The last 12 months have been crazy, extraordinary, unprecedented…I’m not finding the right word (good start Chris), so you decide what the pandemic has been like for you.
It’s like being in the eye of a tornado. In the eye all is calm but the tornado moves and you’re caught up in its chaos and hit from all sides. Eventually you make it back into the eye and relative calm. And then it moves again.
And of course, the chaos isn’t over. We have the Indian variant here and cases are starting to rise again.
One thing has been consistent throughout this pandemic chaos and even before it – the government’s complete lack of support for the care sector.
- We’ve had confirmation of what we’ve always known – the NHS was sending patients, with Covid-19 into care homes.
- The government sets out new guidelines almost weekly with no regard for the impact on your care home. The latest being how many visitors can visit your care home.
- New fee contracts will almost certainly result in further financial hardships for those who sign up to them and result in more care home closures.
- And there was nothing in the Queen’s Speech earlier this month about helping the care sector.
This lack of support goes way back over years, but this last 12 months has really highlighted just how little the care sector is supported.
So, I need to ask you – and maybe you need to ask yourself – when do you say, “Enough is enough.”?
When will you stop doing what the government and local councils want you to do and do what your care home needs you to do?
The government consistently does you no favours and care providers consistently take it?
- Care Homes have been decimated because they took NHS patients in who hadn’t been tested for Covid.
- Care providers try to meet guidelines as if they are law and put even more pressure on themselves.
- New contracts from your LAs and CCGs amount to you needing to deliver more care for less money.
When will you say, “enough is enough”? When will you realise that the government isn’t going to change legislation so that it works for you and definitely isn’t going to set fees that pays you to deliver quality care, employ and train enough staff and return the profit that your business needs.
Only you can do that. Only you can decide what your care home needs so it can deliver the best of care and remain sustainable.
Once you decide enough is enough and decide that your customers (because that is what the government, your local councils and CCGs are) are no longer going to have this power over you then you can shake off the shackles and take control of your care home business.
If the NHS wants you to take patients they haven’t tested or that you aren’t prepared for, then just say no.
If relatives want to visit in a volume that you can’t safely manage, then just say no. (I know that CQC are coming down hard on care homes that haven’t opened up for visitors but if you can demonstrate that you can’t safely manage the number of visitors the government want you to let in but that you do let in what you can manage, then you have a strong case to argue.)
If LAs and CCGs want you to sign up to contracts that will financially hurt your business, just say no. We haven’t and we still take new clients from Las and CCGs for fees that we set.
You don’t work for the government – you run a privately-owned care home business – so do what’s best for your business. [Click to Tweet]
You do need to meet legal requirements and you hopefully aim to deliver standards of care that will give you a ‘Good’ CQC rating. But you don’t have to do what the government guidelines want you to do, and you definitely don’t have to sign up to contracts or accept bed fees that are too low.
(Remember when councils used to run their own care homes? They all closed because they couldn’t even sustain them when they paid themselves £1000 a week per bed. They moved their residents to private homes and offered them around £450 a week.)
The point is that time and time again the government has shown that it has no intention of helping the care sector. It has no intention of increasing their spend in the sector. It has no intention of helping you to provide great care without struggling to maintain a financially healthy business.
So, you can either continue to try and meet their guidelines, accept their awful contracts and low fees and hope that things will change. “The definition of insanity is doing the same thing over and over again and expecting different results.” (A phrase wrongly attributed to Einstein and Benjamin Franklin.)
Or you can decide that enough really is enough and that you are going to take back control and do what is right for your care home.
It’s time for you to decide that:
- You are going to set the fees you need.
- You will take as many visitors that you can safely handle and not as many as the government say you should take.
- You are in charge of your care home, not the government or local councils.
- Enough is enough and it’s time to take back control.
So, how do you take back control?
First, identify where you aren’t in control of your care home business.
For example, if you did things that in hindsight you wish you hadn’t then ask yourself why.
Why do/did you…
- Automatically try to do what the government guidelines want you to do, no matter how difficult that may be?
