Smart decisions. Lasting value. Workforce Review of the Irish Nursing Home Sector Shane McQuillan - Partner Sam Kendlin Senior Consultant 14 November 2019 Workforce Review Nursing Home Sector Workforce Review Crowe 2019 Terms of Reference Analysis of the current workforce in Irish nursing homes Employer of choice, training and upskilling Future recruitment needs of sector, and access to workforce Intended to be a resource for NHI and its members to inform policy, advocacy and approach to workforce planning 3 Survey of Nursing Home Providers Agreed with NHI that we would sample 75 nursing homes through a combination of online survey and telephone interview The 75 nursing homes selected provided a representative sample in terms of size, geography and ownership (independent homes and groups) The Survey: Contained a mixture of qualitative and quantitative questions Collected data in relation to the sectors existing workforce and anticipated demands Gathered key workforce data, as well as insights from providers in relation to key issues such as recruitment and retention Crowe 2019
4 PROFILE OF SURVEY RESPONDENTS 10 nursing homes completed our initial online survey, with telephone interviews conducted with a further 65 homes. 75 nursing homes engaged with the survey in total. Significant variety in homes, with respondents representing small and large homes (>65 beds), as well as both groups and single site operators Engaged with nursing homes across 21 counties, ensuring survey responses were representative of the wider Irish nursing home sector Crowe 2019 5 Survey Findings Staff Profile Discrepancies across home categories Staff Headcounts and WTEs Actual Headcount Nursing staff HCAs Other staff Minimum 5
14 1 Maximum 43 103 56 Median 12 34 18 Average 15.6 38.8 18.1 Rural homes and small homes have smaller average headcounts for all types of staff. There did not appear to be a large difference between group and single homes. The HCAs to nursing staff ratio was generally even across most categories however, rural homes tended to have a higher ratio than urban homes. WTE Ratio of HCAs : Nursing Staff Actual WTEs Nursing staff HCAs Other staff Minimum 4
8.7 0.5 Maximum 42 90 38 Median 14 29 13.5 Average 13.2 31.7 14.1 Crowe 2019 Dublin Urban Suburban Rural Large Small Group Single Site Overall 2.6 / 1 3.2 / 1 2.6 / 1 3.4 / 1 2.7 / 1 3.3 / 1 3.2 / 1 2.9 / 1 3.1
7 Staff Remuneration Salaries are typically 10.6% higher in Dublin-based homes when compared with rural homes Salaries in group and single site homes were virtually the same (group salaries 0.15% higher) Staff Remuneration PIC/DONs CNMs Staff nurses HCAs Other Staff Minimum 50,000 31,616 28,000 18,600 18,350
Maximum 100,000 81,000 57,000 32,520 38,000 98% Median 76,000 50,000 42,000 23,000 26,000 98% Average 76,136 51,242 41,510 24,138 26,022 Salaries are typically 13% higher in large homes when compared with smaller homes (<65 beds) Do salaries include bonus payments? Nursing staff 13% 87%
HCAs HCAs; 2% OtherOther staff staff; 2% 0% 10% 20% 30% 40% 50% Crowe 2019 Yes No 60% 70% 80% 90% 100% 8 Staff Remuneration Have salaries changed, on average, in the past two years? Do you anticipate salaries changing in the next two years? PICs/DONs CNMs Staff nurses HCAs Other staff PICs/DONs 88%
CNMs 92% Staff nurses 96% 95% 96% 97% 99% HCAs 100% Other staff 100% 95% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100% Salary increased in past two years Salary reduced in past two years Crowe 2019 No change in past two years Foresee salary increasing in next two years No change in next two years Foresee salary reducing in next two years 9 Remuneration and Benefits Benefits provided to Nursing Staff Benefits provided to HCAs and Other Staff Other non-pay-related benefits Other non-pay-related benefits (e.g. free parking, uniforms supplied, etc.) Educational support
0% Crowe 2019 20% Staff nurses 40% CNMs 60% PICs/ DONs 80% 100% 0% 20% 40% 60% 80% 100% Other staff HCAs 10 Staff Recruitment Preferred Recruitment Methods Outlook for Recruitment and Retention Most Effective Method of Recruitment How do you regard the outlook for recruitment and retention of staff within the Irish nursing home sector over the next five years? 100 75 50 Positive; 3.64% Very negative; 16.36% Very negative Negative Mixed Positive 25
Mixed; 34.55% 0 R ls ra er f e m fro i ex i st ng ti er v Ad f af st si ng on c r ee r a w s eb
ite R s ru ec e i tm a nt g c en ie s a ci So lm ed D Nursing staff Crowe 2019 ia ep HCAs e th O tm ar en
to ia oc S f D r te ro P l ep tm ar i ct en on to U (E R ) ES a ci o fS ec ot r lP n
tio (IN TR ) EO Negative; 45.45% Other staff 11 Staff Retention Stated Destinations of Staff Leaving Reasons Cited for Staff Leaving (%) Percentage of nursing homes Acute hospital sector HSE nursing home Returning to home country Other healthcare sector 88% 76% 49% 40% Other independent nursing home provider 29% Other Non-healthcare sector 26% 24% 18% Retiring 14% Crowe 2019 10
20 30 40 50 60 70 80 90 100 Benefits Salary Career development opportunities Work-life balance Wish to leave nursing home sector Nursing staff HCAs Other staff Other Work permit expired Leaving workforce for other reason, e.g. caring for children or relatives Leaving Ireland for another country (not home country) 0 Leaving workforce altogether Roster/shift pattern 4% Stress/concerns about existing role 12
Staff Nationalities Actual Headcount Staff Nationality Distribution & Change Nursing staff HCAs Other staff % from Ireland 36.6 60.7 62.2 % from UK 2.3 1.9 0.5 % from EU 19 19.2 27.6 42.2 18.3 8.4 % from Non-EU The distribution of staff nationality was generally quite even across the country, though UK staff tended to work in rural homes.
