Care Home www.chmonline.co.uk
May/June 2017
Management
Toddlers in care homes ‘a medicine for residents’ Quality Big regional differences revealed
Finance Homes making use of Retail Charity Bonds
Worldwide care Different approaches around the world
Issue 67
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Editor’s Letter
Welcome to the May/June edition of Care Home Management
Care Home Management May/June 2017
S
Issue 67
o we are off and running. The General Election we were told we would not be having is now in full swing and before long we will know the shape of the
Annual Subscription £30.00 Where sold cover price of £4
government for the next five years. Whatever your view of the election and the leading topic of Brexit, hopefully other
Editor/Publisher Alan Rustad
issues will also be to the fore. And by that I mean social care.
Design/Production Phil Cunningham www.creative-magazine-designer.co.uk Published by JNJ Media Ltd Croham Lodge, Croham Road, Crowborough East Sussex TN6 2RH
From the time the grim reality of how the squeeze on local authority funding had begun to affect care homes became crystal clear, the issue of how we finance the care of our elderly in the UK has rarely been out of the headlines. We are promised a Green Paper on it before the year is out. We look forward to that. But whenever it comes social care should be a major issue in this election campaign. Will it? Or will it be drowned out by other events? I hope not. General elections are
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rarely fought on one issue alone, but here’s hoping social care gets its essential time in the spotlight.
Advertising Space Marketing Tel: 01892 677721 Email: antoinettem@spacemarketing.co.uk www.spacemarketing.co.uk
Operators of care homes have long called for a level playing field for all. They haven’t got it and there has been more evidence of that recently with the report from Independent Age highlighting wide variations in the standards of care home quality around the country. Perhaps not surprisingly those in areas which have had the biggest budget cuts have come out lower in quality.
www.chmonline.co.uk
No, care is not all about money – but without it caring becomes almost impossible.
Copyright: Care Home Management Magazine 2017
With so many of the smaller operators finding it so tough, in this edition we talk to one operator of three care homes in Yorkshire about the struggles he faces on a day to day basis. I suspect his comments will strike a chord with many. On happier matters, the inaugural Care Home Awards are now just a few
The Publisher holds all copyright and any items within may not be reproduced in any way, for any purpose, without the written permission of the Publisher. While every care has been taken to ensure accuracy, the information contained within this publication is based on submissions to the Publishers who cannot be held responsible for errors and omissions. The publisher does not necessarily agree with the views expressed by contributors and cannot except responsibility for claims made by manufacturers and authors, nor do they accept any responsibility for any errors in the subject matter of this publication.
Care Home www.chmonline.co.uk
weeks away having attracted an excellent range of entries. Judging has taken place and all is now set for the lunchtime event to be held at the Royal Garden Hotel in Kensington, London. There is still time to apply for tickets if you are quick. Go to www. carehomeawards.com – all the information you will need is there. As always you can keep up to date with the latest care home news via our website – www.chmonline.co.uk and we are always interested to hear your views on any issues – feel free to contact us at editorial@jnjmedia.co.uk
May/June 2017
Management
editorial@jnjmedia.co.uk
@Carehomemanage
Toddlers in care homes ‘a medicine for residents’ Quality Big regional differences revealed
Finance Homes making use of Retail Charity Bonds
Worldwide care Different approaches around the world
Issue 67
Alan Rustad Publisher/Editor
May/June 2017 | Care Home Management 3
Contents 6 Care Home Quality Survey shows wide regional variations 8 Leadership New man at the helm at HC-One 1 0 General Election ‘Social care must be an issue’ 1 2 Quality Dame Esther drops in on ‘Outstanding’ home 1 4 Care Home Awards Judging completed – now for the big occasion 1 6 Events Care Roadshows head for Aintree 1 8 Alarm Systems Improving detection for speedier responses
32 4 Care Home Management | May/June 2017
8 20 Technology New wearable alarms to help residents and carers 22 Funding care Let’s make care homes free for all 24 Management One operator’s woe in making the sums add up 26 Raising cash Retail Charity Bonds – a solution for some? 28 Running a Care Home Have you got what it takes? 30 Selling up Getting the legal issues right 31 Selling up Sort out your pay issues
12
2 Budgeting 3 Avoiding nasty energy surprises 4 Laundry 3 Make sure it’s not a losing game
24
8 Laundry 3 How limescale costs money 0 Around the world 4 How other countries run their care homes 2 Spirituality 4 What it offers people with dementia 4 Events and Appointments 4 Where to go and latest movers
42
6 Product Showcase 4 Latest products news
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06/02/2017 09:09:41
News
Revealed - big regional differences in care home quality Simon Bottery
A stark variation in the quality of care homes at a regional and local authority level across England has been highlighted by new research. The North West is the worst performing region in England when it comes to the proportion of satisfactory care homes, whilst London is the best performing region. In some areas such as Stockport or Salford, older people and their families face little choice of quality care, with three in five homes rated not good enough. That’s according to new analysis by Independent Age, the older people’s charity. The key regional findings reveal: • The North West contains seven of the eight worst performing English local authorities on care home quality, with one in three care homes across the region performing poorly. • The North West (33.6% of care homes performing poorly), Yorkshire and The Humber (32.2%) and South East (28.2%) are the worst performing regions of England for care home quality. • London (20.3% of care homes performing poorly), the East of England (20.8%) and the South West (21.1%) are the best performing regions for care home quality. The new analysis is based on CQC inspections of care homes. The analysis regarded homes rated ‘Requires improvement’ or ‘Inadequate’ as being poor performers.
Performance at local authority level shows even greater variation. Five local authority areas have more than half of homes rated ‘Inadequate’ or ‘Requires improvement’: • Stockport – 62.9% of homes • Salford – 61.5% • Tameside – 54.8% • Manchester – 51.3% • Kensington and Chelsea – 50% In contrast, five local authority areas have less than five per cent of homes rated ‘Inadequate’ or ‘Requires improvement’, including three that have no care homes with those ratings: • Isles of Scilly, Islington and Rutland – 0% • Richmond upon Thames – 2.3% • Thurrock – 2.9% And variation even within a single region can see older and disabled people living in neighbouring areas facing very different choices: • In Bury, in the North West, around 1 in 8 care homes in the local authority are rated ‘Inadequate’ or ‘Requires improvement’. • In neighbouring Salford, older and disabled people are faced with far fewer choices of quality care, with 3 in 5 homes in the local authority rated ‘Inadequate’ or ‘Requires improvement’. Commenting on the findings, Simon Bottery, director of policy at Independent Age, said: “No one should be forced to live in an unsatisfactory care home but our analysis shows this is the grim reality in some parts of the country. The market is simply not providing a decent choice for older people and their families but there is little indication that local authorities or the government are giving the problem the attention it deserves. “Money is likely to be one cause but not the only one. The government has an opportunity
6 Care Home Management | May/June 2017
to address this in its upcoming Green Paper on social care but, in the meantime, councils must demonstrate that they understand the reasons for care home failures and are working to resolve them.” Independent Age believes care home quality variation includes factors such as low levels of funding by local authorities, low pay and difficulty recruiting staff, and lack of support for improving struggling care homes. To improve quality in the market, Independent Age recommends: • The government must seek to tackle variation in care home quality in their forthcoming Green Paper • In areas where there is a failure of quality, the local authority needs to understand the drivers for variation and do more to fulfil their Care Act duty to shape the local care market • Drawing on CQC data, Department of Health must understand what drives regional variation and demonstrate leadership on tackling variation in care home quality
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News
Hutchens to lead HC-One
HC-One, the UK’s third largest care home provider has appointed Justin Hutchens (above) as its new chief executive officer. Hutchens has spent his 23-year career in the healthcare sector in the United States and will be joining HCOne on 1st June 2017 from HCP Inc. where he was president. He will begin a handover process with current chairman and ceo, Dr Chai Patel (right) which will conclude on the 30th September 2017. Dr Patel, who founded HC-One
in 2011, will thereafter continue as HCOne Chairman. He brings to the role 15 years in healthcare operations followed by 8 years in healthcare (REIT) investment. His appointment completes the succession planning at HC-One. Aged 42, he is to lead HC-One through the next crucial phase from turnaround to transformation. Dr Chai Patel said: “On behalf of all colleagues at HC-One I am delighted to welcome Justin to the HC-One
family. I am excited to be working with someone with such a similar value base and we have appointed in him a person who started his career as a care assistant, only to then rise to the highest levels and become an industry leader.” Justin Hutchens said: “I am absolutely delighted and excited to be taking up this new role at HC-One. It is an extraordinary business at an extraordinary time for care in the UK. It is an honour to follow in the footsteps of Dr Patel who has led HC-One with tremendous expertise, professionalism and integrity while driving a culture of kindness throughout the organisation.”
Self-payers make up almost half of the market Residents who pay for themselves now account for 49% of the total care home market value and make up 44% of the total resident population. The latest edition of LaingBuisson’s Care of Older People Market Report has found that the privately funded care home sector is in ‘robust health’
partly thanks to people with housing assets in affluent areas. But the report warns that the Competition and Markets Authority inquiry into the care home market may wish to consider the wide disparity of fees paid by local authorities and self-payers for the
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same accommodation amounts to a cross subsidy resulting in a detriment to the consumer. The report says things are not as rosy for the public facing operators with those in the north of the country and other less affluent areas being hardest hit.
May/June 2017 | Care Home Management 9
News
CQC prosecutes owner of York care home
A housing trust that failed in its duty to provide safe care and treatment has been ordered to pay £163,185.15 in fines and costs by Leeds Magistrates’ Court following the death of a 98-yearold man in its care. The Care Quality Commission brought the prosecution against the owners of Lamel Beeches, a care home in York, following two offences of failing to provide safe care and treatment with one offence resulting in avoidable harm to a resident and a second offence resulting in people using this service being exposed to a significant risk of avoidable harm. The registered provider, Joseph Rowntree Housing Trust, based in York,
pleaded guilty to both offences. In August 2015, 98-year-old Alfred Colley fractured his hip during a fall at the home but was discharged back to Lamel Beeches after treatment in hospital. Less than four weeks later he fell out of bed and re-fractured his hip. He died in hospital. The court was told that this fall was avoidable if Lamel Beeches had followed correct procedures around bed rail safety. A safety consultant had previously identified that 14 beds needed bed rail extensions to prevent the occupants falling – but the provider had not authorised the work, until after Mr Colley’s accident. There were four other
‘Social care must be a General Election issue’ There have been calls for social care to be a key issue in the forthcoming General Election. The snap election provides a chance to decide how we look after the oldest and most vulnerable residents in the country, the Independent Care Group says. Chair Mike Padgham said: “Social
care is in crisis with 1.2 million now living with an unmet care need, care homes and home care providers folding and a dire shortage of nursing and care staff. “For the sake of our oldest and most frail and vulnerable people we have to provide a better future for social care and the General Election gives all politicians a golden opportunity to seize the moment and set out their future plans. We have to decide once and for all how we fund and deliver social care in this country as the issue cannot be dodged any longer.”
incidents where Mr Colley had become trapped in the bed rail, or attempted to climb over it, prior to breaking his hip. When CQC inspectors visited the care home in November they found concerns around the use of bedrails used by all 10 people they checked on, suggesting that insufficient action had been taken. The Joseph Rowntree Housing Trust was fined £100,000 for failing to provide safe care and treatment to Mr Colley and £50,000 for failing to provide safe care and treatment which exposed people to a significant risk of avoidable harm. They were also ordered to pay the prosecution costs and a victim surcharge.
