Here, intermediate residential care is defined as services that meet the following criteria, ie care that:. Intermediate care at this home aims to facilitate the transition from hospital care to independent living so that an individual service user may, after receiving the necessary support, return to his or her usual place of residence within a predefined time.
It is important that those admitted into intermediate care at the home benefit from the experience. The home, therefore, considers that comprehensive assessment, careful user selection and clear care planning are vital to achieve the sought outcomes for the individual. The home insists that in each case of proposed admission for intermediate residential care there must always be clear clinical and managerial accountability for each new service user.
The needs of the service user will determine the priority given to their admission to the home and the home will only allow placements for service users whose need for health care meets all the criteria set out below.
All contracts for intermediate residential care should be time limited and that time should be specified at the entering of an agreement. No significant acute changes in medical management should be anticipated within the contracted period of intermediate care provision. The assessed requirement for care should indicate that maximum independence is most likely and can be safely achieved in a residential setting with the appropriate support.
The service user should initially be assessed as being likely to return home within six weeks of admission, unless exceptional circumstances apply. The care home complies with DH guidelines stating that an agreed assessment approach is crucial to the success of the contracting process for intermediate care and that whatever assessment process is used should be agreed between all parties. Tertiary prevention could include, for example the rehabilitation of people who are severely sight impaired see also chapter 22 sight registers.
This can help develop mechanisms to cope with stress associated with caring and help carers develop an awareness of their own physical and mental health needs. Prevention services are, however, something that should always be considered. For example, at the end of life in relation to carers, prevention services could include the provision of pre-bereavement support.
The National Audit of Intermediate Care categorises 4 types of intermediate care:. Rehabilitation services can include provisions that help people attain independence and remain or return to their home and participate in their community, for example independent living skills and mobility training for people with visual impairment.
This could involve, for instance, reaching beyond traditional health or care interventions to help people develop or regain the skills of independent living and active involvement in their local community. These interventions may differ from those for people without caring responsibilities. Examples of services, facilities or resources that could contribute to preventing, delaying or reducing the needs of carers may include but is not limited to those which help carers to:.
This is not creating or adding to their caring role but including them in an approach supporting the person to live as independently as possible for as long as possible. In regard to carers, the local authority should consider how they can be supported to look after their own health and wellbeing and to have a life of their own alongside their caring responsibilities. For this group of people prevention needs to be considered through other means, such as the provision of community services and activities that would help support people to maintain an independent life.
An older man lives alone with some support from his daughter who works full-time. He needs occasional personal care to remain living independently with dignity, and it is likely that these needs will increase. An assessment would consider all of his needs, including those currently being met by his daughter, along with the outcomes he wishes to achieve. Community groups, voluntary organisations, and buddying services could support the father to reduce the social isolation that he may be feeling and maximise opportunities to look after his own health and wellbeing and participate in local community activities.
This, in turn could lessen the impact of caring on his daughter and enable her to continue to support her father effectively alongside paid employment. In this example, the aspects of wellbeing relating to social wellbeing and family relationships might be promoted.
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Local authorities should actively promote participation in providing interventions that are co-produced with individuals, families, friends, carers and the community. Such interventions can contribute to developing individual resilience and help promote self-reliance and independence, as well as ensuring that services reflect what the people who use them want.
Derby City Council used co-production to develop clear and easy to use customer information to support their new customer journey for self-directed support. New information that has been produced includes an assessment form, support planning tools for people using services, customer leaflets and a staff handbook.
A small project team held discussions and workshops to identify information that needed improving to be clearer and suggestions for improvement, for example, a new assessment form. Staff working in adult social care assessment teams had training on how to make best use of the new suite of information. The inclusive approach taken to re-designing the information took longer than an internally managed process, but has resulted in better information, informed people using services and bringing their own perspective and experience. The co-production approach led to the development of key principles which can be used in other areas of communication.
