The Provision of Equipment in Care Homes

The Provision of Equipment in Care Homes

Plymouth Local Agreements

November 2011

(updated June 2012)

The purpose of this document is to clarify the responsibilities to provide equipment between The Community Equipment Service (CES) and Care Homes, including those that offer Nursing Care. The local guidance notes on equipment and care homes have been produced to provide clarity for clinicians and homeowners alike and to give the responsibilities for the provision of equipment a greater equity across our organisational boundaries

These local agreements must be read in conjunction with ‘Getting Started’ Community Equipment and care homes last updated 12 October 2004 (Getting Started document). This earlier document left some areas of provision to local agreements and this document provides these agreements. This document has been produced by Commissioners fromHealth and Social Care.

The Department of Health ‘Care Homes for Older People National Minimum Standards’ (Care Homes for Older People document) setsout the minimum core standards which apply to all care homes providing accommodation and nursing or personal care for older people.

Contents

Introduction - Page 1

Local definitions - Pages 2 to 5

Section 1

Arrangements for provision of equipment - Pages 6 to 11

Section 2

Provision of nursing home equipment - Pages 12 to 16

Equipment for Care homes, Care Homes providing Nursing Care and CES Plymouth Local agreement

Local definitions

Guidance To be read in conjunction with:
‘Getting Started’ Community Equipment and care homes
Last updated 12 October 2004 (Getting Started document).

Fit for purpose

The Care Standards Act 2000 requires that homes – whether providing a long term placement, short-term rehabilitation, nursing care or a specialist service – are successful in achieving their stated aims and objectives. Each home must produce a statement of purpose to enable inspectors to assess whether a home is meeting the needs of the residents. For example if the home declares that it caters for the needs of people with physical disabilities in order to be “fit for purpose” it must have good wheelchair access and a range of equipment which is likely to be needed by people with physical disabilities. If a home declares that it provides for the needs of people with dementia, it will need to make clear how this is done e.g. staff training, structured activity, décor and signage which would be helpful to people with dementia. A home which provides nursing care must employ registered nurses and have the range of equipment needed to care for people with nursing needs.
See page iv and 2 of ‘Getting started’
Equipment to meet
Manual Handling and Health & Safety
The Care Standards Act 2000 requires that the health, safety and welfare of service users and staff are promoted and protected. It is the responsibility of the registered manager to ensure that all working practices are safe. This includes infection control, moving and handling, fire safety, first aid and food hygiene.
The 1974 Health and Safety at Work Act require employers to provide suitable equipment which is maintained, training and supervision and a safe working environment. It is the employees’ responsibility to follow instructions and to ensure their own and others safety at all times. The 1992 Management of Health and Safety at Works Regulations requires employers i.e. the registered manager to ensure that risk assessments are carried out and that risks are reduced as far as possible.
See page 10 of ‘Getting Started’

Variety of equipment available

It is expected that homes will provide a range of standard equipment to meet a variety of individual needs. Account must be taken of variations in height, size, width and weight of patients and seating to have pressure relieving qualities. It is expected that homes will havea range of different types of equipment that can be used to meet their resident’s needs. This includes Seating and Beds.
See page 6 of ‘Getting Started’
The CES Service Provider can advise on a variety of products to meet the needs of residents and ensure best value is achieved.

Service users/residents/patients/clients

There are many different terms used by different organisations for the people who live in care homes. These will include service users, patients, residents or clients.

Facilitating discharge and facilitating placements

‘Getting Started’ Community Equipment and care homes last updated 12 October 2004 (Getting Started document)clearly states that Homes should not accept a client whose assessed needs they are unable to meet. It is important that the ‘Home’ provide the equipment to meet the needs of the client who has been placed with them. There may be occasions that CES would facilitate a short term loan. This would be considered on an individual basis.

