Service developments
Quality of care performance continues to improve Almost nine in every ten Four Seasons Health Care homes in England, about 88% per cent, are rated good or excellent in the latest Care Quality Commission inspection ratings. This positions Four Seasons as one of the highest quality care providers in the country. Our homes in Scotland and Northern Ireland are also achieving substantial improvements in quality performance.
However, they are subject to different regulatory regimes. Congratulations and thanks to all our staff staff who made this achievement possible by their diligence and caring. Our objective now is to move remaining homes from adequate performance into good and those that are good into the excellent category.
Providing more specialised services to meet changing market requirements and delivering high quality care are core to our success. Being able to provide assurance of quality of care has become a pre-requisite to be able to continue to operate and to attract customers. It is not coincidence that along with our improvement in quality ratings in England we have seen occupancy rise to 88% and remain there at a time when many other care home groups are experiencing falling demand.
More homes achieve PEARL specialist dementia care service accreditation
Four Seasons Health Care continues to expand the availability of its award winning PEARL Specialist Dementia Service, with a total of 28 homes now having achieved accreditation. Staff at a further 33 homes are currently in the programme, of which eight homes are due to be considered for accreditation shortly. The company aims to have more than 50 homes with PEARL accreditation by the end of this year increasing to 160 by 2012.
Four Seasons Health Care developed and implemented its own specialist approach to dementia in 2008, which anticipated the Government’s dementia agenda and [exceeds/ is more than compliant with] its current objectives. PEARL involves staff training in dementia care mapping, person centred care and experiential training. Key elements in the programme are that staff recognise and respond to the holistic needs of residents, measures to engage with residents and creating a sensory enhancing environment. One notable success is that the requirement for anti-psychotic medication usage for people with dementia has been reduced by as much as 64% and an average of 50%, along with improved wellbeing of residents.
Care homes in the programme work towards an unannounced validation process in which they are considered for accreditation against a framework of 144 criteria over and above regular quality performance measures for homes.
A highlight of the first year is that PEARL was recognised for its market-leading excellence by being awarded the prestigious 2009 Guy Rotherham Care Home Award by The Improvement Foundation. The Care Minister in the last government, Phil Hope, visited a PEARL accredited home to see the specialist service for himself.
Six homes have achieved PEARL accreditation in recent weeks. They are:
Rosedale Manor, Crewe; Kingston Care Home, Kingston upon Thames; Emberbrook in Thames Ditton; Manor Park in Hartlepool; Whitefield Lodge in Lennoxtown, Glasgow; Gilmerton in Moredun, Edinburgh.
Staff training includes, new ways of thinking about dementia. For example, it challenges the mindset that someone with dementia may be seen as disabled or dysfunctional. Trainees agree to spend half a day experiencing how it may feel to be a resident in a care home where they may have their individuality and personality disregarded.
They wear smeared glasses to impair their sight and earplugs to impair hearing. They have one arm immobilised and are left wearing wet incontinence pads. They are not addressed directly by name, are not given a choice about food or beverages, have “tablets” administered without explanation or warning and are ignored for long periods.
Then they are given the contrasting experience of once again being treated in a person-centred way as a thinking individual with emotions, and preferences as well as physical care needs . Another element of training re-defines what the care industry has tended to term “challenging behaviour” and recognises that this often is a distress reaction. Staff also learn how talking with the resident and their family, friends and health or social workers to understand something of the life of the resident, prior to entering the home can help shape their care programme and provides a focus to engage with them.
A perspective on developments in the care sector Four Seasons Health Care’s Director of Strategy Kevin Roberts was recently invited by Healthcare Market News to contribute a short summary of his perspective on recent developments in the sector. It is reproduced here.
The care home industry has seen a continuous decline in the rate of Local Authority fee uplifts since 2007 so many providers have already been forced to look under every rock for efficiency opportunities in an environment where non discretionary costs, such as payroll and utilities, have continued to increase. In addition LA care home provision is almost certain to continue to decline leading to greater reliance on independent providers. At the same time, barriers to entry continue to rise for new operators as regulation continues to increase and funding constraints tighten.
Quality of care has increasing influence over occupancy and protecting fee rates. Good and excellent ratings were once a differentiator but are rapidly becoming a necessity to survive Fortunately FSHC has invested heavily in quality over recent years and our ratings are at a record high. We have also diversified into a mix of higher acuity services that are in continuous, even growing, demand.
These factors mean our business is well positioned for the challenging markets. Commissioning involves a necessary element of bureaucracy. However, we've seen a partnership approach benefit everyone. Residents and patients receive high quality of care, commissioners get better value for money and operators are helped to sustain returns by maintaining occupancy levels and stability which in turn helps iron out peaks and troughs in running costs. Everyone wins!Commissioning policy continues to move towards home based care services rather than residential care for lower dependency clients who would have typically been admitted in to residential care settings. This should be driven by user needs and choice, without any illusion that it is less of a strain on the public purse. For example, the total cost for care at home includes rent/mortgage costs, food, entertainment, lighting and heating costs.
