Anxiety is running high about the risk of loved ones contracting Covid in a care home over the coming months. And not without reason. Between early March and early August, care homes in England and Wales recorded some 26,500 excess deaths.
With this in mind, many families are now looking for an alternative to residential care for an elderly relative who can no longer live independently, either after a hospital stay, or because of ill-health or old age.
Before Covid struck, Archie Ferguson, 82, from Cambridge, had heard through a friend about Care Rooms, a scheme whereby approved homeowners provide bed, board and companionship to people coming out of hospital or needing respite.
Ferguson had felt unable to return straight to an empty house from hospital after a minor operation. “I was at the bottom of the pile, weak in body and spirit,” recalls the 82-year-old, after five years caring for his wife before she was moved into residential care. “It was the first time for 60-odd years that I was facing looking after just myself.”
Julia Hamilton, 55, in nearby Godmanchester, was able to accommodate him for the three or four days he needed to regain his strength. “It was just what I needed,” he says, “great comfort, good food, good wine – yes – and above all a pushing back of the pain and darkness that was within me.”
If the concept of Care Rooms sounds familiar, that may be because it achieved a fleeting notoriety three years ago when it was negatively branded “carebnb” in the media.
Paul Gaudin, the healthcare entrepreneur behind the scheme, says he and his co-founder daughter, Lizzie Gaudin, considered walking away from the idea, but they were driven on by the conviction that it could meet a real need. Despite the adverse publicity in 2017, hundreds of people came forward to offer rooms.
“We were just a father and daughter trying to do the right thing in a little corner of Essex, based on our own experience of caring for my father,” says Paul Gaudin. “We were probably three years ahead of our time then. Now is the right time.”
Although Care Rooms bookings have been suspended during the coronavirus crisis, with a planned phased resumption from next week it is paradoxically the crisis itself that promises to put the venture on a permanent footing as people in future seek alternative forms of care and support.
Care Rooms says it has more than 600 approved hosts on its books across England and is poised to increase that to 2,000 through formal agreements with five local councils – so far unidentified - that will refer guests when restrictions ease. Under NHS England discharge arrangements, anyone requiring further care post-hospital may have it free of charge for up to six weeks.
The concept is not the only alternative to care homes that stands to gain from loss of confidence that saw their occupancy levels across the UK slump to an average 80% in mid-August, according to latest estimates by analysts Knight Frank. It disguises much lower figures for some care home groups and Knight Frank thinks as many as 6,500 homes – which provide almost one in three beds – may be at risk of closure over the next five years.
Providers of live-in care are reporting a surge in interest. Live-in care, by which a care worker moves into an individual’s home, assuming they have a spare room, is relatively underdeveloped in the UK and little monitored. The UK Homecare Association estimates that between 7,000 and 10,000 people are using live-in services at any one time, most of them self-funders. Some providers are introductory agencies that arrange contracts between the individual and a self-employed care worker and are not regulated by the Care Quality Commission (CQC).
Promedica24 is Europe’s largest provider of live-in care, offering a fully managed and regulated service, but says it has only just over 200 compared to 3,300 in Germany. Paula Beaney, the company’s quality assurance director, says: “We’ve noticed a growing interest in live-in care services for older and vulnerable people. Families are concerned about their loved ones and are looking for safe and sustainable care solutions which meet the physical and emotional needs of older and vulnerable people while significantly reducing the risk of infection.”
A Promedica24 care package starts at £695 a week, with more intensive support costing between £820 and £920. The company says it can work out cheaper than a care home, even allowing for the additional board-and-lodging costs of the care worker, but families often fail to consider it and councils that commission care for eligible state-funded individuals very rarely do. “The vast majority of people we speak with … have very little knowledge about live-in care, with many seeing care homes as the default option,” says Beaney.
Raina Summerson is chief executive of Agincare, a group offering managed and regulated live-in care as well as care homes and domiciliary support. Live-in care is “a growing area for us”, she says, with the group currently providing the service to about 350 people a week. She thinks NHS England’s “home first” drive to discharge elderly hospital patients sooner where clinically appropriate may fuel growth.
Another trend Summerson has noticed is a sharp rise in care workers expressing interest in live-in care positions.
“We’d normally struggle with availability in August, but even that’s not been the case this year,” says Summerson. “It might be a confidence thing among team members who are apprehensive about working in care homes, or about visiting several different people’s homes at the moment.”
Care Rooms finds that many of its hosts are former nurses or family carers who feel they have more to give – although hosts are not expected to provide clinical or personal care. If more support is needed, it is delivered by visiting professionals. Bedrooms that are used are fitted with sensors and 24-hour alarm systems linked to a central control. The guest must have access to a bathroom for their own use. Hosts are expected to offer companionship and to cook three pre-prepared meals – the ingredients are paid for and delivered to the host. The host may go out, however, and their guest may have visitors. The guest pays £135 per day, of which £50 goes to the host, and the remainder pays for food and monitoring equipment and Care Rooms’ fee.
Back in Godmanchester, Hamilton says money is not her motivation. “It’s something that gives me a sense of purpose at this time in my life. I feel I’m giving something back to the community.”
Other guests she has hosted have included people living with dementia. One woman was placed with her after she was flooded out of her own home, but the local council felt she could not go a hotel because of her condition. “I saw a big change in the time she was with me, her whole mood and demeanour turned round,” says Hamilton. “It was just having someone to chat with every day – that whole social interaction. It was so rewarding.”
Paul Gaudin believes Care Rooms relationships can be as beneficial for the host as for the guest. He is taking the model to the US. For that to be any more than a dream, however, he will have to win regulatory approval.
In England, the existing Care Rooms model does not require CQC regulation because it provides only personal support. A spokesman for the commission confirmed that any scheme offering personal care with accommodation would need to be registered. Paul Gaudin says he has been in discussion with the CQC about his proposed enhanced service for more than two years. He admits: “Without regulation it restricts development of the model.”