Adult care crisis: Insights from the front line
The UK government are currently working on a new workforce plan to help ease healthcare pressures. Exclusive interviews with care workers shows just how much it’s needed.
Managers tasked with ensuring care quality while dealing with chronic staffing shortages and underfunding within the care sector face an uphill battle. The voices of these managers, captured through candid interviews, shed light on the challenges they endure and their unwavering commitment to care. This article explores the systemic issues plaguing ASC, the impact on managers, staff, and residents, and potential solutions to ensure the sector’s future.
The staffing shortage epidemic
One of the most pressing issues in ASC is the shortage of staff. This crisis is not new, but Brexit, the COVID-19 pandemic, and structural underfunding have exacerbated the problem. Recruitment in social care has always been challenging, but an increasing demand for staff and low wages make it even harder to attract candidates.
‘There was significant staffing crisis here until recently,’ shared one manager. ‘It’s always difficult to recruit to adult social care because of the minimum wage.’
Despite the widespread awareness of the issue, recruitment remains a slow and arduous process. Background checks, reference verifications, and a lack of suitable candidates all contribute to delays. Managers expressed frustration at losing potential employees during the onboarding process.
‘We lose people in that process because it’s such a lengthy delay,’ one manager noted. ‘They find something else.’
Even when vacancies are filled, retention is often fleeting. Some staff leave within weeks of starting, having decided the role isn’t for them. ‘We recruited two waking nights and a full-time day,’ a manager explained. ‘None of them completed their first week.’
The staffing crisis extends beyond recruitment; retaining experienced and motivated staff is an ongoing battle. Managers describe a ‘pinch’ that affects not just their care settings but the entire sector. One participant highlighted the competition for workers, saying, ‘We’re rural, and there are several homes in the same location. We’re all fishing from the same pond.’
A manager’s role: Caught between strategy and survival
In theory, ASC managers are expected to focus on delivering high-quality care, meeting regulatory standards, and supporting their teams. In practice, they are often thrust into frontline roles to compensate for staff shortages. This duality forces managers to juggle caregiving with strategic responsibilities, often at the cost of both.
‘You can either do your job or work on the floor, but you cannot do both,’ said one manager. ‘The odd shift here and there is manageable, but if it becomes a regular occurrence, it has a dramatic impact.’
Managers recounted long hours spent covering shifts, performing personal care tasks, or stepping in as drivers for residents’ appointments. These additional duties detract from their ability to supervise staff, complete audits, or plan strategically. The cascading effect impacts the entire team, as support workers and team leaders are asked to take on greater responsibilities without corresponding increases in pay or recognition.
As one manager put it, ‘The expectations and job roles are getting bigger and bigger, but the money’s effectively worse. They just don’t feel valued.’
The mental and physical toll on managers
The cumulative stress of these demands takes a significant toll on managers’ mental and physical health. Many work far beyond their contracted hours, with some clocking up to 60 hours a week. The strain of constantly juggling responsibilities, dealing with crises, and striving to meet regulatory expectations leaves little room for self-care or personal time.
‘I’ve worked a whole week of nights, then done the rest of my shifts the following week just to make sure everything is how it should be,’ one manager confessed. Another shared, ‘I reckon I do about 60 hours a week, but because I get fatigued, I’m not working at my optimum.’
This relentless pace has led to burnout for many. ‘I was working between 40 and 80 hours a week for three and a half years until I burnt out,’ said one participant. The physical toll was evident, with others reporting stress-induced illnesses like pleurisy, exacerbated by the pressure to work even when unwell.
Managers also described a pervasive sense of guilt and inadequacy. Despite their best efforts, the overwhelming workload often leaves them feeling like they are failing. One participant shared, ‘People tell you that you’re doing a good job, but you feel that you’re not. I feel like I’m a failure.’
The impact on care quality
Staffing shortages and managerial burnout inevitably affect the quality of care provided to residents. While basic needs such as personal care, nutrition, and hydration are met, opportunities for meaningful, person-centered activities are often sacrificed.
‘When you’re short-staffed, everybody eats, everybody’s clean, but most people don’t get to do what they’ve chosen or would like to do,’ one manager explained. Another added, ‘It’s diluted care rather than outstanding care.’
Temporary or inexperienced staff can further erode care quality, as they lack the training or familiarity to deliver individualised support. Managers spoke of a return to ‘institutionalised’ methods, where group activities replace personalised interactions. ‘Let’s all sit together and watch a movie—that’s the strategy we’ve had to use to keep people safe,’ one manager admitted.
Organisational support: A mixed bag
The managers interviewed acknowledged that some organisations are taking steps to address these challenges. Initiatives such as well-being programs, resource sharing between sites, and technology adoption have provided some relief.
One participant praised the introduction of a well-being group that brainstorms ideas to improve working conditions. Another highlighted the value of a supportive organisational culture, where autonomy and innovation are encouraged. ‘The directors are very happy to listen,’ they said. ‘If I say this isn’t working, they let me try something new.’
However, not all managers feel equally supported. Some described feeling micromanaged in previous roles, where their concerns about staffing and workload were ignored. One manager recounted a pivotal moment when their manager responded to their distress by helping plan the next six weeks of staffing. ‘If they hadn’t done that, I think I would have left,’ they said.
Building a sustainable future
The testimonies of these managers paint a grim picture of the current state of ASC. However, they also offer valuable insights into how the sector can move forward. Addressing the staffing crisis, improving managerial support, and prioritising care quality are critical steps toward a sustainable future.
- Addressing the staffing crisis
Competitive wages and career progression opportunities are essential to attract and retain workers in ASC. Faster recruitment processes, including streamlined background checks and onboarding, could prevent potential candidates from dropping out. Investing in apprenticeship programs and hands-on training can also build a pipeline of skilled workers.
- Supporting managers
Managers need resources to delegate non-essential tasks, giving them the time to focus on leadership and quality assurance. Organisations should prioritise mental health support for managers, including access to counseling and stress management programs.
- Prioritising care quality
Adequate staffing levels are crucial to delivering person-centered care. Technology can play a role in streamlining administrative tasks, freeing up time for staff to engage with residents. Encouraging creativity and flexibility in care planning can also help maintain high standards, even during challenging periods.
A final word
The managers’ voices reveal the deep cracks in the ASC system, but they also demonstrate resilience, creativity, and hope. Despite the overwhelming challenges, these individuals remain committed to their residents and teams, striving to provide the best care possible under the circumstances.
As one participant wisely observed, ‘Start by looking after the staff, and they will look after you.’
The future of ASC depends on this ethos. By addressing the systemic issues and valuing the contributions of those on the front lines, the sector can overcome its challenges and continue to provide compassionate, high-quality care to the most vulnerable members of society.
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