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Business Clinic
‘Care BnB’ – CareRooms launches in UK

CareRooms has announced its UK launch and is looking for hosts in Cambridgeshire. What does our panel think of this new approach to supporting people out of hospital?

CareRooms hit headlines in October 2017 when Southend University Hospital NHS Foundation Trust was said to be considering a pilot of the approach to support people out of hospital and into ‘host’ homes for recuperation. The hospital quickly stepped back from this in a statement saying that it encouraged new ideas and innovation but had no intention to support the pilot at this time.

After the false start, CareRooms has announced its UK launch and is looking for hosts in Cambridgeshire, although it is yet to contract with the council, local hospitals or clinical commissioning group.

CareRooms

Disruptive approaches to care and support have been developing over the years and CareRooms is the newest innovative approach.

Motivated by his family’s experiences of caring, CareRooms was developed by Paul Gaudin. Paul’s mother cared for his father, who had Parkinson’s Disease, up until he passed away in 2016. The loss of Paul’s father left his mother alone and socially isolated. From this situation, CareRooms was born.

The CareRooms approach is to enable people who are medically fit for discharge, but unable to leave hospital due to lack of suitable ongoing care or accommodation, to be discharged into the home of a host.

A representative from CareRooms told CMM, ‘It’s for those who would have nobody there to look after them in the short term when they got home or it’s for those whose homes may need adjustments to enable their continued independent living and while the work is ongoing. We offer a safe space for them to continue their recuperation.’

It gives the individual somewhere to stay while they recuperate and CareRooms says that it also supports hosts who may otherwise be lonely or isolated. As an alternative patient choice to help ease pressure on the NHS and local authorities, CareRooms’ target demographic is older people who live alone and/or at a distance from family.

Selecting hosts

The model involves hosts offering guests a spare room or annexe, with access to a private bathroom.

CareRooms says that the process for becoming a host is highly-selective. Although it doesn’t specifically use values-based recruitment, CareRooms told CMM that, ‘We have our own questions for interviews that enable us to understand that people are a good fit for our business’ culture.

‘Although someone’s ability is of course important, their personality and commitment are very important. That means we only recruit the highest calibre candidates.’

The vetting process includes an initial telephone interview, in-person interview and vetting of the room to be let and communal rooms, ongoing DBS check for host and all residents over 16, and three references.

Once selected, hosts undergo online training in adult safeguarding, Mental Capacity Act, food hygiene, and cleaning and infection control. This includes training on how to clean the room and wash the bedding.

Hosts will also be required to provide home insurance, proof of home ownership, approval from their mortgage lender and have a home visit from a CareRooms area manager before being approved. They must also be registered as having a room for rent so the local authority can inspect them.

How it works

Hosts are not employed by CareRooms and do not deliver care, CareRooms says that hosts ‘are simply there to offer food and beverages and conversation’. Prepared food is delivered to the host’s home and requires the host to heat it. There is no obligation for hosts to be at home. CareRooms says, ‘As long as the patient is provided with three meals a day and has access to what they need, we do not expect the host to be there all day.’

If necessary, CareRooms will undertake a makeover of the host’s spare room, install safeguarding technology and any equipment required by the patient. As part of their on-site Property Suitability Assessment, an area manager will determine whether a room is ready for use and just needs finishing touches or whether it needs a partial or a full refurbishment. There may be a cost to this which is discussed in advance.

CareRooms provides a web-based platform with available room capacity, host recruitment and management, plus a package of support and services. CareRooms has also engaged with insurers to arrange specialist cover for the host and guest.

CareRooms also works with third party suppliers to provide telecare, emergency triage facilities and video GP consultations. CareRooms says this ensures that a medical condition is detected as early as possible and allows early intervention from the patient’s medical team to prevent unnecessary readmission.

Costings

CareRooms is paid £125 per night and hosts are paid up to £50 per night from this fee. Hosts may be charged a fee for setting up the room which can be deducted from the room rate, plus a £200 sign-up fee and per night charges. The money goes towards the technology, guests’ food and CareRooms’ staff. Hosts sign an initial three-month contract, after which time it can be terminated.

CareRooms expects that facilities will typically be paid for by the local authority or patient, or both as an alternative to the existing care provision. Guests can register their interest with CareRooms who will find suitable accommodation. Personal care, if required, will need to be commissioned by the guest at an additional cost.