The approach is being continued. This approach recognises the value in the resources of voluntary and community groups and the other resources of the local area. Local authorities should develop a clear, local approach to prevention which sets out how they plan to fulfill this responsibility, taking into account the different types and focus of preventative support as described above. Developing a local approach to preventative support is a responsibility wider than adult care and support alone, and should include the involvement, by way of example, of those responsible for public health, leisure, transport, and housing services which are relevant to the provision of care and support.
This could include connecting to other key areas of local preventative activity outside care, including housing, planning and public health. Understanding the breadth of available local resources will help the local authority to consider what gaps may remain, and what further steps it should itself take to promote the market or to put in place its own services. Local approaches to prevention should be built on the resources of the local community, including local support networks and facilities provided by other partners and voluntary organisations.
Considering the services, facilities and resources which contribute towards preventing or delaying the development of needs for care and support is a core element of fulfilling this responsibility. A local authority should engage local providers of care and support in all aspects of delivery and encourage providers to innovate and respond flexibly to develop interventions that contribute to preventing needs for care and support. In doing so, a local authority should draw on existing analyses such as the Joint Strategic Needs Assessment, and work with other local partners such as the NHS and voluntary sector to develop a broader, shared understanding of current and future needs, and support integrated approaches to prevention.
Understanding unmet need will be crucial to developing a longer-term approach to prevention that reflects the true needs of the local population. This assessment should also be shared with local partners, such as through the health and wellbeing board, to contribute to wider intelligence for local strategies.
Preventative services, facilities or resources are often most effective when brought about through partnerships between different parts of the local authority and between other agencies and the community such as those people who are likely to use and benefit from these services. At 82, Beryl was diagnosed with stomach cancer and admitted to hospital. As a result of a major operation, she now has a permanent colostomy bag.
After only a month Beryl was successfully discharged from hospital to her own home with a reablement package from Leicester City Council and support from the housing association, Midland Heart, to help her regain her independence. If Beryl had not received this support, she would have been discharged to a more costly care home. The support service has assisted her attendance at medical appointments with her GP and monitored the impact of her medication. Preventing needs will often be most effective when action is undertaken at a local level, with different organisations working together to understand how the actions of each may impact on the other.
Across the local landscape, the role of other bodies including the local NHS for example: GPs, dentists, pharmacists, ophthalmologists , welfare and benefits advisers for example at Jobcentre Plus , the police, fire service, prisons in respect of those persons detained or released with care and support needs, service providers and others will also be important in developing a comprehensive approach. This responsibility includes in particular a focus on integrating with partners to prevent, reduce or delay needs for care and support. Helping people to access such types of support when they need it is likely to have a significant impact on their longer-term health and wellbeing, as well as potentially reducing or delaying the need for ongoing care and support from the local authority.
There are a number of interactions and access points that could bring a person into contact with the local authority or a partner organisation and act as a trigger point for the local authority to consider whether the provision of a preventative service, or some other step is appropriate. These might include, for example:. Local authorities and the voluntary sector should work together on how it can share this information to gain a fuller picture of local need as possible. Authorities should bring data from these different sources together to stratify who in the community may need care and support in the future and what types of needs they are likely to have, and use this information to target their preventative services effectively.
Approaches to identifying those people who may benefit from preventative support should consider how to locate people in such circumstances, for example:. In addition to any more targeted approaches to communicating with individuals who may benefit from preventative support, this service should include information and advice about preventative services, facilities or resources, so that anyone can find out about the types of support available locally that may meet their individual needs and circumstances, and how to access them.timensynchcasi.cf/4376-piropos-para.php
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A preventative approach requires a broad range of interventions, as one size will not fit all. However, where a local authority is not required to carry out such an assessment under the Care Act, it should nonetheless take steps to establish whether the person identified will benefit from the type of preventative support proposed. The local authority is not required to provide a care and support plan or a support plan where it only takes steps under section 2 of the Care Act; however, it should consider which aspects of a plan should be provided in these circumstances, and should provide such information as is necessary to enable the person to understand:.