HC-One looking to buy 150 Bupa care homes HC-One’s chairman, Chai Patel is reported to have held talks over a possible bid to buy half of Bupa’s care home estate for up to £450 million. It would make HC-One Britain’s biggest care homes operator. However, other unnamed bidders are said to be also vying for the sites, which Bupa has been trying to sell since late last year. The estate represents about half of Bupa’s care homes business and includes 15,000 staff. It is thought the 150 care homes could fetch between £300 million and £450 million.
For the latest care home industry news visit http://chmonline.co.uk/ 10 Care Home Management | May/June 2017
The Alzheimer’s Show 2017 London & Manchester
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The Alzheimer’s Show will be at Olympia London on 9th and 10th June and EventCity Manchester on 23rd and 24th June. The two-day conference and exhibition brings the latest thinking, practical advice, products and services under one roof to help healthcare professionals, families and carers access support they need in caring for a person with Alzheimer’s, dementia or memory loss. The event features a wide range of talks from industry experts, those living with dementia and those having cared for a person with dementia, panel discussions, Q&A’s with dementia experts and professional advice clinics from Alzheimer’s Society’s Dementia Advisors, Admiral Nurses and The Law Society. Visitors can take part in practical activities to help those with dementia and discover hundreds of new products, ideas and solutions from dementia and care exhibitors. Both events are CPD accredited. For further information and tickets visit alzheimersshow.co.uk. Tickets are £15 online and £20 on the door.
Qualifications in Activity Provision From care staff to managers, activity organisers to day-centre staff, domiciliary workers to owners and volunteers, these courses are suitable for all. They will support learners to contribute to the planning, delivery and evaluation of individual and group activities and to meet a range of individuals’ different needs. It will further learners’ understanding of the part activity has to play in providing person-centred care. It is increasingly recognised that Activity Provision can make a significant contribution to well-being and quality of life, and the Care Sector reports a need for specialist training for their staff in this area. NAPA is delighted to offer two courses that meet the needs of the specialist activity workforce. NAPA offers: Level 2 Award in Supporting Activity Provision in Social Care (QCF) accredited by OCN London This knowledge only course is provided through distance learning with telephone tutor support. Level 3 Certificate in Activity Provision in Social Care (QCF) accredited by OCN London This higher level course is knowledge and competence based. The student will be supported throughout this distance learning course to research the assignments, write narrative comparisons and evaluate their day to day work.
For further information please visit our website www.napa-activities.co.uk NAPA 1-2 186x110.indd 1
I have grown in confidence through the NAPA course. The course has certainly made a difference to the provision in our home.
15/02/2017 14:59
News
Dame Esther drops in on ‘Outstanding’ home
Brian Robinson and Dame Ester Rantzen
Campaigner and TV presenter Dame Esther Rantzen visited a Greater Manchester care home to congratulate them on being recognised as one of the very best in the country. Dystlegh Grange, in Disley, Cheshire, recently received the ‘Outstanding’ rating from the Care Quality Commission. She said: “This is a unique and wonderful example of a caring home where everyone has choices and are treated as valuable human beings.”
Dame Esther was invited by her longtime friend and producer Patsy Newey, whose mother Etta, had been a resident at Dystlegh Grange until she died last December. Dame Esther added: “Patsy introduced me to this place as an outstanding example. When it’s as beautifully run as this is, people have a life, with company, choices, activities and a feeling of being valued. The CQC must have thought they had died and
gone to heaven when they came here. “Lots of things make Dystlegh Grange special, like people regarding their suites as their home, and the way people have choices and a sense of value. They can enjoy life and enjoy friendships and have fun. Everyone should have fun.” The Grange was once the 19th hole for Disley Golf Club, before being purchased by registered manager and co-owner Brian Robinson in 1980. Brian said: “We were very proud and honoured Dame Esther took the time to travel up from London to see Dystlegh Grange for herself. Dystlegh Grange is founded on the understanding that in most of us is a yearning to live in our own home, somewhere we can be ourselves. Choosing to live in our own home in this neighbourly community is one way to help manage the changes later life can bring.”
Cambridge toddlers bring joy to care home residents
Residents at Home Meadow care home in Toft are experiencing a new kind of therapy thanks to the ‘Little Owls’ project run by local childminders, Nat Jackson and Amanda Strong. Seven children aged one to four are now regular visitors to the Home Meadow after their childminders forged a partnership with the home to enable the children to learn more about older people in their community. Home Meadow provides residential care for up to 49 residents, many of whom live with dementia. Since January this year, Little Owls group has been
based at the home every Monday. The children spend the day with the residents and invite them to take part in their activities such as dance, arts and crafts and singing. The group has a dedicated room to use for their lunch and for nap time and residents are free to come and go as they please. Rated ‘outstanding’ by Ofsted, childminders Nat and Amanda who run the group approached Home Meadow’s activities coordinator Joe Ballard who was immediately keen to progress the idea. After some pilot
12 Care Home Management | May/June 2017
sessions in December it was soon agreed to make the visits regular. Joe said: “Having the children at the home is like a medicine to the residents. Many of the people here live with dementia and spending time with the young ones brings them joy and happiness that is so lovely to see. Some of them have formed very tight bonds with the children and seeing them on a Monday is the highlight of their week.” Nat Jackson of Little Owls said: “We’re really thrilled with how positive this project has been for the children and for the residents. “We were teaching the children about people in the community and wanted them to learn more about our elderly generation. We wanted the children to interact with them, as we understood the benefits for both generations. We approached Joe to see if he would let us come and visit Home Meadow. It’s now a regular part of our week and the children love it.”
Don’t be a dummy about evacuation training Working with the elderly is very rewarding, but with increased age comes a variety of complications such as poor mobility and loss of vision and therefore creating an effective evacuation plan becomes more problematic. No one wants to think about it happening, but do you have an effective plan in case the worst should ever happen? Would your staff feel confident in moving residents quickly and safely and would they feel suitably skilled to carry out CPR in a difficult or dangerous situation? Effective training is vital to help your team to prepare. Often, using a human volunteer is impractical and therefore a training manikin or dummy can be very useful. After all, a manikin won’t complain about sitting in one position for a long time whilst teams brainstorm solutions to a problem, or ask for another cup of tea at a critical moment!
Ruth Lee Ltd are experts in the design and manufacture of training manikins, with more than 30 years’ experience of working alongside the emergency services to create dummies which are suitable for a range of training scenarios. This includes a range of Bariatric Manikins to practise the safe moving of larger, heavier people; not only important for your emergency plans, but also for your team’s ongoing safe manual handling skills. These manikins come complete with a carrying sheet.
Why not create a more realistic environment for your staff to practise their lifesaving skills? Ruth Lee’s Fullbodied CPR or Airway Management Manikins are tough and can be positioned in a range of scenarios, from small bathrooms to mobility vehicles. Completing CPR in a confined space is more difficult – but also more realistic. For further advice about the range of manikins available, please call Ruth Lee Ltd on 01490 413 282 or visit www.ruthlee.co.uk
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You care about your residents, we care about your training needs. Ruth Lee has over 30 years’ experience in designing and manufacturing training manikins for a range of exercises including manual handling. Our Bariatric range includes manikins at 90, 180 and 260kgs. The 90kg Bariatric is the newest in our range and allows staff to practise moving a larger, bulkier resident, without excessive weight.
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May/June 2017 | Care Home Management 13
News
Care Home Awards –
all set for a glittering occasion
The entries have been sorted. The judges have made their decisions. All is now set for the Care Home Awards 2017. This very first Care Home Awards event is being held at London’s Royal Garden Hotel, in Kensington on 25 May. The judges for the care home categories were chaired by Alistair White, marketing consultant of Care England, with the supplier categories led by Care Home Management’s editor, Alan Rustad. Standards for these inaugural awards have been high and the judges faced some tight decisions
The judges at work
when they met to consider the entries. The headline sponsor for the event is NHG. Based at Southwater in West Sussex, the Nursing Hygiene Group, provides equipment, consumables and interior design services to the care home industry. We are delighted to have them supporting these inaugural awards and look forward to working with them in future years.
Dress code for the awards lunch is business attire and the reception will commence at 12 noon on the day. There will be an excellent 3-course lunch – the Royal Garden Hotel is renowned for the quality of it menus, recipes and ingredients – with a reception and wine or soft drinks provided over lunch, as part of the ticket price. Tickets to the Care Home Awards lunch are on offer at £185 + VAT for individual places, or at an even better £166.50 + VAT per person if booked as a table of 10 (£1,665 + VAT). Space is limited for this lunchtime event, so finalists are asked to make sure they at least reserve their places as soon as they can to avoid disappointment. Tickets can be booked online at http://www.carehomeawards.com/ awards-ceremony or you can request a booking form by email for completion and return by post. All bookings will be confirmed by a VAT invoice and, nearer the date you will be asked for any additional information about dietary requirements and the names of any accompanying guests.
The Royal Garden Hotel
14 Care Home Management | May/June 2017
The shortlisted entries 3663 Abacus Playgrounds Active Minds Adept Care Homes Amore Care / Priory Group Apex Medical Aqua Cert Auriens Barchester Berkley Care Group Berwick Care Equipment Brighterkind Canopies Care UK Caring Homes Group CFS Carpets Chilton House Compass Associates (recruitment) Devon Interiors with Anchor Trust Dine Contract Catering Echo Managed Services Equal Arts Exemplar Health Care Flex Maintenance Ganymede Care Gracewell Hallmark Care Homes Hempsons Solicitors L&M Health Care Lilian Faithful Homes Maximum Maintenance Meadow House Nursing Home Mistley Manor Moore Factilities Management MOP Healthcare NABS Peterhouse Nescafe Nursing Hygiene Group (NHG) P&G Professional Pepe Garden Furniture PJ Care Redcrier Training SCF Healthcare Furniture Sheengate Publishing Signature Care Homes SkyVac Special2Us Swanton Care and Community Tanglewood Care Homes and Bungalows The Badby Park Group The Close Care Home Valerie Manor Willow Lodge Nursing Home
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News
Insight, networking and a 20-year anniversary celebration at the Care Forum Wokefield Park in Berkshire will this June play host to 65 senior care professionals and 35 reputable suppliers, who will be meeting to celebrate the 20th anniversary of the Care Forum. The event – which provides an opportunity for care professionals to meet new solutions providers – is shaping up well. Nearly all attending places are confirmed and the seminar programme has some of the most influential names in the business confirmed to speak. The programme includes well-known industry speaker Debbie Harris (above) of Chosen with Care will be sharing her 20+ years’ experience, with a particular focus on ‘The Do’s and Don’ts of looking after self-funding’. She will showcase various examples
of each, with inclusions of what selffunding clients are looking for in care homes and how to support them in their decision making process. Joining Debbie at the event is Bhavna Keane-Rao, lead consultant at BKR, who will be covering a topic at the forefront of every care professional’s mind – how to maximise the efforts of your workforce - in her seminar ‘Workforce – Opportunities and Challenges’. With over 20 years’ experience in regulation, with previous experience of working at the CQC, Bhavna will advise on reducing risks of new recruits, legislations, training, retention and more. Professor June Andrews, director of dementia care at Sedaca, will also be
covering a hot topic of the moment – ‘New Approaches to Dementia’. This will offer essential insight into succeeding at providing the best dementia care and understanding what makes an actual difference. The Care Forum takes place on 12 and 13 June 13th at Wokefield Park, Berkshire. If you are a senior care professional, and would like to confirm one of the remaining places, please visit http:// thecareforum.co.uk/delegatesbooking form. For more information on the Care Forum’s seminar programme, attendees or event overview, please contact Clare Element on 01992 374068 or email c.element@forumevents.co.uk
Roadshows head for Aintree session is perfectly timed to hear the latest findings on care quality in adult social care and to debate the future. Sheila Scott, from the National Care Association will highlight the proposed changes to adult social care that will take effect this July. She will also be discussing key areas of completing the Provider Information Return. Care Roadshows will also be visiting Birmingham in July, Cardiff in October and London in November. Care Roadshows are heading to Aintree Racecourse in Liverpool on 9 May for its second informative pit stop of the year. The event offers free informative and interactive seminars and relaxed workshops to take part in, with specialists on hand to help maximise
your care business to its full potential and to ensure you get the most from your visit. The opening seminar from the CQC will explain what is changing from now to 2020 and highlight CQC’s updated model of regulation following consultations earlier this year. This
16 Care Home Management | May/June 2017
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May/June 2017 | Care Home Management 17
Bathroom alarms
Detecting falls – improving detection and response Palle Stevn, COO at MariCare, looks at the risks relating to falls in a care home, particularly in the bathroom, and how activity sensing systems could improve both fall detection and response.
