Care Home www.chmonline.co.uk
November/December 2017
Management
From tipping point to precarious‌. CQC’s new warning Care home fees Economist proposes new funding formula
Beds Care Finding the right home UK lagging behind the gets harder rest of the world?
Issue 70
Editor’s Letter
Welcome to the November/December edition of Care Home Management
Care Home Management November/December 2017
Issue 70
Annual Subscription £30.00 Where sold cover price of £4
T
he clocks have just gone back and traditionally this is the time of year when annual assessments of the state of social care start to appear. And boy, have they started to
appear! In the following pages you will see our coverage of reports from various bodies. All
Editor/Publisher Alan Rustad
seem to share the view that social care is still being delivered day to day on diminishing
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budgets but with an ever growing need.
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tipping point. Twelve months on he says maintaining the quality of care is precarious.
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by people who will always go the extra mile to provide day to day care for the most
Perhaps the most important is the annual report from the Care Quality Commission. Last year, Sir David Behan’s organisation took the view that social care had reached a It is tempting to ask “How long can we carry on like this?” There is no real answer to that because we know that the vast majority of our care homes are run and staffed vulnerable members of our society. It should not have to be that way – but it is just accepted.
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are we going to see the social care Green Paper the Government has promised for so
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In the light of these reports, the one demand coming from industry insiders is when long now? We are approaching Christmas and the promise of it being published before the year is out is beginning to look questionable. Maybe the forthcoming budget will The problem is that the Green Paper will need to propose funding and delivery of social care for many decades to come. Yet we know Governments and MPs rarely look further than five year cycles at best. Social care can no longer be left for the “next lot” to sort out.
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Care Home www.chmonline.co.uk
November/December 2017
As far as funding for care home places is concerned we publish the latest idea to come from health and social care economist, William Laing. In theory his proposal (see page eight) is a sensible one. But it will still need politicians to bite the bullet and seriously decide where the element of state funding is going to come from. With Christmas on the horizon, we enter a period which can be both joyful and stressful for residents and carers in our care homes. I wish all a very Happy Christmas and hope you enjoy the festive season. Don’t forget you can keep up to date with the latest care home news via our website – www.chmonline.co.uk and feel free to give us your take on any issues that concern you
Management
at editorial@jnjmedia.co.uk
editorial@jnjmedia.co.uk From tipping point to precarious…. CQC’s new warning Care home fees Economist proposes new funding formula
Beds Care Finding the right home UK lagging behind the gets harder rest of the world?
Issue 70
@Carehomemanage
Alan Rustad Publisher/Editor
November/December 2017 | Care Home Management 3
Contents
8
CQC Annual Report 6 Industry calls for action
17 Catering NACC celebrates excellence
Care review 7 Care home sector “resilient”
18 Care Show Thumbs up as new era begins
8 Funding Economist proposes new formula
19 Care home – home care The case for collaborative working
Beds shortage 10 Getting harder to find the right home
20 Quality CQC annual review in detail
Closures 12 Scotland stunned by leading provider
22 Overseas care Does the UK lag behind?
Dementia 14 Hallmark launches new strategy
24 Insurance Do you have cyber risk protection?
Services 16 Leading companies merge
25 Data Protection Get ready for new regulations
10 4 Care Home Management | November/December 2017
22
Furniture 26 Recognise the needs of Huntington’s residents
25 28
Design 28 The architect’s role in care homes Pets 30 Bringing something special to residents Care costs 32 Factor in your profits Activities 34 Activities or Lifestyle – what’s in a name? Cashflow 35 Ensuring the money comes in during tough times Events and Appointments 36 Where to go and latest movers Sleep Ins 38 What’s in store?
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
CQC reaction – renewed calls for a Green Paper now
Martin Green The Care Quality Commission’s annual report which said care was straining at the seams (see pages 22/23) has been met with concern from the social care sector. Martin Green, chief executive of Care England, said: “This is the second year in a row that the chief inspector at CQC has had to outline the precarious state of social care to Parliament. Parliament can ill afford to ignore the warnings from CQC; there is an urgent need for a long term funding settlement that will reach the frontline and support sustainable quality services”. Care England is leading on high profile policy and strategy developments on behalf of providers. It has been triangulating a range of publically available intelligence to consider how well local systems are working and welcome this updated narrative and data from CQC. Professor Green added: “There is a lot of uncertainty in the sector and
by dragging its heels on the social care Green Paper, Government simply cannot abdicate responsibility for those in need of care, especially those funded by local authorities.” Janet Morrison, chief executive of the charity Independent Age, said: “While the report rightly acknowledges improvements made in some areas, others have seen a deterioration of care services, which is likely to lead to more unmet care needs among older people, and families facing an unenviable choice of poor quality services.
vital, authoritative evidence about what kind of health and social care support is available across England. CQC’s analysis of the quality of support comes as such services face unprecedented challenges in a climate of austerity. Social care providers, in particular, are experiencing increasing demands for support, rising costs and recruitment and retention worries.” Niall Dickson, chief executive of the NHS Confederation, said: “It would be a tragedy if the NHS’s 70th birthday was remembered as the year England’s care system collapsed, but the report reveals real concerns that mental health and social care services are not sustainable. “Let no-one misunderstand what is being said here – the health and care system is managing well, with some improvements in safety, but its future is precarious. And one in eight older people are not getting the help they need.”
Janet Morrison “It’s also worrying that the number of nursing home beds is shrinking. The Green Paper promised at the Budget in March has yet to materialise but the clock is ticking and as yet the Government seems no closer to producing a long-term solution for social care fit for purpose for our ageing population.” Dr Rhidian Hughes, chief executive of VODG (Voluntary Organisations Disability Group), said: “This report is
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News
Healthcare sector resilient but still facing challenges
Colliers International’s latest edition of its Healthcare Market Review reveals that in the last twelve months, the sector has continued to provide occupancy, income and fee challenges and opportunities in equal measure however overall, the healthcare investment market is still attracting great interest. In contrast to the more positive pattern of recent years, there have been generally negative trends in the elderly, personal and specialist care sectors but
the nursing sector has proved a little more resilient. Colliers’ 23rd edition of the Healthcare Market Review provides an in-depth analysis of the healthcare property and business sector, focusing on key drivers of the care home industry, covering occupancy rates; average weekly fees; payroll and nonpayroll costs and profit margins. The research shows that the personal care sector has seen pressure this year, with static fees and only a small
increase in average occupancy levels (0.1 percentage points since H1 2016 to 91.8%). With rises in RPI in recent periods, personal care fees have fallen over 3% in real terms over the year. Whilst non-payroll costs have remained static, there has been a marked increase in payroll costs over the last half year. Overall, profit levels have fallen for the sector. Within the nursing sector, occupancy levels have fallen to below 90.5% in H1 2017 (down 0.7 percentage points since H1 2016) but fees have risen by 5.2% in nominal terms and 1.9% in real terms in 2017, continuing the strong growth seen last year. With small variations in payroll and non-payroll costs, profit levels in general show only a small decrease in percentage terms so overall, resulting in a generally positive picture. Adam Lenton, head of healthcare at Colliers International commented: “Demand for quality care provision in care homes, through primary care and the NHS, continues to intensify. This is offset against limited progress with improved facilities, planning regulations, staff recruitment and retention and private investment – and that’s before we make a dent in the Brexit negotiations and the ensuing ramifications of our departure from the EU.”
Four Seasons Care outlines restructuring plans Four Seasons Health Care High Yield Bond Group has revealed details of a proposed restructuring, which it says will improve its capital and financial structure. The restructuring includes new funding from its owner Terra Firma via the transfer of the 24 homes that currently sit in the Non-High Yield Bond Group, and the formation of two separate parts of the business. One group will sit under a newly incorporated holding company
structure, which will comprise existing High Yield Bond Group freehold operating companies, property owning companies and leasehold operating companies. The second division will be a transition group, sitting under the existing High Yield Bond Group holding companies, which will comprise leasehold operating companies where the relevant landlord has not consented to the proposals. The group’s chairman, Robbie Barr, said: “For the past 18 months
we have been very clear that a capital restructuring is needed to ensure the long-term stability of the business and allow it to continue to build on its strong operational turnaround. The proposal being put forward to creditors by the High Yield Bond Group and its shareholders will, we strongly believe, provide certainty and continuity for our residents, patients, and the thousands of colleagues who deliver care across the business, whilst also protecting creditors’ value.”