Loan period would be no more than 6 weeks.
Process for Equipment Loan
The prescriber must get the full agreement of their manager before ordering equipment.
Loan period must be agreed with the ‘Care Home’ and placed on order
A care manager must be assigned to the client and be responsible for liaising with the ‘Care Home’ and conducting the review. This needs to be done prior to raising the equipmentorder. A written record must be kept by Care Home and Care Manager.
CES Manager to be informed of all equipment loaned to ‘Care Homes’. Information required:

• Client name
• ‘Care Home’ loaned to
• Loan period
• Review date
• Care Manager

The equipment must only be used by the resident it is prescribed for and the care home should contact the equipment service at the earliest opportunity that the equipment is no longer required.
At the end of week 5, the Care Home will need to be contacted and to have alternative equipment arrangements in hand and be preparing to return the equipment to the CES store. If it is temporary then the loan may be extended for one more week.
The Care Manager/Home must arrange collection.
There is no Out of Hour provision for issue of new equipment.
Private Rental arrangements for equipment
If a patients needs are assessed but not found to meet the criteria for the loan of equipment from the CES then private rental may be a solution. A rental option may facilitate a timely placement or other temporary situation e.g. rapidly deteriorating condition where needs have changed. This is the responsibility of the home and will not be financed by CES.

Replacement of equipment

When new equipment purchases need to be made it is recommended that consideration be given to replacing with a variety of models to meet different needs.
Height adjustable, electric or manual profiling beds can meet patient and care worker needs.
Chairs and commodes should be offered in a variety of heights and widths.
Chairs with wooden ended arms will show less wear and tear than fabric and are better for pushing up from sitting to standing
Commodes can be offered with removable arms to allow for sideways transfers, they may be wheeled or static and the model chosen should have a generous weight limit. Height adjustable commodes allow for individual needs to be met.
Electric hoists allow for greater ease of use than manual models & greater client comfort
Bath hoists can have reclining backs which can be more comfortable for the patient
Consider integral weighing scales when replacing hoists
When purchasing pressure relieving equipment it may be helpful to consider the following:

• Is it comfortable? Does it have a comfort dial?
• How durable is it? What is the anticipated life expectancy?
• How easy is it to clean? Are there nooks and crannies making cleaning difficult? Do the leads from the mattress to the motor have easily cleaned sleeves?
• How noisy is it? Is it likely to disturb the patient’s sleep?
• Do you need a CPR facility? Are any patients who might need resuscitating going to be nursed on it?
• Will the manufacturers provide on-going service?
• Will the manufacturer provide free of charge loan in the event of breakdown during the warranty period?
• Will the manufacturer provide ongoing in-service training for new staff on the use of the equipment?
• Consult with Nurse Specialist to identify evidence base.

Bespoke equipment
This isnon-standard community equipment and needs to be specifically tailored in respect of design, size, and weight to meet an individual’s need. This equipment must only be used by the identified individual and must not be used by other residents. The need of the patient would not be able to be met by the standard equipment service. It is expected that the home will have a variety of equipment to meet most needs, however there will be very small number of patients that may need a piece of equipment to be made or purchased to meet their needs. This will be assessed on an individual basis and a decision made on the basis of the equipment being above what would be expected for Residentialand Nursing Homes to provide.See pages 2 and 6 of ‘Getting started’.
Bariatric equipment
It is important to consider the weight of a resident in relation to the upper weight limits on equipment. Manufacturers’ specifications vary and safe working loads should be checked against manufacturers’ specifications.
As an example bed frames, mattresses and hoists, all need to be capable of taking the weight of the resident. It is expected that the ‘home’ provide the equipment.
How to return CES equipment
Equipment delivered by the CES is for a named individual following an assessment of their needs. They will need to meet the Fair Access to Care Services or health criteria to be issued with the equipment. Equipment must not be given to other residents. If for any reason they no longer require the equipment it is the responsibility of the Care Manager/Home to arrange the return of that equipment to;

• CES – via Millbrook Healthcare 0845 22 32 454
• Individually prescribed wheelchairs via Millbrook Healthcare 0845 22 32 454

Contact the Plymouth Disablement Services Centre on 01752 792777 with any enquiries regarding prosthetics.
FP10 Prescriptions
Medical items are not available through CES but items listed in the Drug Tariff ( can be ordered on NHS Prescription for individual use.
Specific details of medical items are covered in a Section 2.

Section 1

Arrangements for Provision

The table below forms part of the Plymouth local guidelines around the provision of equipment in care homes, both residential and nursing homes. The table indicates what equipment is considered to be reasonable to be provided by each organisation.

