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Staying on track
sustaining a care home

Opening and running a care home is challenging at the best of times, but the current climate in social care is stretching even the most seasoned care home operators. Sara Livadeas, Director of Social Care Works and author of Opening a New Care Home, explores what providers need to do to ensure success.

It’s no secret that the social care sector is operating in a difficult market – and things aren’t set to get better.

The population in the UK continues to age and demand for care home places is expected to rise exponentially, with a predicted shortfall of 71,000 places by 2025 . However, LaingBuisson recently adjusted their demand supply analysis, suggesting that occupancy across the care home sector is closer to 85%, not 90% as previously reported .

This means more availability and more choice for discerning customers, and care homes having to work a little bit harder to attract residents.

A greater supply of vacant places than previously thought will encourage local authorities to continue to push down fee rates, and the potential impact of Brexit on an already precious pool of staff will only intensify the challenge of operating a care home.

With all of this in mind, the importance of getting both new and established care homes right in terms of quality, occupancy and staffing is more important than ever. But once the basics are taken care of – registration, health and safety and training – what can care homes do to ensure they succeed, and where can they look for support?


The right culture is essential. Opening a new home gives a unique opportunity to set a person-centred culture from the outset, but even established homes can improve the way they involve residents and families in decisions. These can be decisions about their own support as well as choices that might influence the running of the home. Providers should encourage meaningful involvement of residents in, for example, staff training, menu planning, cooking or sharing recipes with the chef, and hosting open days or show-rounds.

Enlisting residents in the recruitment process is great for residents and gives a strong signal to potential employees that the service is person-centred right from the start. Make sure that residents understand company recruitment policies as well as the rest of the interview panel so that they are able to contribute.
When seeking staff, remember that recruitment of all employees, including ancillary staff, should be values based; training can be provided but attitudes are harder to change. Values-based recruitment will also contribute to staff retention, which is just as important as recruitment. Another important retention tool is to know that, once hired, employees need support that goes well beyond on-boarding and induction.

Operators should think about how employees are invested in the success of the home. Spend as much time on team-building and promoting shared values as on training for care quality. If you can promote a positive culture that is person-centred, open, inclusive and empowering, you are on the road to outstanding.

It’s a project

A new home needs to be run as a project for at least 12 months post-opening to ensure its success. It is all too easy to get distracted by new projects once the home is open.

Regularly monitoring care quality ensures that everything is running properly. This is especially important in the early days of operation, when both staff and systems are settling down. Seeking feedback from residents, families and staff means that issues can be picked up and dealt with early. For smaller organisations, there are specialist agencies who will carry out mock CQC inspections. However, this is only going to be effective if remedial action is taken promptly, and preferably written up in a plan. For new homes, Key Performance Indicators should be reported and monitored at the right level in the organisation.


Residents’ needs are increasing and length of stay is getting shorter. On average, new homes take at least 18 months to fill, so be prepared that some residents may have passed away before the home is at capacity. This can put pressure on processes like admissions, assessment and care planning, helping residents to settle in and getting to know the relatives. With more people choosing to die outside of hospital, care staff are also administering more end of life care, so supporting all employees with bereavement is a must.

Shortened length of stay also means marketing departments are having to work twice as hard to maintain occupancy. Bear in mind that however good the demographics, people cannot move into the home if they do not know that it is there, so a properly researched and resourced marketing plan is essential. Care homes operate in a micro-market, with most residents coming from within a five-mile radius, but employees should be prepared to travel long distances, sometimes at short notice, to assess, for example, someone who is moving to be closer to their family. Being open about this from the start could help to maintain occupancy and staff levels.

Don’t underestimate the importance of both staff and residents needing to understand why marketing is required. They will experience a succession of visitors, show-rounds and open events. This can put a lot of pressure on the home, especially the manager but also the residents, who can all feel exposed, particularly when the home is newly-opened and everyone, including the media and local dignitaries, wants to visit. Explain why it’s important to showcase the home and encourage residents to engage with those looking around.

Finding help

Support is available for providers who are running both new and established facilities. Many local authorities operate care home support teams that can provide advice. Consider primary care services, which can also be a source of moral support for providers. National trade bodies and local provider forums and associations are a great place to network, seek support and training.

Surprisingly, considering the level of investment involved, there is very little written about the ‘how’ when operating a care home. Issac Theophilos has written on how to create an outstanding service in his book, How to get Outstanding and Skills for Care produces both training and handbooks for managers and employees alike. Neil Eastwood has also covered every aspect of recruitment and retention with lots of hints and tips in his book Saving Social Care.

Finally, my guide on how to open a new care home sets out some key issues to think about when launching a new service, after the residents have moved in, which is intended to support both new and experienced care home operators. Email for a copy of the guide, which is also available from Care England .

Overcoming obstacles

Despite the challenges, it is more than possible for care home operators to continue to provide good and outstanding care to an increasingly frail and demanding older population. Follow a few key principles, seek help when you need it and your care home will thrive.

Sara Livadeas is Director of Social Care Works Ltd. Email: Twitter: @saralivadeas

What are your tips to keeping a care business flourishing? Share what’s worked for you and feed-back on this feature by commenting below.

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