November/December 2017 | Care Home Management 7
News
Laing proposes Personal Asset Protection Guarantee
William Laing A leading care economist has proposed that individuals should be guaranteed to keep about three-quarters of their personal assets in the event of their needing residential care in their old age. William Laing, of LaingBuison, has published his ‘Personal Asset Protection Guarantee’ (PAPG) White Paper. Under this proposal the White Paper deals with the question of how the cost of long term care should be divided between the state and those individuals (mainly property owners) with care needs who have the resources to pay for themselves. He proposes a novel mechanism which defines individuals’ eligibility for council support for residential care in terms of the percentage of each individual’s assets which has been spent down since being assessed as needing care. Mr Laing argues that the PAPG will be more efficient and equitable as well as easier to understand than the combination of threshold extension and care cost cap. It will also offer peace of mind to all property owners (who account for more than 70% of the older population at risk of entry to a
care home), not just those in ‘spending down’ sight of any feasible threshold such as the £100,000 mooted by the Government at the time of the June election. Other benefits of the proposal include lower assessment, care management and administrative costs since it will not require the monitoring of individuals’ care costs. It also means there is less risk of ‘payor shift’ creating instability in the commercial care home sector in less affluent areas of the country. William Laing said: “For two decades successive governments have struggled to arrive at a comprehensive new settlement for sharing long-term care costs between individuals and the state. In that time, the forecast ageing population has become a reality. “People need a straightforward and effective mechanism which allows them to plan for their long-term care without worrying this will become a burden for their families, either before or after their death. Insurers need to be encouraged that there are real opportunities to build long term care insurance products around whatever scheme is put forward
8 Care Home Management | November/December 2017
by government. And government needs a scheme which is inexpensive to administer and monitor. “The novel approach that I am proposing in the PAPG offers all of these possibilities. It requires the value of an individual’s assets to be assessed by their local council at the time they are found to need care and the individual will be guaranteed that once a certain percentage of their assets have been spent down, they will be eligible for support from the council, subject to income related user charges. My calculations indicate that a PAPG that allows individuals to keep 73% of their assets would cost the state the same as an asset threshold of £100,000 and a lifetime care cost cap of £72,000.”
Slaughter and May advising Bupa on selling care homes to Advinia Slaughter and May is advising Bupa on its agreement to sell 22 of its UK care homes to Advinia Health Care, subject to regulatory approval. Bupa remains one of the biggest UK providers with around 130 homes and seven Richmond Villages, caring for nearly 6,500 residents. The sale will see 22 care homes transfer to Advinia Health Care, an experienced nursing and residential care provider, established for nearly 20 years. Following completion, Advinia Health Care will operate 38 homes across the UK.
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News
Lack of care home choice leaving families ‘settling’ for inadequate places
Systemic failure in the care home sector is leaving the majority of people with limited choice and half of people needing care having to wait for a bed, according to new research by Which? The consumer champion found that almost half of people (48%) who had arranged care for themselves or a loved one said there weren’t any places in at least one of the local care homes they considered. The survey asked people who had arranged care for themselves or a loved one in the past 12 months to share their experiences of the care sector and highlights a worrying trend of people not being able to find suitable local care provision. The research found that a lack of good local places means many people are staying in, or moving
loved ones into, care homes they aren’t satisfied with, with almost one in five people (17%) saying they settled for a care home they had reservations about. A similar number (16%) ended up opting for a home away from friends and family. When they did find a bed, as many as a quarter (25%) of care arrangers said they were left feeling guilty or annoyed that they couldn’t find a more suitable care home. Which? has launched a campaign calling for the Competition and Markets Authority’s (CMA) inquiry into the care home market to go beyond the immediate issues around quality, fees and complaints and to confront the creaking care sector now, recognising that the national picture masks huge
10 Care Home Management | November/December 2017
differences in the number of care home places available at a local level. Which? says the CMA’s inquiry into the care home market must make strong recommendations that the Government addresses this systemic issue of inadequate provision in its upcoming Green Paper. Alex Hayman, Which? managing director of public markets, said: “Making the decision to move a loved one into a care home is difficult enough, so it is unacceptable that so many families are left feeling guilty or concerned about the choices they have made, simply because there is no choice. “The Competition and Markets Authority must look at the huge local disparities in care home provision, which are fast reaching crisis point.”
News Responding to the Which? Research, Councillor Linda Thomas, vice chair of the Local Government Association’s Community Wellbeing Board, said: “Councils are committed to ensuring that people have access to good quality care. But this is being put at risk by the severe funding pressures faced by social care services. “An increasing number of care homes are closing and care providers are handing back their council contracts because of cost pressures. We have warned that £1.3 billion is needed right now just to stabilise the perilously fragile care provider market. “Overall social care faces an annual funding gap of £2.3 billion by 2020. Unless social care is properly funded, the standard of care for elderly and vulnerable people is at risk. Janet Morrison, chief executive of Independent Age, the older people’s charity, said: “Choosing a care home can be a complex decision for older people and their families, and is often done under time and emotional pressure. It is simply not acceptable that
nearly one in five people surveyed have reservations about their care home. “This could be the tip of the iceberg, as this research looks at people who arrange care themselves or for a loved one. It poses questions about the quality of choice on offer for people making do with a care home the local authority have arranged for them. The Government must urgently publish their long-promised Green Paper on social care, and get on with delivering a social care system that meets the needs of older people now and in the future.” Alzheimer’s Society senior policy officer Dominic Carter said: “These findings echo what we hear every day through our helpline – time and again we are called by families of people with dementia who’ve been refused places at care homes because their needs are ‘too complex’. “Even worse, we hear of people with dementia in care homes handed fourweek eviction notices – one woman told us her husband was shown the door after seven weeks at a care
home because he was viewed as ‘challenging and the manager did not have enough staff available to provide the one-to-one support he needed’. “While it could be easy to scapegoat care homes, we know they are finding themselves between a rock and a hard place. They can’t sustain their businesses if local authorities don’t have big enough budgets to cover the care home’s costs. The only way to give people with dementia the care, security and reassurance they deserve is for the Government to inject more money into social care.” Which? recently published research showing that almost nine in 10 council areas across England could see a shortfall in care home places emerging by 2022 unless urgent action is taken. Analysis of care home data in England indicates that 87% of councils responsible for providing social care may not have enough places to meet potential demand by 2022, highlighting a looming local crisis in care home provision.
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News
Charity to close a dozen care homes amid fears over viability of services for older people
Grantsbank - Dunfermline One of Scotland’s leading providers of housing for the elderly, Bield Housing, is to close a dozen residential care homes and decommission a sheltered housing service for those with the greatest care needs. Bield Housing said that as the first step of a new five-year plan it planned to withdraw from care home provision within nine months, and promised to help residents and their families make alternative
arrangements. Bield said the decision had not been taken lightly, but amid a crisis in funding in the sector, most of its residential care homes were no longer viable. The charity is in negotiations with some local authorities to see if some homes can be kept open, but it is expected that most or all of its 12 residential care homes will close forcing 167 residents to make new arrangements.
Wandsworth next for Signature Luxury care provider Signature Senior Lifestyle has announced that it is bringing a new care and nursing home to the heart of Wandsworth, London. Due to open its doors in late 2019, the home will be the 15th addition to the Signature family. The new home will feature 98 private apartments ranging from studios to one bedroom suites and will offer Signature’s award-winning residential and nursing care, which is based around facilities, a varied calendar of events and activities, and the provision of care. The home will also cater for residents with dementia and has been designed using the Gold Standard
framework from Stirling University. The Gold Standard is awarded by the University’s Dementia Services Development Centre to organisations who design and build outstanding environments for dementia care. The £58 million development will
12 Care Home Management | November/December 2017
Bield have an ageing property stock making them unsuitable for modern care. The charity blames above all cuts in the funding available from local councils. Brian Logan, chief executive of Bield Housing and Care, said that with staffing and running costs increasing, higher demand to cope with issues such as dementia and cuts in local authority funding, a long-term solution was needed to strengthen Bield’s finances. “The decision is very much a last resort option,” he said. “We have carefully considered a wide range of options to continue delivery of these services however, we have been unable to find a solution that will be viable in the longer term. “We are aware of the serious impact these changes will make to people who use our services, their families and our staff. Those impacted by the changes have been advised and in the coming weeks and months we will be holding consultation meetings to discuss what options are available to those affected – with the aim of minimising the impact as far as possible.” include a cinema, hair salon, library, several lounges, a therapy room, bistro and a restaurant where families and residents can eat together. Signature will create more than 120 jobs, with varied positions due to be advertised in nursing, care, catering, housekeeping, activities, maintenance and concierge.
