Thinking of providing live in care? A brief introduction UKHCA

Thinking of providing live in care?
A brief introduction
April 2014
UKHCA Policy and Campaigns Team
United Kingdom Homecare Association Ltd
Sutton Business Centre
Restmor Way
Telephone: 020 8661 8188
E-mail: [email protected]
Twitter: @ukhca
Registered in England. No 3083104
Table of Contents
Table of Contents ............................................................................. 2
Thinking of providing live in care? ....................................................... 3
Is there a market for live-in care? .................................................... 3
What type of service? ..................................................................... 4
Can you devote staff resources to the service? .................................. 4
Which model to adopt? ................................................................... 4
What about rules and regulation? .................................................... 5
Have you considered marketing and costs? ....................................... 6
And finally.. .................................................................................. 6
Whilst every effort has been made to ensure the accuracy of this article, it is a
summary, rather than a definitive statement of the law; advice should be taken
before action is implemented or refrained from in specific cases. No responsibility
can be accepted for action taken or refrained from solely by reference to the
contents of this article.
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Thinking of providing live in care?
Thinking of providing live in care?
Live in care provides a flexible option for those with substantial support
needs, and is often able to prevent admission to a care or nursing home.
Service users may have physical or sensory needs that mean they require
“round the clock” care, or a condition such as dementia, Parkinson’s, MS
or others that make it difficult for them to be on their own. Live in care
also provides an answer to social isolation, with the worker acting more as
a companion than a careworker. Live in care is increasingly enabling
service users to stay in their own homes through to end of life.
Live in Care has been the preserve of a small number of specialist
providers and agencies, but is increasingly being offered by homecare
organisations that provide daily care, often in response to user demand.
So what issues should a provider consider before branching out
into live in care?
Is there a market for live-in care?
Before starting up or expanding a business to offer live in care, the
provider should thoroughly research the market. This is not easy as there
is very little data specific to the live in care market, and it doesn’t usually
feature separately in national statistics.
A would-be live in care provider should decide whether they are targeting
their local care market, in which case an exploratory call to the local
authority commissioning team might be a good idea, alongside reviewing
the council’s Market Position Statement (where they have issued one) and
looking to see whether there are already successful live-in providers in the
local area.
Alternatively a provider may want to cover a wider area, perhaps even the
national market. The latter would need a more sophisticated analysis of
the national market for live in care and would need to consider the fact
that separate registrations are required for Scotland and Wales.
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What type of service?
Careful thought will be needed on the type of service provided. Do you
want to give companionship or provide personal care, or support service
users to take their medications? The answer will depend on how you see
your business model and the outcome of your local, or national research.
Can you devote staff resources to the service?
To be successful, you need to have sufficient workers to deliver live-in
care properly, and sustainably. Service users will generally expect
continuity which can be provided through longer-term arrangements, or a
team of two carers sharing a pattern of working, not just when the
provider happens to have a careworker available. The provider must also
be able to provide alternative trained workers in the event of sickness or
staff holiday etc. These individuals will need not only to have the required
skill sets to deliver the appropriate care needed but to be the right ‘match’
for the service user. Often service users receiving live in care like to have
careworkers with shared interests.
Which model to adopt?
Live in care is usually provided either as a managed service, where
workers are employed by the organisation, or as an introduction service technically an employment agency - which introduces people to hirers to
be employed by the hirer directly. Employment agencies are regulated by
the Employment Agencies Act 1973 and the Conduct of Employment
Agencies and Employment Businesses Regulations 2003.
The two different models of service have implications which need to be
considered carefully.
A live in service operated as a managed service proceeds in the same way
as a conventional homecare service. The organisation employs the
worker, and the service user pays the organisation for the service. By
contrast, the introduction service exists to introduce potential workers
who can provide the service required by the service user or “hirer”. The
introductory (“employment agency” model) selects a suitable candidate,
based in part on information supplied by the organisation, and the service
user employs or “hires” the worker directly. The agency does not become
involved in the day-to-day supervision and control of the worker.
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Thinking of providing live in care?
