Care Home Crisis

Article in the Inverness Courier, 7th May 2023

The care sector, especially in the Highlands, is in crisis. It's facing the same combination of extreme cost increases as hospitality, however its situation is far worse.

Food costs are up almost 20% since Russia invaded Ukraine; dairy products, olive oil, flour, grain, chicken and eggs far more. Energy costs are down from the depths of winter but are still three times more than two years ago, and care homes need to be warm. Their biggest cost is staff. You need several staff member for each resident. Staff availability and their costs are major issues making things difficult right now.

The type of people who work in the care sector are kind and caring. They are not in this career for the money, and better pay for fewer hours and less demanding work can be found in most cafés or hotels. Understandably, few Scottish young people choose to go into this area, and won’t do so until the sector gives them a chance for better pay. Prior to Brexit, we relied on foreign workers coming to Britain, where they could earn more than home. Now the pay gap isn’t worth the effort to bother getting a visa, which we aren’t giving out anyway.

This piece is about care homes rather than caring at home, another worrying subject for a different time.

There exists a thriving agency market, which provides staff to the care homes at a much higher rate. Staff resign, then get placed back at the same care home for a lot more money. Frankly speaking, if most of us were offered our current jobs at a lot more money, we’d take the offer. The lack of affordable housing compounds the problem. Both salaried and agency staff need accommodation. In coastal areas especially, there is just nothing available. Total staff costs for care homes, including accommodation costs for agency staff, has doubled in the last five years.

Twice as many people die in the Western Isles each year than babies are born. The situation in the rural highlands will nearly mirror that - we have a surge of baby boomers born in the 1950s who will be needing to move into care homes over the next decade. It is essential our older family members are in care homes close to their families and communities, and not shipped 100 miles away ‘to an available bed’.

The majority of available beds in the Highlands are within privately owned care homes, often quite small and many dated. Although a care home costs c.£50,000 per resident per year, many, perhaps most care homes are not making money and cannot afford to upgrade the properties. This leads us onto an impending issue.

The Care Inspectorate is the national scrutiny body for the sector. A recent ‘Positioning Statement’ from the Inspectorate sets out basic requirements for a care home to be officially registered or sold. It seems certain these requirements will be needed for all care homes in due course. On the face of it, the requirements seem sensible - an ensuite bedroom of a certain size, a sprinkler system, large communal rooms, a garden etc. The document also suggests a care home for 60 residents is the optimum number. However, while this number might make sense in the Central Belt, in the rural Highlands, many care homes simply won’t have this many residents. What are they to do?

As with much Scottish Government legislation, implications have not been thought through, and a way to comply for those impacted is not clear. A care home in Ullapool, Portree or Fort William might be a property that’s 30 years old with 25 residents. The bedrooms are small. Some residents share a room. Not all adjoining bathrooms have a shower. Staff often understandably quit as they can get more money elsewhere, or can’t get anywhere to live nearby.

Many independent care homes are looking at the above list and wishing to sell. If they do, the buyer will have to find alternative accommodation for the residents, as they carry out a £2 million complete restructure of the building to comply. Again, this might just be feasible in Glasgow or Edinburgh, but it's just not going to happen in Caol or Aultbea. The care home will simply close and the problem will be left with NHS Highland and Highland Council.

Already care homes are full, and hospital bed blocking is an issue, with knock on effects on hospital waiting lists.

The only solution is for the Scottish Government to build new 60 bed builds across the Highlands, with accommodation for staff on site. We also need to see massive uplifts in pay for our hardworking care staff. The National Care contract pays care homes £830 per person per week. It needs to be £1,200 to be both economically viable and allow care homes to pay the wages our care workers deserve.

We have seen a trickle of care homes close over the last few years. If inaction, we will soon start to see a massive shortage of capacity.

Angus MacDonald
Highlands Liberal Democrat Councillor and Westminster Candidate