Adult Care & Health Cabinet Panel 5 June 2008: Item 3 Update on Dementia Home Care Services

HERTFORDSHIRE COUNTY COUNCIL

ADULT CARE AND HEALTH CABINET PANEL

THURSDAY 5 JUNE 2008 AT 10.00AM

update on Dementia Home Care Services

Report of the Director of Adult Care Services

[Author: Guy Pettengell, Acting Head of Contracts (ACS) Tel: 01438 844269]

Executive Member:Sally Newton (Adult Care and Health)

Purpose of report

1.1To provide an update on the implementation of specialist dementia services in both the county-wide home care contract (effective 1 April 2007) and the local home care block contracts (effective 1 April 2008)

Summary

2.1In 2003 ACS identified a lack of specialist service provision needed to safely maintain users, with a medical diagnosis for dementia, in the community. In turn this lack of provision was placing additional,and potentially unnecessary, stress on residential care home places. In order to resolve this ACS decided to develop and implement a specialist dementia serviceto meet the needs of users at home. Initially the service was piloted by Leonard Cheshire (LC), who ran the countywide service.

2.2The LC contract transferred to Goldsborough Home Care Services (GHC) in February 2007 and GHC has increased service provision from 920 hours per month at the date of transfer to 1,322 hours of service per month. Alsothe service which transferred was limited to North Herts / Stevenage / Welwyn and Hatfield and Watford, 3 Rivers and Dacorum.

2.5In addition to the GHC service - and as part of the re-tender of home care services in early 2008 - the opportunity was taken to include the same requirement to provide specialist dementia services within the new contracts, together with new targets. In total, once all providers are meeting their targets, there will be a minimum of 350K hours of service available each year.

3.Recommendations

3.1This report is for information and update only.

4.Background

4.1In late 2003 ACS decided that it needed to develop its provision of specialist services for users with a medical diagnosis of dementia. Initially it was decided to pilot this service with Leonard Cheshire (LC) who managed the countywide contract. In February 2007 the LC contract transferred to Goldsborough Home Care Services (GHC) together with the small but effective group of specialist care workers who were delivering these specialist services.

4.2On transfer LC were providing a total of 920 hours of specialist service per month in support of users with a medical diagnosis of dementia. This equates to an average of 11,040 hours per annum, or just over 2% of their total provision. However they had not managed to expand the service to all areas of the county. Within the first year, GHC had increased the original service by a further 17% to 1156 hours per month with an actual provision (by the end of January) of 12,969 hours of service provided. This equates to around 3% of their total guaranteed volume. There have been further increases for the months of February, March and April with a monthly volume in April reaching 1322 hours (15,864 hours per annum). Appendix 1 provides feedback from the areas where this service has been provided from both the local service solution teams (SST) and Specialist Mental Health Teams Older People (SMHTOP)

4.3In order to further imbed the requirements of this service, the contract with GHC included a clear requirement for the ongoing provision of a robust home care service for users with a medical diagnosis of dementia and a requirement that this should be developed to deliver across the county. Following a ‘needs analysis’ conducted with the Older People Mental Health Team (SMHTOP), the new contract specified that tenderers should submit prices based on an initial need for around 10% of the total volume of provision. This would therefore provide a capacity of around 45,000 hours of specialist dementia services.

4.4The ACS contracts team also worked with SMHOTP and the Hertfordshire Partnership Foundation Trust (HPfT) to develop a specialist service specification which formed part of the new home care contracts (attached at appendix 2).

4.5Other Block Contractors

In addition to the county-wide service a similar requirement for specialist dementia services was incorporated in all new block contracts (effective 1 April 2008). Although these contracts are relatively new, all providers are committed to developing and providing these services. As part of these contracts an initial target volume was included in the contracts, again based on 10% of the total guaranteed service provision. This means that eventually these contracts will be in a position to provide a minimum volume of dementia care services (when including the C/wide service) of around 350Khours per annum.