The UK Care Home Market is highly fragmented yet estimated at c£11bn. The 75yrs and over segment of the UK population is projected to increase by over 70% to 8.22m by 2031 so the demand for services and pressure the public purse strings is only likely to get greater!
So, there opportunities for organisations that can weather the combined pressures of funding constraints and rising costs. I'm in no doubt that the next few years will be a challenging for both commissioners and providers, but the need for quality care will continue to grow at a significant rate. There are opportunities for all parties to benefit by challenging the status quo and by working smarter and closer together but success will depend on the ability to change quickly!
Business developments
Four Seasons Health Care in negotiations to acquire Care Principles Four Seasons Health Care and Barclays Capital are in negotiations with a view to Four Seasons Health Care taking over the business operations of Care Principles, with Barclays Capital retaining ownership of the properties. Should a definitive agreement be reached, it would be subject to regulatory approval by the Care Quality Commission.
In the event that a transaction is concluded Care Principles’ employees would transfer to Four Seasons Health Care under TUPE provisions.
Care Principles offer over 430 beds in a total of 18 medium and low secure hospitals, community hospitals and care homes. It employs 1,500 staff who provide care, treatment and rehabilitation for people with learning disabilities or specialist mental health needs. Its operations would be a good fit for our Huntercombe Group, which operates hospitals and care centres providing wide ranging professional treatment in the areas of mental health, acquired brain injury and neurodisabilities, learning disabilities and children with special needs.
We have concluded agreements to take over the operations of 12 additional care homes and three specialist units. This includes the transfer from Eton Square Healthcare of seven care homes and, in a separate transaction, the transfer from Craegmoor of five care homes and three units for people with learning difficulties. The premises that Craegmoor has transferred were leased from Four Seasons and both companies agreed it made sense for their operation to transfer to us as the owner of the facilities. The homes that Eton Square has transferred to us are also leasehold and we have taken over the leases by mutual agreement after they became due for re-negotiation.
Four Seasons Health Care expands its portfolio with 12 more homes and three specialist units Four Seasons Health Care has concluded agreements to take over the operations of 12 additional care homes and three specialist units.
The Group has completed the transfer from Eton Square Healthcare of seven purpose built care homes. In a separate transaction Four Seasons has completed the transfer from Craegmoor of five care homes and three specialist units for people with learning difficulties. The homes and specialist units together provide services and support for about 900 people. Eton Square and Craegmoor staff have transferred to Four Seasons Health Care and the Group’s managers worked alongside them prior to completion of the transactions to ensure a smooth hand-over with no disruption of quality of care for residents.
The premises that Craegmoor has transferred were leased by them from Four Seasons Health Care and both companies agreed it made sense for their operation to transfer to the owner of the facilities. The homes that Eton Square has transferred to Four Seasons are also leasehold and Four Seasons has taken over the leases by mutual agreement after they became due for re-negotiation.
For Four Seasons Health Care the transactions provide strategic additions to its portfolio that are a good fit with the locations of its existing homes. The terms of the transactions are not being disclosed. They are part of normal operations for Four Seasons Health Care and no additional finance was sought.
The homes that Craegmoor has transferred to Four Seasons Health Care are: Houndswood House, Radlett, Herts; Catchpole Court, Sudbury, Suffolk; Woodlands, Mirfield, West Yorkshire; Tall Oaks Stoke on Trent, Staffordshire; Cumbrae Lodge, Irvine, North Ayrshire. The specialist units are: The Dell, Firs Nursing Home and Turner Court, all in Sudbury, Suffolk. The homes that Eton Square Healthcare has transferred to Four Seasons Health Care are all in the North East, they are: The Grange, Riverside View, The Lawns and Grosvenor Park located in Darlington, County Durham. The Lodge in South Shields; The Meadows in Boldon and Ormesby Grange in Middlesbrough.
Negotiations to extend loan maturity Four Seasons Health Care is in negotiations to extend loans of £790 million that mature on 3rd September this year.
The context is that the Group completed a financial restructuring on 9th December 2009 under which certain of the Group’s lenders agreed to exchange debt for equity, so becoming the shareholders in the Group, with a stake in our future. As a result of this restructuring the Group’s debt was reduced from £1.8bn to £790 million.
We are now in negotiations to extend the remaining £790 million of loans. The majority of this debt was syndicated by lender Titan in the form of publicly traded notes. Most of these notes were taken up by commercial banks, institutional investors and hedge funds. With support of our financial advisers, Gleacher Shacklock, we are in discussions with the noteholders with a view to reaching agreement to extend the loan on enhanced terms that we believe represent an attractive investment proposition.
A presentation to the noteholders, including an overview of our business performance was given in April and this can be viewed in full on this site . These negotiations are expected to have no impact on the day to day operation of our homes, or our residents or staff.
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