Type of equipment / Arrangements for provision / Comments
CES / Care Home / Care Home (with nursing)
Bathing Equipment
Range of bath seats / No / Yes / Yes / Homes to provide equipment as being fit for purpose
Shower Chairs / No / Yes / Yes / In certain circumstances specialist shower chairs can be provided but will be considered on an individual basis
Range of bath boards / No / Yes / Yes / Homes to provide equipment as being fit for purpose
Electric/manual bath lift / No / Yes / Yes / Homes to provide equipment as being fit for purpose
Range of shower stools / No / Yes / Yes / Homes to provide Equipment as being fit for purpose
Beds
Range of domestic beds / No / Yes / Yes / Homes to provide equipment as being fit for purpose
Standard electric profiling
Beds / No / Yes / Yes
Height adjustable
(hi-low) / No / Yes / Yes
Range of back rests / No / Yes / Yes
Mattress variator – / No / Yes / Yes
Bed levers / No / Yes / Yes
Chair Raising Equipment
Range of standard chairs / No / Yes / Yes
Chair blocks and raisers / No / Yes / Yes
Dressing Equipment
Stocking aid / No / No / No / Client to supply their own
Tights aid / No / No / No / Client to supply their own
Long-handled shoe horn / No / No / No / Client to supply their own
Environmental Support
Helping hand / No / Yes / Yes / Intermediate care settings will provide pieces of equipment to promote activities of daily living and short-term intensive rehabilitation. May be taken in from home, if already supplied there
Trolley / No / Yes / Yes / May be taken in from home, if already supplied there
Perching stool / No / Yes / Yes / May be taken in from home, if already supplied there
Small pieces of equipment may be brought in by service users; we would also expect care homes to provide small items to promote independence. E.g. adapted cutlery, breakers, plate guards
Mobility Equipment
Walking equipment provided on basis of assessment / Yes / No / No / Long term users of mobility equipment should be assessed, (usually by Physiotherapist) for individual prescription.
Ferrules / Yes / No / No
Walking stick / Yes / No / No
Fischer walking stick / Yes / No / No
Walking frames / Yes / No / No
Wheeled walking frames / Yes / No / No
3-Wheeled walking frame / Yes / No / No
4-Wheeled walking frame / Yes / No / No
Walking frame alpha / Yes / No / No
Walking frame gutter / Yes / No / No
Crutches / Yes / No / No
Gutter crutches / Yes / No / No
Delta-type walker / Yes / No / No
Rollator-type walker / Yes / No / No
Standing frames / No / No / No / This may be provided as part of a prescribed treatment plan following a specialist assessment
Mobility equipment for Bariatric Patients / Yes / No / No / Mobility equipment on request suitable for bariatric patients
Range of canes for clients with visual impairment / Yes / No / No / Supplied following an assessment
Wheelchairs
NB: Wheelchairs and accessories provided by wheelchair services for permanent and substantial usage by a named individual / No / No / No / Following prescription by accredited therapist. The wheelchair user must be able to use wheelchair for mobility. It is not as an alternative to seating provision by home.
Attendant propelled wheelchairs for transit throughout care home. / No / Yes / Yes / Variety of sizes will be needed.
Wheelchair Accessories
Ramps / No / Yes / Yes
Wheelchair cushions for communal use wheelchairs / No / Yes / Yes / Need to be able to be effectively cleaned between patients
Toileting
Bed-pan / No / Yes / Yes
Toilet seats: standard raised 2”, 4”, 6” + toilet frames / No / Yes / Yes
Urinals/bottles and non return valves / No / Yes / Yes
Range of commodes / No / Yes / Yes
Patient repositioning
Weighing scales either integral with hoists or other / No / Yes / Yes / Provision to weigh all patients must be made
For manual handling under Health & Safety at Work Act, e.g. transfer boards, glide sheets / No / Yes / Yes / Need to be able to be effectively cleaned between patients
Hoists including standing type hoist / No / Yes / Yes / Need to be able to be effectively cleaned between patients
Non-standard sling / No / No / Yes / Bespoke slings may be supplied following assessment by health or Adult Social Care professional
Standing turntable / No / Yes / Yes
Standing transfer aid / No / Yes / Yes
Mattresses
Single overlay eg. Dynapad or propad / No / Yes / Yes
Double overlay eg. Dynapad or propad / No / Yes / Yes
Pressure reducing eg. Mercury or soft form / No / Yes / Yes
Full replacement alternating eg. Airplus or Quattro / No / No / Yes
Cushions
Pressure relieving cushions eg. Dynapad, owl or Propad / No / Yes / Yes
Pressure relieving cushions for high/very high risk clients eg.Posture visco, dyna-tek gel or flotech / No / No / Yes
Cushions for wheelchairs – patient specific / No / No / No / Via Wheelchair Service
Respiration
Suction Machines / No / No / Yes
Simple nebulisers / No / No / No / Provided through Chest Clinic or patients buy their own
Seating
Chairs with tilt and space functions and integral pressure management, with adjustable seat depth and width / No / Yes / Yes
Bespoke chairs tailored for individual requirements specifically relating to the need to maintain airways or for feeding complex individuals / Yes / Yes / Yes / Based on specific client assessments completed by health or social care therapist.
Chairs with varying heights, supportive backs, integral pressure relief / No / Yes / Yes / Homes to provide equipment as being fit for purpose.
Sensory/Hearing
There is a range of small Aids available which clients can privately purchase / Advice can be obtained from Adult Social Care Hearing and Sight Centre and RNIB
Hearing loops / No / Yes / Yes
Alerting devices for bedroom door e.g. individual flashing beacon or doorbell / No / Yes / Yes
Amplified phones for communal use telephones, may be adjusted to a variety of hearing needs / No / Yes / Yes
Emergency equipment
Resuscitation equipment to maintain airways / No / Yes / Yes

