SELF-PAYERS ARE CRUCIAL TO COVID OCCUPANCY RECOVERY
Green shoots of improved occupancy are emerging in the sector, with some providers putting strategies in place to return to pre-COVID levels.
LaingBuisson forecasts that it will take until 2023 for occupancy rates to recover from COVID. In total, it estimates that the care home population dropped by more than 30,000 people between March and September 2020 – which is before many homes were hit by the second COVID-19 wave, decreasing occupancy rates further.
Among those affected is Valorum Care, which saw people sadly pass away as well as move out, explains chief executive Rhian Stone.
However, occupancy is steadily on the up following a campaign, including a series of open days throughout the summer and virtual tours of its homes on social media.
Stone said: “We are trying to show that life goes on and care homes are not frightening places. In the past couple of months, we have noticed a significant difference. It is about building confidence back in the sector. It is about opening up.”
Also affected by COVID is The Orders of St John Care Trust (OSJCT), which suffered a seven per cent drop in occupancy. During COVID, its homes, on average, have been 80 per cent full, following prolonged periods of lockdown, COVID-19 infection and a reduction in admissions, according to its annual report.
At care provider Greensleeves, occupancy levels fell to 76.5 per cent at the beginning of the year as the impact of the second wave of the pandemic was felt.
However, rates bounced back to 87.3 per cent towards the end of July and a return to normal levels of around 93 per cent is expected by March 2022, according to the company.
In its latest set of accounts, the company reports that it has taken on more state-funded residents, exceeding its target of 25 per cent. This is partly due to some privately-funded residents falling below the eligibility threshold.
Self-paying residents, many of whom have been deterred from choosing residential care due to the pandemic, will be crucial to the recovery of many care businesses.
ONS data released this month found that only around two in five people in care homes for older people in England were self-funding between 2019 and 2020.
OSJCT has embarked on its own “reassurance campaign” to achieve its goal of a 50:50 split between local authority and self-funding residents. The latter accounted for 40 per cent of its residents at the end of March.
This strategy forms part of a “Recovery to Good Health” agenda which will include matching “resource to occupancy and complexity”, according to the not-for-profit provider.
Valorum Care has also been talking to social workers and commissioners to attract new placements, but this has proved difficult as many are still working from home.
Valorum CEO Stone added that the management was also working to improve home managers’ confidence to take on new residents, while ensuring people are accommodated in the right home.
However, insufficient staffing is holding back its ability to take in as many new residents as it would like and it is recruiting. Stone believes for this reason recovery may be hampered. She said. “It is a very difficult operating environment.”
CARE HOME MANAGEMENT: OCTOBER 2021
CARE HOMES SQUARE UP TO COVID VACCINATION CURVE-BALL
Care home operators were thrown a curveball by the Government when it ruled that all members of staff must have received both Covid-19 vaccines by November 11.
As the September 16 deadline for having the first vaccine approaches, the move has had different impacts among care home operators.
For sole providers, which make up the majority of the care home market, losing even one member of staff can have a huge effect.
Red Rocks Nursing Home on the Wirral has already lost an RGN who refused to have the vaccination and subsequently resigned.
Owner Mike Vaughan said he has been running an advert for a new RGN for four weeks without interest.
He said: “There is just not the pool of people there.”
Vaughan added that if they weren’t able to recruit enough nurses, he would have to look at the home just providing residential care.
He said that there has been a 96.2 per cent take up of the vaccine within the home but he believes a take up rate of 80 per cent was reasonable in his view.
“I would like 100 per cent but I’m not going to get that”, he said. “I think we all need a bit of slack.”
The residents and their families have a strong relationship with the home, which is primarily private-pay – and its staff. There have not been any safety concerns raised, Vaughan added.
At Orchard Care Homes it has been a priority to keep existing and potential residents and their families up to date with the vaccination status of staff across its estate of 24 facilities.
It has used the same approach with councils placing residents with them.
Orchard’s director of people and talent Rebecca Dobson said: “We have been open and transparent with our partners regarding staff’s vaccination status and COVID-19 safety processes within our homes. This will have instilled confidence in our ability to safely welcome and care for new residents.”
