Improving end of life care provided by
Domiciliary Home Care Teams in people’s
homes and boosting confidence and
competence of staff
Professor Keri Thomas, Maggie
Stobbart Rowlands, Lucy Giles the GSF
Centre in End-of-Life Care, West Midlands,
UK
Business Plan
Table of contents
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
Description of Business
About the Applicant
What services do you plan to offer?
Market Analysis and Competition
Start-up Costs
Marketing Plan
SWOT analysis into strengths and weaknesses
Back-up and Contingency Plans
Table of asset/equipment purchases appendix 1
Organizational structures of the service
1.0 DESCRIPTION OF BUSINESS
What is Domiciliary Care?
Different to live-in care where you receive ongoing support, this type of care is for
those who prefer support at set regular times each week. This could be as little as a
weekly housekeeping visit through to several visits a day to help with personal
care, getting around the home or preparing meals, for example. It even covers
overnight support if you need some extra assistance with nightly toilet trips or
taking medication. Those who wish to stay within their own homes may be very
interested in the idea of regular visits from a qualified carer. It may be that they
need a little extra support after having an operation or have a long-term condition
such as dementia, Parkinson’s or multiple sclerosis.
2.0 ABOUT THE APPLICANT
How Domiciliary Care will meet the Health and Social Care Act 2008 (HSCA
2008) and the associated regulations, relevant guidance and any other laws that
apply:
Training and experience
We recognize that we must be able to show how we’ll meet (and continue to meet)
the fundamental standards: explain how we will make sure our service is safe,
effective, caring, responsive and well led.
Registered manager applications
To prove that we are competent to manage we appreciate that we must have:
relevant qualifications current up-to-date training written proof of all your
qualifications and completed training evidence that shows our competence, skills
and experience.
Registered provider applications
It is understood within our rank and file that we have to make sure our proposed
registered manager has: relevant qualifications current up-to-date training written
proof of all your qualifications and completed training.
That they check to ensure that they have written proof of all qualifications and
completed training.
Confirm that they have included all supporting documents, including a statement
of purpose, with the application.
3. Domiciliary Care understands what is required of us. It is clear to the
organization everyone understands and has experience of relevant legislation. This
includes the: Health and Social Care Act 2008 and its associated regulations
Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This also
includes have the qualifications, skills and experience to provide personal care that
meets the needs of the people who’ll use your service
3.0 WHAT SERVICES DO YOU PLAN TO OFFER?
Meal preparation and housekeeping – There is no place like home, right?
Nevertheless, for those who require additional support, housekeeping tasks can
start to build-up. From sorting out the laundry to cleaning the windows and
polishing the surfaces; it can seem like the list is never-ending, especially for
someone who is not able to carry out these tasks efficiently. That’s why
domiciliary home care can involve assisting with these tasks, ensuring that your
home is kept in a tidy and clean condition. This may also be suitable if you have a
family member or friend that has lost weight or is struggling to have regular meals
after some form of surgery.
Hobbies facilitation and companionship – In addition to assisting with
housekeeping and meal preparation, domiciliary care can also include supporting
people with different activities, for example, ensuring that they can still enjoy a
certain hobby. If you want your carer to, he or she can also get involved in these
activities too. After all, loneliness is something that impacts people of all ages all
around the world. This is why companionship is such an imperative part of
domiciliary care. Social interaction and companionship will help to enhance a
person’s wellbeing, ensuring that they have someone on hand to speak to, whether
this is about something that is troubling them or about a specific topic.
Personal care – Personal care is a term that relates to a wide range of tasks and
areas. The level and kind of support that is required will depend on the person that
is receiving the care. However, some examples of what this can include are as
follows: foot care, shaving, tending to nails and hair, maintaining comfort to help
prevent pressure sores, changing continence pads, and of course, assistance with
bathing and showering. You can be sure that our domiciliary care will always be
carried out in a way that respects the privacy of the person receiving the care. If
there are certain tasks that you would prefer to carry out independently, we will
always respect this. We will never try to pressure you into something you are not
comfortable with.
4.0 MARKET ANALYSIS AND COMPETITION
The demand for care
A number of studies have considered the overall level of demand for care in the
future by looking at the main population level drivers, such as the ageing of the
population and the changing pattern of household composition (and hence levels of
informal care), disease patterns and so on. As expected, underlying ‘need’ is
expected to grow significantly in coming years.
There has been far less attention on what factors influence individual level
demand, and indeed how sensitive purchasers are to price and quality differences
between providers. Anecdotally, location, especially proximity of the home to the
person’s previous address or their family’s address has been a key reason for
demanding a place in a particular care home (Nyman 1994; Netten, Bebbington et
al. 2001).10
A number of studies have found that the level of demand is related to a number of
process/quality indicators such as staffing ratios and home level characteristics
including sector, staffing levels overnight and the number of beds (Nyman 1989;
Forder 2000). These results indicate a potential for competition among providers to
have an impact on quality, although the nature of this effect a priori is uncertain.