Falls are a high priority for the care industry. This is not surprising, given that the elderly who live in care homes are at greater risk of falling than those who live in the community. This may seem at first an unlikely contradiction. One that appears to undermine the social contract that is at the core of the relationship between residents, their family members – if they have any – and the duties and responsibilities of the care home. However, this is less revealing of any gap between the expectations of the families – of a safer and more regulated environment for their loved ones – and the care home management, who are committed to providing the safest environment possible. Rather, it reflects that those who enter care homes are often the most vulnerable and frail. Residents may have arrived at the sharp edge of care because of the effects of previous falls, or patterns of falling in their own homes due to deteriorating health conditions. This is reinforced by the sobering statistic that 40 per cent of care home admissions are as a result of a fall.
Breaking the cycle of fear The risk of falls is increasing exponentially with the rapidly ageing population. Measuring from 2012 up to the year 2032, the populations of 65-84 year olds and the over 85s in the UK are set to increase by 39 and 106 per cent respectively, according to research from the King’s Fund in London. About one third of the elderly over the age of 65 endure a fall each year. At 70 years, close to half fall annually.
18 Care Home Management | May/June 2017
The psychological damage following a fall can be immense, producing an inhibiting loss of confidence in older people which can, in turn, lead to self-imposed restrictions that curtail participation in everyday activities. A fall increases the fear and likelihood of more falls and, with any loss of existing mobility, the will to maintain a degree of independence diminishes. Falls also contribute to an underlying accumulation of guilt of becoming a burden, which adds to the negativity of what may outwardly appear as no more than a minor mishap. For the elderly, the amount of time that they lay on the floor following a fall can be crucial. As time goes by, the stress on body processes through immobility signpost serious complications further down the line, such as hypothermia or pneumonia. High risks in the bathroom Approximately 60 per cent of people living in care homes
Bathroom alarms experience recurrent falls each year according to the Department of Health. In bathrooms the risk of a fall is particularly acute as it is an environment with slippery surfaces where an elderly person’s mobility could be pushed to its limits. Worryingly, these falls can easily go unreported or unrecognised. This may be because many of the elderly have a fatalistic attitude toward falls that comes from ageing. Or perhaps they don’t feel it is worth making a fuss because they have personally deemed it to be a minor incident? This may be identified particularly in the context of individuals to whom falling is a regular occurrence. Only part of the solution The safety and security of residents is paramount and there are many existing aids that contribute toward enhanced safety in the bathroom environment. Determining whether bathroom equipment is sufficiently weight-bearing, recommending the provision of appropriate lighting, purchasing physical aids such as slipresistant mats for baths and flooring all are fall prevention solutions. Panic buttons and emergency cords provide a quick link to staff but are
not a failsafe option. There will always be occasions when the suddenness or severity of a fall leaves the victim without the ability to summon help. Advanced layer of safety and security Technology such as activity sensing systems deliver new options that improve response to falls, while building a core of data that will help care providers to predict those residents that are especially vulnerable, thus improving the safety and security of the residents. The sensor works through wireless technology to monitor residents’ movements, and if a fall occurs, it communicates with a remote gateway within the care home. This transfers the information to a cloud server, which then sends a notification to a preselected smartphone. At your convenience The advantage for care home operators is that it is no longer necessary to source potentially expensive specialist help. Activity sensing systems are simple to fit in any bathroom with basic tools and there are no wires required due to the battery power – which lasts
for approximately 12-months and it can be achieved with minimum disturbance for the residents. Specifically designed to make living spaces safer and more secure, an activity sensing system does not require the assistance of carers or relatives yet, it is not an intrusive solution. Research reveals that the elderly will readily accept smart technologies in care homes as long as they are convinced that the solutions will aid their physical movement and independence. Predicting a problem An activity sensing system can be applied beyond identifying when a resident might require immediate assistance. It can also be used to track behavioural patterns that might indicate an underlying health issue. Data that the system receives is stored and can be accessed by a care operator. They can track a resident’s movements and see how often they enter and exit the bathroom, which might alert nursing staff to a hitherto undetected illness. If care homes were to invest in a solution such as an activity sensing system, then they will find it has the potential to reduce elderly fall rates by up to 30%. Gaining peace of mind Activity sensing systems are a lifesaving, technology-driven solution that should be considered as a bolster to a care home’s existing provision for the extra dimension it adds to its safety strategy and as the potential key selling point it delivers for the individual merits of any care home. It’s a time of considerable upheaval in the broader social care system, which is producing an environment where every care home operator has to balance responsibilities to residents’ safety with pressures for financial constraint. In this context, an activity sensing system provides an effective and dependable solution in combatting the perennial and everpresent risk of falling.
May/June 2017 | Care Home Management 19
Personal alarms
The alarm system that connects wearers and carers more carers who can then monitor battery life, location and access fast-touch call buttons. If a wearer triggers a fall detection alarm, or if they send an emergency first alert, their carers receive immediate notifications to raise an emergency A new wearable technology system has been launched that connects wearers with carers. ConnectUs Life has come up with RightMinder, which provides fall detection, first alert monitoring, GPS location reporting and carer connections. RightMinder wearers are securely connected via an app to one or
but also paid professional carers too. “Wearers have embraced smartwatch technology when paired with the app. It has proven to be very easy to use and manage, despite the underlying complexity of the algorithms utilised.”
response. Ben Slater, of ConnectUs Life, said: “Our core focus is to ensure wearers maintain meaningful independence with an efficient, yet discreet safety and security alert system. Anyone can use it without lock-in contracts, nor do they need expensive custom hardware. Our first alert carers are not only from the family and friends orientated network,
Radio Nurse Call Leads the Way! With today’s technology, it is possible to upgrade an old nurse call system in under a week. Gone are the days of engineers installing cables and being on site for weeks, as with the new Radio Nurse Call a call point can be fitted in a resident’s room in minutes. Flexibility is another benefit as units can easily be repositioned when necessary, and multiple displays can be positioned around the care home
to ensure staff never miss a call. Southern Care Maintenance Ltd, SCM, was established in 1987 and are a specialist independent company for the Service and Maintenance of Nurse call, Fire and Nursing equipment. They have many years’ experience in both fitting and servicing Nurse Call systems covering Kent, Sussex, Surrey, Essex and South London. This month they are launching
20 Care Home Management | May/June 2017
mySCM, a new online customer portal, free of charge to all service contract customers, so that they can access service records, certificates and invoices securely 24/7. For more information see southerncare.co.uk and follow the link to the Nurse Call Page. You can also download a case study of a customer using Radio Nurse Call or telephone 01580 890089.
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With today’s technology, it is possible to upgrade an old Nurse call system in under a week. Gone are the days of engineers installing cables and being on site for weeks, as with the new Radio Nurse Call a call point can be fitted in a resident’s room in minutes. Flexibility is another benefit as units can easily be repositioned when necessary, and multiple displays can be positioned around the care home to ensure staff never miss a call. Southern Care Maintenance Ltd, SCM, was established in 1987 and are a specialist independent company for the Service and Maintenance of Nurse call, Fire and Nursing equipment. They have many years’ experience in both fitting and servicing Nurse Call systems covering Kent, Sussex, Surrey, Essex and South London. This month they are launching mySCM, a new online customer portal, free of charge to all service contract customers, so that they can access service records, certificates and invoices securely 24/7. For more information see southerncare.co.uk and follow the link to the Nurse Call Page. You can also download a case study of a customer using Radio Nurse call or ring 01580 890089
Why must we pay for care homes when we can leave our relatives in hospital for free? In our last edition we featured a new concept for dealing with dementia that was created by Andrew Tremlett. Now he discusses how staying in hospital is the cheapest option. This isn’t as controversial as it sounds because the fact of the matter is that hospital beds on average cost £400 per night. And the average cost per bed night in a care home in the UK? Yup, you guessed it - £135. If you went to two furniture stores and found exactly the same sofa with this price differential, which one would you buy? So why don’t we make care homes free, helped by the £265 surplus? Unscrupulous private sector? Is it because most care homes are owned by the unscrupulous private sector and it would be the thin edge of the privatisation wedge regarding our beloved NHS? This is nonsense because citizens just want high quality services and they wouldn’t care how the money goes round. Qualification for this concept would be exactly the same for current free NHS care. And with national press revelations about the state of the NHS maybe it’s time to use some logic and practicality to improve things, whatever the issues might be regarding health tourism, social care integration, spiralling business rates for hospitals and exhausted staff. Calm, measured and determined change is required and the simpler the idea, the better. In general, people don’t like change. It disturbs their lives, takes them out of comfort zones and for some is very stressful. But there are many more people in the UK right now who are
experiencing extremely high levels of stress in dealing with family members who are becoming increasingly dependant on them. What price love? Statistics indicate £1.3 billion “hidden” costs. Of course, there are some added benefits to this strategy apart the financial one. Possibly most important is that families and carers would view their worlds completely differently and be less of a burden in the social care forum. How many people have given up their jobs to be a carer and thus the nation has been deprived of the tax they would pay and then pay them a carer’s allowance? Thoroughly deserved but none the less a double whammy that does not make sense financially and more important socially. All of a sudden, “corridor” wards would disappear, nurses would be
22 Care Home Management | May/June 2017
doing the job they were trained to do and hospital trusts wouldn’t be paying locum doctors ridiculous daily rates. Waiting times in A&E would plummet with hospitals better able to shuffle their resources effectively and with more effective treatments being administered, the financial and social benefits would snowball. Ironically, the best part of this concept is that it wouldn’t be difficult to implement because its simplicity can be appreciated by all. It would be welcomed by the NHS advocates, the care home sector, local authorities, carers and the general public. And the taxpayer would save money – what a strange idea. The only people I can think of who wouldn’t like it might be politicians. Even stranger. What do you think? Do you agree with Andrew Tremlett’s view? Let us know your thoughts. Email editorial@ jnjmedia.co.uk
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‘You can’t have champagne for the price of lemonade’ –
one provider illustrates the stresses the care home sector is under
The financial pressures faced by the care home sector in recent years have been well documented in this magazine. Reduced local authority budgets coupled with increased wage costs are just two elements that have created a perfect storm for the industry. The promise of increased funding in the Budget and the expected Green Paper on funding due later this year provide a little hope that politicians may start to take the issue of social care and its place in the whole care picture a little more seriously. Alan Rustad has been talking to one typical care home operator. His experience in recent years will strike a chord with the many owners and managers who have tried to do their best against almost impossible odds. Roy Young would never describe himself as a major player in the care home industry. He does not run one of the big chains of operators with many care homes and hundreds of beds. He is a blunt talking Yorkshireman from Sheffield who runs three care homes in his Silver Healthcare business. He prides himself on the
individual care Silver Healthcare is able to give, and his strapline ‘it’s the people who make the difference’ tells you all you need to know about his approach. Somehow he has been able to keep his three homes, Fulwood Lodge Care Home, Rosebank Care Home and Leahyrst Care Home going
24 Care Home Management | May/June 2017
against what at times have seemed overwhelming odds. And in recent years, he says he has not taken a single penny out of the business. ‘Never known anything like it’ “I have been in this business for almost 30 years,” says Roy. “We provide both nursing and dementia
residential care for 106 residents. I have around 120 full time and part time staff. And I have never know anything like it.” Some might argue he is another care home operator crying wolf but Roy believes the sector is underfunded and over-regulated and will head to certain collapse unless the government finds a silver bullet from somewhere. Sixty per cent of what comes in to Silver Healthcare goes on salaries. The recent increase in the National Living Wage from £7.20 to £7.50 is causing more hardship to providers but he realises the need for it. Knock on effect of NLW “The increase is not enough. All staff deserve more. And it has a knock on effect for those above the National Living Wage too. The new local authority level of funding equates to just £2.58 an hour for dementia care and £3.51 an hour for nursing care. “But it is just not enough for providers like Silver Healthcare to meet all the present day standards that are now required. “It is also way short of what is expected to cover all bank interest and mortgage payments, food and drink, energy costs, maintenance and decoration to name just a few. “There has never been any discussion around extra funding for unsocial hours such as working during the night, bank holidays or for weekend shifts. “There is no extra funding for nursing equipment and care homes cannot finance major capital expenditure on present nursing fee fund levels.” No cutting corners For all the funding problems, Roy is determined not to cut corners. He says the residents in all three homes can eat whatever they want, thanks to an in-house catering team at each home. All menus provide a wide variety of choices, with home-cooked meals being prepared fresh each day.
