Health and Social Care Professionals
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Frequently Asked Questions
Answers to questions frequently asked by Primary Care professionals. Please read this document alongside our Terms of Business and Client's Guide.
Q. What is Live-in Nursing?
A. Briefly, it's the care of patients in their own homes by nurses or care assistants assigned to live with them for a time. The Consultus Live-in Nursing Services (CLINS) management team creates rotas of suitable Registered Nurses or Care Assistants who stay with clients, providing round the clock general, post-operative or palliative nursing care and home help. Such one-to-one care has huge qualitative benefits for the service user and often comes with cost savings for the commissioning authority. Furthermore, primary care managers say that our system, which includes considerable case management, relieves them of a significant workload.
For a full description of our service and how it can be tailored to meet your needs and those of each service user please speak to a CLINS manager - direct line: (01732) 770403 or 771924.
Q. What do your nurses specialise in?
A. Care of elders and other adults; often people with Alzheimer's, Parkinson's, Multiple Sclerosis and other chronic conditions, and palliative patients. We have ITU trained nurses and can help with BiPAPS, tracheotomies, syringe driver monitoring, Hickman lines, IVs, etc.
Health Care Assistants can provide support up to the level of their training - PEG feeds, etc., and in accordance with the GSCC Code of Practice.
Q. Our service user lives in a very remote location, many miles from your office. Can you provide a live-in service?
A. Yes. Our nurses and carers are based all over Great Britain and we can reliably and consistently supply to any location within the UK, Isle of Man and the Channel Islands. All staff can travel at short notice.
Q. Can live-in nursing at home be made available to everyone?
A. The DoH End of Life Care Initiative "Building on the Best" accepts that if people genuinely want to die at home, then they and their families should have access to the services needed to make this possible", though, as pointed out by a leading cancer charity , "not everyone has their own accommodation or relatives able to provide suitable support at home. The NICE Guidance on Supportive and Palliative Care recognises that "levels and nature of provision will depend on a number of factors, including local demography such as age, levels of social deprivation and ethnicity".
Consultus hopes that its service can be made available to everyone who wants and needs it but recognises that a risk assessment must first identify the suitability of the nurse's accommodation including any health and safety risks, or any potential hazard introduced by other people in the household. This principle is accepted by our existing NHS and other clients.
Q. Does your nurse or carer clean and cook?
A. Depending on the workload - and in accordance with the Care Plan - a certain amount of light housework can be done by our staff at no extra cost but this should not become onerous and certainly not distract from their clinical responsibilities. If the client's partner is perfectly healthy we would not expect the nurse or carer to cook and clean for him/her without a negotiated increase.
Q. There is no spare bedroom in the client's home…
A. Nurses and HCAs must have a suitable private bedroom and if two live-in staff are needed they should each have their own room. If the client can be left at night it may be possible for a room to be found in a local b & b or with a nearby relative. It would not be appropriate for staff to have a camp bed or sofa in the living room.
Q. Can you supply someone for just a couple of days as respite?
A. Yes, but two days of work would probably not be an attractive booking for a nurse or HCA who may have to travel a long way to attend. Our minimum charge, therefore, is for four days service. 'Unworked' days are charged at our lowest rate.
Q. Why is your rate for 24/7 nursing/care so low?
A. Costs are low partly because on-site standby is free. In other words, if the client does not need help during the nurse's rest time there is no extra charge…
Q. But our service user needs someone on duty at all times...
A. If 'waking nights' are necessary we can provide two nurses/carers - one to work days and the other nights - so long as there is a private room available for them both (or one may be lodged elsewhere). Even though higher hourly rates apply overnight you will probably still find that our charges are far below what you would pay for local visiting agency carers on continuous shifts.
Q. So how else to you keep your charge rates low?
A. Our nurses are highly skilled and experienced and many are of a high grade, yet they happily accept a lower than usual rate of pay. You see, our nurses love the life of a live-in nurse. They like to travel and meet new people; and they love the opportunity of providing deeply meaningful one-to-one care and seeing how their efforts directly improve the health, spirits and confidence of their clients.
They also know they will not be out of pocket because (as part of tried and tested terms of business), the nurse or carer benefits from "free" meals and accommodation. Sometimes the cost of these expenses is met by the local authority and sometimes the service user or his family.
The staff member works with the bill payer to keep shopping costs to a minimum and will often eat what the householder eats in order to make best use of budgets. If the nurse or carer has special dietary requirements, e.g. vegetarian, we will discuss this with you beforehand. (Naturally, staff expect to prepare their own meals though they may not be able to shop for food if there is no suitable nursing cover in place).
Q. What happens if we book a nurse but need to cancel shortly before she arrives or at some time during the assignment?
A. By the time the nurse arrives at the service user's home, we will have put in many hours of preparatory work. At the same time, a nurse will have committed herself to a booking which typically lasts for 14 days or more; and may therefore have turned down other offers of work. Unlike local agency nurses, a live-in nurse cannot rely on the probability of new offers of local work coming in. Without some agreed protection she would probably earn no money for a week or more.