The model is positioned as an additional, more personal choice for people. CareRooms says, ‘We are additional rooms that local authorities currently don’t have. Our job is to work alongside the current pathways to create additional choice. We’re not here to replace anybody.’

Over to the experts…

Is there a market for CareRooms in adult social care? Will it help to extend the spectrum of choice? Does it offer anything more than an alternative setting in which to receive homecare? 

We should support brave thinkers

The desperate need for new approaches in health and social care is an undeniable fact. Everyone knows both systems are at breaking point and we should support brave thinkers like Paul Gaudin who are prepared to try something different. If we bring people down for thinking outside the box, we’re not providing an environment conducive to innovation. After all, ‘the definition of insanity is doing the same thing over and over again, but expecting different results.’

There could potentially be a market for CareRooms. In Manchester, Local Care Organisations are actively looking to reduce the use of hospitals and institutions like nursing homes, providing care closer to people’s homes. They urgently need to boost community capacity so are trying new ways of working that help people recover more quickly after illness. This includes factoring companionship into the solution, like we do in Evermore’s small household model, as the health impact of social isolation is finally being recognised.

However, I think there are critical aspects to the CareRooms approach that need addressing. The NHS and local authorities have very low appetites for risk and I don’t know if the safeguarding measures are enough. I’m also not convinced people have the commitment to provide the emotional support needed by an older person recovering after a hospital stay. If the host is at work all day, the person could end up feeling even more alone than if they were on a ward. There’s also the practicalities of supporting a person’s rehabilitation and the need to truly engage with it to make their recovery a success. Simply providing a room and microwave meals is not enough.

Sara McKee Founder, Evermore 

Who has legal duty of care if problems arise?

CareRooms appears to offer an innovative concept to reducing avoidable delayed transfers of care, by using technology to support people leaving hospital.

However, people being ‘medically fit’ for discharge does not necessarily mean that they can meet all their personal care needs independently. Unless additional homecare has been arranged in advance, this could mean that the hosts offering rooms may be asked to offer personal care to people, even though this is not part of the arrangements.

At £125 per night, excluding any personal care, CareRooms needs a clear rationale for why it is a more attractive proposition than enabling someone to return to their own home (usually the preferred option) along with five to seven hours of homecare per day from a regulated social care provider, at a similar cost. The benefit to some people might be the use of sensors and alarms not quickly available for home installation, but this is an important question, both for people funding their own care, and for prospective council and NHS commissioners.

Patients using CareRooms need to be aware that they are buying a service which will not be registered with the Care Quality Commission, but comes close to the threshold of services which do. CareRooms doesn’t employ the hosts offering rooms, and customers ought to be helped to make an informed decision about the benefits and risks of this type of service to them. This means that customers will need to understand who owes them a legal duty of care, and how they might seek redress, if problems arise. This isn’t at all clear from the terms and conditions publicly available on the company’s website.

Colin Angel Policy Director, UKHCA 

The risks heavily outweigh any benefits

Lawyers are frequently tasked with carrying out a risk:benefit analysis of proposals. It seems that with the CareRooms concept the risks heavily outweigh any benefits.

Although founded on the basis that hosts will not provide personal care, what happens if, while sitting down for a chat, the patient falls out of bed or asks for a hand taking their tablets? Suddenly the situation calls for activities they are not trained or regulated to provide.

Whilst CareRooms says that rooms will be equipped with technology for monitoring the patient’s health, contacting a GP and triaging situations, what is the likelihood that the host wouldn’t intervene in an emergency or request?

Furthermore, who actually needs a CareRoom? Delayed transfers from hospitals into care are not caused by a physical lack of places to go. Anyone who needs personal care will have to commission these services, so why not go home and have the domiciliary care worker visit you there? The model is aimed at people living alone or without family to help them convalesce, with a view to alleviating social isolation. If the host is not required to remain at the home save to provide food and drinks, CareRooms doesn’t solve that problem. Why
wouldn’t you commission a professional, regulated service to do this in your own home, on hand to assist with personal care if needed?

I can’t see local authority funding being available for the rent on top of commissioned care if the patient has a home to go to.

The sector needs innovation, but until these fundamental issues are addressed to safeguard service users and uphold the hard work of the regulated providers, I’m not convinced that CareRooms is the answer.

Nicola Cutler Associate, Royds Withy King 

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