Daily activities are provided with residents encouraged to participate as much as they are able. There are regular outings to nearby locations and special events such as barbecues and bonfire parties. Family and friends are also invited to attend events and days out, and are welcome to visit at any reasonable time. “All these things cost money of course,” says Roy. “I want to provide the very best of care. But you cannot have champagne for the price of lemonade.” VAT issues There are other financial issues that concern him. VAT is one. He cannot understand why care homes are exempt from VAT and cannot claim VAT back like other businesses. He also wants to see a set national care and nursing fee level, arguing that there is a considerable difference in fees that exists from one city to another. If there is one issue that stands out in the ‘critical’ category it is the recruitment of qualified staff. It may be a constant headache for all operators but Roy recognises that there is one group doing very nicely thank you out of it all - the recruitment agencies. Recruitment agencies are winners “The recruitment agencies are the big winners here,” says Roy. “We recognise the importance of emergency cover when needed. But the rates paid by recruitment agencies and the NHS prevents the private
sector outbidding them in the search for good qualified staff. “How long can the NHS continue staffing entire wards with agency staff? The country has a shortage of over 20,000 nurses, and it is estimated that the 2016/17 NHS spend on agency staffing will have reached £4 billion. “Increased pay levels for permanent staff could be made from the agency fees charged – and that would make the whole process of working for an agency must less attractive.” Questions for councils Roy would like to see local authorities face some tough questions. “They should be asked ‘what are the true costs of care’ because I believe serious consideration must be given to a new up front calculation, not by the private sector or local government but by an independent organisation such as the Joseph Rowntree Foundation. It would be an important step for a third party to come to a view that everyone could then work to.” But while the outlook is uncertain, this particular Yorkshireman says he and his staff are made of strong stuff. “I am fortunate that I have other interests and I do not depend on my three homes to provide a livelihood,” says Roy. “I have three excellent managers at the three homes who ensure we deliver a top class service for our residents. Our staff are wonderful. “I think we will keep that going but how nice it would be to have some certainty.”
May/June 2017 | Care Home Management 25
Greensleeves Care open trading at the London Stock Exchange
Retail Charity Bonds -
a new option for the care home sector? Money is tight and care home operators are looking at ever more creative ways to find it. Here, Paul Newman, chief executive of Greensleeves Care explains how his organisation raised £33 million on the retail bond market. In March, Greensleeves Care became the first ever care charity to raise finance through a Retail Charity Bond. The offer raised £33 million in just one week. We did it to refinance some loans and grow our services, with the expectation that over its nine-year life, it will save us around £1m in bank interest. What prompted us to take this action? Like many other care providers, we are always looking to reach more people with our highquality care. We have also gone down the traditional route of securing loans from major banks to finance our expansion. Many of you will be familiar with the process - we announce our intention to borrow, the banks line up their offers in a ‘beauty parade’, and we choose the best option available from a narrow field. Aside from having to choose from limited available options, managing
several different loans, each with their own costs and covenants, was becoming increasingly problematic. The complexity of interactions between the multiple arrangements created the risk of a mistake. Reducing the complexity Financial planning was made harder because some of the debt we had was variable. If we had carried on in this vein, we would have faced increased complexity from yet more covenants, banks wanting different security and less certainty about our future obligations – in essence, more risk. We knew we had a challenge on our hands, but what could we do? In 2013 I had attended a workshop organised by Allia, the charity behind the Retail Charity Bonds platform. In essence a retail bond is a conventional bond – it’s long term finance at a fixed rate (in our case 4.25% over 9 years)
26 Care Home Management | May/June 2017
– but accessible to the individual consumer as well as institutional investors because subscriptions can start at just £500. Since the London Stock Exchange launched its new trading platform for retail bonds in 2010, over £5 billion has been raised through retail bond issues. They are typically upwards of £50 million because of the legal and administrative costs involved in issuing a listed bond. For most charities who are looking to raise less than this, the costs would normally be too high for a retail bond to offer value. Reducing the costs Allia’s Retail Charity Bonds platform was designed to bring the costs down, and making a retail bond a costeffective form of finance for charities. It does this by providing a standardised process where the bonds are issued by a special purpose vehicle, managed
by Allia, and proceeds are passed on as a loan to the charity. Greensleeves Care was the fourth charity to raise funds through the platform since it launched in 2014. To raise funds in this way there are a number of criteria you have to meet. You have to be a charity, you need to be looking to raise more than £10 million and you need to be able to show a strong capability to pay the interest and repay the money borrowed. There were several other reasons why a Retail Charity Bond was right for us. We had multiple loans and the bond was a great opportunity to consolidate those under one simple set of covenants. Unlike a bank loan we didn’t have to give security over our assets, and the covenants we now have are much lighter than the three loans the bond funding has replacing. Also, we wanted to continue to grow and the fixed rate gave us the freedom to plan into the future. Finally, the bond requires only a simple ‘bullet’ repayment of the finance at the end of the fixed term, rather than repaying capital and interest together as the banks wanted, so it improves our cashflow. Convince your own team The first step for anyone considering this move is convincing your own team, especially your trustee board. Our chief financial officer, financial controller and the chairman of our finance & audit committee immediately recognised the benefit. The board discussed the decision at length and in detail. We would be the first adopters of the model in the charity care sector, what were the risks? What if noone wanted to invest? What kind of shocks might we face in the next ten years? What if we defaulted on our obligations? We are lucky that our trustees are very experienced and with the support of Allia we worked through the issues. While there are always risks, we decided that carrying on with the
complexity and inconstancy of our multiple bank loans would have been a greater risk. Scrutiny of the business Next was the level of scrutiny of our business. Allia commissioned independent due diligence, which involved a very detailed assessment of our activities and financial model. We also had to work closely with our lawyers to prepare comprehensive information about the organisation and its performance for the bond prospectus. Providing the material needed was by far the most arduous and time consuming part of the process, but overall the process was beneficial. We are all very proud to work for Greensleeves Care and believe we are doing a good job, but proving with hard data that we were leading the way, both financially and in services, was fantastic. The social impact Finally, what surprised me when the bond arrangers, Peel Hunt, took us to meet with some of the key institutional investors was that most questions focused on our social impact, rather than the finances. Don’t get me wrong, potential investors wanted to know
they were making an appropriate investment for themselves or their clients, but having presented the financial details the most challenging questions were around impact. These conversations opened doors to organisations I suspect we would never have met otherwise, and in fact the very first investor we met offered us pro-bono advice on our social impact reporting. The bond was launched on 7 March. The offer was scheduled to close on 24 March but due to high levels of demand it closed early. In just one week we had raised the maximum we wanted - £33 million. We received the funds on 30 March and have already paid down our existing loans. With the remainder, we are going to purchase a new home in Berkshire and redevelop two of our existing homes. Issuing a Retail Charity Bond was a good strategic move for Greensleeves Care. We believe it has provided us an excellent platform for long term growth and that it’s a more appropriate product to bank lending for a business at our stage of growth and transition. For any organisation like ours that is looking at refinancing existing debt or securing funding for a period of growth and investment, we heartily recommend considering it.
Paul Newman (left) and Tim Jones, Allia
May/June 2017 | Care Home Management 27
Buying a care home – have you got what it takes? by Giles Gillingham, a senior commercial solicitor and head of the care providers team at RHW solicitors, Guildford.
There is a lot more to owning a care home than simply being a very good nurse or doctor or having successfully run another type of business. If you have not run your own business before suddenly you will take on the role of managing director, sales and marketing director and personnel officer. The skills you will be required to acquire overnight will include selling, management, and staff 28 Care Home Management | May/June 2017
selection and development skills, not forgetting business planning, cash flow forecasting and client care. For those not previously involved with the care sector, the more onerous regulatory requirements introduced by the Health and Social Care Act 2008 compared to the Care Standards Act 2000 have made entry less than straightforward and, unless the home is adequately managed through
suitably qualified staff, may lead to an early exit.
council will indicate if the population levels are static or likely to grow.
Why do you want to? The whole business can be daunting and probably the best piece of advice is to ask yourself exactly why you want to own a care home. Is it for example because you simply view care homes as a good investment? Or is it because you feel restricted at present, perhaps with regard to the style of management you work under? Or is it because you have a vocational commitment to the care of others and want to be able to fully apply your skills to that. There is no doubt that, as in any business, some people will and should remain as ‘employees’, whilst others have the necessary skills and potential to develop into employers. Before making the final decision to go ahead and buy a care home there are other points worth considering: • Are you a team player? • Are you a leader? • Are you an analyst or a dreamer? • Can you delegate effectively? • Can you carry the responsibility and still sleep at night? It will be important to put together a business plan and a marketing plan and to think about what your vision for your care home will be.
