“Our vision as an organisation is to have sustainable care home businesses that provide the best possible life experience for everyone who lives in, works in, and owns a care home. Everything that we do contributes towards making that vision a reality.”Simon Parker, Founder of SP&P and Founder/Host of The Care Home Show
And we’re all about challenging the status quo here at Maverick’s Headquarters! Welcome to the Challenging The Way We Age podcast by the Mavericks of Senior Living. We are two innovators and entrepreneurs who have huge hearts and passion for our older adults. And we see all kinds of opportunities to improve today’s system and create hope for the way we age. We tackle hard topics with the goal of creating conversation and generating curiosity and ingenuity to solve these problems.
Watch, listen, or read below to:
- Hear what senior care looks like in the UK
- Discover how their government regulates the industry and rates quality of care
- Learn about their massively fragmented market
- Find out what their major challenges are in senior care
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Below is a transcript of the episode, modified for your reading pleasure. For more information on the people, sources and ideas in the episode, see the links at the bottom of this post.
Katherine: It’s amazing to have you as our first international guest on challenging the way at the age Simon. We’re so excited to talk to you.
Simon: Absolutely delighted to be here, folks. Really appreciate you having me on. It’s lovely to be able to reciprocate, having had Frances on my on my podcast recently. I’m delighted to be here. Thank you.
Francis: I just want to give a little bit of background. So I connected the Simon on LinkedIn and I was fortunate to be his first transatlantic guest on the Care Home show. You need to check that out. We’ll put that information in the show notes to the site so you can find out more about that because you’re doing some great things over there. And I talked to Kathy about our experience and some of the similarities. We wanted to have him on our podcast to really bring out that connection between the UK and the states and the challenges that we’re facing. And so we’re really thrilled to share the knowledge and expertise of Simon with those that are listening in the states and possibly elsewhere in the world. And we truly believe he is the maverick of the UK when it comes to care. And so we look forward to having an impactful discussion. Simon, thank you again and we’re ready to learn more from you.
Simon: Superb. Well, I think certainly a lot to be learnt from each other. But yeah, firstly, just thank you for having a as a guest. It’s really exciting to be on the receiving end of a podcast for the first time. That hasn’t happened to me. Thank you so much for having me.
Katherine: Tell us a little bit about The Care Home Show and how you got into this industry.
Simon: As usually is with these things, it is a bit of a story with how it came to be, if you like. So I guess you call it kind of a lifelong fascination and appreciation for the older generation. When I was young, my sister had to have numerous operations on her hip. Like if you think a ball and socket joint for whatever reason, it didn’t quite form properly and that was quite stressful for a young family. I was very lucky in the fact that my grandparents lived quite close. I ended up spending an awful lot time with my paternal grandparents off the back of that. That has a big impact on your on your life. So when my grandparents got to a point when they were kind of in need of more care, I got involved in that process. I tried to help out where I can. I spent an awful lot of time in various different kind of care.
And in doing so, I got to see that the good, the bad and the ugly. Both my grandmothers were named Olive. But they were they were very, very different. My nanny Olive was a beautiful person. And she was a hairdresser. She was a little bit crackers, a little bit out there. All the best ways possible. But she came from kind of a really, really humble background. And then my grandma, Olive was quite well-to-do. She was the wife of a successful business owner. Because of that, their experience of care was very, very different.
And I guess looking back on that, the biggest learning was the fact that not all of the best care necessarily came because just because she was kind of more well-off financially and that was interesting, even as a relatively young person. So being part of that process, kind of looking in on it, and being involved some way had quite an impact on me. For one reason or another, I end up having spent a lot of time as a technology headhunter. I ended up looking at buying care homes in the UK. Now, the first couple of deals didn’t come to come together for whatever reason.
How Do You Go From Technology Headhunter To Buying Care Homes For Elderly At Such A Young Age?
Katherine: Wait just one second. You went from being a technology headhunter to buying homes for the elderly. How did that happen? (Laughing)
Simon: Good question. So what happened was I spent quite a long time as a technology headhunter. It was good and it was challenging, but it never provided me with an emotional payoff of what I was doing. So I just thought, you know, I need to go and do something different with my life. I took a bit of time out and I realized that what I wanted, I needed to do something that was important to me. And because of my experiences as a child, I realized it had to do with something to do with older people. So that was what kind of set me on the path to start thinking, okay, so how can I do something that’s maybe more purposeful and where I can add more value to the world? I like to get paid, but I want to do something where I can contribute something more to society. So that was how that was how that came about.