Orchard has yet to lose any staff members and has been providing regular, independent, medical information in regard to the virus and safety of the vaccination in order to encourage employees to take the jab.
This includes hosting webinars with an associate professor and viral oncologist from a leading University.
Dobson added: “Should we have any staff losses this would be incredibly sad, as we would lose highly experienced and skilled people as a result of the Government’s new policy.”
Following April’s mandatory vaccination policy consultation, the policy was extended to all care homes, including those for younger adults.
The Lisieux Trust, which has two care homes for people with learning disabilities and autism, has also adopted a policy of transparency about the number of staff who have been vaccinated.
It has done this by publishing the figures in several editions of its monthly newsletter, so residents, families and staff teams were aware of the numbers.
Furthermore, it has not been asked to provide evidence of vaccinations by councils before a new placement so far.
Chief executive Jess Alsop-Greenacre said: “We are due to start consulting with staff members about the mandatory vaccines in the next few weeks; following this process we’ll know how many staff members may face dismissal if they refuse to have the vaccination.
“Currently 11 out of 85 staff in the entire organisation have refused to have the vaccination and only two of these work in our care homes; the remaining nine work in our supported living services.”
Alsop-Greenacre added that, if staff members leave or are dismissed as a result of the rule, they will need to use more agency staff while they recruit to fill the vacancies.
Lisieux Trust has already set up agreements with some agencies in anticipation that they will have to use their staff in coming months.
At Anchor Hanover the “vast majority” of staff have already received the vaccine voluntarily.
A spokesperson added: “We have contributed to the government consultation on mandatory vaccinations and would welcome a consistent approach across the care and NHS workforce.
“It is also crucial for government to help social care to enhance professionalism through investment and reform to drive parity of esteem.”
CARE HOME MANAGMENT: AUGUST 2021
TWO YEARS BEFORE CARE HOMES RECOVER, LAINGBUISSON FORECASTS
Occupancy rates during the first COVID-19-induced lockdown plummeted eight percent, equating to 31,800 residents in the UK’s care homes.
During the first lockdown 1 care home COVID deaths accounted for around one in every two of those seen in the general population, denting confidence in the sector and, of course, with the loss of much-loved residents. In total, between March and September 2020, the care home population dropped from 395,100 to 363,300 in September, according to the latest LaingBuisson report, Care homes for older people.
However, according to the report, care homes deaths now represent up to 30 per cent of those in the wider population, indicating current measures are working.
Report author William Laing said: “We are projecting a recovery, but our best estimate for this recovery is 2023.”
After this date, LaingBuisson predicts a rise in demand for care home places of between 412,100 and 488,100 in line with the 2.5 per cent annual growth seen in the population ‘of care home age’.
In the meantime, many homes will be left facing struggling to fill empty beds, putting additional pressure on already tight margins. A key barrier to occupancy is the requirement in some areas for whole homes to be COVID-free for 28 days.
In addition, limitations on referrals from hospital, as well as a move by local authorities and self-funders to manage more people at home have all had an influence.
In hardest hit areas, the reduction in admissions is well above the average – by between 40-50 per cent, he says. And this average belies a wide variation in geography or how individual homes have fared.
Those homes that have avoided the virus have been able to absorb new NHS and local authority admissions, and have been first in line to attract the more lucrative self-paying customers.
Rayner said: “In the context of finances because of cross subsidies it really matters where they are coming from and that balance needs to remain. It is all these things at once.” To make matters worse, the cost of care has increased, particularly with the need for PPE and testing.
The results of NCF’s Pulse survey, published this month, found 87 per cent of providers have seen an increase in operating costs due to COVID-19 while 75 per cent reported a decrease in income.
Rayner said: “It is going to be very difficult for organisations. How can you square that circle? How long is it possible to sustain this? I think we will be living with this for years to come.”
She said some providers had eliminated agency staff as resident numbers fell. Additional Government funding had also made a difference, although the funding gap has not been completely filled.
Chancellor Rishi Sunak’s support for small businesses has also supported care homes. Laing describes the PAYE holiday as “a lot money”. Of course, give-aways of this type have to be paid back and when they do, it’s possible some homes will stop trading.