Where the person refuses, but continues to appear to have needs for care and support or for support, in the case of a carer , then the local authority must proceed to offer the individual an assessment. This is regardless of whether, in fact, the adult or carer is assessed as having any care and support needs or support needs. As part of the assessment process, the local authority considers the capacity of the person to manage their needs or achieve the outcomes which matter to them, and allows for access to preventative support before a decision is made on whether the person has eligible needs see chapter 6 on assessment.
This should not assume that others are willing or able to take up caring roles. A young carer becomes vulnerable when their caring role risks impacting upon their emotional or physical wellbeing and their prospects in education and life. A local authority may become aware that a child is carrying out a caring role through an assessment or informed through family members or a school. A local authority should consider how supporting the adult with needs for care and support can prevent the young carer from under taking excessive or inappropriate care and support responsibilities.
This is to ensure that all people are provided with targeted, personalised information and advice that can support them to take steps to prevent or reduce their needs, connect more effectively with their local community, and delay the onset of greater needs to maximise their independence and quality of life. Where a person has some needs that are eligible, and also has some other needs that are not deemed to be eligible, the local authority must provide information and advice on services facilities or resources that would contribute to preventing, reducing or delaying the needs which are not eligible, and this should be aligned and be consistent with the care and support plan for the person with care needs, or support plan for the carer.
The Care and Support Preventing Needs for Care and Support Regulations continue to allow local authorities to make a charge for the provision of certain preventative services, facilities or resources. The regulations also provide that some other specified services must be provided free of charge. Some effective forms of prevention result from partnerships with other public services, voluntary and community organisations and other providers.
In developing these partnerships local authorities should consider what obstacles there may be which might prevent people on low incomes from benefitting from the activities and take reasonable steps to avoid this. In some cases, charging may be necessary in order to make a preventative service viable or keep a service running. This does not need to follow the method of the financial assessment used for mainstream charging purposes; and the use of such a process is likely to be disproportionate.
In any event, a local authority must not charge more than it costs to provide or arrange for the service, facility or resource. This is for all adults, irrespective of whether they have eligible needs for ongoing care and support. Although such types of support will usually be provided as a preventative measure under section 2 of the Act, they may also be provided as part of a package of care and support to meet eligible needs.
In these cases, regulations also provide that intermediate care or reablement cannot be charged for in the first 6 weeks, to ensure consistency. In some cases, for instance a period of rehabilitation for a visually impaired person a specific form of reablement 2 , may be expected to last longer than 6 weeks. Whilst the local authority does have the power to charge for this where it is provided beyond 6 weeks, local authorities should consider continuing to provide it free of charge beyond 6 weeks in view of the clear preventative benefits to the individual and, in many cases, the reduced risk of hospital admissions.
Poorly considered exit strategies can negate the positive outcomes of preventative services, facilities or resources, and ongoing low-level care and support can have significant impact on preventing, reducing and delaying need. Mr A is a 91 year old man who lives alone with his dog in his house.
He is usually independent, is a passionate cook and enjoys socialising. He drives a car. Whilst out walking his dog he suffered a stroke, he fell, causing a fractured neck of femur. He was admitted to hospital and underwent surgery for a hip replacement which meant he had to follow hip precautions for 6 weeks. The stroke had left him with slight left-sided weakness and problems with concentration, sequencing and attention. He was transferred to a community hospital for rehabilitation where the physiotherapists PTs and occupational therapists OTs worked on mobility, transfers, personal care following hip precautions, stair climbing and kitchen tasks.
Cognitive screens were completed and the OTs targeted their input on helping improve concentration, sequencing and attention. Mr A was discharged, independently mobile using a frame, independent transferring using equipment and stair climbing with supervision. To fulfil its duty under section 4 of the Act, a local authority is likely to need to go further than providing information and advice directly though direct provision will be important by working to ensure the coherence, sufficiency, availability and accessibility of information and advice relating to care and support across the local authority area.
Importantly, this duty to establish and maintain an information and advice service relates to the whole population of the local authority area, not just those with care and support needs or in some other way already known to the system. Local authorities cannot fulfil their universal information and advice duty simply by meeting eligible needs, and nor would information and advice always be an appropriate way of meeting eligible needs.
