Western Trust Board presentation: Older People's Residential Homes
Transforming Your Care– Vision to ActionMay 2013Primary Care & Older People’sPrimary Care & Older People’sServices DirectorateServices Directorate
ProposalProposalThe Directorate seeks Trust Board approval to proceed toconsult on the proposed closure of four Residential CareHomes for Older People in the Western Health and SocialCare Trust area as part of the TYC Vision to Action Report.The Homes involved are: -– Greenfield Residential Care Home, Strabane– Rectory Field Residential Care Home, Derry / Londonderry– Thackeray Place Residential Care Home, Limavady– William Street Residential Home, Derry / Londonderry
Presentation OverviewPresentation Overview This document is a summary of the proposals made byTrust officers in relation to Residential Care for olderpeople. It gives details of the rationale behind the proposal: -– Background & Drivers for Change– Summary of Proposal– Process– Priorities– Next Steps
Drivers for ChangeDrivers for Change WHSSB’s “Meeting the Needs of Older People Locally”, 2007-2017 Transforming Your Care – Vision to Action Consultation Document Demographic Profile Dementia Prevalence RQIA Standards
Meeting the Needs of Older PeopleMeeting the Needs of Older PeopleLocallyLocally Older people want to remain in their ownhomes for as long as possible. Recommended reform of residential care. Recommended development of alternativecommunity supports.
TYC Vision to ActionTYC Vision to Action• The Policy of the Government at both national and local levelis that more older people who require care should be lookedafter at home or as close to their own homes and communitiesas possible.• The overarching intention of community care is to help peopleto live at home with appropriate and timely support.• Re-shaping services to promote independence means lesspeople will require institutional care.• There will be a reduction of at least 50% in the provision ofstatutory residential care.
Demographic Profile:Demographic Profile:The age profile of the Western & Social Care Trustis changing quite significantly, 65+CitysideWardsWaterside&LimavadyFermanagh Omagh &StrabaneWesternTrustCrude PopulationCensus 20116,572 10,515 9,844 11,682 38,613Crude % 17.02% 27.23% 25.49% 30.25% 100%Age Needs WeightedPopulation5,745 10,378 10,435 12,438 38,996PoC 4 Age Needsbased Formula14.73% 26.61% 26.76% 31.90% 100%Age Needs WeightedPopulation adjustedfor Rurality and EoS5,685 10,280 10,524 12,506 38,996PoC 4 Age Needsbased Formulaadjusted for Ruralityand EoS14.58% 26.36% 26.99% 32.07% 100%
Increasing Needs Associated withIncreasing Needs Associated withDementia DiagnosisDementia Diagnosis Increasing numbers of residents withdementia RQIA guidance given regarding placementof people with dementia Implications for staffing, environment, safetyand risk management Registration status needs to be considered.
• The Review of Statutory Residential Care for OlderPeople highlighted that in line with the RQIA standardsregarding the current structure/layout of the homes,each home would require a substantial financialinvestment to bring them up to the identified “MinimumStandards”.• Calculations are highlighted in the following table.RQIA Standards
Home Total upgrade2008Total upgrade2013Greenfield 740k 858kRectory Field 550k 638kThackeray Place 520k 602kWilliam Street 496k 575kOverall £2.673milionTable of Upgrade Cost Estimates forResidential Homes
What does this mean for theWhat does this mean for theWestern Area?Western Area? Older people’s population is growing Older people who require care have a preferenceto stay in their own homes Alternative care arrangements have beendeveloped The need for general residential care is declining Over the last year there has been a further declinein the admission of permanent residents.
What Does this Mean for theWhat Does this Mean for theWestern Area?Western Area? Cash Releasing & Reinvestment Process Alternatives to Statutory Residential Care Priorities
Reform to DateReform to Date Closure of Statutory Residential CareHomes: -– Foyleville, Derry / Londonderry– Drumhaw, Lisnaskea– Gortmore, Omagh
Dependency Scales (as at 31March 2013)Independent Low Medium High MaxDependencyGreenfield 1 11 12 1 0Rectory Field 0 0 9 8 1Thackeray Place 2 7 6 8 4William Street 0 3 4 4 9TOTALS 3 21 31 21 14
Dependency Scales Level ofDependency Scales Level ofPeople in Residential CarePeople in Residential CareOn review of the current dependency scaleswe can see there are increasing numbers ofresidents in the high to maximum category.This would indicate the residents in thesehomes are moving towards requiring nursinghome care, which will result in a furtherreduction in demand for residential carehomes.
Cash Releasing & ReinvestmentCash Releasing & Reinvestment Potential savings of £1.313m We are planning to cash release £313,000 forTYC. The remainder, circa £1m, of the combinedfinances from the proposed closure of thesehomes will contribute to the re-provision costs inproviding alternatives for the existing residentswithin the homes.