“How can I do something that’s more purposeful, and where I can add more value to the world? I like to get paid, but I want to do something where I can contribute something more to society.”Simon Parker, Founder of SP&P and Founder/Host of The Care Home Show
Katherine: That’s really wonderful. Thanks for sharing that story. One of our mantras is creating help for the way we age. And that’s what I hear in some of the things that you’re talking about. It’s the personal drive for you, but it is also the personal drive is born out of doing better for older adults. We can do better and we know we can do better. So we need to do better.
Simon: So I completely agree.
Francis: Your journey is awesome. What was that leap looking like you took? You said you took a little time off from your tech stuff. What was that? How did it transition for you? What started it?
Simon: I kind of went into, I guess, an introspective phase. I went and did some courses. I did some soul searching and I just looked to what did I feel was going to be the best the best route forward. And it had to be a leap of faith, all things being told, because I didn’t really know what I was what I was getting myself into. But it didn’t take me too long to do it, to fall in love with the with the idea by looking at different homes. So a lot of the homes that we were looking at were owned by baby boomers who tried very hard. A lot of them were kind of stuck working in their business rather than working on their business. And a lot of them didn’t seem to be fulfilling that ultimately that potential. And that was a really, really interesting, interesting learning for me.
“I see people working in the business rather than working on the business. That’s something we are very cognizant of in what we do as an organization.”Simon Parker, Founder of SP&P and Founder/Host of The Care Home Show
So that’s something that we’re very, very cognizant of in what we do as an organization. We looked at all of these all of these various different homes. By looking at that, we could see all of the challenges. And that was really how the that the consultancy services business was really born, because one of the guys that was working with me — because I was a complete neophyte at this point — I just like the idea of doing it because it felt like the right thing to do. It was a slightly gung ho approach.
There’s a chap called Rob who is one of my fantastic colleagues who spent his life working in care. He was actually born into car as a as a foster child. So he’d spent his he has spent his entire life kind of repaying his debt of gratitude to the to the older generation, if you like, homes. And he and I kind of came up with this idea of a model of executive coaching for the game sector. So that was helping the leaders of care homes to address their biggest challenges and to try and help them to achieve whatever that kind of big, bold aspiration was for their future. And that was that was just how it all started. So since then, there’s now there’s a team of five of us. We’ve got people kind of spread out all over the UK as SP&P is a professional services company specifically for the elderly care home sector. And we help our clients to achieve three things:
- We help them to build high performance teams.
- We help them to deliver outstanding care. Because if you remember, that’s the that’s the highest rating that you can achieve by that the English regulator.
- And to to accelerate the growth of that that care home business.
Our vision as an organisation is the sustainable care home businesses provide the best possible life experience for everyone who lives in, works in, and owns a care home. Everything that we do contributes towards making that vision a reality.
“Our vision as an organisation is the sustainable care home businesses provide the best possible life experience for everyone who lives in, works in, and owns a care home. Everything that we do contributes towards making that vision a reality.”Simon Parker, Founder of SP&P and Founder/Host of The Care Home Show
Simon: The Care Home show is now a digital product of SP&P and it just helps us to be able to go and share the message, the world view, the kind of positive reinforcement that we want to be able to share out there into the into the into the UK sector. Now we’ve got to do globally as well, by being on your show!
Katherine: You’re an international sensation now.
What Does Senior Care Look Like In The UK?
Francis: So what is a care home in the UK? Can you kind of describe that for our listeners?
Simon: Oh, yeah. OK. So you would have I guess the equivalent would be an assisted living facility. So in the UK, a care home will be a care home will deliver three different types of care. Traditionally for older people, there will be residential care, which is to my understanding, that’s the equivalent of assisted living. You can have dementia care and then you can have nursing care. And then there’s different homes will sometimes have kind of a mixture of those different homes with it within them. So I guess the the British and the American kind of phraseology, if I’m talking about care homes generically, that will either be in the states, that would be either an assisted living facility.
Francis: What they do is almost like you do a continuing care retirement community where you have assisted dementia and then skilled nursing care in the US.
Katherine: And so that’s what some of the bigger models are doing that here in the States.
Simon: So there’s a range in here. If you look at the kind of modern purpose built homes in the U.K., typically they’ll be across two floors. Typically, they’ll have about 60 beds. Typically, they’ll have kind of a small suite with kind of an en suite and kind of a relatively small kind of living area. So you’ve got some space and then kind of big open communal areas, usually a decent sized garden, hopefully. And obviously, any kind of services type space that one might need, obviously, to deliver to deny care.
