4.2 enabling independence through care at home joint improvement team
Enabling Independence through Care at Home Alex Davidson Joint Improvement Team Associate
The key messages of Home Care Re-ablementare> The approach changes the culture of home care from ‘task and time’ to better outcomes> ‘Doing with’ service users rather than ‘doing to’ or ‘doing for’ service users> Maximise users long-term independence and quality of life> Appropriately minimise ongoing support required and, thereby, minimise the whole life-cost of care> Service users making the most of their lives
Home Care Re-ablement – Why do it?> Compelling evidence • improves confidence, motivation, empowerment, choice and maximised independence for service users> Service users need less care hours than traditional home care service> Growth in need for Home Care Demography - Early Discharge from Hospital> Pressure on limited budgets> Resurgence of Outcomes Approach> Personalisation Approach> Shifting the balance of care> Reshaping Older People’s Services> Provides one of the building blocks for Rehabilitation/ Re-ablement Framework> Added value for local authority in house service
Key Findings> Benefits for Service Users – Independence> Reduction in Care Hours Required - Leicestershire 58% discontinued (no care hours) 17% reduced 17% maintained 8% increased> Duration of Benefits for 2years – 4 schemes 36% to 48% still discontinued (no care hours) 34% to 54% maintained or reduced package > 65 and > 85 marked reduction
Satisfaction SurveyWhat level of service are you Did you think the decision now receiving after Home about the amount of help Care Re-ablement? was appropriate for you? None 28 Yes 55 The same 18 No 4 Less 8 Not Sure 2 More 5 Null 1 Null 3 Total 62 Total 62
Reshaping Older People’s Care Re-ablementactivity> Into the Spotlight Conference Dec 2008> National Outcomes Conference Mar 2009> City of Edinburgh Research> Step by Step Guide 2009 (including tools – finance, workshop etc.)> 4 x Regional Events for Partnerships> ADSW event> Independent Sector Workshop> Continued Support to Partnerships> Change Fund support
Into the Spotlight Conference Dec 2008National Outcomes Conference Mar 2009> National and International speakers> Focus on the changes needed – (pre Reshaping activity)> Workshops – multi agency, users/carers> Engagement of key players
City of Edinburgh Research> JIT commissioned research into findings of implementation i9n Edinburgh> Related to Re- ablement research in England
EVALUATION OF CITY OF EDINBURGH COUNCIL HOME CARE RE-ABLEMENT SERVICEBarry McLeod and Mari Mair RP&M Associates Ltd Scottish Government Social Research 2009
Step by Step Guide 2009 (including tools– finance, workshop etc.)> Development of materials, toolkits> Compilation of evidence base> Website developments> Set programme of necessary steps, communication, procurement, finance, implementation etc
Care at Home Services – Online Redesign System Step Process Preparation Preparation Statutory Engagement Engage Service Stakeholder Involvement Users, Carers, Providers &TU Data CollectionANALYSE Data and Analysis Data Analysis Evaluation Policy Evaluation & and Visioning Vision Policy PLAN Direction Option Appraisal Option Appraisal and Decision Making Policy Decisions Commissioning Plan DO Procurement ProcurementREVIEW Review
Care at Home Services – Online Redesign System Planning Project – Step Process Definition of objectives and issues Leadership commitment Governance arrangements Preparation Project management arrangements Preparation Resourcing Work programme and time-line Statutory Stakeholder involvement Engagement Communication Arrangements Stakeholder Involvement Local Baseline DataEngage Service Resources Users, Carers, FinanceProviders &TU Market / Balance of Providers Workforce Dependency Measurement Data Need And Demand Collection SOA Related Data Outcome/Performance/Quality/Cost Indicators and Benchmarking Data Analysis Analysis Strategic Issues Outcomes Evaluation Care Pathways & Intensive Support Policy Vision Rehabilitation/Re-ablement/Intermediate/Rapid Services Evaluation and Practical Supports Policy Visioning Carers Support Direction Specialist Issues – Care Group/Dementia/Palliative Care Technology/Telecare/Telehealth Integration of Social Care, Health And Housing Option Political Issues Appraisal Equality Impact Analysis Option Policy Appraisal Decisions and Decision Option Appraisal Making Capacity Plan / Service Redesign Commissioning Risk Assessment Plan Financial Planning Workforce Planning Market Analysis Decision-Making Procurement Procurement Procurement Planning Service Specifications Tendering and Contracting Review Transition Monitoring and Review
As Percentage of Days Per Year Percentage Days Annual Leave and Public Holidays more than 5 years 28 Sickness Levels 10 26 Training 5 Percentage Cover Rate 22.7 59 260 1Service Users 2Number of Service User Per Week 3Number of Service Users Every 6 Weeks 4Number 6 Weeks Periods Per Annum 10 60 8.7 Capacity 5Volume of Referrals 6Number Every 6 Weeks 7Average Number of Hours 60 10 Planning 8Total Hours Per Week 1 600 9Other adjustments10Two to visit adjustment - 12% of cases - hours per week11Handover costs - 2 hours per service user - per 6 weeks 72.0 20.0 Tool12Total Hours Per Week 2 692.013Total Staff 1 - 40 HPW WTE 17.314Team Meetings weekly - 3 hours - add 8% Staff 1.4 815Supervision 6 weekly - 2 hours - add 1% Staff 0.2 116Telephone Contact time - 1 hour per week - add 3% Staff 0.5 317Total Staff 2 19.418Cover19Adding 22.7% for cover - Annual Leave etc 4.420Total Staff 3 23.821Adding Travel Time Total Hours Travel Time22Travel Time Rural @ 33%% 228 692 22823Adding further 22.7 % for cover 5224Total Hours PW 28025Total Staff additional staff rural for travel 826Grand Total Staff Rural 31.627Percentage staff to service users 52.628Travel Time Urban @ 8% 55 692 5529Adding further 22.7% for cover 1330Total Hours PW 6831Total Staff additional for urban 232Grand Total Staff Urban 25.733Percentage staff to service users 43
4 x Regional Events for PartnershipsADSW eventIndependent Sector Workshop> Multi-agency – LA Social Work, Housing, NHS, Independent Sector, users and carers> Regionally based, local data> Mixture of input and group work> Use of toolkits, evidence, local data.