ProcessProcess EQIA 13 week full consultation Relatives’ and Residents’ meetings Staff / Trade Union meetings Inviting written and oral submissions Public Representatives
Alternatives to StatutoryAlternatives to StatutoryResidential CareResidential Care Reablement Flexicare Supporting People Schemes Independent Sector Provision Domiciliary Care Day Care Integrated Service Delivery Teams including: District Nurses, SocialWorkers & AHPs Rapid Response Nursing Active Living Schemes Community Challenging Behaviour Service
ReablementReablementThis service provides the opportunity to allow people tolearn or re-learn the skills necessary for daily living, whichhave been lost through deterioration in health and well-being and/or increased support needs. A focus onregaining physical ability is central as is active re-assessment, reducing ongoing support needs throughsustaining independent living.
FlexicareFlexicare A service made up of a partnership approach with a rangeof local community and voluntary groups to enable peopleto live within their own homes for as long as possible. Flexicare provide services such as: -– Befriending– Assisted Shopping– Handy Help for odd jobs around the house– Chaperones to help people attend appointments– Additional services relate to affordable cleaning / gardeningservices.
Supported LivingSupported LivingA service that enables vulnerable people toaccess and maintain accommodation suitableto their needs and help them to live asindependently as possible, through working inpartnerships with local Government, serviceusers and supportive agencies to allowservices to visit their home in the forms ofpersonal care and clinical care.
Independent Sector ProvidersIndependent Sector ProvidersA number of local independent sectorproviders have approached the Trustindicating plans for provision of a number ofresidential / nursing bed within the WesternTrust area in the next 12 – 15 months: -160 beds in Cityside / Waterside50 beds in Limavady
Alternative Care ProvidersAlternative Care ProvidersStrabane AreaThrough the Western Area Supporting PeoplePartnership, the Directorate is exploring the potentialfor the provision of a Residential and Housing withCare Supported Accommodation Facility for OlderPeople with Dementia in the Strabane area.The Trust will engage with the independent sectorwith a view to encouraging the development ofadditional accommodation in the Strabane area.
Strabane area continuedThere currently 23 individuals placed in a privatefacility within the Strabane area. These individuals arefrom the Derry / Londonderry and Limavady areas. Itis anticipated that when alternative options becomeavailable in these individuals’ own areas the Trust willengage with those residents to facilitate transfers backinto their own areas if they wish. This will then createcapacity within the private sector within the Strabanearea.Currently in Greenfield there are some residents with adiagnosis of dementia whose needs would be bettermet in a dementia specific facility.
Derry / LondonderryThe Trust has been approached by an independentsector provider who will open a 46 bedded care homeon the Culmore Road area of the City in December2013. There is also a plan within the following 12months to increase capacity by an additional 34 beds(making 80 in total).
Derry / Londonderry continuedThe Trust has been approached by an independentsector provider indicating plans to open an 82 beddedfacility in the Trench Road area with a mixed provisionof dementia care, residential, intermediate and nursingcare.There are currently some residents within the RectoryField and William Street with a dementia diagnosiswhose needs would be better met in a dementiaspecific facility.
Limavady areaAn independent sector provider has advised the Trustit will be increasing its current bed capacity by 50.A further proposal for Limavady will be the subject of aSOC (Strategic Outline Case) and will be submitted viathe WASPP (Western Area Supporting PeoplePartnership) for consideration.There are currently some residents in Thackeray Placewith a dementia diagnosis whose needs would bebetter met in a dementia specific facility.
PrioritiesPriorities– Supporting Residents and Families through this difficultperiod including Independent Advocacy.– Supporting Staff through the change process andsecuring suitable alternative employment– Securing Supporting People funding to develop somealternative accommodation.– Keeping the public and service users aware of directionand developments.NB: No closure would happen unless asuitable alternative is in place.
Summary of ProposalSummary of Proposal In summary the Directorate currently provides statutory residential care forOlder People in 5 homes with a total bed complement of 153. The Directorate proposes to complete a full EQIA Consultation over a 13 weekperiod. Homes subject to consultation are: Greenfield, Rectory Field, Thackeray Place& William Street Residential Care Homes involving 128 beds. The exception is Seymour Gardens Residential Care Home which is aDementia Care specific home The consultation would commence on 1stJune 2013. Proposal if agreed – homes would close 12 months following decision beingmade, subject to suitable alternatives being in place. Subject to Trust Board approval Subject to Ministerial approval
Next StepsNext Steps The Directorate submits this proposal to Trust Board forapproval to proceed to consult on the proposed closure offour Residential Care Homes for Older People in theWHSCT area as part of the TYC Vision to Action Report.