What type of care home? Are you looking for a care home offering nursing care or only personal care or a concept that embraces both and perhaps also includes other care facilities. Do you want to care for adults or children? Will you focus on general nursing care or specialist dementia care or other particular needs such as those with learning/ physical disabilities or who have problems with drugs and/or alcohol? Consider with your advisers what resources you will need to have in place to efficiently operate a care home of the type you have in mind.
What is your vision? Once you have decided that buying a care home is definitely the right option for you, the next thing to consider and define is the vision of your ideal care home. Without a vision, setting out in some detail where you want to operate and how your care home will run, you will waste a lot of time and energy looking at completely unsuitable care homes. The next important step is to prepare a business plan and a marketing plan. Carry out research into the needs in your desired area and whether there is potential for growth. Enquiries with the local
Finding a care home Once you have decided on the type of care home you plan to run, the next thing is to find a care home that suits your requirements and the needs of your potential residents. This is probably the most difficult part of the jigsaw, but having found the right one, you will need to identify a bank, or broker with financial experience of dealing with care home purchases, an accountant and a solicitor. All preferably people with extensive experience of the social care sector and people with whom you feel you can deal. Make enquiries of other care home owners, seek recommendations of suitable advisers and ask for details of the experience they have. Ask questions, and expect and get satisfactory answers. Choosing a lawyer It is well worth seeking out one of the limited number of lawyers who have extensive experience of working for care home providers. Their specialist knowledge is more likely to give you the edge in your negotiations and resolve issues before they become problems at a later stage. We find that where other parties appoint solicitors who do not specialise in the social care sector,
this invariably adds to the time and the cost to our clients of concluding transactions. It is a false economy to opt for a low fee estimate rather than choose a specialist care sector solicitor – be prepared to pay the appropriate level of fees for specialist advice. Consider also the longer term. We also, for example, provide specialist advice on regulatory issues, CQC inspection reports and enforcement action so appointing a lawyer who can cater for most, if not all, of your requirements for legal advice is a wise decision. Buying a care home is a major capital outlay. Throughout the transaction the lawyer you choose should be approachable, respond quickly and be able to explain things clearly to you. Common sense Use your own common sense and gut feeling. Use an accountant and a valuer who also specialise in the social care sector - they are trained to assess the viability, or otherwise, of a care home, and to look for any ‘holes’. If someone else has doubts about your proposed investment, listen to them and weigh up their advice, remembering that at the end of the day it is only you who makes the final decision on whether or not to proceed with such a major acquisition. You should not be afraid to pull out if something does not ‘feel right’ - it will almost certainly be cheaper in the long run. The experience will not have been wasted; you will undoubtedly be more knowledgeable when you consider the next care home. Website: www.rhw.co.uk or e-mail: giles.gillingham@rhw.co.uk
May/June 2017 | Care Home Management 29
Buying or selling a care home – the legal necessities by Monica Macheng, partner corporate, Wright Hassall. Buying or selling a care home business is a complex process. It involves understanding numerous intricacies that come with owning and operating a care home. We recently acted for clients who were selling one of their care homes to a new entrant to the care home market. In preparation for the sale, the sellers had undergone a reorganisation which involved putting their care homes into a new group structure with each care home ringfenced into a separate subsidiary with its own holding company. All of the business and assets and employees relating to each care home had to be transferred into each relevant subsidiary. As the care home owner and provider, the subsidiary needed to be registered with the Care Quality Commission. We were instructed on the sale of the holding company of one of the subsidiaries. Due diligence demands We guided the sellers on dealing with the buyer’s due diligence requests relating to (amongst other things): • the various steps of the reorganisation and the transfer of the care home, business and assets and employees into the subsidiary company, including what liabilities had transferred with the care home into the subsidiary
• the property • the residents’ contracts • contracts with local authorities and other commissioners • the registration of the care home • regulatory and inspection issues • any investigations in relation to other compliance matters, such as, hard wire/mains electrical installations, portable appliance testing, gas boilers, water heater(s) and other gas appliances • employees, issues with the minimum wage, the living wage, calculation of holiday pay • any claims made against the subsidiary and the care home prior to its transfer into the subsidiary, whether by local authorities, residents or their families, or by employees Warranties and Indemnities We then negotiated the share purchase agreement. The sellers were expected to give warranties and indemnities which would serve as a retrospective price adjustment if the warranties were not true and accurate or were misleading or liability crystallised under an indemnity. To limit the sellers’ liability to the buyer under the warranties and indemnities, we negotiated limitation of liability provisions including limiting the period in which the buyer could bring claims and the amounts which the buyer could claim from the sellers.
30 Care Home Management | May/June 2017
We further limited the sellers’ liability by drafting a disclosure letter to qualify the warranties. We guided the sellers to ensure that the disclosures met the standard of fair and accurate disclosures. The buyer was purchasing with bank funding. As well as dealing with the buyer’s requirements, the sellers also had to satisfy the requirements of the buyer’s funder. The funder’s requirements are to ensure the strength and covenant of the funder’s security. There were therefore matters that the buyer and sellers were willing to take a view on, but unacceptable to the funder’s lawyers. The sellers had to have good financial management information that the funder could rely on for its funding. As a new entrant to the care home market, the buyer was also keen to ensure post completion support from the sellers. Appropriate provisions for the support were negotiated and included in the share purchase agreement. The sale and purchase completed to all parties’ satisfaction. Be prepared for what the process entails. It was important that the right team was built around the buyer and sellers. Advisors who understand the particular nuances of health and social care and the sale and purchase process should bring simplicity to an otherwise complex process.
How to avoid legal pitfalls over pay when selling your care home business Selling a care home business can be riddled with legal pitfalls. Charlotte ThorntonSmith and Stephenie Malone, specialist healthcare lawyers from Harrison Clark Rickerbys, warn of some of the hidden issues around pay and how to avoid them. Stephenie Malone
Getting the business in order and ready for sale achieves the best price possible. It is important to ‘get your house in order’ as a prudent buyer will want to obtain much information about it to ensure they can accurately assess their risks. Ensuring you have key information and documents to hand in advance helps to streamline the process. In our experience it can be less obvious issues which delay a transaction or cause it to falter. For many buyers, the cost of putting issues right in a target care business can cause them to walk away from a deal. Over the last 12 months, one issue which has dogged care businesses is staff pay. There have been numerous employment tribunal cases on what constitutes “working time” and about which work which should accordingly be paid at National Minimum/ Living Wage (NMW/NLW) rates, and what elements of pay should be considered when calculating holiday pay. Sleep in pay Under the current statutory definition, any period during which the worker is: • working • carrying out duties • at the employer’s disposal is deemed as working time, and
Charlotte Thornton-Smith
attracts NMW. This definition has led to the risk of high value claims from large numbers of staff who have been paid for sleep in shifts at flat rates. Furthermore, HMRC are focused on NMW breaches at the moment - recent results of investigations show care as the fourth worst offending industry. Because this is a prime concern, buyers will look for price reductions if they will have to put right noncompliant practices or they may delay transactions to force the seller to address historic underpayments (back pay to staff) and/or consult with staff to bring in new pay arrangements. Coupled with tight margins through reliance on public sector contracts, the prospect of acquiring a business with historic back pay liabilities is a concern to potential buyers. Holiday pay With decisions that holiday pay should take account of compulsory overtime and commission, many employers have been on the receiving end of claims for only paying holiday pay at basic rates of pay. Although tribunal claims limit awards for unpaid holiday pay to two years, if your staff have been required, either by a clause in their contracts or because of custom and practice, to
work overtime, and these additional hours have not be taken into account in holiday pay calculations, the risk of claims could make your business less attractive to buyers. The key to a smooth sale process By working with a specialist healthcare legal advisor before even embarking on the sale process to iron out any hidden issues, you can minimise unexpected events and keep your sale process on track, and on budget.
Case study Resolving back pay issues pre-sale to achieve best price A residential care provider was looking to sell. The business had considerable historic back pay liabilities, which made it less marketable. Before the due diligence process, in conjunction with their accountants, we assessed the liability of back pay and advised on methods of introducing a compliant pay arrangement to minimise the risk of claims from staff. This meant the business could be marketed at a fair price and in the best possible condition for sale, setting it apart from other providers competing for sale.
May/June 2017 | Care Home Management 31
Care homes counting the cost of energy bills by Rachel Adamson, head of regulatory law at Stephensons
Media coverage of the decision in the Budget to devote extra funding to tackle the dire state of finances in the UK’s care home industry generally overlooked one of the big causes of the squeeze. The Chancellor’s decision to pledge £2 billion extra into social care over the next three years comes after warnings by the Care Quality Commission last year that services for the elderly had reached a ‘tipping point’. Rise in insolvencies Care homes are suffering from huge pressure on their finances. Figures released by the Insolvency Service late in 2016 showed that a total of 380 care home businesses had been declared insolvent since 2010. The cash crisis has been blamed on councils paying less towards fees for residents, and rising costs, particularly staffing overheads. Care homes also face paying for administration and regulation. Providers are dedicating increasing time and resources to the maintaining of standards and accreditation for
the various regulatory bodies – often at the expense of front-line care, and often involving copious amounts of reporting and so-called ‘red tape’. Soaring energy prices create risk The high cost of gas and electricity has largely been overlooked. Soaring energy costs are a big factor and they could be helping put the health, safety and well-being of residents at some of the nation’s 20,000 care homes at risk. There is an intense and almost round-the-clock demand for energy and water at care homes, which are open 24/7. While some estimates say energy bills at care homes went up by 151 % from 2004-2012, others say energy costs have risen by 40 percent in three years. Whatever the precise figure, there is unanimity that prices have increased substantially. Fuel costs to double again And this is only the beginning. Energy experts predict that fuel bills will double in the next 10 years.
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Added to that mix is an increasing pressure due to legislative demands. Energy Performance Certificates come into effect in 2018 meaning care home operators must ensure their buildings comply with the minimum standard, or it will be considered unlawful to offer residence within their property. It wouldn’t be surprising if there was speculation that this background of intense financial pressure was having an impact on standards of care provided in care homes. Thousands not being fed properly According to a Parliamentary answer published in December last year, 11,000 care home residents a year are not being properly fed or are being left without food and drink. It also said that around 312 homes had been found to be in breach of basic standards to ensure vulnerable residents are not left hungry or dehydrated. In 2015, the Care Quality Commission found that a third of care homes required improvement and seven per cent were inadequate. While the vast majority of workers in care homes work hard to maintain good standards for residents their jobs are being made harder by cash pressures of which rising energy bills are a growing component.
Wi-Fi - a digital cure for loneliness Hannah Williams, national care account manager at Sky, highlights how investing in enabling technology such as Wi-Fi can have a positive impact on care home residents.