This question is addressed below.
Market power and pricing in the care homes market
The demand for care home placements is also related to price, other things equal.
Identifying price elasticity of demand is challenging because observed prices in a
care home market also reflect the impact of supply-side (cost) factors. Moreover,
demand decisions are ‘lumpy’ in that people buy just one place in a care home. In
an inverse demand function, we would expect price to be negatively related to
demand i.e., lower price implies higher demand, other things equal. But highcapacity homes might also have lower marginal costs and so in estimating an
observed price to output relationship we need to account for this and other similar
effects in order not to over-estimate demand price elasticity. Instrumental variable
approaches can be used in this case. After accounting for supply-side factors, a
number of UK and US studies (Nyman 1989; Forder 2000; Mukamel and Spector
2002) have found demand prices for care homes are negatively related to output
indicating: (a) that potential residents are sensitive to price; and (b) that homes
retain some market power.11
The evidence regarding the extent of market power from these papers is mixed.
Forder (2000) found that mark-up rates in the care homes market for people with
mental health problems was relatively modest at around 11%. This study used a
sample of 477 residents from a survey of 9 facilities that provided residential care
to people with mental health problems from 8 districts in England and Wales. The
analysis showed that private care homes had significantly lower market power
compared to non-profit care homes but had a significantly greater likelihood of
using their opportunity to make profits. Non-profit providers had a price elasticity
of demand of -0.28 compared to private providers that had a price elasticity of
demand of -0.082.
US studies found that nursing homes markets were less competitive than Forder
found in England and Wales, with much higher mark-up rates in the US; up to 50%
in the analysis by Nyman (1989). Mukamel and Spector (2002) examined private
nursing homes in the state of New York using data from 1991 and found price
elasticities of demand that are consistent with mark-up rates of between 25% and
40%.
Analyses that estimate Lerner indices12 gain a direct indication of mark-up rates
rather than having to infer these rates from measures of competitiveness. There are,
nonetheless, issues in correctly identifying demand-side elasticity in estimates
using observed price and outputs data. It is perhaps for this reason that most studies
of market performance in the care homes sector focus on measuring the level of
competition and/or its impact on prices and quality.
Anecdotal evidence relating to the English care homes sector suggests that margins
are very tight. A study funded by the Joseph Rowntree Foundation concluded that
most public sector commissioning bodies do not at present pay fees at levels which
are adequate to support and sustain a care home sector that meets all of the most
recent National Minimum Standard (Laing
2008).
Price differentiation
Individual self-payers are largely price-takers in the market. Local authorities,
however, are seen as exercising monopsony buying power and can secure sizeable
discounts. These discounts are thought to be paid for by charging higher prices to
self-funders (Office of Fair Trading 2005). Similar price differentials are seen
between public (Medicaid) and private payers in the US nursing home market
(Mukamel and Spector 2002; Grabowski 2004) where Medicaid pay rates run at
around 70% of private pay rates
4.0 START-UP COSTS
We appreciate that there are many factors to take into account. One of the most
important is the potential costs – from initial investment to site selection and
hiring, among others. Startup costs are one of the first things to consider. In most
cases, it’s easy to drastically underestimate the amount of investment – both time
and financial – necessary to start your own business.
Skilled medical home healthcare agencies, for instance, administer licensed
nursing care and rehabilitation therapy services under a physician’s orders. The
startup costs for these types of home care agencies are understandably higher.
Typically, the profit margins are higher, too, once the business gets up and
running. Similarly, Domiciliary Care seeks to walk this path.
It is understood that many of the initial costs incurred will include licensing
expenses, administrative work and expenses of the care providers. Additional costs
include computer software and hardware, training, consulting and the costs of
commercial office space.
Finding the right systems for every facet of Domiciliary Care can be challenging
but a franchise model takes care of these areas for us. Not only does the franchise
model provide proven systems and a framework for success, but the expenses of
getting the organization up and running are all included in the initial franchise
investment. This circumvents any problems we may have from unforeseen costs.
5.0 MARKETING PLAN
Domiciliary Care hopes to utilize range of interventions to mark in the competitive
market of home-based care. The most important are listed and explained here.
1. Ask for referrals from current clients
Referrals from current (and past) clients are an excellent way to promote a home
health care agency. Nothing is more powerful than social proof in the form of
testimonials and reviews. And the best way to get those referrals is by developing a
solid relationship from the start, so it’s much easier to ask for a referral later down
the line. According to the 2020 Home Care Benchmarking Study, current and past
clients are the top source of new referrals.