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News
Hallmark Care Homes launches Together Dementia strategy
Hallmark Care Homes has launched a new, three-year dementia care strategy at both Ty Enfys Care Home in Cardiff, and their recently opened, Chamberlain Court Care Home in Tunbridge Wells. The strategy, which follows extensive consultation with 100 residents, 75 relatives and 100 team members, details the actions Hallmark Care Homes will undertake as part of their vision to be recognised as the leading provider of high-quality relationshipcentred care for all residents by 2020 and will be supported by the creation
of a number of specialist dementia care roles. This includes a dementia strategy Lead, a Hallmark Care Homes’ dementia nurse in England and Wales, three peripatetic dementia trainers and a dementia care coordinator in larger homes. Hallmark is also introducing an outstanding relationship centred home in dementia (ORCHID) award to recognise their homes which have successfully implemented the strategy. To support the strategy new tools for recruitment, including an attitudes to
dementia questionnaire have also been created to ensure that team members recruited have the compassion and sensitivity to care for someone living with dementia. Included within this strategy will be extensive dementia training for new team members as part of their induction, which will extend to relatives and members of the local community as part of their commitment to become a dementia friendly organisation. Hallmark Care Homes, managing director, Avnish Goyal said: “2017 is a very exciting time for Hallmark Care Homes, with our 20th anniversary and the launch of our Together Dementia strategy, which will further enable our team members to deliver high-quality, relationship-centred dementia care to residents. “We understand the importance of working with residents, relatives, team members, external professionals and the local community, which is why our strategy is called Together and it has been written in collaboration with representatives from all of these groups. This strategy will equip our team with the tools and confidence to enhance the quality of life of residents living with dementia and we are looking forward to the journey ahead.”
Social care spending rises by £556m – but costs up too Annual spending by local authorities on social care rose by £556 million in 2016/17 to £17.5 billion - a 3.3 % increase in cash terms and a 1.0 per cent increase in real terms. The Adult Social Care Activity and Finance Report published by NHS Digital shows that, while expenditure has risen, there has been minimal change in activity, which may be linked to the increasing costs in the provision of care.
The average costs of care per week for residential and nursing care have risen: ■ The cost of residential care for a person aged 65 and over was £565 a week – up from £549 in 2015/16. ■ The cost of nursing care for the same age band increased to £606 a week from £563.
14 Care Home Management | November/December 2017
There is a large amount of variation in year-on-year spending among councils. Ten councils reported cash terms increases of over ten per cent, four of which reported increases of over 20 %. In comparison, 42 out of 151 councils reported a decrease in expenditure compared with 2015/16. It is the first time social care expenditure has risen in real terms since 2009/10.
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News
Nursing Hygiene Group (NHG) and Clinicare Supplies announce merger
Nursing Hygiene Group (NHG) and Clinicare Supplies are to merge, with change of ownership effective as of end of October. The merger represents the joining of two businesses very similar in their products and services, with strengths that are highly complementary and
will enable them to provide a new and broader set of services to clients. Both companies will continue to operate separately throughout the integration period, and will bring to market a newly combined and branded, single entity business by July 2018. This is to ensure a smooth transition across all workstreams and minimal disruption to clients. Scott Andrews (left) , managing director at Nursing Hygiene Group (NHG) says: “After months of intense work to bring us to this point, we’re really excited to be able to announce this merger. “Founded 30 years ago, both NHG and Clinicare Supplies share similar cultures and values built on teamwork, transparency and trust, as well as business ethos based on strong relationships and innovative ideas. The success of both companies to date can be largely attributed to this as well as our talented employees, loyal customers and strong supply chain.” Nathan Campbell (right), managing director at Clinicare Supplies says:
“We’re all really excited about this merger. We’re confident that it will create the ideal platform for growth, and will benefit our employees, our customers and our suppliers. “Both Clinicare Supplies and NHG are extremely proud of the quality of their products and services, and the quality of their customer service. Clients can rest assured they can expect from the newly combined business the same focus, the same high-quality service and the same team that they have come to know.”
HC-One prosecuted over serious burns injury HC-One has been ordered to pay almost £60,000 in fines and costs by Camberwell Magistrates’ Court after admitting failing to provide safe care and treatment. The Care Quality Commission brought the prosecution following an incident when a 72 year old woman was burned after sitting on a portable heater at Elmwood Nursing Home in Croydon. The nursing home had been experiencing difficulties with its heating system during January 2016. They placed some oil filled electric heaters in residents’ bedrooms and communal areas. Late one night a member of staff
found Mrs Polly Dunkley, who has vascular dementia, sitting on one of the portable heaters. As staff put her back to bed they noticed a burn to the back of her thigh. Staff did not appreciate the severity of the burn or follow the appropriate wound management procedure. It was only the following morning, and after Mrs Dunkley had experienced a fall, that paramedics arranged for her to go to hospital. She spent 72 days in hospital, including 28 days in the specialist burns unit at Chelsea and Westminster Hospital after receiving a skin graft to treat her burns.
16 Care Home Management | November/December 2017
A spokesperson for HC-One said: “We are very sorry for the mistakes that led to a resident at our home sustaining an injury in March 2016, and we have apologised personally to the resident involved and her family. “This accident was the result of the health and safety systems we have in place being incorrectly followed. We have now removed the type of heater involved from all of our homes, and the staff involved in this accident no longer work for our company.”
Celebrating excellence - the NACC Awards 2017
The 2017 NACC Awards winners were: Care Establishment of the Year Award: John Wills House, St Monica Trust. The National Association of Care Catering crowned the winners of the NACC Awards 2017 at a gala dinner held at the East Midlands Conference Centre, Nottingham, which also celebrated the association’s 30th anniversary. The winners of the eight awards exemplified excellence, innovation and exceptional service in the care catering sector and a commitment to improving standards and experiences for all, from service users and their loved ones to the people on the front line. Neel Radia, national chair, NACC said: “What a night! Heartfelt congratulations to all our award winners in our 30th anniversary year. Every single one of them, and all the finalists, exemplify exactly what is so great about the care catering sector. They all have an unwavering commitment and desire to raise standards of catering through innovative and exceptional service,
and ultimately improve the lives of the people they are feeding. “I know for a fact that the judges had a tough time selecting the overall winners from such a fantastic pool of entries. Observations by the judges, such as ‘a model for success’, ‘a supremely well-led team’, ‘commitment and boundless energy’ and ‘outstanding service’, sum up perfectly the award-winning characteristics that are plentiful within our sector. “Catering for the elderly and vulnerable requires specific skills, knowledge, responsibility and care, and the NACC Awards are proof that we continue to push the boundaries and raise the bar.”
Meals on Wheels Award: West Sussex County Council, Meals on Wheels Service
Catering Team of the Year Award: Gracewell of Horley Park Catering Team
Catering Manager of the Year Award: Stuart Keown, Dining Service Coordinator, Sunrise of Banstead
Our Care Catering Hero Award: Joy Whitlock, Head Chef, Harton Grange
Region of the Year Award: South West Region
Pam Rhodes Outstanding Achievement Award: Roger Bayliss, who has been a member of the NACC since 1990 and still contributes to the life of the association in the role of National Treasurer. Chairman’s Award 2017 – Era Varellas for her inspirational, long-term support of the care sector, working for the London Borough of Haringey, and the NACC.
News
Time to start planning those Care Home Awards entries The call for entries to the Care Home Awards is open. It’s time to start thinking about the categories to enter and preparing submissions well in advance of the deadline date of 22 January 2018. Care homes should think about the aspects of their provision which are excellent or innovative and enter the most appropriate categories. They should try and think ahead, too. For instance, an entry about gardens and outdoor spaces will not look as good in deepest December as it might at the moment. So capture photos sooner rather than later. Care homes should think also about the suppliers, practices, agencies and consultants they believe offer excellent products and services and encourage them to enter the Awards. Similarly, suppliers who service great care homes should urge them to enter, as well, especially if they have helped the care home to new levels of excellence. The Call for Judges is also open and the Awards will draw on care professionals, specialist
service suppliers, care home senior managers, consultants, trade bodies and academics to provide broadbased opinions and voting. Four or five judges from the 2017 judging panels will be re-invited, to ensure consistency of scrutiny, but the rest of the two panels - one for care home categories, the other for supplier categories - will be new for 2018. NHG as headline sponsor continues to provide high level,
Thumbs up for new look Care Show The care sector has signalled its overwhelming approval to the Care Show as the leading conference and exhibition saw its biggest attendance increase in years.
The Care Show at the NEC in Birmingham saw more than 190 exhibitors reporting brisk trading on the packed show floor, where new technologies and show-floor education hubs proved a hit with more delegates attending than ever before. The show is under new ownership of specialist healthcare events producer CloserStill Media who unveiled the show’s 2018 manifesto ‘Building a Better Future for Care’ and a new refreshed brand identity for the Care Show. “The Care Show has faithfully served its profession and the industry
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interested support for the Care Home Awards and Avery Healthcare, Helme Hall, Care England and IHCP in Northern Ireland all add their knowledge and support. If any company is interested in joining the growing roster of sponsors they should make contact with the sponsorship team at Space Marketing - antoinettem@spacemarketing.co.uk - to discuss opportunities that can benefit them. for many years and we believe it is time that the show benefited from a fresh injection of energy and resources from our highly experienced, award-winning healthcare events team” says Michael Westcott, director at CloserStill. CloserStill says it will deliver a stronger, more practical training and education programme at the Care Show. Across its five-stream education and training programme it will focus on Business, People, Assets, Regulatory/Compliance and Excellence in Care from the frontline, sharing expertise and success stories from the some of the UK’s most innovative care home operators and service providers.
