The impact of life-changing injuries can result in someone losing much of their identity, as it is swept away by waves of complex medical, clinical, and social factors which accompany their injury and give rise to many and varied needs.
Case managers support people with disabilities which are highly complex and nuanced – and which often arise from life-changing injuries.
The case manager aims to help the injured person steer through the changes their condition has brought into their life. In doing so, the hope is to reassemble a sense of normality, to put the pieces of life that went before back together, to retrieve the lost identity and restore the person so that they may navigate their new world.
A crucial aspect of the case manager’s role is the recruitment, training and supervising of support workers for each vital package of care. This network of support workers also navigates the many challenges that can present. Support workers are exceptional people, who are highly skilled in their roles, and are motivated to make critical changes to the lives of those they support.
This in turn reduces the pressure on families to whom the waves have also brought great change.
Dark clouds are gathering overhead. Let us understand the nature of these challenges.
The British Association of Brain Injury and Complex Case Management (BABICM) is an organisation devoted to the sharing of foundational knowledge and providing guidance and resources in support of case managers. BABICM also seeks to cultivate excellence in the landscape of case management.
Recently, BABICM conducted a pivotal survey, which received over 200 responses in six days. Nearly 64 per cent of respondents were case managers. Other positions included ‘registered manager’, ‘director’, ‘Court of Protection deputy’ and ‘clinical lead’ – each in boats navigating a perfect storm.
Overall, the survey revealed perpetual difficulty in both recruiting and retaining support workers arising from several interlinked and multifarious factors. The prominent concern was the impact of these factors on people with life-changing injuries and their families.
The ripples of such factors have added additional challenges for case managers and support workers in their work. 90.45 per cent of survey responses agreed with the question ‘Have you experienced increased difficulty in recruiting support staff?’
When encouraged to outline the main reasons for issues with recruiting staff, various themes were identified in the responses. Firstly, it is important to highlight that the combination of insufficient pay rates, poor working conditions and the prospect of unsociable hours have rendered the perception of the support worker’s crucial and skilled role as undesirable. In addition, increased agency rates and the impact of the COVID-19 pandemic (such as the remote delivery of services decreasing job satisfaction levels) and Brexit (people leaving the care sector) have exacerbated the situation.
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“I think pay rates will need to increase to attract staff – and recruitment issues have actually worsened due to the impact of Brexit. The cost-of-living crisis will serve to put additional pressure on raising pay rates…”
As case managers and support workers seek to continue providing meaningful support in the lives of those they work with, one wave continues to rear its ugly head: increased agency rates…
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“…I have had to authorise payments of up to £34.27 per hour for agency staff cover when a support worker left to go back to the EU. Support for the client is for 7hrs p/day and costs the client £959.56 per week, as opposed to £392.00 with the employed worker who has now left…”
“We have seen requests for 45 per cent increases in pay… We have had to provide greater incentives for staff to cover shifts at times; this has included paying time and a half for emergency cover, double time and even offering triple time on Christmas day…”
The survey results demonstrated that 64.80 per cent of responses agreed that they had to pay increased agency rates in order to access staff. Indeed, specialist nurses sourced by Case Managers through an agency have been known to cost a client anything from £40 to £80 per hour, with last minute cover priced between £500 and £1000. In addition, with less people applying to fulfil the role of support workers, agencies often lack the capacity for starting a new care package; in one case up to 15 agencies were contacted in an attempt to arrange a care package.
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“…To ensure waking nights would be covered by a new agency, the carer flew to Devon from Scotland! Whilst the agency covered flights and additional time, I was asked to pay £1460 to cover hotel costs…There was no cover available in 12 agencies within Devon…”
In scenarios of failed recruitment and where often state funds are insufficient to cover increased costs, families have had to step in, or community-based individuals have had to transfer back to residential care. Considering that a client’s specific and complex needs are dynamic and changeable over time, this is particularly concerning. With these changes, the demand for support workers increases – and yet, is not being met.
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“…There are significant risks to clients potentially being left unsupported and neglected. We have had to arrange emergency admission to care homes to address issues…”
The survey further exposed key findings regarding issues of safeguarding.
The challenges have mounted as multiple shifts are left uncovered, meaning that vulnerable clients lack the necessary professional support. Additionally, when shifts are allocated, they are often reduced in frequency and/or duration due to a decreased pool of resources.
In turn, this can result in the care agency or individual support workers resigning from the overall package, adding to the pressures. Furthermore, because of the often-high-risk characteristics of shifts, extortionate fees are involved. As families lose and cannot replace support workers, they can often be left isolated. Inevitably, this impacts on both their own and their family member’s wellbeing and quality of life as they are forced to step into providing care.
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“Families are struggling due to increased pressure for them to provide care in the absence of formal support, leading to effects on the wellbeing of them and their family member…”
At the time the survey was conducted, a further wave of difficulty approached – the prospect of proposed mandatory vaccination for all frontline care workers. 82.14 per cent of responses anticipated further loss of staff due to the mandate; the findings demonstrated a spectrum of viewpoints on the issue. In exploring the responses to questions concerning the mandate, we can now look at the deeper issues present in the overall landscape – buffeting waves of difficulty intrinsically linked to one another.
Concerns were raised regarding clients and families seeking potentially unregulated, inappropriate services to avoid the need for vaccination. However, these concerns still very much exist as agency fees increase; this is a vicious cycle which implicates case management time and costs alongside the soaring costs for support workers. Of course, at very heart of the matter is the risk to the clients, and increased strain on families.
With existing staff lost and the excessive struggle to recruit more staff, how will the resulting risks to clients be reduced and how will some care packages be able to continue?
The recruitment and retention storm is set only to grow on the horizon; the feeling present in the survey results is that there is not a solution in sight. … “I can see case managers, as well as support workers, and many others in our industry leaving the profession…I do not have much hope for the foreseeable future that things will change” …
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“…If support workers, some of whom have been trained over many years, have to leave their employment, the client would be highly at risk and, in some cases, there could potentially be fatal consequences…”
The results of the survey thus draw attention to the myriad intertwined and highly complex factors crowding the landscape of brain injury and complex case management. The uniformity of the emerging themes and stories woven into the responses is striking and serves to truly emphasise the prevalence of issues today.
Each little boat in the storm is being swept to and fro here and now, doing its best to sail forth into the headwind and resist the troubling swirling eddies.
Whilst some clouds may always be present in the sky of brain injury and complex case management, such challenges are generally manageable and enjoyable. It is to be hoped that the wider storm will subside at some point – that the blue sky of recruiting and retaining support workers at reasonable hourly rates will return, and a calm will descend.
For now, though, there is a perfect storm brewing overhead: how can skilled support workers be both recruited and retained?
If the challenges of this stormy sea are to be navigated, a positive change in the recruitment and retaining of skilled and respected support workers is required. Only then will there exist a safe harbour for those who need it most: the people with life-changing injuries and their families.
