Care Home Celebration Day: the critical role of nursing homes

Theresa Fyffe, Director of RCN Scotland, shares her perspective on the importance of Scotland's care homes and their nurses


Writing in the Herald, Theresa Fyffe, Director RCN Scotland, said: 


Today is Care Home Celebration Day. It is, according to Scottish Care, an opportunity to bust some of the myths about and celebrate care homes in Scotland, the role they play in our communities and tell good news stories about those who live in, work in or engage with them. The focus is very timely. 

In Scotland’s integrated health and social care landscape, care homes are providing essential alternatives to hospital care and are increasingly being used to reduce delayed discharge from the acute sector, making them fundamental to local health economies. And the importance of the role they fulfil is only going to become more significant. 

People in Scotland are living longer. By 2039 the number of people over 75 is projected to expand by 84%. But even now, before the projected population increase, care homes are increasingly caring for people who may have several long-term conditions. These include frailty, chronic obstructive pulmonary disease (COPD), dementia, multiple sclerosis, Parkinson’s disease. They may also have palliative and end of life care needs. Fifty-four percent of all people in Scottish care homes for older people have a diagnosis of dementia, and many have advanced dementia. 


As ever, the statistics only tell part of the story. Behind every percentage point are many personal stories of older people and their families, trying to find the right situation and combination of care to help them age well. 


We need to recognise that many people have very complex care needs and require skilled nursing and other expert health care input. RCN Scotland believes it is the right of every resident in Scotland’s care homes to receive high quality, safe care, to be treated with dignity and respect and to have their human rights upheld.  


A key component of supporting care home residents is managing clinical conditions effectively, at the same time as promptly responding to new symptoms. For many residents their clinical needs will require the presence of a registered nurse 24 hours a day, seven days a week.  


Registered nurses in care homes have a valuable role in being able to recognise and take action when a person’s condition is changing. This can enable more timely clinical intervention within that homely setting, and help to prevent avoidable hospital admissions. As expert practitioners, registered nurses use their clinical knowledge and skills to undertake ongoing care assessment, make decisions around the management of long-term conditions and complex medication regimes and therapies, and deliver clinical interventions within the care home. They are only able to achieve this with assistance from skilled support workers, who rightly are a valued part of the care home workforce.  


Complexity of clinical need is only going to increase and the skills, competencies and availability of the registered nursing and support workforce employed in care homes will become ever more important.  


Nursing care is a fundamental right for Scotland’s care home residents. I have met many registered nurses and support workers working in the care home sector who agree and are hugely positive about the experience and how the role satisfies their professional ambitions. But the care home sector has difficulty recruiting enough nurses into the workforce mainly due to the overall shortage of nurses in Scotland. Workforce planning must take account of the nursing and support staff needed across both health and social care, and more needs to be done to showcase the role of nursing in social care and to ensure that career and development opportunities are available in the care home sector. 


Theresa Fyffe 

Director, RCN Scotland