Section 504: hospices
This publication is intended for Valuation Officers. It may contain links to internal resources that are not available through this version.
Hospices are subject to co-ordination as set out in the Practice Note for Reval 2010 and subsequent Revaluations. They were previously mainly dealt with by Groups. Hospices do not have a separate SCAT. Those which are providing in-patient care should be assigned SCAT code 135 while continuing to be described as “Hospice & Premises”. Those which are providing only out-patient and/or day centre care on the premises should be assigned SCAT code 067G but described as “Hospice & Premises”. Those hereditaments which provide neither in-patient nor out-patient or day-centre facilities should be described as offices under SCAT code 203
2. Development and present position of the Hospice Movement
The Hospice Movement can trace its origins to the nineteenth century, but in its modern form it dates from 1967 and the work of Dame Cicely Saunders in developing palliative care, which is a special type of care for people whose illness may no longer be curable. It enables them to achieve the best possible quality of life during the final stages of their illness. Hospice care also embraces families and friends by supporting them through the illness and into bereavement.
The driving force behind hospice, or palliative, care is the desire to transform the experience of dying. Still in the 21st century in the UK people die in avoidable pain and distress. In hospices multi-disciplinary teams strive to offer freedom from pain, dignity, peace and calm at the end of life. Underpinning this care is a philosophy that takes as its starting point the affirmation of death as a natural part of life. Built on that bedrock are the values of respect, choice, empowerment, holistic care and compassion. Hospices care for the whole person, aiming to meet all needs - physical, emotional, social and spiritual. They care for the person who is dying and for those who love them, at home, in day care and in the hospice. Nearly half of all people admitted to a hospice return home again. The average length of stay is just 13 days. All care is free of charge. Within hospices you will find a range of services - pain control, symptom relief, skilled nursing care, counselling, complementary therapies, spiritual care, art, music, physiotherapy, reminiscence, beauty treatments and bereavement support. Staff and volunteers work in multi-professional teams to provide care based on individual need and personal choice.
3. Description and classification of Hospices
A Hospice is an Institution, not merely a building. Many of its services may be provided off the premises, for example in patients’ homes, and many hospices do not have in-patient facilities. Hospices which do not offer overnight beds may consist of offices and staff facilities, with or without day-centre or outpatient facilities. The larger hospices, which can provide 50 or more beds, have the appearance of small hospitals. Palliative care departments are found within NHS Hospitals, and are operated by NHS Trusts, but some private Hospices operate from NHS sites. All private Hospices are charities and receive 80% mandatory relief from non-domestic rating; many receive in addition the discretionary 20% relief. Since no such relief is available to NHS Trusts, it is important that hereditaments rateably occupied by charitable Hospices on NHS sites should be identified and separately assessed.
4. Identification of Hospices
A useful website is available to assist in the identification of Hospices ( http://search.hospiceinformation.info/UKDirectorySearch.aspx) . This provides a regionally organised Directory of Hospices with and without beds; the number of beds is recorded. The range of services offered is also shown. Mention of “Day Care” is indicative of out patient facilities. Services such as “Home Care”, “Hospice at Home” and “Bereavement Services” may be provided by outreach, the hospice premises being sometimes merely a base for staff. The Directory also records NHS palliative care services, and can assist in distinguishing between charities operating from NHS sites, and those provided directly by NHS Trusts (the latter being indicated by the appearance of “nhs” in quoted e-mail contacts). The Directory also provides web site addresses which can assist in identification of buildings and locations as well as providing more information about the operation of the Hospice, and sometimes current and future development plans.
5. Background to Valuation and Method of Valuation
5.1 Domestic/Non-Domestic Borderline
For many years it has been customary to treat Hospices with beds as domestic property having regard to the improbability of patients returning home. No distinction was made in respect of respite uses. However the proportion of in-patients who return home is about 50% on the basis of latest available statistics (2005-6), although in individual hospices it can be as low as 22% or as high as 92%. But whether the stay is terminated by death, a return home, or a transfer to another care facility, the nature of the use must be regarded as non-domestic, unless where there is one or more patients whose stay on the hereditament is 60 days or more. Stays of this duration should be regarded as indicating domestic property, and no enquiry should be made as to whether such patients retain sole or main residences elsewhere. The proportion of such stays is likely to be very low, and in 2005-6 the average duration of stay was just over 13 days, with the highest recorded average for any hospice being only 34 days. Longer stays are probably more likely in Inner City areas. The proportion of 60 day + stays should be found at the AVD and used as a means of apportioning ancillary areas (e.g. kitchens and laundries) between domestic and non-domestic use in the same manner as NHS hospitals. Accommodation provided for staff as a permanent residence (not for “on-call” use) should also be regarded as domestic.