Katherine: I think in the US that would be comparable to our big brand names, right?
Francis: That’s sort of. Yeah, I mean that would be comparable to our 60, 70, 80 hundred plus bed facilities. Yeah, exactly.
Simon: Those we’ve got homes that are up to. I think the biggest one I’ve ever heard of was about a hundred and twenty five beds, but that’s behemoth and that would usually be one site split up with different buildings.
Francis: But it’s all in one in one location in the states. We’ve got one building that has a hundred plus people on it. So.
Katherine: So it sounds like you have a little bit smaller versions of some of our bigger brand. And then do you also have people who have homes, actual physical homes that you would raise a family in, that you modify and turn into an assisted living or a memory care home?
Simon: Yeah. Sure. So, yes, we do. Typically, they’re being phased out. I think there’s a big push for a more modern purpose built type homes. But we have, I guess, what we’d call more traditional stock if you would look at looking at it from kind of a property perspective.
Let me put this in context. OK. So if you’re looking at the wider sustainability of the UK home sector, banks will at the moment they tend to get less interested about homes that have maybe less than 30 beds because they see their ability to be able to be sustainable into the future as being somewhat compromised because of their size and limited availability or access to economies of scale. So at the moment, there are quite a lot of smaller homes that are being phased out, maybe repurposed that specifically for older people, though, in younger people services, you can have a six person type home. But again, this kind of nuance is depending on kind of the type of people that the service provides that they’re care to interest in.
Francis: I just want to pop in for our listeners that we love your video podcast. So as a reminder, it’s called the Care Home Show. And we will put that link in our show notes so that they can go and listen and see some of the great things that you are trying to do and are doing over in the UK. So kind of we’ve talked a little bit about it, right? How it works in the UK, the elder care. Tell us a little bit more as to what you’re seeing in the market, like how things are shifting are the challenges that are that you’re facing there?
Simon: Would it make sense to kind of put in context kind of a little bit about the UK market, just so the American audience kind of understands kind of the dynamics for it? And then maybe I’ll explain some of the challenges that that sit within that.
Francis: That sounds perfect.
There Is A Real Push For More Care In People’s Homes
Simon: We have an aging population, the that’s something that’s going to transform really the world over the next 15, 15, 20 years, and that’s something that’s going to have a huge impact on all sorts of different things. So I think one thing that is big at the moment for various different reasons in the UK is that there’s a big push for care to be delivered in people’s own home, and that can be achieved either formally by an organization or informally by family or members of the members of the community. Now, depending on the needs, wants and desires of that person, that can be a great choice.
One of my episodes recently was with somebody who runs a business called Hill Nursing Partners, who they do. They help people who maybe they’ve had a fall. They’ve ended up in hospital for whatever reason, but they provide a an intense rehabilitation process in their own home so that they don’t have to move into a care facility of any type, which, again, depending on the needs, wants and desires, that can be exactly the right thing for people. But obviously, there are huge amount of people that do end up living in some type of care facility because it’s a requirement for them to do so. And that’s effectively that’s the market that we serve.
Private Pay or Subsidized In Home Care?
Katherine: So let me ask a question on that. So in-home care, is that private pay or is that something that the government subsidizes?
Simon: You’re really, really good question. So I’ll come onto this probably in a little bit more detail. But in the UK, it would be widely recognized that we have a funding crisis. So if you have assets under a certain threshold, the state effectively will pay for your care. Unfortunately, they don’t provide anywhere near that level of funding required to actually look after a person in any real sense, which is a real big challenge for us.
So privately funded domiciliary care or home care, as you might call it, is fine and it’s well funded because people just have to pay the set price that any provider might set. I have friends who run care businesses and it’s a tough, tough market out there. We have lots of lots of businesses that are that are creaking because of the funding challenges. So it’s not it’s not an easy business model to be successful in in the in the UK. That’s for sure.
A Massively Fragmented Market
Simon: So in the UK, we’ve got about 22000 care homes who serve the vulnerable people within our communities. I don’t know what it’s like in the States, but I’d imagine it’s probably fairly similar in the fact that we have a massively fragmented market. But even the biggest groups in the UK who think they might have maybe 300 homes around the country, they individually owned probably no more than about 2 percent of the market share. Whilst at the other end of the scale you’ve got a huge and I do mean huge amount of single care home operate operators out there which make up the vast majority of the of the market. So how does that compare to the to the States?
