Having undertaken surveys of our customers over the last few weeks, we note that there is currently a significant demand for Care Act reviews of commissioned care packages and moving and handling equipment and adaptations. Some Local Authorities also think this demand will grow as the Covid-19 lockdown eases.
Access Independent propose an innovative solution to this demand, by provisioning a team of occupational therapists with a background in social care and moving and handling to undertake annual Care Act reviews, alongside a team of social workers. This approach enables us to provide social care reviews and moving and handling reviews either as a combined or separate service, including double to single handed care initiatives. Our projects in this area have demonstrated this approach can reduce the need for commissioned care packages and double up calls by smarter use of technology, moving and handling techniques and client resources.
This approach can deliver innovation, efficiency and change, meaning improved outcomes and services as well as reduced costs for Local Authorities.
Occupational therapists are very well suited to undertaking annual care reviews, and their deployment in this area can promote alternative solutions to commissioned care packages. For example, if specialist equipment can be provided to help the service user perform a task, this can reduce reliance on carers, help the service user regain some dignity and potentially ‘right-size’ care packages.
Undertaking annual reviews, as mandated by the Care Act, also allows reablement through liaison with community therapists, education of client, family and formal carers to enable the person to increase their independence.
A review could involve several repeat visits and establishing a programme or a one-off training session with involved people, or an administrative exercise putting people in touch with reablement services. Our service can be flexible depending on what level of input is needed.
Moving and Handling Reviews
Where appropriate, as part of these reviews, our OTs could complete a moving and handling review, and/or single-handed care (SHC) assessment and assess the care package in terms of reduction of double up care or if time could be reduced, proposing SHC equipment and a plan to aid a single-handed care approach. Many of our OTs have a moving and handling ‘train the trainer’ certificate, so are able to teach techniques to carers. Also, if the number of carers can be reduced on a call, this may enable the Local Authority to provide care services to another person in need, enabling distribution of scarce care resources where they are needed.
It can be an advantage for an organisation such as Access Independent to undertake these reviews; many service users are resistant to change, and a review resulting in changes may cause difficulties with future therapeutic relationships. Also, many Local Authorities, especially those with large rural areas, have difficulties with capacity and there not being enough carers to provide double-handed care, hence Service Users can often end up waiting a long time or receiving a poorer service if they require two carers. So, provisioning single handed care can mean that there is more availability, better provision of service and less waiting time.
Many Local Authorities find that after a person returns home from hospital their health improves and the amount of care they receive can be altered to suit their new needs, giving them less dependence on the care service, increasing their independence and dignity. The service user also gets the mental health benefit of being more independent. Therefore, annual reviews of these commissioned care packages are essential to ensure people are getting the care they need, focusing on interventions which enable them to be as independent as possible and to main as much dignity as possible.
The input from OTs ensures that the assessments focus on well-being and enabling people to achieve outcomes in line with the Care Act:
- Service users experiencing more personalised and dignified packages of care based around their specific requirements
- Appropriate equipment solutions can improve productivity, enhance comfort, reduce cost, increase client independence and prevent residential care, hospitalisation or more intensive support. Additionally, equipment provision in partnership with adaptation can reduce need for complex care packages
- Completion of robust risk assessments to ensure that reductions from more than one carer are completed safely
- Cost savings from ‘rightsizing’ care packages, promoting independence, signposting to community providers and using moving and handling equipment, assistive technology, telecare and environmental enablers.
During our work with Nottinghamshire, an audited sample of 153 reviews, found reductions in care costs on 46/153 cases (30%), with 11 increases. These adjustments produced net yearly savings of £109,588.74 and represent only a small proportion of the total reviews completed. The procurement cost of this sample is slightly over £30,000, demonstrating a significant sustainable saving.
Additionally, we analysed our double-handed care review project in Kirklees which demonstrated implementation of alternative interventions, equipment or adaptation solutions to reduce care in 54% of cases. This work included assessing the effectiveness of providing ceiling track hoists as opposed to manual hoists and recommending both simple and complex items of equipment to enable single handed care.
By using a multidisciplinary team, we can deliver alternative solutions through focus on reablement and increasing independence. Our team works collaboratively to identify the best solutions, with service users’ wishes at the centre. This person-centred approach ensures that changes are sustainable, by offering informed choice and engagement in decision-making. Below are case examples of this from our work:
- A bed bound client living with her adult daughter in receipt of a care package of x4 double handed calls per day to attend to personal care. Carers often found the client in soiled pads at the AM call. She was provided with a ceiling track hoist, Wendylett sheets and wedge positioning cushion to enable single handed care. The care package was reduced significantly, and her daughter was trained to use the equipment. Therefore, the client was able to have her pad changed during the night by her daughter, promoting her dignity and tissue viability. The client benefitted financially as her assessed financial contribution was reduced following the reduction in her package of care.
- An elderly lady living alone with dementia had an old boiler, causing condensation and damp. We assisted her application for an Affordable Warmth Grant, providing a new boiler and cavity wall insulation.
- A housing association tenant in 4-bed house was affected by the spare bedroom charge. We helped her apply to the housing list for a 1-bed ground floor flat with LAS, for which she would get full housing benefit. This released a family house for a homeless family under the Homelessness Act.
- As part of a SHC assessment, the OT determined from the service user’s care file that the carers were not using all the time that they had been allocated on a frequent basis. The OT completed a tally chart of time actually used and had the care call reduced from one hour to 45 minutes. The OT felt more confident to do this than previous Social Workers had, as there was moving and handling plan in place.
- On a SHC project we went to see a gentleman who was plus size and independently mobile with two carers. The only reason there were two carers was ‘in case he should fall’, however if the gentleman did fall, they would not be able stop this from happening so our OT reduced the carers to one and instead provided a falls plan.
- On review, it was discovered that, for a service user with a double-up care call, one carer would wash up and fix lunch while the other completed personal care, and they then both left early. Our OT reduced the carers to one but increased the time allocation for that one carer.
- On a SHC our OT found a Care company specified that two carers were required to roll a lady. One carer was always late, and the service user was compliant with no pain or high tone and already had a CT hoist. The OT prescribed a wedge and turning sling and reduced the carer to one and the carer always arrived on time.
Our OTs have found the most effective approach is to contact the care provider first, explain the review or assessment, and that we are looking at ensuring that carers time is used efficiently to enable maximum capacity in the county. Our OT will then provide feedback to and discuss the outcomes with the care provider afterwards and communicate with the service user as to the benefits of their recommendations. This approach has meant we could work together with the care providers to provide a better service while keeping service users and care providers on board.