4.6In order to ensure that providers meet the contractual target as soon as possible for this much needed service, ACS intends to agree a phased range of targets with each service provider identifying how quickly they will be able to achieve the 10% target. ACShasalready agreed the same approach with GHC and will continue to work with this provider in order to take them from their current level of service (of 3%) to their agreed contractual target of 10%. This will be achieved with both an increase in provision within their current areas together with the introduction of new services for East Herts and St.Albans / Hertsmere areas.Appendices 3(a) and 3(b)outline the progress made to date together with the agreed targets for the 08 / 09 contractual year.

4.7These targets, together with those agreed with the remaining block providers will be monitored on a monthly basis and reported via the quarterly ACSCommissioning Data Group (CDG) to ensure that the implementation remains on target.

4.8In order to maximise efficiency and provide a robust service, ACS provides free access to a rigorous and specialist training programme which adopts a ‘Train the Trainer’ approach in order that the providers’ senior care workers and staff who will be expected to provide this service can do so appropriately and effectively.

Background Papers

None.

080605 AC&H Cabinet Panel

Item 3 – Update on Dementia Homecare Services

APPENDIX 1

Feedback from SMHTOP:

“We have used the service in Wel Hat for about three or four years, are only problem is that places are limited and we have more individuals we would request this service for. Some of our service users have been with them for three years and have excellent relationships with their care workers that prove hugely beneficial in enabling the person with dementia to stay at home. This service could be expanded by offering discharge from hospital support for service users who are on the edge of needing residential care but not wanting to accept it”.

“A quick survey of those currently in the office provided an overall satisfactory response. It seems the DCO (Claire Stevens) will automatically refer to the dementia service if the care plan identifies dementia”.

“We have received quite a number of requests from CCS to reassess and increase care packages they have taken over, as well as one they want to reduce. Time will tell if their assessments are accurate.”

“The Specialist Dementia service in North Herts and Stevenage continues to be a vital element in our provision of dementia care. We have a close working partnership with both the HCC, Service Solutions team and Goldsborough Specialist dementia Service to ensure the best use of the team. This sense of partnership in care is crucial to the care management of some of our very vulnerable service users. Without the flexibility which this service offers many would not be able to remain in their own homes safely for as long as possible. The service is currently up to capacity in the area so it would be really beneficial to increase this capacity as more of our service users could then benefit from this very client centred care”.

“…staff are very frustrated about lack of service in some areas and not enough elsewhere. Demographics indicate big increases in people with dementia and we need to take more seriously the value of providing a specialist service both to benefit SU and carer”.

“… staff would be pleased to work with ACS Contracts and providers to kick start new services. I’m sure this is having an impact on the number of admissions for residential care.

NB Sally Hickman has identified that Residential applications are higher than she expected.

“Hertsmere SMHTOP does not have the benefit of this service, but would appreciate receiving it a.s.a.p!”

Feedback received from NH SST:

“The dementia service in N Herts & Stevenage works quite well. We have a regular monitoring meeting with Goldsborough and SMHT OP to discuss people already on the scheme and those who are waiting. Care planning, care worker training needs and additional support that the expertise within SMHT could offer are also covered at these meetings. Available capacity is determined by the dependency levels and needs of those on the scheme”.

Feedback received from Dacorum:

“Initially the service in Dacorum was very successful, the extra training that careworkers received enabled a number of clients to remain in the community who may not have been able to otherwise. The roll out to Watford/3 rivers was not as good, there seemed to be limited trained care workers in a number of areas, rather than a dedicated team with 1 manager. Eventually this was changed to 1 team, but this was only about 4 months prior to the transfer to Goldsborough. Due to the issues with GHC the service became less reliable and with the suspension of contract we had virtually ceased to purchase as a specific service. I have requested dementia trained careworkers for 2 clients in the last few weeks, but these are both small packages & feel it is too early to evaluate if the service is being successful again”.I believe that a dedicated team with a properly trained manager worked well & we may need to ask Goldsborough to move towards this model again”.