Care homes – home care. How both can benefit from partnership working Over the last ten years, Complete Care Agency has developed collaborative and innovative relationships with the NHS who have approached them to support care home residents who wish to remain in their care home and not move to a specialist unit or a home environment
Louise Ellis-Copley, managing director of Complete Care Agency Ltd looks at the importance of specialist service and partnership working across the care home and home care sectors. She gives us an insight on how Complete Care Agency is supporting the care home sector. Over the last 10 years Louise has developed a specialist, nurse led business in the home care sector delivering highly complex care. She works at national and local levels with local authorities and the National Health Service. “We recognise that in order for health and social care to provide the specialist care needed, collaboration and partnership working is essential,” said Louise. “We are bombarded by the media that care in your own home is better for the client. I believe that the client having choice is what provides the first positive step to independence. Not all clients want to be in the home environment and often the failure in the system is an inability of care homes to be able to deliver these more complex care needs. As we live longer and survive with more complex health needs the sector must consider this need.
Collaborative thinking “It is important that partnership working exists across the care home and home care sectors. There is a crisis due to continued budget, legislative and regulation pressure and to succeed in these climates we have to think about the sector collaboratively. We have many positives to offer each other and insight into the trouble we face is powerful when petitioning for change.” Louise added: “The need for care homes to develop closer working relationships with home care businesses like Complete Care Agency will allow care homes to gain valuable support and insight into providing this specialist care. With stretched primary care services and a lack of training and understanding, the specialist services we provide become more valuable. To ensure the best care is delivered we will continue to support the care home sector.”
Ever more complex needs Often care homes are unable to support those people who have the highest need due to an inability to deliver ever continuing complex care needs. Through working in collaboration they have supported care homes and nursing homes to train nursing and care staff in the necessary care delivery to these complex clients. “By ensuring your staff have the knowledge, skills and continued professional support, providing this level of specialist care is not impossible,” said Louise. “The long term saving to the NHS where there are suitably trained and knowledgeable staff is well documented. It is noteworthy that when people are where they want to live, with the people they trust and are supported by, there are significant improvements in wellbeing and health outcomes. This is generally the feedback and trend we are seeing. “It is now time that care homes, home care, Government and the NHS recognise that for the future to be addressed long term planning needs to be prioritised. The role of the private sector and the knowledge we hold is crucial in planning for future generations.”
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Last year they said adult social care was approaching a tipping point. This year’s State of Care report from the Care Quality Commission says future quality of care is ‘precarious’ as the system struggles with complex new types of demand, access and cost. And the reason why? Well the CQC says quite simply that the number of nursing beds is dwindling while there is an increasing number of older people with high acuity needs. Last year, the CQC based their ‘tipping point’ rating on five pieces of evidence: ■ Quality ■ Bed numbers ■ Market fragility ■ Unmet need ■ Local authority funding
The state of health care and adult social care in England 2016/17
8-1-5286-0051-4
Sir David Behan
Care Quality Commission
917121928 10/17
Quality of care moves from tipping point to precarious says CQC
The state of health care and adult social care in England 2016/17
One year on, the overall picture remains precarious, with no long-term solution yet in sight. Demand for care is still increasing through an ageing population with increasingly complex health conditions. At the same time, the capacity of the adult social care sector continues to shrink, with fewer nursing home beds in particular available. But quality it seems is being maintained. The CQC says that thanks to the efforts of staff and leaders, the quality of health and social care has been maintained despite very real challenges and the majority of people are getting good, safe care. Some encouragement The CQC’s annual assessment of the quality of health and social care in England contains much that
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is encouraging. As at 31 July, 78% of adult social care services were rated good (71% were rated good at 31 July 2016) as were 55% of NHS acute hospital core services (2016: 51%); 68% of NHS mental health core services (2016: 61%) and 89% of GP practices (2016: 83%). Two per cent of adult social care services, are rated outstanding. Many services that were originally rated as inadequate have used the findings of CQC’s inspection reports to make the necessary changes and have improved. However, the changing nature of demand – increasingly numbers of older people who are physically frail, many with dementia, more people with long term complex conditions – is placing unprecedented pressure on the system.
Decrease in nursing beds In adult social care, the number of beds in nursing homes has decreased across most of England and domiciliary care contracts are being handed back to councils because providers say the funding is insufficient to meet people’s needs. Estimates show that one in eight older people
remember is testament to the efforts of frontline staff, managers and leaders. However, as people’s health and care needs change and become more complex, a model of care designed for the 20th century is at full stretch and struggling to cope with 21st century problems. “The impact of this on people is
are not receiving the help they need. A very small minority of care was found to be failing people – between 1% and 3% of providers across the services CQC regulates were rated inadequate. There is also much care that needs to improve – 19% (2016: 26%) of adult social care services. Sir David Behan, chief executive of CQC, said: “The fact that the quality of care has been maintained in the toughest climate that most can
particularly evident where sectors come together – or fail to come together, as the complex patchwork of health and social care strains at the seams. “Last year, CQC warned that social care was ‘approaching tipping point’ – a point where deterioration in quality would outpace improvement and there would be a significant increase in people whose needs weren’t being met.
“This year, nursing home bed numbers are down, more contracts have been handed back and Age UK estimates that there is more unmet need. Helpfully, however, an extra £2bn has been made available through the Better Care Fund – and improvement in quality continues to outpace deterioration, although the rate of improvement has slowed. “The future of the social care system is one of the greatest unresolved public policy issues of our time – a long term sustainable solution is urgently required. The anticipated green paper on adult social care will provide the opportunity for Parliament, the public and professionals to consider how we can collectively develop an appropriately funded social care system that can meet people’s needs, now and in the future. “If services are to deliver consistently for people, there must be better coordination of care to create a sustainable and effective health and care system. Staff and leaders can’t work any harder; the answer must be to work more collaboratively, not just between sectors but between agencies and professionals, supported and incentivised by the national health and care organisations. “People should be able to expect consistent, personalised, safe care, and to be able to access that care when they need it – whether that’s delivered in an acute hospital, a nursing home, a community mental health hospital, a GP surgery or in their own home.”
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Is UK elderly care lagging behind the rest of the world?
by Jitesh Patel, project director, Kajima Partnerships Britain’s population is ageing, with one in twelve people predicted to be aged over 80 by 2039. Adapting to this trend poses significant economic, social and political challenges and has major implications across all sectors of society, from demand for goods and services including housing, transportation and social care, to implications on family structures and intergenerational ties. According to the United Nations, virtually all countries are experiencing growth in the proportion of older people. The questions are - what challenges and opportunities does this create for our society, how does Britain’s elderly care compare to other developed nations, and what can we learn from other societies facing similar challenges? Columbia University’s Global Aging Index which indicates how
different countries are adapting to dramatic increases in the number and proportion of older people, revealed that the UK significantly lags behind other developed nations, failing to reach the top 10 countries on the list. The Index comprises specific measures across five social and economic indicators reflecting the status and wellbeing of older people in a given country over time. These include: ■ Productivity and Engagement ■ W ellbeing – indicating state of health ■ Equity – economic security ■ C ohesion – social and generational connectedness ■ S ecurity – support for retirement and physical safety.
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One of the most critical aspects of elderly care, pertaining to several such indicators, is accommodation. Despite increasing numbers of elderly people continuing to live at home, a recent Lancet study found that 70,000 additional care home places will be needed in the UK by 2025. Providing appropriate accommodation for older people has immense benefits for society and the economy. Despite improvements in mainstream and specialist housing in the UK, they are not sufficient to respond to our rapidly expanding and aging population. Finding better ways of integrating housing with flexible forms of care and support has become imperative. As a global real estate developer delivering tailored care homes and assisted living environments across the world, Kajima is concerned with advancing international best practice in elderly care accommodation. Here are some cutting edge methods being implemented in some of the most advanced economies in the world.
