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Staffing is key to good long term care

Residents of private nursing homes are at risk from falling standards of care as a result of inadequate regulation of the nursing home industry, according to researchers.

During a period of enormous growth in private long term care, quality assurance mechanisms have not kept pace. While the number of nursing home beds in England has increased sevenfold since the mid-1980s, the number of inspectors has risen only threefold.

Writing in the British Medical Journal, Susan Kerrison and Allyson Pollock argue that new legislation governing long term care, which comes into force next year, does not provide adequate safeguards for residents.

At present health authorities have responsibility for registering and inspecting nursing homes. Local authorities have similar responsibilities for residential care homes. Next year the distinction between the two will disappear and both will come under the National Care Standards Commission in England, the National Assembly for Wales, and the Scottish Commission for the Regulation of Care.

Although the regulators will have the power to fine or close homes which fall short of accepted standards, there is concern that the inspectorate will lack the resources to do the job properly.

Staffing levels are the key factor in maintaining good quality care, say the researchers. ‘Research in the United States and Australia has shown that having low numbers of staff is associated with poor quality care.’

But they are worried that this is not on the regulators’ agenda: ‘Despite the industry’s poor record...the national minimum standards for care homes for older people in England have set no minimum requirements for the number of staff.’

Kerrison SH, Pollock AM. Caring for older people in the private sector in England. BMJ 2001;323:566-9