Post No59...What are good staffing ratios in care homes?

Introduction

One question that often crops when presenting care homes is staffing, both the level of retention and the ratios of staff per resident. In this post, I will consider the latter.

Staffing ratios in care homes tend to follow a similar structure because many providers have similar dependency tracking tools, but each home / provider will have its own independent view on ratios, and indeed ratios can vary depending of care type and care need.

Ratios in Residential Care

As a ball park figure, many residential settings will run at a ratio of 1:7, that means there is one staff member to seven residents. For those readers who have younger children in a nursery setting, you may be aware that nursery’s run at about the same ratio.

The ratio in residential care is often the lowest of the different care types, because the dependency of the residents is usually lower in this setting than in others. Residents in this setting are often still independent in many daily tasks, but might need support of one carer at some stage during the day.

In a residential setting, there are often no nurses actively on the floor, meaning the team will be made up care assistants and team leaders / unit managers.

Some care providers are starting to build very high end residential only homes, and although these homes are often more expensive, they do tend to come with a higher-than-normal staffing ratio.

Residential Dementia Care

Because this care type is also residential (i.e nursing care is not being provided) then the ratio for this care type is not as dramatically different as people sometimes think. The ratio for this care type can often be found between 1:5 and 1:6, depending on the level of dependency that has been assessed by the home.

The type of care being provided in a dementia setting is of course different to a residential setting. Often residents need prompting and re-orientating, and will need support with personal care including washing and dressing, but the clinical dependency is still lower than a nursing setting.

Nursing Care

As you may expect, ratios in nursing settings are higher than any other setting in most care homes, because the needs of the residents are higher. The ratio in many nursing settings will range from 1:3 to 1:4, including a nurse.

Not included in this ratio is the position of a Clinical Lead, with many purpose-built nursing homes having a budget to support someone in this role. The Clinical Lead will add an additional oversight and management to the nursing setting, with some homes having the Clinical Lead specifically managing the nursing floor.

With that said, it is still important that the home provides the correct ratio, as the Clinical Lead is often a supernumerary role and sits outside of the required ratios for day-to-day care provision.

 Agency Staff

In the UK health care system, the need for agency staff will probably always exist. Many (if not all) care homes will need to use agency at some stage to cover sickness, the issue with agency is when the home has very little full-time staff and are relying heavily on agency to fulfil the required ratios.

However, if the home uses agency to fill gaps to achieve the required ratios, but has predominantly its own permanent staff, this does not often cause any operational concern.

Conclusion

Ratios will always be an important question that families ask, and with good reason. It is important that care homes provide the correct ratios to keep the residents safe, but also to increase staff retention and moral. If staff are forever rushed off their feet, retention and quality may reduce, so keeping this standard high is important for all involved.

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