Scotland is facing a care home crisis as one in five homes have closed in the past decade, leaving thousands of elderly and vulnerable people without adequate care. A new report by Scottish Care, the representative body for the independent care sector, has warned that the industry is in an “incredibly difficult” position due to funding and staffing challenges, and that smaller, family-run homes in rural areas are the most at risk of closure.
Funding gap and staff shortages
The report, which was based on the annual Care Home Census for Adults in Scotland, revealed that at 31 March 2021, there were 1,069 care homes for adults and 40,632 registered places – 20% and 5% fewer, respectively, compared with 31 March 2011. The estimated percentage occupancy at 31 March 2021 was 82%, compared with 88% on 31 March 2011.
The report also showed that the number of residents in care homes for older people decreased by 10% in the same period, from 32,545 to 29,317. Most care home provision is delivered by the private sector, which saw a 5% decline in residents, while the voluntary and not for profit sector and the Local Authority/Health Board sector saw a 19% and 29% decline, respectively.
The main reasons for the decline in care home capacity and occupancy are the funding gap and the staff shortages that the sector faces. According to Scottish Care, the 6% uplift in the National Care Home Contract (NCHC) agreed with the council umbrella body Cosla for 2020/21 does not cover the increased costs of energy, food, personal protective equipment, and recruitment. The NCHC sets the fees for care home residents who are funded by local authorities.
The report also highlighted the difficulties in attracting and retaining staff, especially nurses, in the care sector. The vacancy rate for nurses in care homes for older people was 34% in 2020/21, up from 28% in 2018/19. The turnover rate for nurses was also high, at 36% in 2020/21, compared with 29% in 2018/19. The report attributed the staff challenges to the low pay, poor working conditions, and lack of career progression in the sector, as well as the impact of Brexit and the Covid-19 pandemic on the workforce.
Impact of Covid-19 pandemic
The Covid-19 pandemic has also had a devastating impact on the care home sector, both in terms of the lives lost and the disruption to the normal operations and services. The report estimated that 3,779 care home residents died with Covid-19 between March 2020 and March 2021, accounting for 47% of all Covid-19 deaths in Scotland. The report also noted that the pandemic has increased the demand for infection prevention and control measures, testing, vaccination, and digital technology in care homes, which have added to the financial and operational pressures on the sector.
The pandemic has also affected the admissions and discharges of care home residents, especially for short stay and respite care. The report showed that the number of short stay admissions declined by 20% and the number of respite admissions declined by 68% in 2020/21, compared with 2018/19. The report suggested that this may be due to the reduced availability of care home places, the reluctance of people to enter care homes during the pandemic, and the increased use of home care and community support services.
Call for urgent action and reform
Scottish Care has called for urgent action and reform to address the care home crisis and to ensure the sustainability and quality of the sector. The organisation has urged the Scottish government and local authorities to provide adequate and fair funding for care homes, to recognise and value the workforce, and to involve the sector in the decision-making and planning processes.
Scottish Care has also welcomed the Scottish government’s commitment to establish a National Care Service, which would see social care services directly overseen by the government instead of local councils. However, the organisation has expressed concerns about the potential loss of local accountability, diversity, and innovation in the sector, and has called for a co-produced and collaborative approach to designing and implementing the new service.
Karen Hedge, deputy chief executive of Scottish Care, said: “It is incredibly difficult right now, I’m having phone calls from our members in tears who are having to close what has been a family business for them for many years. What we are seeing as a result of that is the impact on the residents and their loved ones, who in some places are having to drive up to two hours to go to another care home in a different community.”
Adam Stachura, head of policy and communications at Age Scotland, said: “The care home closure figures should be setting alarm bells ringing across the country. Social care is critical to the lives of hundreds of thousands of people – it is incredibly worrying and I actually don’t understand how it will get better.”