From Opportunities to Action Market Position Statements Mental Health Dementia Diagnosis Dementia Advisors Learning Disability Supported Housing Day Opportunities Older People Extra Care Day Opportunities Dementia Care Working Age (PD & SI) Personal Health Budgets Telecare
Reablement in the Independent Sector Pilot Project - East Sussex Lynn Mounfield, Head of Contracts & Purchasing – Adult Social Care
Reablement Reablement focuses on prevention and enabling clients to return to independent living through a short therapy led outcome programme. Reablement is at the heart of personalised adult social care system – presenting a market development for in house and external providers of homecare In house home care service redesigned to deliver reablement (the Living at Home Service (LAHS)) mainly focused on hospital discharge clients with some step up. The LAHS has been able to demonstrate the positive affect reablement has on clients which significant numbers going on to receive no further support.
Pilot Project Aim The purpose of this project is to test whether providing reablement through our independent providers will improve service user’s outcomes and reduce the overall need for homecare in East Sussex. Benefits: 1.Members of the public successfully reabled in their own homes will have greater independence to live their lives as they see fit and an improved quality of life. 2.Those who currently receive homecare still usually spend most of the hours a week with out a home carer on their premises and are therefore relatively likely to have accidents or be readmitted to hospital. Those successfully reabled will therefore be less likely to have accidents and be readmitted to hospital. 3.If reablement provides significant financial savings on homecare for the Council, some of this money could be put towards more universal services, further reducing the number of people whose health and mobility deteriorate to the extent that they need reabling in the first place. 4.A more dynamic independent sector that is capable of reabling people as well as providing traditional homecare will be more responsive to people’s individual needs, and therefore more capable of fulfilling its role within the personalisation agenda set forth in the government policy Putting People First: Transforming Adult Social Care.
Delivery Independent provider carers are working partnership with ASC Occupational Therapists and Social Workers to successfully reable clients. The pilot launched in October 2011 with: A training programme developed by ASC to deliver reablement care packages with 39 care staff across both providers trained Assessments carried out on the 100+ existing services users of both providers found existing care packages were efficient, with no reablement scope (due to conditions such as dementia or severely impaired mobility). This demonstrates the high level of support needs within East Sussex’s communities. The Project Board agreed to extend the pilot to new cases, providing reablement services to all clients at point of review in localities in Hastings, Rye, Bexhill and Battle that the independent provider covers. The pilot is unselective, so all clients will be offered reablement service (after professional assessment for suitability). Data will be collected on whether the desired outcomes and benefits have been achieved as a result of this reablement service.
Case study – Mrs M 86 years old, widowed and lives with her daughter who provides support with daily living including shopping, housework, laundry, meals, drinks and snacks. History of agoraphobia, anxiety and incontinence. Became bed ridden, due to loss of confidence, after a fall Initially the Reablement Package of Care was identified for 10-20 hours per week with two care workers. Keen to maintain her own independence and avoid too much reliance on others. The reablement programme, worked on increasing Mrs M’s confidence and tasks she could do for herself. Longer term limitations were identified and a revised ongoing Package of Care developed. The package at the end of the reablement service was for 2½ hours per week. Benefits: Mrs M was determined to be able to mobilise herself and not be reliant on two care workers three times a day. Mrs M’s goal was to maintain her privacy and be less anxious about doing day to day tasks for herself. This has been achieved with work from the OT’s, the Care Provider and Mrs M.
Agency Personal Assistant Project Interim findings Frood Radford Service Development Manager Direct Payments
Context: Self- directed support and Personalisation Improved support services and outcomes - for older people in particular Increasing emphasis on Direct Payments - challenging performance targets Developing council role as an enabler
‘There needs to be a middle ground…’ Service users have told us they would value an alternative to using Direct Payments to employ their own staff – Personal Assistants (PA); They want a service that has the key attributes of the PA model, but where they do not directly employ their worker; We wanted a model that would offer a high degree of personalisation but with less of the hassles and responsibilities that come with being an employer.
Service overview – key attributes The service will normally be paid for by the service user via Direct Payments. (Commissioned by ESCC by exception.) Choice of PA and high degree of consistency of worker More choice and flexibility as to when PA works Service user chooses exactly what PA does on any given day
Service overview – key attributes Agency manages: Cover - Holiday, Sickness, Contingency Employment issues, dispute resolution etc. Payroll Contract is between service user and Agency Payment through 3 rd party managed account or Direct Debit
Money management Self-managed Direct Payments Agency only Managed Account
Pilot project Worked with known and trusted provider to tap into their expertise from the outset Agency identified potential PAs who attended training provided by ESCC Practitioners in Hastings and Rother had two hour workshop session around Support Planning Set up evaluation framework Aim is to use learning to roll model out with other providers across county
What we want to know: Profile users (location; rural v urban; age; number of hours; and who didn’t take up) & experiences/views on the service Review the provider experience of providing the service, the effect on the rest of their services and the cost and viability of the model Review PA experience of providing the service Review the experience of the ASC back office staff including SPT, finance teams (e.g. DP and FAT) and Quality Monitoring team in relation to the service Understand the viability of the model for ESCC and the likely level of take-up if the service was rolled out across East Sussex
What we have learned so far How Support Plan describes service is a key factor People want the level of choice and control that is right for them Fairly traditional use of time so far Flexibility – partly through DPs, partly through approach to Support Planning Continuity of worker(s) is an important factor Almost all service users will have at least one visit that is 3 – 4 hours long and this makes the service practicable / worthwhile There are greater than usual overheads for agency at start-up of package; this is being quantified and detailed as part of pilot
What next: Pilot runs until mid August Final evaluation and findings in September Wider discussions with other providers about wide scale roll out Training for social care workers in more personalised way of support planning
Future Much wider use of Direct Payments – transition from commissioned being the norm to being the exception for long term support Working together with providers to understand implications and manage change