Improvements in healthcare and living standards mean that people in the UK are living longer. However, chronic conditions, disease and disability mean that the number of people with complex needs is also increasing.
Meeting the care requirements of these people, and ensuring that they get the right care, by the right team and at the right time, is a challenge for commissioners.
Exemplar Health Care is a specialist provider of nursing care for adults living with complex and high acuity needs, which currently has 35 care homes across England – and plans to double in size by 2026.
“We have an ambitious growth plan over the next five years, and we are currently expanding in the Midlands, North West, North East and Yorkshire and Humber,” says Charlotte Lloyd, developments director at Exemplar Health Care.
“We are different from other care providers. Around 60 per cent of our service users come to us following a failed placement, having not settled at their previous home or homes.
“This is mostly due to their previous placements not being fit for purpose in terms of the environment, staffing levels and staff training.
“There is evidentially a gap for younger adult services and we are the answer to that.”
Exemplar Health Care point to the factors it believes are its USPs as being crucial to its expansion – its strength in effectively supporting those with behaviours which challenge; its high staffing levels; the fact it creates ten-bed units to promote small group living; its focus on community involvement and re-integration; and the provision of in-house therapy teams.
It also highlights the positive impact of its in-house Exemplar Positive Behaviour Support training which has been certificated by Bild ACT, and five of in-house leadership programmes which are CPD accredited.
“Our high staffing levels of registered nurses and health care assistants, and holistic approach to care, ensure that people get the right care, at the right time, the first time round,” says Charlotte.
“This reduces re-admissions to acute settings, facilitates faster returns to lower-cost community living and brings an end to the cycle of failed placements.
“We’re building more specialist care services across the country, to meet the growing demand for complex and high acuity placements.
“One thing that makes us different is that during the assessment process we do a ‘community fit’ assessment, as well as a care needs assessment.
“This ensures that the home is the right ‘fit’ for the individual, and that they’re the right ‘fit’ for the people who are already living in the home.
“We work closely with a number of CCGs and local authorities to understand the gaps they have, and involve them in the process to ensure that our new homes are fit for purpose and meet local need and demand.”
Such demand for specialist placements is something that continues to grow, which inspires Exemplar Health Care to increase the resource available to people badly needing such specialist resource.
“The number of children born prematurely or with other medical or complex conditions is growing,” says Charlotte.
“So, too, is the number of older people developing complex needs in later life. This is leading to an increase in demand for complex care services.
“High-quality, person-centred care for people living with complex needs often requires the support of a multi-disciplinary team, which involves registered nurses, health care assistants and other specialist roles such as clinical experts, psychiatry, physiotherapy and occupational therapy – as well as high staffing levels, an adapted environment and specialist equipment.
“This comes at a cost – but public sector funding is decreasing.
“These ongoing financial challenges can often lead to people being placed in an unsuitable or inappropriate setting, that isn’t able to meet their complex care and clinical needs.
“This can have a detrimental effect on people’s health and wellbeing, as well as the wellbeing of their family and friends. There is also a high number of people spending an unnecessary amount of time in hospital settings due to the shortage of specialist nursing home providers.
“We find that a lot of people are placed out of their area as there is not enough provision for specialist nursing homes close by – when opening a new home in a new area, we often receive referrals to support service users being repatriated.”
The latest addition to the Exemplar Health Care portfolio is Blackmoor in Birmingham, a 30 bedroom home comprising three ten-bed units, which will support people living with complex mental health needs, including behaviours which challenge, early onset dementia and neurodisabilities.
Its Tolkien Unit is a ten-bed male-only community. It supports those living with complex mental health needs, neurodisabilities, complex physical health needs and behaviours of concern.
The James Brindley Unit is a ten-bed mixed community. It supports those living with complex mental health needs, early on-set dementia, brain injuries and neurodisabilities.
And the Bournville Unit is a ten-bed female-only community, which supports those living with complex mental health needs, neurodisabilities, complex physical health needs and behaviours of concern.
It adds further to the provision from Exemplar Health Care in the area, with two specialist nursing homes in Birmingham – Otterburn and Maypole Grove – and Bridgewood Mews and Parkside in Tipton.
While each home continues the provider’s overall commitment to delivering personalised care to each resident, the creation of each one builds upon the last.
“Each time we build a new home, we’re continually learning and enhancing the design of the homes, and we implement lessons learned along the way,” says Charlotte.
“At Blackmoor, we’ve implemented more energy efficiencies including under floor heating, LED and automatic lighting and all our new homes are fitted with electronic car charging points.
“A few months ago, we asked our service user council what enhancements they’d like to see in our homes.
“They fed back a range of suggestions including bigger bedrooms with more space for equipment, more communal living spaces, accessible outdoor spaces and a hydrotherapy bath – so we used this to adapt the design of our new-build homes, much of which has been incorporated at Blackmoor.
“At Blackmoor, the overall size of service user bedrooms and en-suite bathrooms has increased. We’ve also included lots of communal spaces such as a hub area with bistro/coffee shop set up, a salon including hairdressing back basin, Barber chairs and nail bar, a multi-faith room and a sensory room.
“There is also an assisted bathroom on each floor which has a hydrotherapy bath with sensory and spa-like features.
“All of our homes benefit from the same support from central services including clinical experts, behavioural support specialists, learning and organisational development, marketing, HR and recruitment support.”
Blackmoor is also another example of the role Exemplar Health Care’s homes play in their local communities, with the provider keen to make a positive impact.
“During the planning phase, we worked closely with the local authority and purchased seven new park benches for the local community,” says Charlotte.
“The home has also created over 100 jobs for the area, ranging from nursing and health care assistants, domestic, administration, catering and management positions. Our first new cohort will benefit from a unique four-week induction and training experience to ensure the staffing team are well prepared for our new admissions.”
