2. The key messages of Home Care Re-ablement
are
> 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
3. 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
4. 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
5. Satisfaction Survey
What 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
6. Reshaping Older People’s Care Re-ablement
activity
> 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
7. Into the Spotlight Conference Dec 2008
National 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
8. City of Edinburgh Research
> JIT commissioned research into
findings of implementation i9n
Edinburgh
> Related to Re- ablement research in
England
9. EVALUATION OF CITY OF EDINBURGH COUNCIL HOME CARE RE-ABLEMENT SERVICE
Barry McLeod and Mari Mair RP&M Associates Ltd Scottish Government Social Research 2009
10.
11. 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
12. Care at Home Services – Online Redesign System
Step Process
Preparation
Preparation
Statutory
Engagement
Engage Service Stakeholder Involvement
Users, Carers,
Providers &TU
Data
Collection
ANALYSE 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
Procurement
REVIEW Review
13. 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 Data
Engage Service Resources
Users, Carers, Finance
Providers &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
14. 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 adjustments
10Two to visit adjustment - 12% of cases - hours per week
11Handover costs - 2 hours per service user - per 6 weeks
72.0
20.0
Tool
12Total Hours Per Week 2 692.0
13Total Staff 1 - 40 HPW WTE 17.3
14Team Meetings weekly - 3 hours - add 8% Staff 1.4 8
15Supervision 6 weekly - 2 hours - add 1% Staff 0.2 1
16Telephone Contact time - 1 hour per week - add 3% Staff 0.5 3
17Total Staff 2 19.4
18Cover
19Adding 22.7% for cover - Annual Leave etc 4.4
20Total Staff 3 23.8
21Adding Travel Time Total Hours Travel Time
22Travel Time Rural @ 33%% 228 692 228
23Adding further 22.7 % for cover 52
24Total Hours PW 280
25Total Staff additional staff rural for travel 8
26Grand Total Staff Rural 31.6
27Percentage staff to service users 52.6
28Travel Time Urban @ 8% 55 692 55
29Adding further 22.7% for cover 13
30Total Hours PW 68
31Total Staff additional for urban 2
32Grand Total Staff Urban 25.7
33Percentage staff to service users 43
15. 4 x Regional Events for Partnerships
ADSW event
Independent 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.
16. How do we spend the £4.5 billion …
Other Social Work
Care Homes
Emergency admissions
£0.2bn
£0.6bn
£1.4bn
Home Care
£0.3bn
FHS
£0.4bn
£0.4bn £0.8bn
£0.4bn
Prescribing Other Hospital care
Community
17. Talking Points
Service user defined outcomes
Quality of life Process Change
Feeling safe Listened to Improved
Having things to do Having a say confidence
Seeing people Respect Improved skills
As well as can be Responded to Improved mobility
Life as want (including Reliability Reduced symptoms
where you live)
18. The continuum of intermediate
care (adapted from Brophy 2008)
Social Care Healthcare
Self 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
19.
20. 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
21. Increasing Pressure - Growth in FPC
Costs
400
350
300
Expenditure (£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
22. 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 ity
W S u le ly
e s he t h a n de
Du 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
23.
24. 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 ire
W 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 ire
Du 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
25. Continued Support to Partnerships
> Focussed workshop intervention
when requested
> But on specific issues, not more of
the same
> Mentoring and Networking
> Benchmarking
26. And now?
> 18 Partnerships have introduced or
are introducing re-ablement services
> Change Fund activity all have re-
ablement focus
> Dementia addition being progressed.
27.
28. Thank you
For any more information please visit
www.jitscotland.org.uk
Alex Davidson
alex.davidson6@btinternet.com
07801 952257
Gerry Graham g.b.graham@btconnect.com
07788 951182
