Independent care homes in Scotland are "on the breadline" due to a recruitment crisis and wage pressures, according to a new report.
Industry body Scottish Care said the sector is facing a "real emergency" including further closures unless remedial action is taken within the year.
The Care Home Workforce Data Report found recruitment difficulties were hitting the "quality of care".
Almost four out of five homes (79%) said they are struggling to recruit nurses, while a quarter face recruitment problems for front line care staff and 35% struggle to find managers.
The potential impact of Brexit was highlighted as almost two thirds of homes (63%) recruit nurses from the European Union and around a quarter (44%) also recruit EU care staff.
More than three quarters (77%) of the homes have vacancies and one in five (21%) have "significantly increased" their use of agency nursing staff to fill gaps.
Average turnover of staff in the care homes surveyed is 22%, up from 17% in 2015.
More than one in four (42%) of care home services believe paying Scottish Living Wage of £8.45 an hour has made them less sustainable, mainly due to lack of funding.
Scottish Care chief executive officer Dr Donald Macaskill said: "We are struggling to recruit new staff and hold on to existing staff. There is a shortage of nurses which is little short of scandalous. There is a wholly inadequate resourcing of initiatives such as the Scottish Living Wage. Put simply, care homes cannot continue to survive on the breadline.
"Discussions on reform are coming to a critical stage. I hope this research sharpens the minds of all involved to realise that unless we identify real positive actions which include an adequate funding of care homes, we will be in a state which will be irretrievable.
"There is at the moment a small number of care homes closing because they simply cannot survive. It is incumbent on government at local and national level to recognise the real dangers this sector faces today and to respond accordingly or within the year, we will be faced with a real emergency. We cannot continue to get care on the cheap."
A total of 161 care homes responded to the survey, looking after an average of 9,327 residents each week.
Health Secretary Shona Robison said: "Our care sector is just one of many in Scotland which rely on the hard work of people from elsewhere in the EU - and this survey is yet another stark reminder of how a hard Brexit could have a real detrimental impact on the services on which many people rely on a daily basis.
"Raising the status of social care as a profession, and attracting and retaining the right people, is key to delivering quality care.
"That is why we have taken action to protect care services, including paying the Living Wage to adult care workers boosting the income of up to 40,000 people.
"This commitment is in place for care workers in both public and private sectors.
"In the current year, there will be almost half a billion pounds of NHS investment in social care and integration, underlining that we are treating this as a key priority.
"We are also working with COSLA and care providers to deliver major reforms to adult social care, which will consider workforce issues and new models of care and support."
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