Adopting design innovations As the elderly live longer, care homes – once labelled ‘God’s waiting room’ – must transform themselves into places to live, not places to die. The US leads the way in radically rethinking retirement living, developing homes that are designed to support and empower continued resident growth spiritually, physically, intellectually and socially. The Green House Project has pioneered a new approach to longterm elderly care, basing its model on homes for no more than 10-12 residents which operate more as mini hotels than hospitals or care homes; their intimate scale is crucial in cultivating close relationships between residents and carers. The model’s success has meant that over the past 10 years it has expanded to a network of 204 homes in 29 states. Recently, Japan opened its awardwinning Setagaya Nakamachi project, a care home designed specifically to cater to those with dementia. Its built environment aims to reduce stress and anxiety for residents. All aspects of the design respond to challenging dementia symptoms, such as disorientation and shifts in vision. Embracing assistive technology - robocarers Despite the UK’s hesitance in advancing assistive technologies for elderly care, Australia and Japan are in advanced trials of carer robots. ‘Robocarers’ help residents with tasks such as taking medication, rehabilitation or simply moving between rooms, reducing pressure on human carers and allowing them to spend more face-to-face time with patients. Robocarers are already operational at one of Australia’s most luxurious elderly residential homes, Mark Moran Vaucluse in Sydney. In Japan, where over a quarter of the population is aged 65 years or older, Meijo University has developed a robot capable of moving patients from bed to wheelchair; and exoskeleton company Cyberdyne,
which is trialling strength-enhancing mechanical limbs for the elderly, raised $89 million in its Tokyo IPO last year. Japan has forecast that the market for “care service” robots will rise to $3.7 billion within 20 years. If adopted in the UK, these machines could result in considerable savings in the delivery of care services. Funding elderly care In part, the UK’s elderly care lagging behind other developed economies is due to funding constraints. In the UK, the NHS and welfare systems are crippled under the weight of evergrowing demand as people rely on the State for care in old age. Despite a commitment this year from the Communities and Local Government secretary, Sajid Javid, for a £240 million adult social care support grant to help councils with care of older residents, the Local Government Association estimates there will be a £2.6 billion funding gap in providing adult social care in England by 2020. In the US, individuals assume responsibility for their housing needs in old age; the government provides a safety net for the poor and a regulatory structure to govern the private market. This has precipitated the rapid expansion of privatelyfunded assisted-living and continuingcare retirement communities, where larger budgets allow for state-of-theart care. There are now more US residents living in such facilities than in government supported care homes. Internationally, governments are beginning to appreciate that it is better and cheaper for individuals to remain in their own homes for as long as possible. The Australian Commonwealth estimated that it costs approximately £18,000 per annum to fund an average residential-aged care bed, compared to £6,000 per annum to deliver a Community Aged Care Package. This realisation was acknowledged by the UK Government in 2013 when it announced its £5.3 billion Better Care Fund to ensure
transformations in integrated health and social care so that people can manage their own health and wellbeing, and live independently in their communities for as long as possible. Leveraging cultural shifts Despite packages like the BCF, the question remains – who is going to pay for innovations in assistance and the development of purpose built accommodation? The answer might lie in a cultural shift. The economic crisis of ten years ago precipitated numerous social and economic developments, which have led to shifts in attitudes towards household structures. Rising house prices at a time of austerity and stagnating wages have led to increased intergenerational living. Expanding on this cultural shift may present a solution not only for the housing crisis of the young, but for the future of elderly care. Realising the profound wellbeing and care benefits for the elderly, and the fiscal benefits for the young, some countries - notably the Netherlands - have begun to develop intergenerational living complexes. Each individual/family has their own self-contained space complemented by community rooms and gardens. Typically the community rooms are used for meetings, shared meals and for workshops/hobbies. As populations get progressively older it is imperative that governments design innovative policies targeted to elderly people’s needs, including those addressing housing, employment, healthcare, social protection and other forms of intergenerational support. If the UK is to catch up with other advanced economies, it must embrace design and technologyrelated healthcare innovations, respond to shifts in cultural norms and developments in attitudes surrounding end-of-life care. It must also prioritise funding strategies and adopt international best practice to improve the lives of generations of elderly people to come.
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Are you protected for the growing cyber risk in social care?
by Glenn Trafford, of Cass Stephens, business and personal insurance brokers. Technology is enabling us to do more. The majority of the time it is making tasks quicker, easier and safer. However, this information age comes with risks. Most of us have thought about these risks in our private lives, but not so much in our businesses. As care providers, looking after people is second nature. But not only do you care for people, you document what care has taken place, who has delivered it and in what manner. It is only right that we protect the individuals in our care, so we conduct DBS checks on carers, we also check their employment backgrounds, their driving licences, their health records and their social security details. The information care providers collect is highly sensitive, increasingly stored electronically and potentially life-changing in the wrong hands. Not only this, care providers can be fined up to £500,000 for breaches of the Data Protection Act by the Information Commissioners Office. Keeping data safe Every good employer will endeavour to keep their employees and service users’ data safe. Clearly
things may go wrong and your policy may provide you with cover in the event of an accidental breach of the Act. However, where your standard care home insurance policy will only look to cover legal liability and defence, at best, this could leave your organisation in serious financial difficulty. Breaches can occur for a number of reasons, but the main reasons are: ■ Fraudulent emails ■ Viruses, spyware or malware ■ Impersonation (either in emails or online) ■ Ransomware ■ Hacking Just under half of UK business identified a breach in in the last 12 months. This rises to two-thirds among medium and large firms. What is generally under-reported, is that it is generally employee error, rather than malicious intent, that causes major harm. This can be very hard to protect against, even with all the training in the world, due to the adapting methods of the cybercriminal community.
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Best protection So how best to protect your business? How would you cope, for example, in the event of a serious loss of data and systems like the NHS suffered after the Wannacry attack in May? A Cyber Insurance Product can provide you with immediate assistance to industry experts to assist you in the event of a breach. Not only can they assist you with crisis matters such as extortion and data loss, they can also help manage negative PR and assign a legal team immediately. A Cyber product covers ‘First Party Losses’ such as equipment damage, data reinstatement and business interruption, as well as ‘Third Party Liability’, which covers your legal liability to others for their data being breached, credit reporting fees for breach subjects and ICO fines. If you are considering taking a Cyber policy, you should speak to someone experienced in both the Care and Cyber markets, who will be able to determine what cover you have in place already through your current insurances. InsurewithCare offers Cyber policies starting from just £150. www.cass-stephens.co.uk Insure with Care - : www.insurewithcare.co.uk
Data protection overhaul - how care home managers can avoid hefty fines
by Sarah Finnemore, solicitor, litigation and dispute resolution department, hlw Keeble Hawson. Care home owners and managers are urged to get to grips with the biggest overhaul of data protection law in a generation before new rules come into effect on 25 May 2018. The General Data Protection Regulation (GDPR) will spark a series of challenges for businesses across the care and healthcare sector. It will be regulated by the Information Commissioner’s Office (ICO), a government watchdog, and fines for non-compliance could be as much as €20,000,000 or four per cent of annual turnover. A very complex area, covering a huge array of requirements, GDPR will govern how all private, public and third sector organisations across the EU handle personal data. The government has said that it will remain in place post-Brexit. Specific consent needed Under GDPR, every person whose personal information is stored by a
business for any reason must be told why that organisation wants it and what it will do with it. Care homes seeking to share the data with any third party will also need the specific consent of the individual. This consent must be very clear. For example, you cannot simply rely on a click confirming that a privacy policy has been read. Legal consent under GDPR must be explicit, informed and freely given. It can be made in a statement or by ticking a box. Personal data must be stored securely with specified protocols to ensure that it is not breached, stolen, leaked or shared without authorisation. The far-reaching changes allow anyone to inspect their personal data at any time so care homes must be ready to handle ‘subject access requests’ informing anyone who asks what data is held on them - and how it is used - within one month. This means that it must be kept accurate and up to date.
Staff will need training The need for easy amendment and management is also vital as anyone can request that their personal data be removed at any time. GDPR also requires that employees are trained in how to protect and manage the information they hold. The personal data of care home residents and their families are among the most sensitive held by any organisations – public or private. This means that they will have to look carefully at the specific rules that apply to processing ‘sensitive data’. The confidential nature of such information may also influence the security systems that care homes require in order to keep it safe and secure. Healthcare providers generally operate under the doctrine of ‘implied consent’ when using sensitive personal details. Under the new, more stringent GDPR rules, relying on the ‘implied consent’ may not pass the requirement that consent be given explicitly. However, the regulations do provide an alternative legal basis of processing sensitive data for health or social care purposes. A particular headache for managers and owners, who may already have amassed large amounts of information, is that GDPR applies retrospectively – i.e. to all data collected before May 2018, as well as all data from that date. Comprehending and complying with the massive overhaul will be extremely challenging - and it is still possible that there may yet be even more new developments and changes in the lead up to implementation. Adopting the adage that forewarned is forearmed, enlisting a legal practice with a track record in data protection upfront can help to prepare your business for the changes to come, and avoid severe financial non-compliance penalties further down the line.