Social care providers and charities are increasingly looking at ways of tackling the issue of loneliness. Fortunately, Wi-Fi enabled digital technology can provide a simple and effective way of helping vulnerable people to keep up with old friends and make new ones too. Recent research by Age UK has revealed that 1.2 million people over 65 are chronically lonely, with 46% of individuals that fall into this age group revealing that they would not know where to turn if they were experiencing loneliness. A further report produced by the Department of Epidemiology and Public Health at UCL highlighted how the number of older people experiencing loneliness is set to continue increasing, in large part as a consequence of a rapidly ageing population. In response to the growing problem of loneliness amongst older people, the Jo Cox Commission on Loneliness was established at the beginning of this year as a ‘call to action’ to tackle this issue. Supported by a number of leading organisations such as the British Red Cross and the Alzheimer’s Society, the Commission seeks to draw attention to the long lasting implications of loneliness and the need for wider communities to work together to address this pressing issue.
New campaign to make a difference The #happytochat campaign was recently launched with this goal in mind and has provided people with the chance to make a difference in their communities, fostering discussions around the topic and encouraging new friendships to be formed as a result. The care sector has an important role to play. With the number of older people regularly using the internet rapidly rising adopting digital technologies can help care providers engage with the #happytochat campaign and can empower residents to connect with others online. Ever growing range of options Care homes that choose to invest in a Wi-Fi package give residents access to an ever-growing range of options for socialising and sharing with friends and family, from email and social media to direct face-to-face channels such as FaceTime and Skype. These serve as great resources for those whose family members are unable, perhaps because of distance or work commitments, to visit loved ones on a regular basis, and
can also help care home residents to connect with new people and make new friends. The #happytochat campaign seeks to broaden the reach of online communication by asking people to proactively connect with and chat to each other, and in particular with people at risk of suffering from loneliness. Facebook and Twitter users are being asked to share the hashtag #happytochat to indicate their willingness to connect with new people, with the hope that in doing so people feeling lonely will feel confident enough to communicate with these people. Encouraging residents to be more socially connected online can prove to be a simple but effective way of tackling feelings of isolation and promoting both the mental and physical wellbeing of older people. By giving residents access to online social media through the adoption of Wi-Fi, care homes operators can help make a real difference in the fight against loneliness. For more information on what Sky can do for your business and your residents, contact hannah.williams@ sky.uk or visit www.business.sky.com
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Make sure laundry is not a losing game
Clothing is key to personal identity in the care home environment, yet too often items are lost or mixed up in laundry processes. It is vital that residents’ belongings are returned to their rightful owner – outsourcing can ensure this and guarantee peace of mind. Moving into residential care can be a traumatic and challenging transition for some at first. Not only do people have to learn to adapt to a new environment, but also some experience emotional difficulties, and feel that they are losing their independence and sense of self. Ensuring that the resident feels welcome, valued as an individual, and cared for can ease the stresses and upset that sometimes come with a move to a care home. It can also shift the change from a negative one to a positive that can be viewed as a fresh start.
High standards and personalised service Once the resident is settled in their new home, it is vital that care staff uphold the high standards and personalised service that helped to make the move as comfortable as possible. It is critical that each person is treated as an individual with varying specific needs to ensure that dignity, which is recognised as a fundamental human right in legislation, is maintained at all times. This is particularly important when it comes to residents’ personal belongings. In their own home they would rarely have worried about other people touching, moving or, worse still, losing their possessions. In a care home, however, it is up to the staff to keep the setting clean and tidy, which inevitably involves handling residents’ effects.
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Clothing, in particular, is central to a person’s identity and some people, understandably, have an emotional attachment to certain items – especially as nice outfits are frequently a gift from relatives or associated with memorable events. Keeping up appearances Furthermore, ageing or deteriorating health typically does not mean that a person no longer wants to take pride in their appearance. In fact, quite the opposite is true, as the freedom and choice to decide what to wear is quite often one of the few daily aspects in which residents can feel they have full control over. Clothing allows residents to shape and display their own unique personality and identity, as well as keeping them warm and comfortable. As a result, it is hardly surprising
Do you feel like the
task of laundry
goes around and around and around? ...Maybe it’s time to let someone else handle it.
A care home laundry service from Berendsen includes: • A complete solution that removes the hassle of laundry • Freeing up space and staff time • Total compliance with infection control standards
• Track and trace technology (no lost items) • Complete garment care in one service (no shrinking or damaging) • All in one service for linen and garments • Potential cost savings to your business
Are you stuck on the laundry merry-go-round? Why not call us on 0808 281 0310 or visit www.berendsen.co.uk/care May/June 2017 | Care Home Management 35
that when an item is lost or mislaid or even worn by another resident in the care home it can be extremely upsetting for the rightful owner. Research goes so far as to suggest that this type of incident compromises the respect of residents and their personal property, and neglects to protect their right to dignity. It is equally distressing for the relatives of the resident and calls into question the level of care that their loved one is receiving. Indeed, beyond the harm to residents’ sense of identity, lost items can cause irreversible damage to a care home business’s reputation. Even if the loss is accidental, both residents and their families can lose trust in staff, which can create a detrimental culture of doubt and destroy important relationships that can be tough to rebuild. Lost clothing also hits the bottom line of businesses, as it is best practice to reimburse and replace items that go missing. Missing items ‘alarming’ The frequency with which this occurs in care homes is alarming, particularly within those that operate their own in-house laundries. Research has shown that missing clothing or linen is one of the most common laundry issues experienced by care home staff. In a survey conducted among managers that have laundry provisions on site, half reported that misplaced or lost personal items are the cause
of significant trouble to them, their residents and their staff. In addition, 81 per cent of surveyed care homes reported that they had lost or misplaced items within their premises and one in ten admitted this to be a frequent occurrence. Understanding that this state of things is unacceptable, care homes said that they would like to make improvements to their laundries and one in seven said that they feel their current inhouse set-up is simply ineffective. The trouble is that care homes are facing immense pressure in the face of funding cuts and staff shortages, meaning that the mammoth task of overhauling internal laundry operations and equipment is forced to take a back seat. Those homes that realise the problem cannot be ignored and need an immediate and robust solution are increasingly deciding to outsource laundry with remarkable results. Heavy investment to avoid lost items Specialist textile and laundry services providers have invested heavily in sophisticated technology to cut the risk of lost items. Market leaders, such as Berendsen, use the latest electronic barcode labelling and scanning equipment that uses tracking systems to ensure that every item is traceable throughout the entire laundering process. This guarantees that everything
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is safely washed, dried, ironed, finished and packed within its facilities and delivered back to only its rightful owner for complete peace of mind. Moreover, every resident within a home is given his or her own dedicated, labelled laundry bag that is assigned to them and their care home to further ensure that it can always be safely identified and traced. Scanning items also flags up any special care requirements to prevent delicate clothing being tumbled dried or washed at unsuitable temperatures that could cause damage. Some laundry services providers, including Berendsen, will apply the discreet tags on behalf of the care home to eliminate the need for staff or residents’ relatives to laboriously tag all items of clothing themselves. Outsourcing saves staff time Meanwhile, outsourcing offers many other benefits beyond the security of possessions. For instance, it frees up considerable time for staff, allowing them to focus their energy on delivering exceptional care to residents, and it is typically more cost effective than operating in-house laundries because there is no longer the need for pricey lease machinery, maintenance, insurance, detergents and utilities. As a person’s appearance is integral to their identity and self-worth, it is essential that care homes take maximum care to preserve residents’ personal clothing. While the value of some misplaced belongings can be reimbursed, there are items that will be priceless and irreplaceable to people within a home. Losing these can have severely negative and permanent results for the resident and their relatives, as well as the home staff and business. Consequently, it is vital to look at alternatives, such as outsourcing laundry, to guarantee that residential care homes are places where individuality is celebrated and respect is prioritised to promote excellent quality of life for all.
PROCESS VALIDATION Given the vulnerability of care home residents, it is imperative that operators are fully aware of the importance of hygiene when it comes to both the handling and cleaning of laundry. Paying due care and attention to laundry processes is absolutely vital in the fight against the outbreak of infections and diseases. Establishing an effective Laundry Cycle Management plan is the first step to achieving this. The simplest of these would be a tool that could validate the wash process, guarantee full hygienic thermal disinfection to each and every wash cycle, and eliminate the risk of infection spreading as a result of varying wash temperatures. Electrolux Professional is launching a Process Validation tool that records and stores data from the entire wash cycle. As well as confirming thermal disinfection has taken place, this allows for complete traceability when it comes to filing reports or audits for the Care Quality Commission (CQC), with all operational and cycle data available for download to USB. For more information, visit www.electrolux.co.uk/ professional or 08444 631 261.
YOUR NEW WEAPON AGAINST
INFECTION YOUR NEW Electrolux Professional
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professional INFECTION Email: epr.info@electrolux.co.uk Electrolux Professional Web: www.electrolux.co.uk/ professional Email: epr.info@electrolux.co.uk Tel: 08444 631 261
Follow us on Facebook Electrolux Professional UK Follow us on YouTube Electrolux Pro UK Follow us on Twitter @ElectroluxProUK Follow us on LinkedIn Electrolux Professional UK
Trouble free temperature validation to protect against infection
Complete Care Laundry Solution for the Care Sector For any successful on premises laundry operation it is essential to source a knowledgeable supplier and to have a reliable service partnership in place. This enables the correct procurement decisions, based on logistical and regulation requirements, and also secures access to the necessary engineer responses when they are needed. Established in 1926, Forbes Professional offers a wide range of flexible solutions for commercial laundry equipment provision. As well as purchase with maintenance options, we offer a Complete Care solution, which is ideally suited to a care environment. This solution gives access to Miele’s market leading commercial washers and dishwashers without the upfront capital outlay, and with the security of a same day/next day engineer response. We can also provide auto-dosing pumps as well as a range of detergents for a comprehensive, streamlined service via a single point of contact. We always assume a consultative approach, applying our understanding of industry requirements to advise upon WRAS and CQC stipulations. All clients are allocated a dedicated account manager from the initial site survey, who remains their contact for the life of the contract. Installation and commissioning are carried out by our manufacturer trained field engineers, who also provide user training to ensure that equipment is fully optimised. After delivery our service led infrastructure facilitates a first class local service, on a nationwide basis. ‘Engineers who attend are very knowledgeable…Very fast response to call out and repair. ’ Care Home, Cambridgeshire. Forbes Professional 0345 070 2335 info@forbes-professional.co.uk
Tel: 08444 631 261
Trouble free temperature validation to protect against infection
Follow us on Facebook Electrolux Professional UK
Electrolux Professional are committed to helping you create a safe and efficient laundry within your business. With Temp °Check you can have peace of mind that your laundry cycle management will be at its most efficient, both economically and procedurally.
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> Checks the temperature of the wash cycle to validate thermal disinfection process.
> Universal control unit, will fit onto any Electrolux Professional washing machine.
Follow us on Twitter @ElectroluxProUK
> Validation Reports stored for 1,000 wash cycles. > Productivity Reports show the efficiency of your laundry equipment, to create a more economical laundry and improve profitability.
Follow us on LinkedIn Electrolux Professional UK
Electrolux Professional are committed to helping you create a safe and efficient laundry within your business. With Temp °Check you can have peace of mind that your laundry cycle management will be at its most efficient, both economically and procedurally. > Checks the temperature of the wash cycle to validate thermal disinfection process. > Universal control unit, will fit onto any Electrolux Professional washing machine. > Validation Reports stored for 1,000 wash cycles. > Productivity Reports show the efficiency of your laundry equipment, to create a more economical laundry and improve profitability.