- Take patients from the NHS who hadn’t been tested if it resulted in the tragic death of a number of your residents?
- Accept fees or sign up to contracts that will financially harm your care home?
These are examples of outside pressure that you don’t have to succumb to.
But this kind of outside pressure could point to a lack of control from within.
Know your numbers.
For example, do you accept low fees or sign up to these damaging contracts or bid low online to win clients because you don’t have a firm grip of your numbers? [Click to Tweet]
Do you know:
- What your running costs are and hence what your weekly breakeven point is?
- How much care each resident can receive as part of your weekly running costs?
- Your care and nurse average hourly rates so that you can accurately calculate the true cost of care?
- What fee you need so you can deliver the care a person needs and keep your care home financially healthy?
- How much an empty bed costs you so that you can make an informed decision about what fee level you can afford to hold out for and not panic and accept a low fee just because you feel you need to fill the bed.
Knowing your numbers is crucial if you are going to make sound, strategic decisions and avoid being pressured to make decisions that could harm your care home.
Knowing your business like this will also give you the confidence to push back and challenge when pressured to do something – like open your doors to too many visitors.
On that subject, I did a quick calculation using the Coronavirus Cost Calculator for a fully occupied 50-bed nursing home based on face-to-face visits lasting 30 minutes.
Worst-case, across a week, 50 residents equals 100 visitors a day (2 separate visits per resident over the course of one day), which means 700 visitors a week.
One carer will be needed to escort each visitor to and from the resident and stay with them to ensure contact rules are not broken. The area will need to then be cleaned after the visit. (For this cost exercise, whether it’s the carer or a domestic doing the cleaning, I’ve simply added the time for cleaning and kept the same hourly rate.)
Let’s say total time for visit is 1 hour. That’s 700 hours a week of the equivalent of 1:1 care.
Using the national living wage of £8.91 plus employer on-cost of 25% (a real cost you must add) you have an hourly rate of £11.14.
This worst-case (but realistic) scenario would cost this care home £7,798 a week just to cover these visits.
These are the costs and time that the government don’t think about, and don’t really care to think about, but they are the kinds of costs that you as care providers must think about and include in your running costs and hence in your fees if you want to remain financially viable.
I assume you’re very confident when it comes to care delivery and that you are able to make the right decisions. That’s because you know care – you’ve been delivering care for long enough may have a medical background.
When you know your numbers – when you have that financial knowledge and awareness of what your fees need to be and how to manage your costs – you can build that same confidence and make the right decisions.
Too many businesses fail because they are too reactive and not strategic. Basically, being strategic means deciding where you want to get to, figuring out the best route to take and then keeping on course to get there. It’s about replacing hope and luck with as much certainty and control as possible.
We’re going to cover this more in coming blog posts. But for now, here are 4 articles worth reading.
Change your mindset.
Taking back control starts with you. You need to decide that from today you will do what is right for your care home, your residents and your staff.
It is your care home, not the government’s or the council’s – yours. Only you can make sure that your care home delivers the care your residents need whilst keeping it financially healthy.
You need to be that strategic leader.
And you will only do that by always remembering that you don’t have to do what they want you to do unless they make it law. You don’t have to accept low fees or let in more visitors than you can handle.
Please don’t wait any longer for the government to do the right thing – they aren’t going to. Instead, say enough is enough, shake off those shackles and take control of your care home business.
About your numbers – this is the most important part of your business. It’s vital that you know your numbers because unless you earn 30%+ profit margins, then these (and other) cost increases will hurt you financially. And what hurts you financially ultimately impacts the care you can deliver.
Your local authorities expect you to be happy with no more than 10% profit margin. If you accept their fees you won’t even make that. The best you can hope for is to break even.
Not least because you have suffered an extra unexpected cost in the last 12 months with the pandemic. I calculated that the pandemic has cost care homes at least 10% of their revenue.
Know your numbers. Keep your care home business financially healthy. Deliver quality care.