Francis: I think it’s very similar. I think the largest provider has somewhere around 10,000 units, I think maybe 15,000 now. But on the grand scale of it, it’s still very fragmented. It’s almost region by region. And then there are a lot of single or double site operators that have maybe 60 total units. So I think we’re ripe for disruption in this market in the US here of really challenging our build philosophy, all that stuff. We’re right for someone to really come and sneak under the radar and have a huge impact that will rattle, I think, a lot of the bigger players that are currently in the market right now.
Simon: This is maybe a podcast to have in the in the future. But one of the one of the contentious issues in in the UK is around scaling care home businesses and scaling them too quickly and potentially using the wrong types of unsustainable funding to be able to go and scale businesses over leveraging with debt financing whilst trying to achieve scale. There’s all sorts of problems that come with scale, but maybe that’s a conversation for a podcast another day. But that’s something that the operators in the UK have fallen foul of on a number of different occasions. And there are there are people who are kind of in the midst of that at the moment. Yeah, they they’ve scaled in an unsustainable way, where one would hope that people have an end to suffering all or not enjoying the best possible life experience, but equally one would expect that on some level that maybe they there that life experience has been has been compromised. And that’s never a good thing.
Katherine: So that’s why we’re in this for is to provide better quality of life.
Francis: It goes back to what you said earlier and your “two Olives.” Isn’t that you realize that all the wealth in the world might not guarantee the right quality or the great quality or outstanding care that you deserve. And just like financially, the lower end of the spectrum shouldn’t automatically mean that you get the poor quality of care. Right. It’s coming up with solutions that no matter your wealth status, you deserve the same basic level, outstanding care. And then, yes, you could do a la carte add ons for those that are very wealthy. But we need to get to some baseline care that does not matter about their assets. Yeah, we must. We have to.
Simon: I think that’s one thing that if we were to walk away with one kind of one or maybe a handful of points of agreement, if you’d like, off of the back of this. That’s definitely something that both the UK, America and kind of the rest of the world should just be striving for. Because that’s fair, right? That’s what that’s what fairness looks like to people. When people spend their life contributing, they deserve to be the beneficiaries of a requisite level of care. And that looks like a decent life experience. Looks like choices that looks like fulfillment because, well, when people spend the rest of their lives doing that stuff, why should that stop just because they’re in the later years of their life?
“When people spend their life contributing, they deserve to be the beneficiaries of a requisite level of care. And that looks like a decent life experience. That looks like choices. That looks like fulfillment. Because, well, when people spent their lives doing that stuff, why should that stop just because they’re in the later years of their life?”Simon Parker, Founder of SP&P and Founder/Host of The Care Home Show
What is the Care Quality Commission And How Do They Rate Homes?
Francis: So I said you made a mention of the CQC, the quality the Care Quality Commission, can you dive a little bit deeper and explain how that is and what that does?
Simon: Yeah, definitely. Okay. So the CPC, so the Care Quality Commission. So that’s the regulator just in England. In Ireland. In Wales and in Scotland they have different regulators as well. Me being in England, I’ve got I’ve got kind of my most of my exposure, if you like, is to the CDC. And they effectively they have a rating system where they have a traffic like system, if you like, so that their worst rating is inadequate. And that looks like a kind of a red dot that they’re their second worst is requires improvement, which is an orange dot that that kind of middle of the road doing okay. Good is a green dot. And then the best dot is the outstanding dot. And it looks like a little star.
The CPC reviews five different areas. The first question that they ask is, is the service safe? The second question that they ask is, are they effective? So are the team effective? Third question they ask is, are the team caring? The fourth question that they ask is, are the team responsive and responsive to the client’s needs and is the team well led? Well. So if you imagine if you overlap with that traffic light system across those five planes, ultimately those are the questions that the CPC are looking to ask.
And what they’ll do within that is they’ve got a system called the KLOIs, which is the key lines of inquiry. So each one of those five sections has a number of subsections and they will ask the operator questions around those key lines of inquiry. So each one of those sections has quite a number of different key lines of inquiry. So undergoing that process, usually what will happen is if you’ve got an average size service maybe of 60 or 70 beds, you might have anywhere between four and six inspectors that will come to a home. And usually they’ll stay around for maybe two days. If they’ve got problems, then they’ll stick around for longer and they’ll scratch deeper under the surface. And that tends to happen around, I’d say on average between about 12 months to about 18 months.
