage increase on independent LTC providers by looking at effects on wages, employment, weekly hours, and employment contracts. Using data from the Adult Social Care Workforce Data Set (ASC-WDS) and applying a 'before-after' analysis, we found that the substantial increase in minimum wage had a strong and positive effect on wages in the LTC sector, but with substantial compression of the wage distribution at the lower end. Although, as in other studies, the employment effect was rather elusive, we found that for care homes this can be partially explained by a negative effect on total weekly hours. We also found positive but short-term effects on employment without guaranteed working hours (i.e. zero-hour contracts) for both residential and domiciliary care.

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“…However, alongside the complex needs of residents, the care home sector is characterised by high workloads, high rates of staff turnover, and difficulty in recruiting and retaining competent staff [ 1 , 13 ]. These issues challenge efforts to introduce and embed quality improvement (QI) and positive safety practices within care home organisational culture [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Providing Staff Training and Enhanced Support to Care Homes on Care Processes, Safety Climate and Avoidable Harms: Evaluation of a Care Home Quality Improvement Programme in England

Damery

Flanagan

Jones

et al. 2021

IJERPH

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Older people living in care homes are at risk from avoidable harms, which may require hospital attendance or admission. This paper describes a mixed methods evaluation of a large quality improvement (QI) programme that provides skills training and facilitated support to staff in 29 care homes across two localities in the West Midlands, UK. The Safety Attitudes Questionnaire (SAQ) is used to assess changes to care home safety climate between baseline and programme end at 24 months. We use routinely collected data to assess pre- and post-programme avoidable harms and hospital attendance/admission rates. Semi-structured interviews with programme managers (n = 18), and staff (n = 49) in four case study homes are also used to assess perspectives on programme implementation. Our results show that safety climate scores increase by 1.4 points. There are significant reductions in falls (p = 0.0006), severe pressure ulcers (p = 0.014), UTIs (p = 0.001) and ‘any’ events (p = 0.0003). Emergency hospital attendances reduced, but admissions increased. Interview participants report improvements to teamwork, working practices, information sharing, knowledge and skills. Upskilling care home staff can improve working practices and attitudes towards resident safety and care quality, which may be associated with significant reductions in avoidable harms rates. Care staff turnover rates are high, which may impact the potential for longer-term sustainability of the changes observed.

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The Association between Staff Retention and English Care Home Quality

Abstract: The version in the Kent Academic Repository may differ from the final published version. Users are advised to check http://kar.kent.ac.uk for the status of the paper. Users should always cite the published version of record.

Cited by 38 publications

References 43 publications

Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study

Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study

The Effects of Minimum Wage Policy on the Long‐Term Care Sector in England

The Effect of Providing Staff Training and Enhanced Support to Care Homes on Care Processes, Safety Climate and Avoidable Harms: Evaluation of a Care Home Quality Improvement Programme in England

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