A crucial difference is who employs the worker and who is responsible for
giving them directions, operating PAYE and national insurance and
ensuring that working time and National Minimum Wage (NMW) rules are
adhered to.
There are also differences in who is responsible for drawing up a care
plan. A direct service provider will draw up a care plan. The employment
agency may draw one up as a service to the user, but the user is not
required to follow it (some people prefer to draw up their own list of
tasks), and the agency mustn’t try and impose it on the careworker. It is
also very important to note that not all introduction agencies are
regulated services.
What about rules and regulation?
The extended hours worked by a live-in careworker (there will be times
that they are working and other times when they are effectively on call)
mean that a specific rota will need to be drawn up. An average hours
agreement is a good idea, to determine how working time and NMW are
calculated. UKHCA has a National Minimum Wage Toolkit
( and specimen Daily
Average Hours Agreement, drawn up by our preferred solicitors Anthony
Collins Solicitors LLP, available to member organisations.
There may well be regulatory implications for the model chosen. For
example, the introduction service model does not trigger regulation by the
Care Quality Commission in England (but is likely to do so in the other UK
administrations), unlike the conventional managed service model. Some
organisations choose to operate both models side by side, which brings its
own challenges for management and administration, and can result in
complex legal arrangements. Whichever model is chosen, it is essential to
note that with a “hybrid” arrangement, where an introduction agency
manages services, it is much harder to prove compliance with regulatory,
employment and revenue law.
Pure introductory agencies are bound by the Employment Agencies Act
and the Conduction of Employment Agencies etc. Regulations. While
these do not require registration with a specific regulator, there is an
inspectorate (through BIS) who may come and inspect documentation etc.
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Have you considered marketing and costs?
Marketing of live in care tends to be different, with advertising in
traditional “up-market” magazines which appeal to those who can afford
to self-fund care a popular choice. If you do take the plunge, please
inform UKHCA so we can help market your service via our online directory
of members and their services.
Overall, the introduction model is generally felt to be a less expensive
service to run, because it does not involve employing a workforce, is less
regulated or and does not require on-going supervision and control.
However, if your intention is to provide a live-in care service, rather than
run a business essentially introducing staff, then the managed service
model is the more appropriate.
Whatever direction you take, it is a good idea to take proper advice on
your plans, to ensure that your business planning and documentation are
in order.
UKHCA has two specimen contracts, drafted by our preferred solicitors,
that can help UKHCA members. One is a contract between a self-funded
service user and an organisation, for a managed service:
The other is a contract between an organisation and a service user to
introduce a care worker for employment by the service user:
UKHCA also offers members human resources advice and a legal helpline
to give a limited amount of free telephone advice on business and
regulatory issues. To be referred, call our member helpline on 020 8661
8188, option 4.
And finally..
A word of caution. Live in care demands particular skills from
careworkers, who need to be sufficiently trained and self-reliant to be able
to function with less supervision than a daily careworker. So you will need
to think carefully about pay rates, recruitment, training and supervision to
make sure you have sufficient workers of the right calibre to offer the
service. That is why a good many live in care specialists, who offer a
managed service, invest heavily in developing their workforce and allocate
the resources to do this.
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Thinking of providing live in care?
So budget implications will form a very important part of your business
planning when considering a move into live-in care, as will checking the
skillset of both staff and managers before venturing into live in care.
If you decide to go ahead you will be providing a service that is highly
valued by service users and their families in helping to maintain
independence at home.
UKHCA’s Policy Director, Colin Angel, said:
“Live-in care can range from providing much-needed companionship and
peace of mind, to intensive services which help people remain at home,
rather than use residential care. It also increasingly assists service users
to stay in their own homes through to end of life and, as such, is an
important component of the full spectrum of home-based care.”
UKHCA Policy and Campaigns Team
April 2014
If you have particular needs which make
it difficult for you to read this document,
please contact 020 8661 8188 or
[email protected] and we will
try to find a more suitable format for
UKHCA, Sutton Business Centre, Restmor Way, Wallington, SM6 7AH
020 8661 8188 | [email protected] | 
© United Kingdom Homecare Association Ltd, 2014, v2
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