Some owners who have been thinking about shutting homes might now bring that decision forward, Rayner suggests.
CARE HOME MANAGEMENT TODAY: FEBRUARY 2021
CONSENT IN PRACTICE: COVID-19 VACCINATION ISSUES FOR CARE HOMES
Key among the many issues related to vaccine deployment will be getting consent from residents, particularly those with dementia.
While the Government has issued a standard consent form for care providers to use, there are issues around some residents’ capacity to make the decision to consent to COVID-19 vaccination.
Consultant in human rights and mental capacity in social care, Rachel Griffiths, said: “We need to make sure consent is capacity.”
Griffiths said that, if someone can’t consent to COVID-19 vaccination, it will “best interests” decision.
In most cases it will be in that person’s best interest as receiving the vaccine is comparable with getting the flu jab, she explained.
Partner at law firm Gordon’s Partnership, Neil Grant, added: “In the vast majority of cases, the risk/benefit analysis is likely to be heavily in favour of administering the vaccine to a resident who lacks capacity.
“However, the important point is that the registered provider and manager must ensure the law is applied correctly with a proper record kept of decisions taken.
“This ensures the rights of the resident are upheld, as well as providing legal protection to the care home and its staff.”
Grant added these decisions legally need to be made on an individual basis and “not in a blanket fashion”.
There will be people who won’t consent, for example, as it is against their beliefs or they are scared of needles. “If they say ‘no’ there is nothing you can do”, Griffiths said.
She added that there would be issues about restraint while delivering the vaccine: holding a service user’s arm or hand while the injection is given, that would be considered proportionate.
At Community Integrated Care (CIC) around 70 per cent of residents had given consent at time of going to press.
“This is a situation for individual choices”, said chief executive Mark Adams.
He said CIC had been involving families of residents with dementia with decision-making, trying to give them as much information as possible.
“We are very sensitive to what the side effects might be”, he added.
These could lead to staff absences and care homes having to manage adverse symptoms in residents.
Care England chief executive professor Martin Green also highlights the uncertainty for care homes managing residents who only receive one dose. “This is an enormous amount of extra work with no recognition from Government”, Green added. “It is going to be an enormous cost burden.”
To vaccinate all residents and staff within the short shelf-life after defrosting, care homes will need sufficient fridges and trained vaccinators. Being prepared by arranging rotas and transport has ensured 30 Orchard Care Homes’ workers were able to be vaccinated while on duty while maintaining safe staffing levels at its Penwortham Grange & Lodge home in Preston.
An Orchard spokeswoman said: “The timing was a challenge as we were given very little notice.
“However, we acknowledge the importance of acting swiftly in order to be vaccinated as soon as possible and therefore prioritised this above all else.
“Being vaccinated puts us one step closer to having visitors back in the home and reduces the risk and severity of Covid-19.”
Adams said situation in UK care homes will only change in three to six months’ time.
“That is what we hope for. We are hoping that the majority of people will have the vaccine.”
CARE HOME MANAGEMENT TODAY: DECEMBER 2020
DESIGNING FOR A COVID-FREE FUTURE
One of the fundamental problems in stopping the spread of COVID-19 in care homes has been their design.
Most homes have been built for communal living, not to isolate residents in the event of a pandemic.
Now Newcastle City Council is trying to find a balance between the two by building a ‘new model’ care home.
Partially funded by Legal & General, the design and operation of the 20/25 bed home will incorporate key lessons learned from the COVID-19 outbreak.
This will encompass infection control, operations of lockdowns, the creation of support bubbles and minimising the impact on residents, particularly those with dementia. As a result, smaller homes, designed as households with up to 10 residents living together with four or five staff during the day, could make social distancing easier and limit the spread of an outbreak.
This design will to ensure that staff and visitors only come into contact with members of one ‘household’, keeping them safe, while allowing visits to continue, preventing loneliness and isolation.
New technology will be also integrated into the building, including telehealth, telemedicine and remote monitoring.
In larger homes, en-suite bathrooms can also reduce the risk of cross-contamination and designing corridors to be more than two metres-wide will allow people to comfortably pass each other.
