How Financial Cutbacks Affect the Quality of Jobs and Care for the Elderly

Abstract

Based on case studies in 12 nursing homes in the United Kingdom, the authors illustrate how financial cutbacks affect job quality and the quality of care. The dimensions of job quality that suffered most were those directly related to the ability of workers to provide care: reductions in staffing, longer working hours, and work intensification. Cuts to labor costs eroded the quality of workers' jobs in all 12 homes but with two differential outcomes: in seven homes, care quality was maintained, and in five homes, it deteriorated. Care quality was maintained in homes where a patient-centered care approach and remaining job quality allowed workers to develop work-arounds to protect residents from spillover effects. Care quality declined in homes where custodial approaches to care and low job quality did not provide workers the time or resources to protect residents or to maintain prior levels of care. A tipping point was reached, leading to a spillover into impoverished care. W orries about the quality of residential elder care are a global concern (OECD 2013). As the number of residents in nursing homes 1 has increased dramatically in recent decades-and will double in the next 40 years (European Commission 2008)-a key challenge is the provision of

Handovers in care homes for older people – their type, timing and usefulness. Findings from a scoping review

“…A blog written for care providers and retrieved for this review (Quality Compliance Systems 2012) referred to Canadian research on handovers but the references it cited appeared to concern handovers in hospitals. With two exceptions (Haines and Davey 2011; Lyhne et al 2012), handovers were generally described in the context of wider systems for information exchange (Gaskin et al 2012; Munyisia, Yu and Hailey 2011; Tariq, Georgiou and Westbrook 2013) or in terms of their role within the routines that exist in care homes (Bennett et al 2015; Bland 2007; Burns, Hyde and Killett 2016; Luff et al 2011).…”

“…Financial constraints, as well as status, could also influence who attended handovers. Burns, Hyde and Killett (2016: 1003) contrasted one home in which all staff were involved in handovers with another where cutbacks in fees paid by the local council led to a decision not to pay care workers to attend handovers. It was not clear from this account whether this decision also applied to other grades of staff, such as senior care workers or shift leaders.…”

“…By comparison, care workers in the other home were reliant on the information passed on to them by the senior staff on duty. The care workers themselves did not consider this to be adequate and developed their own informal handover by ‘huddling together to share information and to discuss which parts of the workload each would do’ (Burns, Hyde and Killett 2016: 1004). The absence of care workers during handover meant that opportunities to use handovers for training or supervision were also missed.…”

“…Staffing levels are currently under pressure in many care homes in England. This is a long-standing problem (Hussein, Ismail and Manthorpe 2016) worsened by evidence that the 2008 economic crisis has resulted in cuts in staff to resident ratios, in the ratio of qualified to unqualified staff, and to reductions in pay, all of which can contribute to diminished handover procedures in some homes (Burns, Hyde and Killett 2016). Care home owners have specifically warned about the consequences of the introduction of the National Living Wage, which specifies the minimum pay per hour most workers are entitled to by law.…”

Provision and perceived quality of mental health services for older care home residents in England: a national survey

“…Since fieldwork completed, reports suggested that implementation of the National Dementia Strategy (Department of Health, ) was hindered by financial constraints (All‐Party Parliamentary Group on Dementia, ). Furthermore, recent media reports raise concern that care homes may have been particularly affected (Ruddick, ), which is tentatively supported by early evidence linking local authority funding cuts with reduced care home quality in some instances (Burns et al ., ).…”