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Huntington’s Disease the benefits for residents of using correct seating Huntington’s Disease was first written about by George Huntington, a practicing GP working in New England in 1872. Originally a European disease, it was spread around the world by European sailors and travellers. As with many diseases, people working with those living with Huntington’s are always looking for new developments of equipment which will help their patients and increase their levels of comfort and dignity. One such solution is the Harlem Porter chair from Repose Furniture which has been developed in conjunction with Mike Wooldridge, who is one of the UK’s leading experts in caring for people with the disease and Kate Sheehan, Repose’s resident OT. Mike has been working with people with Huntington’s disease for over 30 years and has seen many changes in the way people are cared for. Importance of correct seating “I started working in large mental institutions in 1969 and healthcare
wasn’t like it is today,” he said. In the mid-70s people started looking at solutions that might help people with Huntington’s and one of the first things they looked at was seating. People with Huntington’s have strong involuntary movements and a suitable robust chair was required which would stop them sliding down or falling out.” The disease is a genetic condition with people carrying the gene having a 50% chance of passing it onto their children. A brief review of the number of patients cared for by the Huntington Disease Association in the UK indicated that approximately 6,700 individuals are currently living with HD. This means that one out of every 8,065 individuals may be affected. Mike has seen various developments in seating over the years and believes that the Harlem Porter chair is one of the best seating solutions he has seen. He is currently working with several service users who now use a Harlem. “We have a lady in her forties in Horncastle who has been using a
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Mike Wooldridge with Helena Elcocks, national sales manager, Repose Harlem for several months. Prior to getting her new chair, she had to spend all her time in a wheelchair which was not bespoke and therefore did not meet her specific requirements. We knew she needed an alternative seating solution and having worked with Repose I knew the Harlem would be perfect and had no reservations in recommending it to her and her family. They wanted to know that what we were suggesting would make a difference and without a doubt the chair has had a huge impact and has been a great benefit as she can now sit in a comfortable position. She is happier in herself and this makes it easier to care for her and also means she is more willing to interact as she feels settled and content”. What could more traditional homes do to help people with Huntington’s Disease? “I think the important thing is for those of us who have experience of supporting people with Huntington’s to share our knowledge,“ he said. “That way, hopefully our colleagues who are
running care homes can ensure they are providing their service users with the same level of quality care that we are delivering. “The big problem is if people are not aware of the products available then they cannot recommend them for their service users. I would also urge people to contact the Huntington’s Disease Association as they can offer fantastic advice and support for people not used to working with the condition.” What should be taken into consideration when designing furniture for someone with Huntington’s Disease? “The involuntary movements associated with Huntington’s can be extremely powerful despite the patient appearing frail, and their constant
Helena Elcocks with Leti, a carer who works with service users that have benefitted from the chair
movement puts a huge amount of pressure and wear and tear on all parts of the chair. There are also issues with pressure sores from force and friction. “The constant movement back and forth and repositioning means that someone with Huntington’s may require up to 5000 calories a day just to maintain body weight due to the constant movements and weight loss can be significant which puts the client at greater risk of pressure related issues. “It is extremely important to provide people with Huntington’s with the correct level of support around the head, neck and body to prevent them getting into positions which do not provide good postural support. “There are also issues regarding manual handling as when they stand
up they will not necessarily follow exact instructions due to their involuntary movements. All these concerns were taken into consideration during the design of the Harlem. For example, reinforcing the footrest to ensure it could withstand somebody standing on it without it moving. “The original structure of the chair was also strengthened so when someone moves in an unusual way they would still receive the core support from the chair with their body shape maintaining a good position. Another factor we took into consideration was maintenance costs. People with Huntington’s put an incredible amount of stress on furniture. For example, if someone continually puts their leg over the arm of the chair it will eventually wear out the fabric, so we designed each part to be easily replaceable if required” concluded Mike. Lisa Wardley, Repose’s managing director, commented: “I know from the feedback we have already received that people with Huntington’s and their carers are already benefitting from this when they try out the Harlem Porter chair for themselves.” Available in small, medium and large, the Harlem Porter has a maximum user weight of 20 stone. Standard features include an independent back rest recline with a range of angles and seat angle adjustment to reduce the risk of a patient falling out. There is also a deep padded seat area for additional safety and comfort, a choice of six interchangeable back styles facilitating different pressure management and posture solutions and four different seat cushion options to accommodate different comfort and pressure management requirements depending on the user. Further safety features include high arms and a sliding padded footplate for ease of patient movement. For more information or to find your nearest retailer call 0844 7766001, email info@reposefurniture.co.uk or visit www.reposefurniture.co.uk
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Expertise in care homes design and delivery – the architect’s role
by David Coundon, architectural director of Space Architects In July the Care Quality Commission (CQC) released a national report on their comprehensive programme of adult social care inspections from 2014 to 2017. The report found that while the majority of adult social care services are of a high quality and many are improving, too many people across England are receiving care in their homes that is just not at an acceptable level.
Research by property consultants JLL, also in July, revealed that we are currently building only half the number of care home beds every year that we need, warning that up to 3,000 older adults will not be able to get beds in UK care homes by the end of next year. With our ageing population, the research claimed that “over the course of the next decade there is going to
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be 2.5 million more over-65s, and as a result, that means there is going to be demand for care home beds.” The simple solution requires us to double the rate of delivery. Then, in September, the Local Government Association (LGA) released their analysis which concluded that the number of specialist homes for older people would need to increase by 75 per cent by 2035. The LGA called for a ‘residential revolution’ to support our ageing population, saying that councils need funding to adapt existing housing and to deliver accommodation that suits the older generation. At the same time, the Department of Health claims that local authorities in England have been given ‘an extra £2bn boost over the next three years to maintain access for our growing ageing population and to put the social care sector on a sustainable footing for the future’. The care of some of the most vulnerable in society should not become a tit-for-tat argument. The facts are speaking for themselves – we need more beds and not just any beds. Well-designed, caring environments that cater for everyone’s needs, whether that be an older person needing to ‘right-size’, or the very frail in need of specialist care. While as architects, we can do little to impact the austerity measures that some would argue are crippling the ability of local authorities to deliver high-quality care, we can, and should, use our knowledge to deliver living spaces that not only deliver for specific end-user needs but which are also flexible enough to change and adapt as these needs change. And there are opportunities. Whether it be from forward-thinking local authorities or private care providers, architects can deliver environments that will not only provide the necessary care for a range of needs but which are also designed in a way that can contribute to a better quality of life and improved living standards, as outlined here:
A New Care Model – Alnwick Care Home Take for instance the 88-bed specialist facility on the edge of the Conservation Area in Alnwick, Northumberland with the award winning Prestwick Care, due for completion in September 2018. This particular home caters for a variety of special care requirements spread over four floors. While the ground and upper floors are aimed at more elderly occupants, the lower-ground level will house 17 beds for young physically disabled (YPD) residents. The facilities for the elderly range from general residential accommodation at the ground level, but becoming more specialist (with more medical facilities) as one moves up through the floors. The ground floor will house 21 beds, designed in a hotel style for the mentally and physically able and includes a hairdresser’s salon and cinema, along with a café that has its own external terrace for the residents to enjoy the views. The first floor is set up for 25 beds and caters for those with dementia, while the second floor, also with 25 beds, is for the very frail and ill, providing onsite nursing facilities and monitoring. This project is truly unlike any other in the region providing more of a 4-star style hotel accommodation.
Ryhope
Respecting the Context – Ryhope Care Home This development will house 66 beds in Ryhope village -- a Conservation Area in Sunderland. The development is on the site of an old Victorian school, half in and half out of the Conservation Area, flanked by residential estates on three sides and a historic church on the fourth. The two-story building will be arranged around a landscaped courtyard, and deliver general residential and dementia care for the residents. Although there isn’t any specialist medical accommodation intended for this development, the care provided will be exceptional and stimulating and match the needs of the community. Saving Our Heritage Whitley Bay Care Home This 83-bed development is due to start on site in the spring of 2018 and complete the following summer as part of the Whitley Bay rejuvenation project. The Rex Hotel in Whitley Bay has its origins back in the 1907 Waverly Hotel (parts of which are still incorporated) and the more famous 5-storey Rex added in the 1920s has been a seafront landmark for years. The size of the building lends itself to a range of high-end facilities to enable the residents to enjoy an enhanced quality of life including a cinema room, hydrotherapy pool, beauty salon, physio therapy facility and roof garden. The build will also include a
Whitley Bay skills kitchen for the YPD so they can learn to look after themselves and gain independence. The architect’s approach Using forward-thinking technology is an area that architects are increasingly utilising, with advances in point cloud surveying being the first step. This laser technology enables a survey of the spaces of an existing building to create a digital version of all the geometric points. This data is used to generate the building and eventually creates a 3D model. This is the start of an exciting process that will result in the finished design (with all information required) and an ‘as-built model’, saving time and money. An architect should be passionate that a building results in spaces that work for the occupants, whether that means luxurious surroundings or specially adaptable spaces for those living with the confusing and debilitating effects of dementia – listening to the clients is paramount. Good design in the built environment enhances our lives, and this is where an architect’s expertise comes to life. Combining design knowledge with a sensitivitiy for a building’s occupants are delivering results for some of the most vulnerable in society. Just think for a moment what you would want if you ever needed residential care?
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Enhancing elderly lives through human and animal relationships management of pets within the care home and for ensuring the safety of residents and team members. In addition to this, the general manager should also ensure that all relevant risk assessments are in place, that they are up to date and applied in practice. It is the team member’s responsibility however to notify the manager of any known allergies that may affect them when they come into contact with pets in the workplace.
