Nursing homes are established to provide supervised and protective care setting for older persons who are vulnerable to exploitation by others, and or unable to care for themselves due to cognitive dysfunction, mobility issues or physical illness. However, recent research and government commission reports indicate that a number of employees within nursing homes are practicing person-centred care without adequate qualifications or experience, having little understanding of the philosophy of caring for this vulnerable population (Royal Commission on the Funding of Long Term Care, 1999). Further, the image of nursing homes has been discredited by the public associating residential care with that of a "warehouse" or "final way station" given the amassing negative publicity of the management of such facilities. For example, is has been suggested that abuse occurs to a disproportionate level within nursing homes (Richardson et al., 2003).
This paper will critically review factors contributing to the apparent mismanagement of nursing homes in the UK to demonstrate the need for undergraduate training in the areas of team-work, quality management and leadership practices. Firstly, recent research into the management practices of nursing homes will be presented. Secondly, issues of quality management, leadership and team-work will be explored. Next, the implications of extending knowledge of these factors on recruitment and retention will be highlighted. Finally, a conclusion shall synthesise the main points of this paper to illustrate the positive benefits of management changes to improve the image and practices of nursing homes, and subsequently the person-centred care of residents and the health and well being of staff.
A Review of the Literature
Nursing Home Management
The current system of nursing home management within the UK is viewed by many elderly, their families and the public in general as 'unjust', as identified by the Royal Commission set up to investigate perceptions of nursing home care. This perception has been reported in numerous other studies (Heath, 2002). It has been suggested that the current state of affairs has occurred through management trying to improve the cost effectiveness of their facilities by the provision of less care. This situation exists due to the government's decision to privatize long-term care for older people, which ahs occurred on a massive scale. As the government redefined health care of older persons as a social care issue, it was removed from the health service and has been subjected to various means tested charges. The separation of those who were most in need of medical care from those who were in the best position to provide it (i.e., within the National Health System [NHS]) resulted in older people feeling that their trust had been betrayed and feelings of anger and confusion.
Studies show that the reshaping of nursing home services can begin immediately with small and systematic changes to administration, wards (i.e., sections of the nursing home) and clinics (Tonks, 1999). As such, wards could