A record number of care homes are closing in Scotland and providers fear this will "escalate at speed" in the coming year amid a row over funding.
Ending months of stalemate, members of Scottish Care - the umbrella group for private operators - have voted to accept a 6% uplift in the National Care Home Contract (NCHC) rate which was tabled by Cosla in March.
The increase is the highest ever and Scottish Care acknowledged that it was "realistically the best that they can offer without additional Scottish Government funding".
However, it warned that it is too low to reverse the crisis engulfing care homes.
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In a statement, Scottish Care said providers are battling "crippling" cost of living pressures which have seen some smaller premises faced with a 500%-plus hike in energy bills and growing challenges in recruitment and retention as the pay gap widens between NHS and social care workers.
It added: "Faced with these significant pressures we have sadly witnessed the largest number of care home closures the sector has experienced in the last few months and the very real fear is that this will escalate at speed.
"Every week at least one care home is closing down.
"Unfortunately, it is the small, rural, and remote private and charitable care homes which are not managing to continue operating.
"This is an especial risk in Scotland where most private providers are small family run businesses."
Adam Stachura, head of policy for Age Scotland, said the warnings should "set alarm bells ringing at all levels of government".
He added: “The availability of care home places across Scotland is already challenging, especially so in rural communities, with many older people just not able to get one near to their family, or indeed afford it.
"Further closures will have a devastating impact on our country’s ability to keep many older people safe and well cared for."
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Official figures show that at least eight care homes in Scotland shut between January and March this year, but this is understood to have accelerated since April.
The NCHC, which is agreed annually, is the amount that councils have to pay care home providers for state-funded residents.
More than 70% of people in residential care homes and nursing homes are partially or completely funded by local authorities because they have less than £32,750 in savings and assets, such as property.
Councils are liable to cover care home fees in full once a person's capital falls below £20,250.
In the current year, the rates are fixed at £838 per week for nursing homes and £719 per week for residential care homes - equivalent to less than £5 per hour.
Fees for self-funded residents are considerably higher, however, and have been climbing as providers increasingly rely on them for revenue.
By 2022, a self-funded care home resident with nursing care was paying £1,200 a week on average, up from £699 in 2012.
Scottish Care said it had rejected the 6% offer initially because it would not be enough to increase the hourly pay of frontline workers to at least £12.
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In April, First Minister Humza Yousaf promised to increase the minimum wage for social care staff from £10.90 to £12-an-hour, but "not immediately".
In its statement Scottish Care described mounting frustration over recent weeks, blasting the Scottish Government as "incapable of making a decision and acting in a manner which would indicate that their stated promise to pay frontline care staff £12 is going to happen".
Following the pay deal struck with NHS staff back in April, a healthcare support worker is now earning 19% more an average than someone in an equivalent role in care homes.
Rachel Cackett, CEO of the Coalition of Care and Support Providers (CCSP) - which represents not-for-profit operators in Scotland - said there must be "immediate action" to raise pay for all social care staff to £12-an-hour.
She said: “For months our members have been telling us that, due to the current Scottish Government-funded base rate of pay of just £10.90 per hour – which only applies for some workers in the sector – many staff are leaving the workforce for better paid jobs elsewhere.
"Providers are struggling to replace them."
A spokesman for Cosla said the increase in the NCHC rate recognises "the critical role of care homes and their staff".
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The Scottish Government said local authorities had received a real-terms year-on-year increase in funding of 3%.
A spokeswoman said: “We are pleased Scottish Care members have voted to accept the offer from Cosla to agree the National Care Home Contract.
"We know the sector faces challenges and are committed to working with all partners to improve social care services.
“Over the last couple of years we have increased the pay for social care workers by more than 14%.
"We are looking at how we can plan for, attract, train, employ and nurture the workforce, working with Cosla on consistency of improved pay and conditions, improving access to training and development and ensuring a career in social care is attractive and rewarding.
“We are also continuing to work towards our commitment to increase spend in social care by 25% by the end of this Parliament, an increase of over £840 million.”
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