Julie Rayner is care, quality, governance and compliance director at Hallmark Care Homes. With over 20 years’ experience working for the National Care Standards Commission, the Health Care Commission and CQC, she looks at how animals bring something special to care home residents. Animals can bring joy to many care home residents and there are several health benefits of pet ownership and interactions. The general benefits include an improved mood and decrease in stress; lower blood pressure and cholesterol levels; less risk of heart attack; and an increase in motivation and exercise. This is not new news. However, it is important that care home managers are able to determine whether the home can accommodate a pet, whether they can provide on-going care of those pets and what the requirements are for welcoming visiting pets into their home before any decisions are made. Do the ‘pros’ outweigh the ‘cons’ Hallmark Care Homes has recently implemented a policy that ensures that
all of the important questions about pet ownership and visiting animals are asked before coming to a decision. We have developed this policy, because we know in some cases, the benefits of pet ownership and interaction with companion animals outweigh the cons. Also, when a resident moves into a care home, we are sympathetic and understand that giving up a pet with whom they have a day to day relationship could have a devastating effect on their health and wellbeing. Moreover, by doing risk assessments and asking all the important questions early on, care providers can be confident that they have made the right decision, in line with the residents’ best interests. Historically, the general manager is responsible for the day to day
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An animals’ policy Our pets and visiting animals policy outlines a framework pets moving in with residents, pets living in homes, visiting animals, as well as infection prevention and control. Since the policy’s implementation in February 2016, the process has become more streamlined and we have introduced our own resident PAT dogs into our care homes, which has had an amazing effect on residents’ wellbeing. Moreover, we have also supported a resident to look after her dog and bring it into the care home. The most important consideration for general managers within this policy is that the subject of the residents’ pets is discussed at the pre-admission stage. This must then be documented, explored and discussed with the wider care home team, taking the residents’ care needs and wishes into consideration as well the current and type of animals already resident in the home before a decision is made. Generally, most care homes can only accommodate small household pets for the reason that larger pets and exotic species require substantial support from the care home team. There is also no guarantee that the care home can continue to care for the residents’ pet in the event the
animal outlives the owner, so this possible outcome must be discussed prior to the resident moving in. In terms of costs, understandably the resident and/or their family are responsible for paying all food and vet bills relating to the animal. Visiting pets In terms of visiting, animals such as PAT dogs and cats and encouraged in care homes as their presence can positively impact on residents’ enjoyment of life. They are also registered with the Pets as Therapy charity and hold appropriate liability insurance. Team members’ animals have not undergone the same vetting procedure as PAT animals do, therefore it is essential that a robust risk assessment is completed and any mitigating actions applied prior to welcoming the pet into the home. As with all animals, care must be always taken to ensure that residents and team members observe strict handwashing procedures after holding any animal, especially prior to
handling or eating food. Pet excrement should also be cleaned appropriately and immediately to reduce the risk of infection and sickness. Guidelines document To support our policy, a guidelines document for the care of a pet in a care home has been developed. This outlines what information the general manager should obtain from the resident, family, or representative regarding the pet, what should be discussed in the meeting regarding the care of the pet and what support the care home will provide.
As we all care for vulnerable adults, Hallmark Care Homes feel we have a responsibility to share best care practice. Every effort must be made to ensure that new residents are not separated from their much loved companions and only by working together can we help to secure a future for the care sector, where the health and well-being of each resident is held above all else. If you have any questions regarding Hallmark Care Homes Pets and Visiting Animals policy, please contact Julie Rayner directly at Julie.Rayner@ HallmarkCareHomes.co.uk
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Why it is important to factor profit into the cost of care Do you know how important it is to factor profit into the cost of care? Richard Shore, finance director of Caresolve, says too many care homes are not paying close enough attention to the financial aspects of running their businesses.
What does ‘Profit’ include? Profits made on care home businesses would be used to cover the following items:
Why is it important to factor profit into the Cost of Care? A standard cost of care calculation will generally cover items such as staffing costs, other direct costs and overheads. This is true whether the cost calculation comes from you as a provider, or as a template for completion from, for example, a local authority as part of an annual review of fees. The issue of profit (or cost of capital) is often less straightforward. It is important providers understand the level of reasonable profits they should be looking to make, and to be in a position to have appropriate discussions with commissioners about why this is also important for them to consider properly.
■ Interest on bank debt
Providers are often hesitant or nervous around having a discussion with commissioners around the need to make profits, what level of profits should be made by a business, and why this is the case. There may be a feeling that commissioners would see profit and being directly related to what an owner takes out of the business, when this is not the case. Commissioners do not always give the issue the prominence it deserves when looking at fees and can be dismissive of it. We have seen templates from local authorities which completely ignore a detailed discussion of profit – stating they will ‘apply a fixed percentage to all returns from providers to account for return on capital employed’. This is unsatisfactory.
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■ Repayment over bank debt (which traditionally will be over a 15 to 20year period) ■ Capital expenditure (including, for example, new beds, new boilers, kitchen equipment, significant refurbishments – none of this is properly accounted for as an ‘overhead’) ■ An adequate return for the owners’ time spent in the business ■ An ability to build reserves of cash within the business to cover any unforeseen events ■ A return on the amount of capital (asset value) invested in the business
Why is this important? What is your annual budget for capital expenditure? Have you any large projects on the horizon (next one to three years for example)? Do you have significant levels of equipment in the home nearing the end of its useful life? How will all this be funded? Standard models for calculating ‘overheads’ would include repairs and maintenance but not these items. These are funded from profits, either directly or by way of funding further debt to buy assets on a HP agreement for example. Any care provider funded by bank or other debt will almost certainly have profit targets (Bank Covenants). Failure to meet those targets will over the longer term have consequences for continued availability of funding and the viability of the business. Failure to meet those targets by a significant margin will impact ultimately on the ability to repay debt.
This factor is likely to be relevant to all debt funded homes. As a provider, how much time do you spend within your business on a weekly basis? What do you feel this time is worth, and is the business in a position to reward you adequately for your time and efforts? Does your current fee structure leave sufficient free cash to enable the business to cope with unforeseen events? What if there was an unexpected drop in occupancy combined with a need to utilise a lot of agency staff over a short period of time, and a key piece of equipment failed? Why is this important for commissioners? A stable care sector requires investment. It requires this investment in order to maintain and improve on quality standards over time, and ultimately to have a sustainable provision of social care. Profit is a vital part of this alongside other cost elements.
Can any commissioners attract or even expect investment in the future if they do not properly account for a reasonable level of profit within their fees? Whilst we understand there are many non-financial reasons providers work in the sector, would good providers ultimately leave the sector if they feel they could make more money with their time (and assets) elsewhere? Conclusion Profit is an important element within the calculation of the true cost of providing care. There are many reasons behind the need to make a reasonable level of profit and these can form the basis of a detailed calculation and subsequent discussion with commissioners, and we do not feel that providers should be unwilling to have this discussion. A reasonable level of profit should be able to be confidently explained and justified. www.caresolve.org.uk
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Activity v Lifestyle – the language shift in our care homes by Sylvie Silver, executive director of the National Activity Providers Association.
I have spent more than 20 years looking for an alternative word to ‘activities’ in the context of care settings. For many people being asked to consider what activities they might enjoy epitomises the view that they are now living in an institution. Try asking someone how they would like to spend their day and the response might be markedly different. At NAPA we have seen a welcome shift in the language used in recent years. Although the job title of activity coordinator still dominates, we are seeing some more innovative ones emerging. New titles Top of the list at the moment is ‘lifestyle leader’. We also have some ‘wellness coordinators’, ‘wellbeing leaders’ and ‘leisure and lifestyle’ leads amongst our membership. These titles reflect the shift in culture around meaningful engagement that NAPA has promoted for many years. True person centred care looks at
every aspect of a person’s life across all elements of health and well-being. The traditional focus on nursing and personal care is struggling a bit to embrace requirements to look at mental health and wellbeing as of equal importance and not just a nice extra. Offering a fixed programme of activities for a couple of hours in the afternoon will never meet the needs of every individual. In reality it never did. Skilled role It takes some skill to support an individual to live the life they choose. It is perhaps more complex than just meeting personal care needs which is why it is a challenge to some. Lifestyle leaders can show the way and encourage the whole team to see each person as an individual, supporting them to have a voice and choice and control over their day. Some folk will always want to join in with large group highly structured sessions, but, in our experience, the majority will relish a small group of 2 or 3 with a shared interest coming together in a more casual way to enjoy spending some time together.
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Christmas opportunities The approach of the festive season offers a brilliant opportunity to truly personalise how an individual might want to celebrate Christmas. We all have significant rituals, developed over a lifetime, that go with this time of year. Inviting the staff team to write down how they always spend Christmas is a great exercise for illustrating our individuality. Just agreeing on what time of day to open presents will lead to a hearty debate. Move this exercise on by establishing how each resident is used to spending their time at Christmas and see how you can replicate that for them. It may bring to light that this can be a sad time of year for some who have lost loved ones and they may miss them more at this time as they can’t replicate the rituals of old. Approaching Christmas with sensitivity is the mark of a really personalised care setting especially if it can create a good time for the staff team too.