Do you anticipate this nationality mix changing over the next five years? % of Homes with Staff of X Nationality Nursing staff HCAs Other India 96% 59% 36% Philippines 86% 57% 34% Poland 34% 66% 80% Romania 25% 30% 16% Croatia 7% 18% 11% Latvia
0% 5% 16% Lithuania 2% 4% 7% UK 5% 2% 4% Crowe 2019 41 59 Yes No 13 Our Findings Issues Frequently Cited by Nursing Homes Crowe 2019 Widespread frustration with NHSS / Fair Deal rates, with respondents feeling the rates simply dont reflect the quality of services provided The low NHSS rates impact on the ability of nursing homes to recruit and retain qualified and motivated staff, with numerous respondents recounting how theyve seen staff move to HSE
homes who ultimately benefit from the low Fair Deal rates Low salaries exacerbate the current challenges of recruiting staff, particularly in the Greater Dublin Area. Staff generally appear content with their working conditions, with salaries and benefits being the major contributing factors to high staff turnover. 15 Origin of Staff Crowe 2019 Numerous nursing homes informed us how the proportion of their staff who originate from outside of Ireland has grown in recent years with many citing a lack of interest from Irish-born applicants. While Eastern European countries provide a large number of staff, the two largest countries of origin for staff in the nursing home sector are India and the Philippines. Multiple nursing homes report attending career fairs in these countries so as to recruit staff directly. While nursing homes are able to recruit nursing staff originating from outside of the EU directly from overseas, those wishing to work as HCAs must already be resident in Ireland. With this in mind, we regard petitioning the State to include HCAs on the Critical Skills Occupations List as being one of NHIs top priorities. 16 Challenging Recruitment & Retention Market In this context, nursing home owners and operators must consider how best to recruit and retain staff in an increasingly competitive labour market. Offering staff incentives such as pensions, enhanced benefits, improved salary packages or career development opportunities will cost significant sums, which will need to be either recovered from funding sources such as Fair Deal or from residents directly. It is important that labour market issues are factored into the ongoing dialogue between NHI and the State, as otherwise the continued provision of nursing home care let alone meeting forecast demand will quickly become unsustainable Crowe 2019 17
What next? Conclusions and Recommendations NHI should continue to petition the Government for inclusion of Health Care Assistants on the Critical Skills Occupations List. NHI should continue to liaise with the HSE and the Department of Health regarding the rate of payments provided to nursing homes. NHI should continue to engage with the HSE and support NHI members in working with local hospitals to identify opportunities for cooperation, taking pressure off the acute care system. NHI should initiate a publicity campaign to draw press, public and political attention to the findings of this review. On this note, we recommend that NHI seek to update this research at least every two years to ensure that it remains relevant and can identify new trends. Crowe 2019 19 Smart decisions. Lasting value. Crowe Marine House Clanwilliam Place Dublin 2 Ireland Tel: +353 1 448 2200 www.crowe.ie Shane McQuillan Partner, Consulting [email protected] Sam Kendlin Consultant, Consulting [email protected] Crowe Ireland is a member of Crowe Global, a Swiss verein. Each member firm of Crowe Global is a separate and independent legal entity. Crowe Ireland and its affiliates are not responsible or liable for any acts or omissions of Crowe Global or any other member of Crowe Global. This material is for informational purposes only and should not be construed as financial or legal advice. 2019 Crowe Ireland
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