For these reasons, we charge an Early Release Fee that is equivalent to up to seven days service (proportionately less if the service was due to end in less than a week or was not to begin for another day or more). We pass on to the nurse the vast majority of this fee - the wages she would have earned - and thereby help ensure she stays on our books to help you again in the future.
If the client has died, the nurse need not leave straight away; she will willingly stay a while to help the family through the difficult times, thus offering better cost and qualitative value all round. For more information please see our Client's Guide.
Q. Can we postpone start of care or interrupt service for a short time?
A. Delays to hospital discharge can force postponements to confirmed bookings leading to a necessary delay in our nurse's arrival. Similarly, you may request a break in service due to a temporary hospital admission. In these instances, to avoid the break-up of an established rota, it may be possible for the nurse to remain on paid standby. Please ask for details or see our Client's Guide.
Q. What happens if your nurse or carer goes sick or has to leave the client's home suddenly?
A. In the unlikely event our nurse is unable to continue work, we or the staff member will let you know immediately. Usually we will have had some warning and there will be no interruption to care, but to be on the safe side we will work with you in advance on a 'Plan B'. You may want to use your own bank staff, or you may prefer us to work with a local sub-contractor agency. Alternatively you could opt for us to place a nurse on a retainer, so that we can have a substitute on site within, say, 6 to 24 hours.
Q. We have a set budget and can only afford for your nurse or carer to work a limited number of hours.
A. Live-in staff are booked to work ten hours a day, seven days a week and won't normally expect a day off during their stay with the client. If funds are tight and you want to avoid overtime payments you can state a preferred maximum number of hours that the nurse should work. Of course it's impossible to say that no overtime will ever be claimed; as a resident in the client's home the nurse could not in good conscience ignore the client if he were in need of urgent help, nor should she expect to do this work for free. Some contingency or flexibility therefore needs to be established.
Q. Can we spread the cost of the service between two bill payers?
A. Yes. If payment for the service is to be met by two organisations or persons - e.g. PCT and the service user, or Health Authority and ILF - we can raise two time sheets and two invoices. Of course, you would need to agree with the other party which scheduled hours will be paid by which bill payer. You must also agree how to split the cost of any overtime worked.
Where the cost of the service is to be shared we and our nurse or carer should ideally have one point of contact in regard to clinical matters, time sheets and local supervision.
Q. Do you send an assessor to visit our service user before service begins?
A. Before you book live-in staff our experienced, qualified consultants work closely with you, the service user's GP and/or other local healthcare professionals to ascertain each client's particular needs and circumstances. If we have any reason to believe that we cannot supply a consistent, suitable, reliable service we do not accept the assignment. Our first live-in nurse usually writes a formal care assessment and care plan (based on the Roper Scale) within a few hours of her arrival or reviews any Plan already in place.
We can often arrange a pre-service assessment if this is a necessity and service is not being provided in an emergency. This may be necessary for bookings of live-in health care assistants who are not qualified to write a care plan. Please ask for terms.
Q. Is it okay for your staff member to work 70 or more hours a week?
A. We ensure our live-in staff have the stamina and fitness to work long hours. There are no implications under the Working Time Directive because a) they get plenty of time off once each 2-week assignment is over and b) nurses in this situation are exempted. Of course, nurses and carers must not be called upon to do arduous levels of overtime. If they regularly do not get enough sleep we will offer to provide a second staff member or ask you to arrange local cover; If the nurse is regularly called at night, an additional person should be arranged for night duty. We reserve the right to remove or replace any nurse who we feel is not benefiting from enough rest.
Working Time regulations recommend a minimum break of 20 minutes in any period of work of six hours or more however due to live-in staff's overall weekly workload we ask for two hours (unpaid) break in any day-long shift.
Q. Is your agency contracted with the NHS?
A. Increasing numbers of PCTs and Health Boards are using Consultus, not only because of what we do and how well we do it, but also because we have possibly the only dedicated live-in nursing operation in the UK! However, until quite recently we offered our service only to private clients so there was no need to seek NHS Purchasing & Supply Agency (PaSA) approval.
In August 2007 we discussed at length our circumstances with a senior PaSA category manager with responsibility for the Agency Projects. She assured us that (contrary to popular belief!) there is no NHS-imposed barrier to trusts wishing to use our service. She advised us that when no listed agency is able to supply the kind of nurse or service that a trust needs it is fully acceptable for you to use a non-listed company.
She added that in any case CLINS may have met insurmountable difficulties had we applied for Agency Project approval as the initiative was set up to evaluate staff hire agencies, not 'managed nursing services' like ours.
Our PaSA contact has offered to speak to any trust representative personally to confirm this advice - please ask us for the contact details. Our company profile is available on SID.
We will be happy to supply an ad hoc 'spot' service to any health or local authority and to formally contract with any care provider that is committed to the 'live-in' option.
Q. How do I book staff?
A. Please contact a CLINS manager or consultant, direct lines: (01732) 771924 / 770403 / 369413.