How do we spend the £4.5 billion … Other Social Work Care Homes Emergency admissions £0.2bn £0.6bn £1.4bnHome Care £0.3bn FHS £0.4bn £0.4bn £0.8bn £0.4bn Prescribing Other Hospital care Community
Talking Points Service user defined outcomesQuality of life Process ChangeFeeling safe Listened to ImprovedHaving things to do Having a say confidenceSeeing people Respect Improved skillsAs well as can be Responded to Improved mobilityLife as want (including Reliability Reduced symptomswhere you live)
The continuum of intermediate care (adapted from Brophy 2008) Social Care HealthcareSelf Care Re-ablement & recuperation Clinical Rehabilitation Links to acute clinical care, Rapid response & Residential beds, A&E & primary & supported with nursing care community healthcare Links to mainstream & discharge team community hospitals preventative social care Independent sector Residential care resources & re- including step up Acute care at home ablement / including step down & specialist teams discharge from for clinical hospital rehabilitation
Greater Pressure? - Workforce> Nursing/care workforce very large> Largely female> Somewhat older than rest of workforce> Nurses – short hours, relatively well-paid, low turnover> Care assistants – short hours, poorly paid, high turnover 20
Increasing Pressure - Growth in FPC Costs 400 350 300Expenditure (£m) 250 CH Nursing Care 200 CH Personal Care 150 Home Care 100 50 0 2003-04 2004-05 2005-06 2006-07 2007-08 21
Rate per 1,000 population aged Gl 65+ as g In ow 0 5 10 15 20 25 30 35 v C So Ei erc ityW S u le ly e s he t h a n deDu t D tla Ay Si m un nd rsh ar fri ba Is ir es rt la e & o n No E G nsh ds a a ir So rth st A llow e u L Cl th ana yrs ay ac La r hir km n ksh e an a rk ire n s M an hire id s h No Ea s lot ire rt t L hia A r h A ot h n gy yrs ia n ll hi & re B Fa ute lk Ab Ed Mo irk e in r Ea Or rde bu ay st k n en rgh Re ey C week), 2008/09 n f Is i t y Sc Du rewlan ot n s ds tis de hir W hB eC e Ea e o it st Re st L rd y Du n ot ers n fr h A b ba e w i a n (rate per 1,000 population aged 65+) r s Pe erd ton hire rt ee sh h n ir & sh e Ki ire n St ros Hi irli s gh ng la nd Older people receiving intensive home care (10+ hours per Fi An fe gu s
100% 0% 20% 40% 60% 80% An g Hi F u s Pe g if rth S hla ne A b & ti d Ea er K rlin st Re dee inro g Du nf ns s s n re h Ab ba r ws ire e t o hi Ar rde nsh re gy en ire Sc Du ll & Cit ot nd B y tis e ut h eC e Bo it W Edi rde y e s nb rs Supported in care homes t L ur Or S oth gh No k ne cot ia n rth y I la n s d Ea Ay land st rs h s Lo ire t M hia n or Cl GMid Fa lk ay a l l i So ckm as g oth rk home care, 2008/09 ut an ow ia n h L na C i No ana ns h ty rth In rks ireW La ver hir es t D Ea na clyd e un st rks e h So bar Ayrs ire ut t on hi Ea h A sh re st E yr ireDu Sh Ren ilea shir m e t f re n S e Balance of care: Supported in care homes and intensive fri la w ia es nd s h r & Isl ire Ga an llo ds w Intensive Home care (10+ hours per week) ay
Continued Support to Partnerships> Focussed workshop intervention when requested> But on specific issues, not more of the same> Mentoring and Networking> Benchmarking
And now?> 18 Partnerships have introduced or are introducing re-ablement services> Change Fund activity all have re- ablement focus> Dementia addition being progressed.
Thank you For any more information please visit www.jitscotland.org.uk Alex Davidson email@example.com 07801 952257 Gerry Graham firstname.lastname@example.org 07788 951182
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