I am a Residential Care Home owner and ex-nurse of some 30 plus years. I was also an elected Public Governor for the Sussex NHS Community Foundation Trust, although no longer.
I know from Trust meetings that Bed Blocking is a huge issue, costly and causing discharge delays and therefore a knock-on effect on admissions. A and E is also impacted by bed blocking as new and acute patients cannot be moved on to wards.
CQC heavily regulates all care homes, and it is a very stringent and protracted process, these days even small residential homes such as mine, deliver a significant level of skilled personal care to residents, who are all very dependent and/or have dementia. CQC expects us to hold daily activities, daily weighing, monitor and log all food intake, continuously update extensive care plans and reviews, carry out life histories and so on, we have to annually complete the PIR form which is lengthy, employ a registered manager, at great cost, and we must strive each year to come up with new initiatives to maintain our CQC ratings. Nothing wrong with any of that; we are up to the challenge, but it comes with a cost. Even a cheap residential care home is now in the region of £900-£1000 per week, many are far more.
When I started in the care home business, many years ago, this was not the case- and there was a clear distinction between residential care and nursing care, but the lines are blurred now. Formerly residential clients were generally mobile, self-medicating, able to go out and about independently, and actively chose to come into a Home, as a positive lifestyle choice in their old age- but now it is all end-of-life care and providing a very full-on service and the broad age group has gone from 70’s to 90’s and even 100’s. Times change of course, and people want to be in their own home until they really can’t cope which is totally understandable.
However, it has occurred to me that a solution that would work to the advantage of the public and the taxpayer alike, would be to permit the old style ‘convalescent home’ business to re-emerge- in some new modernised guise.
Communal buildings where patients with lighter care needs could be discharged for a strict maximum of three- four weeks to get them out of hospital and then back home. Currently there is nothing like this, as it is basically all or nothing- full CQC regulations with all of the costs and complications that entails, or nothing. Wait in hospital or go straight home and take your chances- and often early discharges fail, and readmission is necessary, particularly with older patients.
As an example, I recently had a knee replacement myself and I live alone, so I had to manage as best I could at home, thankfully I am younger, and in good health, and was able to cope, though it wasn’t easy in the first few days. I would not have wanted a full-on care home facility by any means, and I certainly didn’t want to stay in the hospital. But the early days were quite difficult, especially cooking and getting upstairs, carrying laundry, cleaning etc. I am sure that older and less fit people than I would have really struggled with basic life tasks for the immediate post op days, and may have had to stay in hospital longer, although not needing actual medical care.
However, there is literally no ‘halfway house’ provision of this type in existence.
If businesses could offer a specialised service with meals, laundry, and assisting people just to get back on their feet, regain confidence, and get back home again, without needing the full range of care that elderly frail people require in a registered care setting, it would really help relieve pressure on beds. No minimum staff on duty stipulated, no awake night staff, no entertainment program or outings , just wifi and tv, and a physio and OT visiting if required, with food and laundry provided, light supervision with everyday tasks, and a call bell/emergency button, and perhaps telecare linked to the GP or consultant if required, but always with a view to the person going home as soon as possible -and most importantly, enabling and aiding them to do so and readying them for discharge.
A lot of folk, especially older ones, just need that extra buffer time - maybe even only a week or so- to feel confident to get out of the hospital and back home- or even just a little time for their house to be adapted or get equipment in place etc. Many languish in hospital for that to happen and it is causing huge backlogs, a hospital bed is not needed, just a safe environment with a low level of personal and/or physical care and hotel services and someone to call on if needed.
Not having CQC registration would make delivery of this type of very light touch care/supervision far cheaper to deliver, and it would be purely for convalescence/ rehab and then home again, not in any way as a replacement for registered residential or nursing care.
There are many single households in the UK. People like me, who don’t have anyone they can ask to help them, who could potentially use this service rather than staying in hospital or entering residential care homes for respite, which is very expensive, not always easy to find, as registered homes will always prefer to take permanent clients, and not appropriate in many cases anyway for the younger more independent patient.
It would be more comfortable for patients, with hotel-style rooms, a dining room, and a little help if needed, maybe to get in the shower or get dressed etc, so not like lying in scarce hospital beds, in nightclothes all day; but also not being a care home resident either, which is very expensive, and certainly not desirable for younger ‘elderly’ folk.
it seems short sighted that is not even possible to offer this service currently, as it would be breaking the law- for as soon as someone helps a person with anything physical, or were to market such a service, CQC would be knocking on the door and demanding full registration was undertaken, and then it cannot be provided cheaply or easily. A light touch regulation, with strict admission criteria, and a discharge plan would be needed as always in this day and age, but not the full weight of CQC registration. It would create a great new business opportunity for the private sector, and save money. Most crucially it would free up expensive and valuable hospital beds. Sort of like a ‘hotel with benefits’.
I just thought this might be a good policy to explore further, or even allow a pilot scheme- I know there are numerous considerations, and nothing is simple, but in the main, the private sector could deliver this - it would be chargeable- but even if the NHS paid the service providers to get people out of their beds, and go for ‘convalescence’ it would save money, and be a better option for the patient’s recovery. I think you could slash at least 50% off those extortionate registered care home fees!
I’d be very interested to know what other think of this idea.