If you’ve got if you’ve got an outstanding home, it could be anywhere to two and a half years before you before you get re-inspected. And then if you’ve got a home that’s experiencing difficulties of whatever reason, it could be anywhere between maybe four to six months because they’re obviously keeping a keeping a closer eye on you. So one of my friends, I think his last inspection, he’s just been inspected recently and I think his last inspection was in April 2017. But he’s got an outstanding home. He’s kind of in a position where they’re giving him head room because they know he’s doing a doing a good job.
Katherine: A little lower priority for them. But it sounds like they do want the ones that are rated a little bit lower to solve their problems pretty quickly. So they stay on top of them.
Simon: If you get a requires improvement or specifically an inadequate. If that happens across two inspections, they will start coming down very, very hard on you. And they have the ability to close a service if it’s up to scratch and they do that quite a lot. The great thing is so proportionately, I think as a country, we tend to do very, very well. I think if I remember correctly, the state is at least 80. I think it’s 84 percent of homes in the UK have a good CPC rating overall. And I think around 3 percent are outstanding. And that number is on the rise as well, which I think is really, really cool.
Katherine: That’s great. I mean, it goes back to just straight business — what gets measured gets improved.
Francis: Right. But what I loved about these questions, though, there weren’t so much questions about policy procedures. Yes, it’s important, but they’re actually asking questions. Is it safe? Is it effective? Is it caring? Is the team responsive? Are they well led? These are like personal engagement things. These are just let me see your policy and procedures and review those. I like I like this way of asking questions versus what they do in the US, at least in Colorado. They want to see your policy procedures. They want to see the paper file or the electronic file. I think we want to get there. But this approach- we may want to do more research on it because I find this very interesting.
CRC Ratings And Reports Available To the Public
Simon: I would say so within the key lines of inquiry, they will go deep into policies, procedures, systems, processes, all of that type of stuff. But because it’s not on a journey on a basis where people are actively within the homes they get an understanding of probably some of the more intangibles. So if you get an inspection, you’ll get a quantitative report in as much as you’ll get a score, whether your outstanding good requires improvement or inadequate across the board because you get a mixture of obviously each one of those will then be rated on the on the traffic light system, then quite a lot of information is then it detailed from a qualitative basis, basically detailing the inspector’s interpretation of what’s going on within the home.
So you’ve got a good balance of those two worlds, the kind of more specific data led response so that they can quantify that their findings. But then it’s also done in quite a you’re able to understand the narrative for what’s going on home. What’s interesting about that and it’d be interesting to hear more about how it works in the in the states. But so all of the inspections, it is a legal requirement if you have a website which obviously most care homes do. It’s a legal requirement to have your CRC inspection available on your website for people to download in its entirety. It’s also a legal requirement for you to have in the front entrance hall. You need to show people what your inspection report is.
If you if you don’t show it in your front reception, that would be considered a breach and you would be marked down from an inspection perspective. I think it’s illegal. Yeah, there’s a legal expectation for you to do that. So if you walk into a home, from a new client or a family member perspective, when you go to go and explore a home nine times out of 10, you probably will know their CRC score already. But if you don’t, if it’s just a walk in type scenario, you want to know whether it’s a decent, facility or not and whether people are being properly looked after.
Funnily enough, there’s a direct correlation in between the homes that do really well and the ones that have the best CRC rating.
“Funnily enough, there’s a direct correlation in between the homes that do really well and the ones that have the best CRC rating.”Simon Parker, Founder of SP&P and Founder/Host of The Care Home Show
Katherine: No surprise. No surprise there.
Stay Tuned For Part Two of This Interview Next Week!
Katherine: Hey, Mavericks. This is Katherine. We had so many great things to talk with Simon about that we split this episode into two parts. Join us next week for Part Two with Simon Parker from the U.K., where we dove deeper into the challenges in senior living that they see in the U.K.. And if you like our podcast, you like this episode, please subscribe. We’d love to get your feedback and hear from you, what you like, and what you’d like to see us change. Until next week!
Announcer: Thanks for listening. The Mavericks want to hear from you. Leave us your comments, questions and ideas for future podcasts.
Mavericks of Senior Living is sponsored by Serenity App, Inc. and Assured Assisted Living. This episode was produced by Katherine Wells and Francis LeGasse. You can subscribe to Mavericks for Senior Living on Apple Podcasts, Google Play or Stitcher. You can also find us on Twitter, Facebook, or via email at challenges@mavericksofseniorliving.
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