2. Optimize your Google My Business profile
Google My Business (GMB) lets us set up a free business profile on Google and
connect with new potential customers inside the Map pack. Since local map packs
are shown in most local search results, this is a critical element of any wellrounded home care marketing strategy.
3.Develop an organic Search Engine Optimization (SEO) strategy
Once we’ve optimized our GMB profile for placement in the local maps, the next
step is to develop local landing pages on the website to rank in organic search
results below the map pack. The goal is to rank top of Google Maps and the
organic search results.
4. Collect reviews on key third-party websites
People do business with those they know, like, and trust. And there is no better
trust signal than a bunch of 5-star reviews on independent third-party websites.
For every one-star increase that a business gets on Yelp, it sees a 5-9% increase in
revenue. And when a product gets five-star reviews, the likelihood of it being
purchased increases by 270%. Think about the sites that people go to when
researching companies that provide the services you offer, for example, Google
Maps, Yelp, and industry review sites. We want to proactively happy customers if
they would be willing to leave a positive review on our chosen sites.
6.0 SWOT ANALYSIS INTO STRENGTHS AND WEAKNESSES
Internal: Strengths & Weaknesses
The top two sections (STRENGTHS and WEAKNESSES) both originate
internally. These are things that we can control. Strengths are helpful; Weaknesses
are harmful.
STRENGTHS: List of our capabilities and resources that can be the basis of a
distinct competitive advantage. Ask: What are the most important strengths? How
can we best use them and capitalize on each strength? Strengths could include:
a new and/or innovative service
capabilities or cost advantages
cultural connections
extraordinary reputation
other aspects that add value
special expertise and/or experience
superior location or geographic advantage
WEAKNESSES: What areas need improvement (or should be avoided)? Ask:
What would remove or overcome this weakness? Weaknesses can sometimes be
the absence of certain strengths, and in some cases, a weakness may be the reverse
side of one of your strengths. Weaknesses might include:
absence of marketing plan
damaged reputation
gaps in capabilities or service areas
lagging in technology
management or staff problems
own known vulnerability
poor location or geographic barriers
undifferentiated service lines
External: Opportunities & Threats
The lower two sections (OPPORTUNITIES and THREATS) both originate
externally. These are things that you cannot control. Opportunities are helpful;
Threats are harmful.
OPPORTUNITIES: In addition to new or significant trends, what other external
opportunities exist and how can we best exploit or benefit from each? Examples
might include:
a market vacated by a competitor
availability of new technology
changes in population profile or need
Competitor vulnerabilities
lack of dominant competition
new market segment that offers improve profit
new vertical, horizontal, or niche markets
THREATS: Can include anything that stands in the way of your success. No
practice is immune to threats, but too many people miss, ignore or minimize these
threats, often at great cost. Ask: What can be done to mitigate each threat? Can a
threat become an opportunity? Threats could include:
a competitor has an innovative product or service
a new competitor(s) in your home market
adverse changes in reimbursement or regulations
changing insurance plans and/or contracts for major area employers
competitors have superior access to channels of distribution
economic shifts
loss of key staff or associates
new or increased competition
seasonality
shifts in market demand or referral sources
Seven simple rules for successful SWOT analysis
1. Be Specific: Avoid gray areas, vague descriptions or fuzzy definitions.
2. Be Objective: Ask for input from a well-informed but objective third party;
compare it with your own notes.
3. Be Realistic: Use a down-to-earth perspective, especially as you evaluate
strengths and weaknesses. Be practical in judging both sections.
4. Apply Context: Distinguish between where the organization actually is today,
and where it could be in the future.
5. Contrast and Compare: Analyze (realistically) in relation to your competition
i.e., better than or worse than your competition.
6. Short and Simple: Avoid needless complexity and over-analysis.
7. Update your marketing plan and goals: Once the key issues have been identified,
define the action steps to achieve change.
7.0 BACK UP AND CONTINGE PLANS
For a contingency plan and business continuity approach to work effectively, staff
and key stakeholders need to know where the plan is, what’s in it and how it
works. This means having a light touch communications plan. It also means that
councils must deliver training around the plans.
Contingency and business continuity plans should be reviewed and refreshed at
least every 12 months. It is particularly important to make sure that contact details
are up-to-date. However, it’s even more important to update plans every time they
are used or when situations change, such as a change in contracting arrangements
or changes in personnel.
Whether taking a continuity or contingency approach, the focus is always on the
individual and their needs. So, plans need to take account of those needs, assessing
them and helping individuals choose new care provision if required, taking into
account any health or social implications of a move or change of provider. For
people who may lack capacity to make good decisions about their care, extra
consideration is needed.
8.0 TABLE OF ASSET/EQUIPMENT PURCHASES APPENDIX 1
9.0 ORGANISATIONAL STRUCTURE OF THE SERVICE