Laundry case study
Weald Hall upgrades Miele Professional machines
One of the many challenges for the care sector is the prevention and control of infection within a vulnerable patient community. Creating an environment that helps to safeguard
against the spread of infection is therefore vital. Investing in the right laundry machines can be an essential part of this, starting with equipment that conforms to best practice regulations. Miele Professional’s washing machines have thermal disinfection cycles which meet these requirements. One home which has benefitted with Miele Professional machines is Weald Hall residential care home, situated in Thornwood Common, near Epping in Essex. The home needed reliable, cost effective machines with guaranteed infection control. They consulted Miele Professional partner Forbes Professional, who
conducted a comprehensive on-site survey and then fully installed Miele Professional laundry, as well as a new thermal disinfector. Tracey Beeby, laundry supervisor at Weald Hall said: “The Miele machines that Forbes installed have been a great improvement on their predecessors. The machines are a lot more efficient and the wash result is far superior. They are high quality products that are robust enough to cope with our laundry demands. “The Miele equipment also offers healthcare specific programmes to ensure stringent standards of infection control are maintained, in accordance with UK CQC Guidelines.”
The limescale problem The age old problem of water quality and hardness has a costly and detrimental effect on a care home through the provision of cleaning and laundry care and management. Water has always been the most important commodity in any type or size of laundry. The effects of water and its quality is more critical today than ever before in the performance of cleaning linen products and the protection of capital equipment/appliances. More than 60% of the UK suffers from hard water. It is this hard water that brings with it a detrimental side in the form of limescale. Staggeringly, the problem of limescale costs the UK an estimated £1 billion every year to sort out through replacement, servicing and maintenance. It is also estimated that hard water is responsible for up to 70% of equipment failure, be it a washing machine, dishwasher or a range of commercial equipment. As such, it is important to consider water treatment as part of any capital equipment expenditure review to help eliminate unnecessary costs to your business.
One size does not fit all. As such it is important to review your water hardness, machine capacity and volume of water going through your system to ensure you make the right water treatment choice. Once installed you can expect to see the removal of any limescale but also achieve protection from aggressive minerals to help extend the working life of your equipment, as well as reduced energy bills. The introduction of a suitable water treatment system including; water softeners or scale prevention systems etc. also help to ensure soil and stain removal, preventing white fabrics from greying, whilst also ensuring coloured fabrics stay bright
38 Care Home Management | May/June 2017
and soft. Remember that the working life of a garment can be lessened by up to 40% when washed in hard water and some linen and fabrics may have to be discarded before wearing out. Kevin Johnson, Managing Director at Monarch Water, commented; “Water treatment equipment should be seen as an investment and insurance to help maintain a successful care home rather than a cost. With professional advice, wholesale benefits can be achieved from the point of its installation, providing appliance protection, energy bill and labour savings as well as maintaining the quality and working life of linen by virtually eliminating the scale build-up caused by the calcium and magnesium.”
The end of DOLS? by Helen Edwards, associate, Hempsons On 13 March 2017, the Law Commission published its report on the Deprivation of Liberty Safeguards (“DOLS”) with proposals for their replacement. The report calls the DOLS “overly technical and legalistic” and sets out how the current regime is “in crisis and needs to be overhauled” as a matter of “pressing urgency”. The proposed replacement system is called the Liberty Protection Safeguards. The key aspects of this new system include: • It applies to ages 16 and above (DOLS is 18+) • It covers any setting (not just care homes and hospitals) including travel between one and another • Responsibility for authorisation belongs with the body commissioning the care, such
as local authorities or Clinical Commissioning Groups. • It is a front-loaded system in which authorisation is sought as part of the care planning process • Urgent authorisations are replaced by a statutory authority to deprive someone of their liberty temporarily in an emergency to allow lifesustaining treatment or prevent a serious deterioration • Introduction of an Approved Mental Capacity Professional comparable to the Approved Mental Health Professional in mental health legislation. These are significant changes and address many of the problems arising out of the current system. However, the key question at the moment is how far down the government list these changes are in the current climate.
Helen Edwards
In conclusion, we are one step closer to a world without DOLS. However, it is likely that this is, as yet, some way off.
Care Management Home Leading Health and Social Care Lawyers
Free Legal Advice Line 01423 724056 Care Home Management and specialist health and social care law firm, Hempsons, have launched a free advice line for Care Home Management readers. If you would like some free legal advice simply call 01423 724056 quoting ‘Care Home Management Advice Line’ or email socialcare@hempsons.co.uk Legal advice provided by Hempsons. The Legal Advice Line is open between 9.00am and 5.00pm, Monday to Friday and offers up to 20 minutes of valuable preliminary advice on a range of issues social care providers face. Charity law • Commercial property • Company law • Contracts • Corporate Law • CQC regulatory Data protection • Disputes and litigation • Employment law • Fundraising • Governance and Constitutional Reviews Health and safety • Information law • Inquests and coroners • Judicial review • Mental health law Primary care contracting & community law • Safeguarding • Tendering
May/June 2017 | Care Home Management 39
Care homes around the world – how do they compare to the UK?
The spotlight is on the UK’s care homes as never before in terms of costs, quality and service. Much national coverage has been far from positive as the industry deals with the funding crisis on a day to day basis. But what about the situation outside the UK? Matthew Evans from Encore Care Homes has been examining how the rest of the world looks after its elderly population. For the first ever time, 2017 will see more elderly people requiring care than there are families able to provide it. This means that more and more elderly people are having to move into a care home. Although there have been some very negligent incidents, I believe these are isolated incidents and don’t truly represent the quality of care that the UK can provide. As a nation, the majority of us will always worry about the quality of care our mothers, fathers and grandparents receive and would never dream of relocating them into a poor environment. However, recently there has been a rise in families sending their elderly relatives overseas in the hope they can receive better care. This got me thinking. There was a need to find out what care homes are really like around the world and how they compare to the UK. I am going to focus on countries that are realistic as an option for an elderly UK citizen - France, Spain, Canada, Australia and Portugal.
Canada Although a long journey, Canada is a great place to start as it has always had a reputation for the people being very polite, positive and welcoming not to mention the size of the country that means that their average care home would be larger than in the UK. The most common types of elderly care in Canada are retirement homes, supportive housing and long-term care homes. The tricky thing about finding a care home in Canada is that they differ on price depending on what state you are in. Of course, in England, London care homes are more expensive than more northern areas of the country, but the prices won’t differ as much from county to county. For example, a retirement home in Ontario would cost you on average $3,204 a month where as in Quebec it would be around $1,520 a month which is much cheaper than in the UK. The quality of care is good, and although there have been incidents
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of negligence, the quality and type of care seems similar to what we have here in Great Britain. The actual homes themselves are on a larger and grander scale which is to be expected with the size of the country and price of real estate. Exchange rate at April 2017: 1 Canadian Dollar = 0.60 British Pound. Australia In Australia, there appears to be much more of an emphasis on care in your home rather than care in a purpose built facility as only six per cent of over 65s live in a residential care home. These care homes are priced differently as they are broken down into fees - daily fee, care fee and an accommodation fee. Prices vary but you can expect to pay around $3,562 a month for the basics. Similar to Canada, Australia has, on average, larger buildings to house their elderly population, but the actual care they
provide is very similar to the UK offering meals, cleaning, laundry, heating/cooling and entertainment. Exchange rate at April 2017: 1 Australian Dollar = 0.62 British Pound. Spain In Spain, the care home industry is nowhere near as large as it is in the UK. However, the past decade has seen a rise and the market is growing. Some of the care homes that have been built have actually been created with British people relocating in mind, which shows how few Spanish people actually use them. Spanish care homes provide a doctor who will visit regularly, 24 hour nursing as well as the basics, such as meals, entertainment and laundry. According to a study undertaken in 2014 the average monthly cost for care was around €2,110. However, if you were to add more services on you could be expected to pay up to around €3,518. As Spain is relatively new to the caring industry, for the price it would seem that you may get more value for your money staying in the UK.
The care homes are good quality as well as the care provided within them. Offering what the UK offers, but with the added bonus of more beds and better views. Exchange rate at April 2017: 1 Euro = 0.85 British Pound. Portugal There is a legal obligation in Portugal for adult children to care for their parents, meaning that, like Spain, there is more focus on organisations providing home care services rather than residential care.
However, the care home market in Portugal is growing, just slowly. Currently a residential care home in Portugal would cost you around €2,580 per month. This is for a basic care home, a more luxury facility could actually be double the price.
A very expensive place for the elderly to live has meant that there has been an increase in illegal care homes, families taking in the older generation and charging them much less but still providing a care service. The actual care homes are of good quality. As well as the service provided, they offer similar care as the UK apart from the weather and the views. Exchange rate at April 2017: 1 Euro = 0.85 British Pound. The majority of care homes around the world offer the same type of service - meals, entertainment, nursing and company. As for the level of care, we are fortunate that standards here in the UK are generally very high. Offering services at an average cost of around £29,270 per year, the UK not only has the added bonus of keeping your relatives close, but also the peace of mind that they are comfortable somewhere familiar. This article was brought to you in conjunction with www.encorecarehomes.co.uk.
Exchange rate at April 2017: 1 Euro = 0.85 British Pound. France The relaxing French way of life certainly has an appeal, so it is not surprising that many elderly British people relocate there. Of all the countries in Europe, France has the most developed residential care. Offering more beds per head than the UK, France has great care but it comes at an expensive cost. The average care home could set you back around €2,700 per month and in Paris this price rises to €3,100. But there is a way to lower the cost. If someone passes a residence test, is over 60 years old, needs help with daily activities and has an income lower than the threshold, then they could receive a payment called the APA to help lower the costs. May/June 2017 | Care Home Management 41
Spirituality for people with dementia
In our last edition we looked at spirituality at the end of life. Now Keith Albans, director of chaplaincy and spirituality at MHA, considers the importance of spirituality for people with dementia. Learning how to deal with a lifechanging diagnosis is a difficult emotional process not just for the person affected, but for their wider network of friends and family too. Dementia is particularly prevalent amongst those aged over 80 in the UK and, in fact, 80% of people living in care homes are said to have some form of the condition. With that in mind, what role can spiritual care play in supporting those going through these demanding situations? Spiritual care’s focus lies in making personal connections and finding out what brings meaning to a person’s life. Although some see spirituality as a religious concept, its reach is universal in terms of helping us all as individuals to find our own identity and maintain mental wellbeing. Given that, at MHA, 54 of our homes are specialist dementia care facilities, a big part of our chaplains’ role is the spiritual care of people with dementia. Our role in this type of situation is to act in a non-intrusive, supportive manner and build up
strong relationships with our residents. The focus is on offering quality, spiritual care throughout the process, from initial diagnosis to late-stage dementia. Creating routines and forming habits With memory loss a major symptom of dementia, the importance of forming regular rituals and habits cannot be understated. Many of our care staff have found that something as simple as taking a regular stroll around the grounds or returning often to a favourite prayer or poem builds up a sense of familiarity which can help residents with dementia feel more settled. In the same vein, having regular weekly visitors, whether these be family, staff or a chaplain, can spur someone into being more social and improves mental wellbeing as a result. Concentrating on making them feel valued and a part of a discussion, rather than left out, is key in these social situations.