080605 AC&H Cabinet Panel

Item 3 Appendix 1

Appendix 2

Specification - Specialist Dementia Home Care Services

The Specialist Dementia Home Care Service will provide effective social care and domiciliary support to people with dementia and their carers. This service will be provided to Service Users who have been assessed as needing a specialist dementia service, as confirmed by Specialist Mental Health Team for Older People, (SMHTOP) for Service Users already with a recognised diagnosis of Dementia. Detailed criteria will be shared with Providers by 01.04.2008. For the avoidance of doubt the there will still be a requirement for Providers to provide a mainstream homecare service to Service Users with dementia in the community within the block contract at the core rates quoted in Schedule 5.4.

Please note there is a requirement for Providers to submit Price Rates for a Specialist Dementia Service as set out in Schedule 5.8 of the Return Schedules.

The service will enable people to have appropriate support in their own homes, have a better quality of life, and delay the need for residential care. The service will be flexible and responsive and particularly address the needs of carers.

In addition to providing personal and practical support, Care Workers will work closely with staff within the Specialist Mental Health Teams for Older people. Care Plans for this service can be more flexible. Plans will indicate a weekly allocation of hours, a defined range of tasks and a specified minimum number of visits per/day week. Care Workers can then make decisions with service users and carers about the specific visits within the parameters set by the care plan. Care plans can also be more rigid if the assessment indicates that is needed.

Care Workers on the Dementia Home Care Service will have the appropriate knowledge, skills and attitude to deliver a person centred service. They will also have received additional training in working with people with dementia and their carers, and most likely work in small teams which specifically focus on the need s of people with dementia and their families.

Eligibility for the Service:

To be eligible for this service, service users would have a recognised diagnosis of dementia, and have been assessed to need a home care service by the Specialist Mental Health Team for Older People.

Key Principles of Specialist Dementia Home Care Service

Person centred care
Respecting dignity and privacy
Encouraging independence
Valuing individuality and difference
Promoting choice and self esteem
Recognising rights and responsibilities
Maintaining a balance between safety and risk responsiveness
flexibility,
choice
control
Enabling
Support to carers
Promote independence, and offer greater control, choice and flexibility to older people and their carers.
Respect the dignity of those that are receiving them
Offer better support to older people and their carers wanting to stay in their own homes.
More control, choice and a louder voice for older people and their carers about how
Services which promote independence, improve health and quality of life.

Service Availability

This service shall be made available to accommodate 10% of the total block contracted hours. This percentage of the service may be negotiated and reviewed on an annual basis.

Specific Teams each with own Team leader

Resourced to provide 10% of block contracted hours

Referral Arrangements to the Specialist Dementia Home care Service

Assessment -Intake - Specialist Dementia Home care Service

Assessment - Specialist Dementia Home care Service

The main focus of the service is:

To work in partnership with service users and carers to identify and minimise risk elements.
To meet the social, emotional and cultural needs of the service users and carers,
To promote service users independence and empowerment by a range of activities.
To ensure the quality of life of the service user and carer can be maintained and or improved
To be flexible, supportive and provide relief from the stress of giving and receiving care
To work in partnership with service user, carer and the multidisciplinary health and social care team to support both health and social care needs
To develop an effective communication system to ensure all individuals from all agencies work in partnership with service user and carer.

Care Worker Training

Care Workers must receive an induction, one day foundation, and a specialist training programme to include but not be limited to the following:

Care Workers on the Specialist Dementia Home Care Service will have the appropriate knowledge, skills and personal attitude to deliver a person centred service. They will also have received additional training in working with people with dementia and their carers. This training will be over and above that received as part of the general induction training received by all Home Care Workers.

Training needs to address the fact that dementia can affect people over a wide age span and can manifest itself in a number of different ways which present challenges to the Care Worker. The particular needs of carers also need to be recognised and supported.

Learning Objectives

Session 1