5 November 2018
Nursing homes : trends and challenges of the sector
ING and Probis have carried out a new study of 550 institutions representing around 1/3 of the market. This reflects the main challenges and trends facing the sector.
Key learnings from the study
A sector in full evolution
In recent decades, the emphasis has essentially been on increasing the capacity of facilities (care homes and sheltered accommodation). We are now seeing a paradigm shift towards the diversification of care delivery that goes beyond the traditional residential care centre concept. A growing number of managers and executives are aware that senior citizens' needs have changed. Yet the large majority of the care facilities questioned have no concrete short-term plans to introduce daycare services, daycare centres or outreach care (e.g. home-based care).
Fall in the occupancy rate
Occupancy rates within residential homes for the elderly/nursing homes are slightly lower than they were three years ago. This is down to the new expectations of senior citizens, shorter lengths of stay, alternative forms of care and increased capacity. Most managers (71%) report that the structural waiting lists that existed three years ago are no longer there – or practically no longer there – today. A quarter of the facilities questioned are finding it difficult to achieve a maximum occupancy rate. In a large city such as Brussels, where accommodation capacity is high, as many as half of them do not achieve this level.
Increase in the level of dependency and in problems related to dementia
In our sample, the level of dependency on care has continued to increase in the past three years, rising from 76.2% to 78.3%. In Flanders, the median value of the level of dependency stands at 81%, which is a significantly higher median than in Brussels and Wallonia (approximately 70%). More than a third (34.4%) of residents are living with dementia, compared with 32% in 2013-14.
Some mobility within the region
On average, nearly half of residents (47.9%) come from the town where the facility is located, approximately a quarter (25.5%) from towns nearby and around a quarter (26.6%) from the wider region. The local mission and footing are important for most of the facilities (and the senior citizens), but some mobility can nevertheless be observed within the wider region.
Status quo in the number of workers
Despite the increase in the level of dependency, staff supervision has remained practically the same over the past three years. The median value stands at 10.5 full-time equivalents for nursing staff and care staff for every 30 residents. However, wide discrepancies can be observed within the sample depending on subsidies, the region and the type of manager.
The current supervision is also largely related to the incoming and outgoing flows (and characteristics) of new employees. The global ageing trend within our society is also reflected in the care staff. A quarter of the facilities report an average length of service on pay scale of more than 18.7 years for the nursing staff group, which reflects the level of job stability within the sector. For nursing assistants and paramedical staff (physio/occupational/speech therapy and re-education/rehabilitation staff), this length of service stands at 13.6 years and 15.6 years respectively. Furthermore, we find that it is not easy to attract sufficient qualified and motivated nursing staff, nursing assistants or physiotherapists in a number of regions. This difficulty was mentioned by those surveyed at the rates of 87%, 50% and 61% respectively. For occupational therapists, cleaners and kitchen staff, this problem is less prevalent but nevertheless stands at the not insignificant rates of 30%, 19% and 25% respectively.
Funding: growing imbalance between the different regions and types of manager
Firstly, the significant difference between Flanders on the one hand, and the Walloon Region and Brussels on the other, is largely due to regional funding policies for nursing homes. Flemish facilities consequently receive more funding, enabling adequate staff supervision to be put in place.
In practical terms, the difference in supervision per resident (residential homes for the elderly vs. nursing homes) stands at around 75%. This situation also makes greater financial incentives to achieve a higher level of care possible. Secondly, the historic difference between the various Flemish facilities – lower funding for public and commercial structures and higher funding for non-profit-making facilities – is narrower.
Additional investment in staff despite pessimism about the financial future
The majority (57%) of those surveyed are somewhat pessimistic about the financial future of their facility. Yet the large majority of them are investing fully in care, particularly in care staff.
The median NIDHI turnover stands at €23,836 per resident. On average, facilities are investing €1,502 more in care per resident per annum. In Flanders, this figure is slightly higher than in the other regions, notwithstanding the higher funding related to the nursing homes ratio.