The service should also address, prevention of care and support needs, finances, health, housing, employment, what to do in cases of abuse or neglect of an adult and other areas where required. This chapter of guidance should therefore be read in conjunction with guidance throughout this document, including:. Local authorities should ensure that people are able to access all of these types of financial information and advice which help people plan and pay for their care.
In doing so local authorities should take account of the services currently in place and actions already taken and plans with partner organisations resulting from Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies. The information and advice service must cover the needs of all its population, not just those who are in receipt of local authority funded care or support.
For example, people may often require information and advice before they need to access care or support services, to consider what actions they may take now to prevent or delay any need for care, or how they might plan to meet the cost of future care needs. When a local need for additional information and advice services is identified, local authorities should recognise the relevance of independent and impartial advice and should consider carefully whether services should be provided by the local authority directly or by another agency, including independent providers.
This is a very broad group, extending much further than people who have an immediate need for care or support. It will only be achieved through working in partnership with the wider public and local advice and information providers. This may include information and advice on:. Information and advice must be open to everyone who would benefit from it. People access information and advice from a wide variety of sources. The authority should take account of information standards published by the Information Standards Board for Health and Social Care under the provisions of the Health and Social Care Act Information and advice should only be judged as clear if it is understood and able to be acted upon by the individual receiving it.
Local authorities will need to take steps to evaluate and ensure that information and advice is understood and able to be acted upon. Staff providing information and advice within a local authority and other frontline staff should be aware of accessibility issues and be appropriately trained. Local authorities must seek to ensure that all relevant information is available to people for them to make the best informed decision in their particular circumstances, and omission or the withholding of information would be at odds with the duty as set out in the Act. Local authorities should consider when this might most effectively be provided by an independent source rather than by the local authority itself.
This is particularly likely to be the case when people need advice about how and whether to question or challenge the decisions of the local authority or other statutory body. Depending on local circumstances, the service should also include, but not be limited to, information and advice on:. These include:. Local authorities should particularly be aware of the needs of individuals with complex but relatively rare conditions, such as deaf-blindness. Reasonable adjustments could include the provision of information in accessible formats or with communication support.
Intermediate and Continuing Care
The duty in the Care Act will not be met through the use of digital channels alone, and information and advice channels are likely to include all of the following:. Local authorities must ensure that their information and advice service has due regard to the needs of these people. These include, but are not limited to:.
From the point of first contact with or referral to the authority consideration of the duty to provide for independent advocacy to support involvement in assessment, planning and reviews should be undertaken see chapter 7 on independent advocacy. More complex issues may require more intensive and more personalised information and advice, helping people to understand the choices available to them, while general enquiries may require a less intensive approach.
For example, providing a person with too much information, more than they can take in, perhaps at a time of crisis, can be counter-productive. This can prevent them asking the right questions and can mask the articulation and identification of needs that they have, for which they could benefit from information and advice. All contact for information and advice should take account of this and be able to respond with an assessment of needs when appropriate see chapter 6.
This could include enabling access to the support of registered social work advice for those providing information and advice to people contacting the local authority. The focus should be on enabling people to access what they need through a tailored range of services that assists people to navigate all points and aspects of their journey through care and support.
People with good and impartial financial information and advice have a better understanding of how their available resources can be used more flexibly to fund a wider range of care options. This section should be read in the context of the overarching chapter and all requirements set out in this chapter, for example on accessibility and proportionality, must also be applied to financial information and advice. It should provide some of this information directly to people in its community. However, where it would not be appropriate for a local authority to provide it directly, the local authority must ensure that people are helped to understand how to access independent financial advice.
The local authority must have regard to the importance of identifying those who may benefit from financial advice or information as early as possible. This should be complemented by broader awareness raising about how care and support is funded. Local authorities may also include how care and support costs interact with retirement decisions. Actions taken by a local authority to do this should include:.