Rooms will be exempt where used wholly for training patients or keeping patients “suitably occupied” (LGFA1988 Sch 5 para 16 (1)(a)). Qualifying areas will be those used for involving patients in art, music, reminiscence, beauty treatments, flower arrangement or gardening. A place of worship may be exempt (Sch 5 para 11(1)(a)) if it is used as a place of public religious worship, and provided that it is certified as a place of religious worship, but a “multifaith” prayer room will not qualify.
5.3 Method of Valuation
Hospices receiving either in-patients and/or outpatients should be valued on the Contractor’s Basis. They are within the definition of healthcare hereditament and therefore subject to the lower prescribed decapitalisation rate. Hospice premises which consist solely of administrative offices and/or bases for staff providing outreach services in the community should be described as offices and valued as such by reference to rental evidence/local tone.
Hospices providing in-patient and/or out-patient/ day-centre facilities on the premises should be referenced to GIA. Care should be taken to ascertain the total number of inpatient beds at the AVD (and subsequently if that number has altered), and the number of in-patients staying 60 days or more at the AVD. In some hospices there are fluctuations in use, and note should be taken of any unused areas, and the reasons for any lack of use. In all instances where the hereditament is a composite, the size and layout of domestic property (including any staff accommodation used as permanent residence, not merely “on-call” accommodation) should be recorded. Hereditaments occupied by hospices not providing in-patient beds, and/or outpatient or day-centre facilities on the premises should be referenced to NIA.
Practice Note 1: 2010: Hospices
1. Co-ordination Arrangements
Hospices with in-patient beds are a SRU class subject to a national scheme. Responsibility for implementing the scheme as set out within this Practice Note lies with the SRU, as does responsibility for ensuring effective co-ordination.
Special Category Code 135 should be used for Hospices with in-patient beds. As a SRU Class the appropriate suffix letter should be S. They should nevertheless be described as “Hospice & Premises”
All other types of premises occupied by Hospices are Group class hereditaments Hospices with outpatient and/or day-centre facilities should be given Special category code 067, and should still be described as “Hospice & Premises”.
Hospices with no outpatient and/or day centre facilities should be given Special category code 203 and should be described as “offices and premises”.
2. Method of Valuation
For Hospices with in-patient beds the contractor’s basis should be used, applying the same scheme as that agreed for Private Hospitals (non acute).
For Hospices containing no in-patient beds but including outpatient facilities and/or day centres, the contractor’s basis should be used, applying the same scheme as that agreed for Health centres valued on the contractor’s basis (RM 5:840:PN2:2005 Section D).
Other Hospices will consist wholly or largely of offices and should be valued as such, on local tone.
3. Valuation Considerations
Since this Practice Note was not available for the 2010 Revaluation, a significant number of hospices have already been valued. The valuation approach applied to them may not be in accordance with the advice contained in this note. While the valuation approach accorded to other comparable hereditaments inevitably forms part of the “tone” of the list, in the case of In-patient hospices, it should not be given overwhelming weight, and the valuations of existing hospices in this category should be revised in accordance with the method recommended above. In the case of other types of Hospice, full regard should be had to the valuation approaches already applied to comparable hospices already assessed to NNDR, and the valuation advice provided above should only be followed to the extent that it is not in conflict with existing tone.
3.2 Domestic/Non-domestic Boundary
An opportunity should be taken when inspecting hospices with in-patient accommodation, to ascertain whether any patient stays were 60 days or more at or about the AVD. The objective should be to find the proportion of beds occupied by long-stay patients at or around the AVD and at the same time to discover whether that proportion is likely to hold good for the future (i.e. at or around 1.4.2008. It is likely that a majority of hospices will not have this length of stay.