Writing in the RIBA Journal, associate at Glancy Nicholls Architects Danielle Swann said: “There’s no doubt that coronavirus is influencing current thinking among care home clients and the situation offers an opportunity to raise the game for design and quality of care.
“We need to promote an expansion, or an overhaul, of the national minimum standards for care home regulations to drive forward quality design. The current standards were last updated in 2006 and only require a minimum of one bathroom per eight residents, which is one aspect that should be revisited.”
Smaller homes, however, are more prone to the financial impact an outbreak of COVID-19could cause.
As a recent Knight Frank report found: “While not a blanket rule, outbreaks are likely to have a more pronounced effect on smaller independent care homes, typically with less than 40 beds.
“Our analysis shows that around half of UK care homes are below this size and those without large group backing or the economy of scale to absorb occupancy loss, are at greater risk.”
Newcastle Council intends that its new model home will gather data to help to determine how best to operate care facilities in a post-COVID environment, with information fed to the UK National Innovation Centre for Ageing, the Urban Observatory as well as other researchers and care providers.
The council will own and operate the facility, but a site has yet to be identified.
Leader of Newcastle City Council Nick Forbes said: “The pandemic has shown how vital good quality adult social care services are. We have an opportunity to move away from large scale facilities to smaller, community-based services that provide a sense of independent home living, are dementia-friendly and improve everyone’s quality of life.”
CARE HOME MANAGEMENT TODAY: OCTOBER 2020
WHAT HAVE OTHER COUNTRIES TAUGHT US ABOUT COVID-19 IN CARE HOMES?
“There are many lessons that the Government must learn”, was the conclusion of a scathing report from the House of Commons Public Accounts Committee published in July into the impact of the Covid-19 pandemic on care homes.
The report concludes: “Rather than seeking to give the impression that it has done so, the Government urgently needs to reflect, acknowledge its mistakes, and learn from them as well as from what has worked.”
To do this, the UK Government would need to look at the nations that took decisive and early action to keep their care home residents safe.
According to the report Mortality associated with COVID-19 outbreaks in care homes: early international evidence, at the end of June 5.3 per cent of UK care home residents had died from the virus or a related cause.
This compared to 0.4 per cent in Germany and no deaths at all in Hong Kong.
Adelina Comas-Herrera, assistant professorial research fellow at the Care Policy and Evaluation Centre and one of the report’s authors said that countries that had gone into lockdown very quickly in the full community appeared to have many fewer deaths from Covid-19 in care homes.
Those countries that understood that care homes could not act as isolation centres and those with a wide community testing programme to identify local hotspots also halted the spread, she said.
Arguably the biggest mistake the UK Government made was directing hospitals to discharge 25,000 patients into care homes without ensuring all were first tested for Covid-19, even after there was clear evidence of asymptomatic transmission of the virus.
Not admitting infected patients was critical to halting the spread in Germany’s care homes. Germany imposed a strict lockdown for four weeks in April with care homes not allowed to admit anyone who was not employed there and everyone wearing masks as well as full body cover by the end of March.
Any resident being admitted had to provide a negative test result or isolate for 14 days, either in a separate section of the care home or in healthcare facilities such as a rehab centre.
Isabell Halletz, CEO of the German Employers’ Association of Care Providers, told the House of Commons health select committee in May: “If it is in the residential home… it is very hard to stop the virus. When you detect it, it is already too late, so you have to do a lot of prevention to keep it out.”
An even stricter approach was taken in Hong Kong with care home residents showing symptoms sent to hospital and anyone they have come into contact with isolating for 14 days. The Government also require that one member of care home staff, usually a nurse, is trained to handle infection control. Nursing home operators in Hong Kong also carry out an annual drill for infectious disease control.
Professor Terry Lum, head of social care policy at Hong Kong University, told the committee: “It is extremely well practised in nursing homes. When anybody shows a flu-like symptom, they start the process right away.”
Halletz agreed, saying it was “very crucial and helpful to have pandemic planning” so everyone knew who was doing what and who to report to.
Professor Lum added that in Hong Kong, nursing homes are now designating a specific area solely for family visits. Before visitors can enter a nursing home, they must have their body temperature checked, follow strict protocol for hand sanitizer, and both relatives and residents need to wear face masks when meeting each other.