This long-term outlook means that people will want to access financial information and advice at different points in their journey to enable them to make sustainable plans to pay for their care. The local authority should provide a service that covers this breadth and that facilitates access to the full spectrum of financial information and advice — from basic budgeting tips to regulated advice — to ensure that people within its area who would benefit can access it.
They should also be aware and provide for the fact that some people will be less able to protect themselves from theft, fraud and financial exploitations see chapter 14 on safeguarding. This must include the charging framework for care and support, how contributions are calculated from both assets and income and the means tested support available; top-ups see chapter 8 on charging ; and how care and support choices may affect costs.
In the case of top-ups, the local authority should ensure that someone is willing and able to pay for them — this information will be fundamental in helping with this. The local authority should use the knowledge it has of the local care market — types of care and local providers of information and advice — to complement and develop the overarching narrative on how care funding works at the national level.
This would include both domiciliary and residential care. This will be of particular relevance where a person will be meeting the total cost of care and support themselves or may be considering taking out a deferred payment agreement see chapter 9 on deferred payments or purchasing a financial product. At the lower end of the spectrum, people may just need some basic information and support to help them rebalance their finances in light of their changing circumstances. Topics may include welfare benefits, advice on good money management, help with basic budgeting and possibly on debt management.
The local authority may be able to provide some of this information itself, for example on welfare benefits, but where it cannot, it should help people access it. In many situations the role of the local authority will be to understand the circumstances of the person, understand their preferences and help them to access the tailored information and advice that they need to make well-informed decisions. Where a person lacks capacity, the authority must establish whether a person has a deputy of the Court of Protection or a person with Lasting Power of Attorney acting on their behalf.
The local authority may consider the timing and context of any retirement decisions a person might be making and how this interacts with paying for their care and support. They should advise people of the ways to pay that others in similar circumstances would usually consider and the range of information and advice they should be considering to help make their decision.
The local authority should take a role in joining up information and advice organisations locally so they can work collaboratively. The local authority should help information and advice providers and people to understand the role of each information and advice provider so people can access the right provider at the right time and not be sent round in circles. Local authorities should provide and publicise links and information on access to wider sources of information and advice, including those available nationally.
Staff should have the knowledge to direct people to the financial information and advice they need, explaining the differences and potential benefits from seeking regulated or non-regulated financial advice. This should include both generic free and fee-based advice as well as services providing regulated forms of financial advice. Local authorities should make people aware which independent services may charge for the information and advice they provide. The local authority should ensure that they do this on a transparent basis.
But this must not mean preventing them making their own choices and having control over their lives. Everyone in the community should understand the importance of safeguarding and help keep people safe see chapter 14 on safeguarding. The information and advice provided must also cover who to tell when there are concerns about abuse or neglect and what will happen when such concerns are raised, including information on how the local Safeguarding Adults Board works.
The local authority must make its own arrangements for dealing with complaints in accordance with the regulations. The information and advice service should be aligned with wider local authority strategies such as market shaping and commissioning, and with joint area strategies with health.
The development of such plans should have regard to some common principles, including:. These national resources include guidance on principles for local information and advice strategies, case studies and practice examples. It must also co-operate more generally with each of its relevant partners taking account of their respective functions see chapter 15 on integration, cooperation and partnerships. The plan and the resulting service should adapt to changing needs and as a result of feedback and learning on what works best.
The plan should be reviewed at agreed intervals. As a minimum, the process of developing a local plan should include:. Some of the factors and circumstances that local authorities should consider in doing this will often be identified in Joint Strategic Needs Assessments. These factors may include, but are not limited to:. This may be another statutory party, such as a GP or other NHS professional, other professionals, such as a solicitor or funeral director, care and support and housing providers, or a local group, user-led or charitable organisation, rather than the local authority itself.
Local authorities should consider whether independent sources of information and advice may in some circumstances be more trusted — and therefore more effective — than the local authority itself see chapter 15, para. In particular, people should be signposted to appropriate independent information and advice when they are entering into a legal agreement with a local authority or other third party, such as a deferred payment agreement or committing to a top-up, or they wish to question, challenge or appeal a decision of the local authority or other statutory body.
