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Why ‘care hotels’ are not the answer
If you ever find yourself looking for a hotel, I’m sure you will have at some point used review sites to find a place to stay. Here are two reviews that I found for a hotel in a city in south-west England.
“Enormous choice for breakfast rooms amazing service and staff very good,” reads one glowing review. “Had a work meeting, nice food provided, tea coffee and water on the tables," reads another. The reviews paint this particular hotel as a great place to stay for business travellers or holidaymakers.
I don’t wish to name the hotel or even the city that it is situated in, so why list the reviews?
Well, what the reviews don't tell you is that the hotel in question is also doubling-up as an NHS Care Hotel. You can read more here.
Hotels are increasingly being utilised by the NHS to alleviate pressure on hospitals, where there is a shortage of beds. Anyone in the NHS and the social care sector will understand the dire scenarios – some of them a consequence of COVID-19, some of them not - that are being played out in the health and care sectors right now.
How care hotels became a reality
However, for anyone reading this article not familiar with what’s going on, here’s a brief summary: Hospital beds are in short supply due to COVID- 19 and a growing backlog of unmet need. According to Statista.com, for instance, the NHS has lost 20,000 beds since 2010. Many patients occupying beds are vulnerable with complex needs. Often they cannot go home, and increasingly they are unable to return to the care home that they were living in previously, as they are unable to support the individual’s changed needs following re-assessment. Often the residential home is over-subscribed and has no vacancies, or due to ‘the perfect storm’ of challenges that COVID-19 has brought about, the care home has temporarily closed to new admissions, or worse still, has shut its doors for good.
The question therefore is how do you provide a package of care for those who can’t return to the family home straight away without such a care package? After a period of reflection, the government provided a national discharge fund via the NHS “to help cover the cost of post-discharge recovery and support services”, which came into effect on 1 October 2021 and is set to end in March.
Mounting evidence suggests that care hotels are not the answer
The problem is that there is increasing evidence that care hotels aren’t providing the person-centred care that is the inalienable right of all those who find themselves living there. Take the hotel in South-west England, which I alluded to at the beginning of the article, for example. Last week, the Guardian newspaper carried a story in which a care worker claimed that bathrooms were being utilised “as an overflow for clinical waste with bags filled with faeces and urine-soiled materials”. Care hotels are also a drain on resources. According to Age UK, for instance, “an excess bed day in the NHS” costs a maximum of £2,532 per week. In residential care, the cost is just £519 per week, the Guardian says that some hotels are charging £300 per night to care for people. The question many people will be asking, is why is this money not being channelled directly back into social care?
But back to the article. When I read it, I experienced a range of emotions. Firstly, I was absolutely horrified, then disgusted that basic Infection Prevention Control measures appear to have been utterly ignored. I use the word “appear” as according to The Guardian, the Local Commissioning Group, City Council and the private operator running the care contract said they “did not agree” with some of the care worker’s claims. But they admitted that there were “issues with a waste contractor”.
Who is regulating care hotels?
I don’t wish to comment any further on the Guardian story, but in general it begs the question as to how alleged breaches in IPC are allowed to happen in the middle of a pandemic. It also makes me wonder who is regulating care hotels? Working as a consultant for Quality Compliance Systems, the leading provider of content, guidance and standards for the social care sector, not only piqued my interest, but inspired my quest for answers.
Let me tackle the second part of the question first. In short, from reading the section five of the DHSC’s guidance on ‘Hospital discharge and community support’, several stakeholders are listed including acute health providers, community health service providers, adult social care services, healthcare commissioners, social care providers and domiciliary care providers. However, apart from NHS guidance, there is no guidance specifically relating to hotels.
Could this be due to the fact that the guidance recognises ‘care hotels’ as being the same as residential care homes or domiciliary care settings? Or could it be that no regulation has been introduced due to the fact that ‘care hotels’, some of which are being used for long periods, are only supposed to be utilised for days?
Care hotels are not care settings
Firstly, ‘care hotels’ should not be considered to be a care home. There is no comparison. Both from a physical and environmental perspective, a residential care home has been specially designed to implement IPC measures. It has assisted bathrooms, disabled bathrooms, call bells and a raft of other features which mark it out from a hotel. It employs highly trained and experienced staff, whose performance is closely monitored by managers and the Care Quality Commission.
In contrast, to pick up on my second point, ‘care hotels’ are, in my opinion, care homes ‘by stealth’. Currently, NHS guidance states that ‘care hotels’ are supposed to be used for days rather than weeks. But, increasingly there are reports that suggest people are being ‘warehoused’ in ‘care hotels’ for months. Even if the people were being supported in ‘care hotels’ for days, there should be clear regulation in place. The problem is that by default they are offering regulated activity, otherwise known as ‘Accommodation for people who require nursing or personal care’.
The article states that the ‘care hotels’ are recorded as locations where domiciliary care is being provided. The CQC is currently undertaking at risk-based inspection of the hotel identified in the Guardian article. But this hotel and other ‘care hotels’ are not homecare settings either. They have not been through the registration process that all homecare services are subject to. I strongly believe that ‘care hotels’ should be classed as offering a designated service by the Department of Health and Social Care (DHSC) and the NHS should be responsible for putting the wheels of regulation in motion.
If it becomes common practice to care for people in hotels for week and months, rather than days, the government should force the CQC and the NHS to treat ‘care hotels’ as regulated services. That would mean them registering their service with the CQC and following the same regulations as every other provider, including undergoing face-to-face inspections.
The need for compliance
If the government, however, decides not to introduce legislation, ‘care hotels’ should hold themselves to higher standards than they currently do. But where should they start? Over 5,000-plus care providers have chosen QCS for their content and compliance needs. QCS, which provides the most comprehensive suite of policies, procedures and best practice content in the UK - including care plans, risk assessment, benchmarking and mock inspection tools, has helped some of them to overcome registration and inspection challenges, and most importantly, provide better care.
Having a robust compliance framework in place, which is centred on person-centred care, also gives them the best opportunity to avoid being the subject of a newspaper exposé brought about by whistleblowers, who heroically choose to expose gaps in integrated health and care systems.
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