However, measures adopted by some UK care homes, such as staff staying onsite for up to two weeks and then being replaced with a new “shift” of tested workers, have been effective, according to Comas-Herrera.
Giving evidence to the committee she added: “We have not finished with Covid. It will still be around us for a while, so it is important that each care home now starts having good technical support for their isolation capabilities. By capabilities, I mean the fabric of the building, the facilities they have and the staff.”
A Department of Health and Social Care spokesperson said: “We keep our policies under continuous review based on the emerging international and domestic evidence.
“Our help has meant 55 per cent of England’s care homes have had no outbreak at all and the proportion of coronavirus deaths in care homes is lower in England than many other European countries.”
CARE HOME MANAGEMENT TODAY: AUGUST 2020
LIES, DAMNED LIES AND COVID-19 CARE HOME STATISTICS
Getting national social care statistics has been one of the key challenges during the Coronavirus crisis. While daily figures for infection rates, testing and, sadly, deaths were regularly produced for the NHS, for the first month data on the impact on social care was scant. Rates in care homes were combined with other community deaths and came with the caveat that that Coronavirus was only suspected of being the cause. So why was it initially so difficult to produce an accurate, up-to-date picture?
A lack of pre-existing data and infrastructure meant the Care Quality Commission, which records all care home deaths, had very little to build on and did not have historical information with which to compare the current figures, the watchdog said. A spokesman explained: “This makes it more difficult to get an accurate data set – and the lack of established data gathering infrastructure adds to this challenge.”
CQC said that it wanted to ensure reporting data did not to add to the significant pressure care home providers were under and the data gathering systems had to be set up quickly without the normal level of planning and engagement.
However, timely, reliable data is crucial for planning a response to the crisis. Liz Jones, policy director at the National Care Forum (NCF), said: “It just feels really unjust, like the Government focus was on hospitals, and care homes were just not visible in planning.” As an example, she said it was not clear how the available data on social care was being used, and in particular, to give a sense of where the virus was, the characteristics of care homes with infected residents, the type of care they offered or the geography.
William Laing, founder and chairman of healthcare consultancy LaingBuisson, said access to testing would have helped inform this dataset directly and indirectly and, along with tracking the virus, could have slowed down the spread. “All the main focus was on the NHS but they could have relied on Office for National Statistics (ONS) data”, Laing said. “They (the Government) could have put more resources into ONS.”
A Department for Health and Social Care (DHSC) spokesman responded saying that the NHS, as a public body, is network of publicly-owned providers. This facilitates data collection as there is access to more frequent and timely data. In comparison, social care is largely delivered by private providers and therefore it can take more time to compile data through these channels, the spokesman said.
Since mid-April, the CQC and ONS have published national data on care home deaths. CQC said it was confident that this weekly reporting ensures a “more complete and timely picture of the impact that COVID-19 is having on social care”. It is also now working with ONS to understand the impact of the outbreak, publishing data in early June on the number of deaths of people with learning disabilities and autism.
Laing added: “The story you have to consider is not just coronavirus deaths but other excess deaths.” This could be from a lack of medical assistance being available, such as ambulances and GPs. LaingBuisson modelling shows that by the end of June there will be around 50,000 excess deaths as a result of the crisis and half of these deaths will have been care homes residents. “This figure is not only to do with Coronavirus but also collateral damage”, he said.
NHS England’s Capacity Tracker tool is now being utilised to report care home bed availability, and staff and PPE shortages. However, only the NHS and local authorities can access the results and around a third of councils have yet to sign up, says the NCF, despite 98 per cent of its members supplying information.
Policy director Liz Jones said: “If we had a minimal dataset, we would have more consistent information about the people we care for. It would be worth investing in a central infrastructure. Providers are willing to give data if they have a clear line of sight where it is going.”
Jones added that providers needed to be involved in interpreting the data so the intricacies and nuances of care provision can be explained.
CQC is now reviewing death notifications and how it works with providers to ensure the data is both accurate and accessible, including the impact on autistic people. The DHSC says it is committed to giving the care sector the technology and data it needs.