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Maintaining this constant network of connectedness also eases the minds of loved ones who may be worried about the potential isolation or depression that dementia can bring to those with the condition. Knowing that their friend or relative’s spiritual needs are being cared for can be a comforting thought in difficult times. Tailored to the individual Living with dementia can lead to changeable moods, so it is important to be aware when someone is perhaps not having the best day and engage with them accordingly. Even if someone isn’t able to fully verbalise their emotions, it’s normally quite straightforward to tell if they’re happy or not and to adjust your communication accordingly. From a spirituality perspective, drawing on personal possessions or photos that are dotted around a person’s room can help you to build up a sense of who they are and what they’ve done in their lifetime. Our chaplains will often turn to
objects kept close by the person’s bedside as they are usually the ones which hold the most spiritual value. A treasured photograph might act as a prompt for a conversation about the person’s family, for example, or a book could point you in the direction of their literary interests. Hobbies and activities Hobbies and interests can often be turned into social activities which can boost the mood of all residents, including those with dementia. Creative hobbies, such as drawing or singing, are ideal as they allow people to express how they are feeling and remain connected to the wider world. At MHA, we’ve found that the music therapy sessions we run in our homes are particularly good at breaking through to people even when they are in the later stages of dementia. One resident, who was a dance teacher and jazz drummer before being diagnosed with dementia, had stopped engaging with music as his condition progressed. However, once he started attending sessions with one of our qualified music therapists, he was able to once again enjoy his old passion, and his wife said that it was able to break through to him in a way that nothing else could.
Chatting with residents and listening to them is a huge part of what our chaplains do. For residents with dementia, who might be feeling isolated and scared, this social interaction can go a long way to caring for their spiritual needs. Supporting families It is equally important to connect with family members and offer them support – a dementia diagnosis also affects the loved ones of the person with the condition. Everyone has different responses to the discovery that someone they hold dear has been diagnosed with dementia, and difficult times often bring emotions to the surface. Some relatives might feel angry, whilst others might fall into deep sadness or feel guilty for not spending enough time with their loved one before they were diagnosed.
Often, families need space to adjust to a new set of circumstances. However, our chaplains also find that many of them appreciate knowing that someone is there to listen should they need to talk. Offering to take someone for a cup of tea in a quiet corner or simply sharing a reassuring smile in a corridor can let relatives know that they are not alone. There’s no doubt that a diagnosis of dementia changes someone’s circumstances dramatically. But one thing that I’ve seen in my work is that actually, people’s spiritual needs remain remarkably similar. We all crave that feeling of being connected to other people and to the wider world, and helping residents with this – whether they have dementia or not – is an important part of caring for them as a person. Showing them they are valued and listened to goes a long way.
Memory triggers Sometimes, making a few educated guesses can help forge a connection with someone. Care staff working in homes in industrial areas, for example, could ask a resident if anyone in their family ever worked in a nearby factory or mine. This could throw up memories of being a child and seeing parents going to work, or of what the job of a partner might have been when they were still in work. For people with dementia, the past becomes even more important than the present so reminiscing about times gone by can be a great activity to engage those with the condition. May/June 2017 | Care Home Management 43
Events and Appointments
Events line-up 9 May 2017 Care Roadshow Liverpool
Aintree Racecourse http://www.careroadshows.co.uk/ 25 May 2017 Care Home Awards
Royal Garden Hotel, London http://www.carehomeawards.com/ 12-13 June 2017 Care Forum
Wokefield Park, Berkshire www.careforum.co.uk 28-29 June 2017 Health + Care
ExCel, London www.healthpluscare.co.uk 4 July 2017 Care Roadshow Birmingham
Villa Park http://www.careroadshows.co.uk/ 10-11 October 2017 Care and Dementia Show
NEC Birmingham www.caredementiashow.com/ 17 October 2017 Care Roadshow Cardiff
Cardiff City Stadium http://www.careroadshows.co.uk/ 14 November 2017 Care Roadshow London
Epsom Downs Racecourse http://www.careroadshows.co.uk/ 16 November 2017 Care England Conference ‘Shaping Tomorrow’
Church House, Westminster, London
Appointments Greensleeves Care appoints three new trustees
Jeremy Newman takes chair at Skills for Health
Greensleeves Care has unveiled three trustees to its board. Des Kelly, was executive director of the National Care Forum from 2003 until his retirement in 2016. Dallas Pounds, after a career in the NHS is chief executive at the Royal Trinity Hospice in central London. Kim Davies is currently director of group real estate at Legal & General where she is responsible for the property strategy and facilities management of the occupied portfolio across the UK.
Jeremy Newman has been appointed as the new chair of Skills for Health and Justice having taken over from Chris Hannah. He was previously chair of the Audit Commission, chair of the Single Source Regulations Office and a member of the Council of the Open University and has been a trustee of a number of charities particularly in the education and health sectors.
From bingo caller to Bupa director A former Bupa care home manager from Glasgow who began his working life as a bingo caller, has been promoted to regional director. Alan Twigg began working as a staff nurse at Bupa’s Fullarton care home in Irvine. Now as regional director, he is responsible for a team of managers across nine care homes. , Alan said: “Starting out my career with Bupa was a great opportunity and it’s really exciting to have been promoted to regional director. I feel honoured that Bupa believe I am capable of doing this job and I think that starting out as a Staff Nurse has given me a valuable insight into how important that role is.”
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Meanwhile Bupa have appointed Jonathan Easby as the new manager of Burley Hall Care Home at Burley-in-Wharfedale. Jonathan spent the first 20 years of his career in retail but decided on a change of profession to care and gained experience at Knowles Court and Southlands care homes. He will oversee the running of the 49-bed home and take responsibility for a team of 60 staff.
Less paperwork and more time for care “We can now deliver the care and spend time with the residents, which is what everyone of us goes into care for” This is the conclusion reached by Orton Manor Nursing Home after choosing Sekoia as their digital care planning tool. In 2016 Orton Manor, just outside Birmingham took a step forward on to the digital path saying goodbye to their paper records. The carers at Orton Manor faced the classic challenges of completing heaps of paperwork, instead of delivering care and spending time with the residents. Easy to use Sekoia’s most important feature is how user-friendly it is. Together with its touch-screen technology and range of apps, Sekoia makes it easy for any carer to complete basic documentation or access residents
Care Home Management
Toddlers in homes care for residents’ ‘a medicine
Quality Big regional differences revealed
Finance of Homes making use Retail Charity Bonds
The carers are delivering a more personalised service. Shahzada Ahmed has noticed this change: “I have seen measureable return on investment for me, I have held resident meetings, family meetings and I have seen significant changes in families and residents noticing much greater time that is allowed in direct contact from carers and service-users without the need for duplicating paperwork.”
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care plans. Director Shahzada Ahmed lets us in on his thoughts going “paperless”: “I wanted something more, something that would integrate the different platforms into something that would be much more user-friendly, so that my carers were using the technology to be able to deliver a much higher standard of care, to give more care time, to free their time up.”
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WELL CAREPLUS PROVEN TO IMPROVE QUALITY AND EFFICIENCY OF RESIDENTIAL CARE Researchers at Cardiff University have found that Well Careplus’, Well Pad, reduces administrative tasks in care homes by up to 65 hours each month, allowing staff to spend more time on face-to-face resident care. Results of the study of 66 care homes showed that staff previously devoted up to 300 hours a month on associated administrative tasks - use of the Well Pad reduced this time by up to 60%. Shiraz Khan, Head of Well Careplus: “From speaking to care home managers, we know that traditional paper-based processes used to manage medicines, in the vast majority of care homes, are outdated and arduous. Our technology is proving to dramatically reduce the amount of time spent on medicine management.” Tel: 03302 23 24 25 - www.well.co.uk/WellCareplus careplus@well.co.uk
MARBREX WALL PANEL SYSTEMS [Stand C30] Marbrex is showing its range of decorative wall and ceiling panels at the 2017 Health Plus Care Show, 28-29th June, EXCEL London. This stylish and versatile panel system replicates the look and feel of marble, wood and stone but without the weight and high installation cost of the natural material. Designed mainly for use in bath and shower room installations, Marbrex is a stunning alternative to paint, wallpaper, tiles and other wall covering systems. Available in a wide range of widths, colours and patterns, from traditional to the more contemporary, there is a design for almost any room in the care home environment. Using panel based systems such as Marbrex and its big sister – the metre-wide Roomliner, has many advantages over conventional methods of decorating such as tiles, paint or wallpaper. The large panel format means it is quick to install, it is totally moisture resistant and because there are no grouted joint, it is easy to clean and will not harbour mould and germs. The Roomliner, wide panel format also means a typical shower enclosure is quick to install and can even be fitted over existing tiled substrates. Because there are no grouted joints to the system, they are also hygienic, easy to clean and will not harbour mould and germs Marbrex and Roomliner panels also provide a degree of insulation to the room and so helps reduce condensation.
INFECTION CONTROL THERMOMETERS Infection control is a top priority for care homes with food safety no exception. That’s why TME offer a dedicated thermometer range for preventing bacterial crosscontamination in the kitchen. The CA2005-PK comprises an IP67 waterproof HACCPcompliant thermometer together with 6 interchangeable colour-coded needle probes, for reducing the risk of crosscontamination between food groups. The probes are also dishwasher-safe, offering a more hygienic system than all-inone thermometers which are more difficult to keep clean. For cash-strapped care homes, the new CA2005-PK also represents great value for money at around £130, or individual probes and thermometers can be bought separately if preferred. TME – When temperature matters Tel: +44(0) 1903 700751 Web: www.tmethermometers.com Email: sales@tmethermometers.com
See Marbrex “White Dune” panel system at the Health Plus Care Show [Stand C30] Marbrex and Roomliner are brands of Swish Building Products. t: (01827) 317200 e: info@marbrexpanels.co.uk www.marbrexpanels.co.uk
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THE NATIONAL EVENT DEDICATED TO SECURING THE FUTURE OF CARE TAKE A DAY OR TWO TO INVEST IN THE FUTURE OF YOUR CARE BUSINESS AND COME AWAY WITH A WORLD OF INSPIRATION:
28–29 June 2017 | ExCeL London
Discover new innovations and technologies to enhance the services you provide. Hear how to plan for your next CQC inspection from those who have achieved an outstanding rating. Hear from ministerial speakers about developments in the regulation of adult social care that will directly affect your business. Meet experts who can demonstrate new ways of training and retaining your staff whilst managing the impacts of the National Living Wage. Participate in educational workshops where you’ll find solutions to safeguard the future of your business and your patients. Visit the brand new Care Home Live area at the conference, a real-life care home where you can test out the latest innovations. Use the new Catering & Nutritional Zone to discover new ways of providing the people you care for, with the best, at a more affordable rate.
CARE HOME MANAGEMENT PROFESSIONALS ARE ENTITLED TO FULLY SUBSIDISED CONFERENCE PASSES TO ATTEND HEALTH+CARE FOR FREE.
Supported by:
Organised by:
BOOK YOUR PASS ONLINE: WWW.HEALTHPLUSCARE.CO.UK/CAREHOMEMANAGEMENT SUBSIDISED PASSES ARE ONLY AVAILABLE UNTIL 31ST MARCH, AFTER THIS DATE PASSES WILL BE CHARGED FROM £599+VAT.
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48 Care Home Management | May/June 2017