A local authority plan should therefore allow for the urgent provision of information and advice when necessary. Local authorities should work with health organisations and other partners to provide targeted information and advice to people in these critical situations and where people have long-term health conditions such as dementia see paragraph 3. Where appropriate, local authorities should signpost or refer people to national sources of information and advice where these are recognised as the most useful source. Examples might include:. Local authorities are encouraged to explore how they can make the most of cost-effective partnership opportunities with national providers.
Referral or signposting to national sources should only occur where this is deemed to be in the best interests of the person and their circumstances and should not take the place of local services necessary for local authorities to discharge their duty under the Act. Local authorities will need to find the appropriate balance between local and national provision to cost-effectively meet their local need. The role of the local authority is critical to achieving this, both through the actions it takes to commission services directly to meet needs and the broader understanding of and interactions it undertakes with, the wider market, for the benefit of all local people and communities.
This can be considered a duty to facilitate the market, in the sense of using a wide range of approaches to encourage and shape it, so that it meets the needs of all people in their area who need care and support, whether arranged or funded by the state, by the individual themselves, or in other ways. The ambition is for local authorities to influence and drive the pace of change for their whole market, leading to a sustainable and diverse range of care and support providers, continuously improving quality and choice, and delivering better, innovative and cost-effective outcomes that promote the wellbeing of people who need care and support.
Local authorities have a vital role in ensuring that universal services are available to the whole population and where necessary, tailored to meet the needs of those with additional support requirements for example housing and leisure services. Market shaping and commissioning should aim to promote a market for care and support that should be seen as broadening, supplementing and supporting all these vital sources of care and support.
Commissioning and market shaping are key levers for local authorities in designing and facilitating a healthy market of quality services. Market shaping activity should stimulate a diverse range of appropriate high quality services both in terms of the types of services and the types of provider organisation , and ensure the market as a whole remains vibrant and sustainable.
It also includes working to ensure that those who purchase their own services are empowered to be effective consumers, for example by helping people who want to take direct payments make informed decisions about employing personal assistants. From the s onwards care services have been increasingly procured from the independent sector for example, not directly commissioned from and provided by an authority itself and covered all services that the authority arranged for people receiving state funding.
Since when personalisation became a mainstream policy, commissioning has also covered activity to ensure that sufficient and appropriate services are available to meet the needs of growing numbers of people with personal budgets and direct payments. This has changed the commissioning role, as purchasing decisions have been increasingly devolved to individuals and families and direct procurement using block contracts has reduced.
Commissioning has come to be shaped more by the outcomes commissioners and individuals identify, rather than volumes of activity expected and commissioners have sought to facilitate flexible arrangements with providers for other forms of service to support choice and control, such as Individual Service Funds ISFs. Contract management is the process that then ensures that the services continue to be delivered to the agreed quality standards.
Commissioning encompasses procurement but includes the wider set of strategic activities. Market shaping, commissioning, procurement and contracting are inter-related activities and the themes of this guidance will apply to each to a greater or lesser extent depending on the specific activity. Outcomes should be considered both in terms of outcomes for individuals and outcomes for groups of people and populations. Local authorities should consider the emerging revised Care Quality Commission standards for quality and any emerging national frameworks for defining outcomes.
Local authorities should ensure that achieving better outcomes is central to its commissioning strategy and practices, and should be able to demonstrate that they are moving to contracting in a way that has an outcome basis at its heart. Local authorities should consider emerging best practice on outcomes-based commissioning. Moving to an outcomes-based approach therefore means changing the way services are bought: from units of provision to meet a specified need for example, hours of care provided to what is required to ensure specified measurable outcomes for people are met.
Moving to an outcomes-based approach will need to recognise that some outcomes are challenging to assess and local authorities may wish to consider involving service providers when considering how service evaluations can be interpreted. Outcomes should be used as a principal measure for quality assurance of services. Paying for Community Services. Financing care coordination services under Medicaid.
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