Loss of mental capacity – mitigating the financial impact for care providers by Kerry Blackhurst, private client solicitor, SAS Daniels Care home places are in high demand, yet many are struggling to stay afloat. Government funding, or rather lack of it, is causing ongoing pressure on local authority funded adult social care, and the impact of the National Living Wage which has caused wage bills to rise by about five per cent, has resulted in many care homes being forced to close. For those providers managing to remain profitable in these tough economic times, it’s vital that selffunding residential fees are paid promptly and payment delays are minimised. An assessment of a resident’s mental capacity should of course be a priority for any residential care home provider. A resident with capacity can choose to manage their own financial affairs and pay their own fees or, more commonly, may choose to appoint an attorney (or attorneys) to help them with their finances. It is advisable to ensure that this is fully discussed at the outset to avoid any issues further down the line for the continuity of payment of care fees, in the event that a resident subsequently loses the ability to make financial decisions. If a particular resident does not have suitable family or friends to undertake
this role, they could always consider appointing a professional such as their solicitor, accountant or financial advisor. What if a resident with no appointed attorney has lost capacity? In theory there will be no-one with the legal authority to authorise payment of the care provider’s fees, until a suitable person has applied to the Court of Protection to be appointed as a financial deputy. Again this is most commonly a close family member or a friend, but could also be a professional if there is no other suitable person. The Mental Capacity Act 2007 provides the legal framework for making decisions on behalf of those who lack capacity. Section 7 of the Mental Capacity Act does allow for the payment of a ‘reasonable price’ for ongoing ‘necessary’ expenses and could be used to justify the ongoing payment of care fees in order to avoid a resident losing their placement. This should only be seen as a temporary option whilst a suitable deputy is being appointed – a process which can take several months to complete.
What about occasions when the care provider has concerns about the resident’s attorney or deputy? Financial abuse of the elderly is rapidly escalating. Sometimes this is due to attorneys and deputies simply mismanaging the older person’s finances and misunderstanding their role, but on other occasions there are more sinister motivations. A care provider will usually be the first to suspect something is amiss, for example, fees are being paid late or not at all; funds are not being made available for the older person’s benefit or family members are having inappropriate conversations with the older person about money. A resident’s funds should be used for their benefit, primarily to fund their care needs and everyday expenses. If this is not being facilitated by an attorney or deputy then this is a primary indicator of financial abuse and should result in an immediate safeguarding referral to minimise any further dissipation of the resident’s funds. It may also be worthwhile obtaining legal advice to see what further steps can be taken to protect the resident and ensure the payment of fees can continue unimpeded.
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Events and Appointments
Events line-up 14 November 2017 Care Roadshow London
Epsom Downs Racecourse www.careroadshows.co.uk/ 16 November 2017 Care England Conference ‘Shaping Tomorrow’
Church House, Westminster, London www.careengland.org.uk 30 November 2017 NAPA Conference: How to
connect to your community and volunteers Bristol www.napa-activities.com/events/ conference
2018 12-18 March 2018 Nutrition and Hydration Week
https://nutritionandhydrationweek. co.uk/ 21 April 2018 Care Home Open Day
www.carehomeopenday.org.uk 25-26 April 2018
Appointments Balhousie Care Group celebrates 25 years with new CEO Balhousie Care Group, celebrating its 25th anniversary, has announced a new chief executive officer, Steve White. Formerly CEO of Sussex Housing & Care and Blackwood, Steve White (above right) has also been at the leading edge of business performance and employee engagement and motivation. Tony Banks will continue as chairman. Meanwhile, Fiona Duncan (right) has been appointed manager of the Group’s Alastrean House in Aboyne, which is re-opening following a £160,000 refurbishment.
Four Seasons names new MD for South East Region Four Seasons Health Care has appointed Fiona Williams as managing director for the England South East Region, leading a number of senior managers in 40 care homes. She is currently the Group director of operations at Bluebird Care Group. Fiona joined Bluebird Care in 2012 and has led significant growth in revenue as well as excellent quality standards. She will join Four Seasons on 15 December.
Dementia Care and Nursing Expo
NEC Birmingham www.carehomeexpo.co.uk 25 May 2018 Care Home Awards ceremony
Royal Garden Hotel, London www.carehomeawards.com 27-28 June 2018 Health + Care
ExCel, London www.healthpluscare.co.uk 17-18 October 2018 Care Show
Oakdale Care Group makes strategic appointments Oakdale Care Group has made two strategic appointments in readiness of their imminent expansion plans. Rachel Cadd has been appointed as home manager for Timken Grange in Duston, Northampton, which will open in January 2018. Ann-Marie Baker will be joining the head office team as Group Admissions Manager. She joined from a similar position at Gracewell Care.
NEC Birmingham www.careshow.co.uk
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Durapipe HTA takes care of heatcare
Durapipe HTA installed at Cumnor Hill House care home Durapipe UK is celebrating a successful five year partnership with specialist residential care sector contractor Heatcare, which has seen its HTA pipe system installed in an array of new care home developments across the country. Heatcare has selected Durapipe UK as
its preferred hot and cold water pipework partner, specifying its purpose-designed HTA system to cater for the hot and cold water services within many of the new care and retirement living construction projects it is involved with. Durapipe HTA is specifically selected as it speeds up the installation
The sky’s the limit with new over 55s housing thanks to forbo
Forbo Flooring Systems has played a vital role in bringing the outside in during the design of a new extra-care housing scheme, for Southampton City Council thanks to its range of colourful and practical floor covering solutions available. The result is a design that ensures that the residents have a bright, healthy and hygienic environment to live in and subsequently, the project won a Commended award in the Fly Forbo 16/17 competition. Design Consultant Alex Salway, from Daring Design UK Ltd, designed the interior of Erskine Court for Southampton City Council; a ‘housing with care’ facility designed for the over 55s and one of the first of its kind in Southern England. Residents have access to care 24/7 if they need it, while also maintaining their
process, with its simple solvent weld jointing technique saving significant time and costs on site. For further information on Durapipe HTA or any other products within the Durapipe UK building services portfolio please call 01543 279909 or log onto www.durapipe.co.uk.
Wipe out winter germs with Gompels Antibacterial Spray
independence and having space in which to socialise and be part of a community. Fiona Astin, Interim Regeneration Manager, Southampton City Council, said: “Southampton City Council is delighted with the appearance, practicality and durability of the flooring at Erskine Court. Daring Design has used the colourways and products to great effect, creating a really attractive environment that’s sensitive to the needs of the residents. We are planning to build another new Extra Care scheme in the city starting by early 2018. We have been so happy with the flooring at Erskine Court that we plan to replicate it in the new scheme.” For more information about Forbo Flooring Systems please visit www.forboflooring.co.uk/agedcare
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Sleep-ins – an overview Traditionally, staff in the social care sector who undertook sleep-in shifts for clients were paid a set allowance for each sleep-in shift. Those allowances were not at National Minimum Wage (NMW) levels. When the NMW regulations were implemented in 1999, they were not expected to have any impact on support workers who were undertaking sleep-in shifts. However, the regulations themselves did not expressly adopt the Low Pay Commission’s full recommendations. There have been a number of challenges to whether the NMW should apply to sleep-ins. In the case of Mencap, the Employment Appeal Tribunal found that sleeping time should have been included in the NMW calculations. It was always a question of fact whether an employee was “working” whilst asleep. Mencap has indicated that they will appeal.
Current position ■ Unions are actively promoting claims by both existing and former staff ■ Local authorities and other commissioners for social care are struggling with funding ■ Many commissioners have continued to only pay allowances for “sleep-ins” without recognising the crisis amongst providers ■ The political consensus that was beginning to develop was overtaken by the 2017 general election ■ HMRC enforcement is currently suspended and extended now by one further month - this cannot continue indefinitely and it remains to be seen what proposals the government have ■ The Local Government Association’s “state of the nation- adult social care funding” highlighted that sleep-ins pose a significant risk to the market
The future It would be a surprise if the government removes all potential liabilities for all social care providers (and those holding personal budgets). Providers should therefore: ■ Review their sleep-in arrangements to fully understand whether there are potential back pay liabilities ■ Consider the value of potential back pay claims ■ Develop strategies for the future to accommodate back pay liabilities as well as future payments
Contact: Martin Cheyne Partner Hempsons Tel: 01423 724121 Email: m.cheyne@hempsons.co.uk
Care Management Home Free Legal Advice Line 01423 724056 Care Home Management and specialist health and social care law firm, Hempsons, offer a free advice line for Care Home Management readers. Simply call 01423 724056 quoting ‘Care Home Management Advice Line’ or email socialcare@hempsons.co.uk 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 faced by social care providers. 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 and community law | Safeguarding | Tendering
38 Care Home Management | November/December 2017
Legal advice provided by Hempsons.
Leading Health and Social Care Lawyers LONDON | MANCHESTER | HARROGATE | NEWCASTLE
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November/December 2017 | Care Home Management 39
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