Section 2

Provision of Nursing Equipment in Care Homes

August 2011

FP 10 Prescriptions
Items ordered on FP 10 are for the sole use of the individual for whom they were prescribed. Items will have been prescribed following an assessment of the individual; they may not be shared or used by another service user as this may be clinically inappropriate. Furthermore, this could be fraud and the person/organization who contravenes this can be liable to prosecution.
The following items can be ordered on FP10 for individual use.
Category / Considerations
Medication
Oral
Rectal
IV
PV
Topical
Eye and Ear / As prescribed by prescriber.
Dressings and bandages / All dressings and bandages must be prescribed for an individual on FP10. Some dressings can only be prescribed following assessment by the Tissue Viability Team.
Urology supplies
Urinary indwelling catheters
Catheter Bags
Catheter valves
Catheter maintenance solution
Sheaths
Urinal systems etc
Products e.g. pads / All residents with continence issues are eligible for a continence assessment. For Nursing Home residents the Continence Specialist Nurse will support the Nursing Home continence link nurse. Residential Home residents will be assessed by the Continence Support Nurses. Specialist nurses from the Continence Service are available for support. Appliances and products should only be prescribed following a thorough assessment that identifies a clinical need.
Nutritional supplements
PEG feeds
Subcutaneous fluids
Nutritional supplements e.g. Sip feeds
Thickening agents / PEG feeds can only be prescribed following a nutritional assessment by a Dietician/Consultant. They will set up the feeding regime and prescription. Ongoing supplies are obtained through commissioned provider.
Saline for subcutaneous fluids is available on FP10 following a medical prescriber assessment. Care homes with nursing only.
The ‘MUST’ nutritional assessment should be completed by a nurse or relevant trained professional and diet adapted to increase calorific and nutritional content before considering nutritional supplements. Available on FP10.
On the advice of a prescriber or Speech and Language Therapist for patients with swallowing problems.Available on FP10.
Stoma Care products / Stoma Care Specialist/Link will recommend most appropriate product.
Skin creams and emollients / Prescriber will prescribe following a nursing/medical assessment
Suppositories and enemas / Prescriberwill prescribe following a nursing/medical assessment. For acute problems can be supplied under a patient group directive (PGD) by a District Nurse.
Elastic hosiery / Dependent on class of hosiery and previous investigations, may need a Doppler assessment and accurate leg measurements taken before a prescription is issued by a prescriber
Diabetics
Hypodermic needles and syringes
Blood glucose testing strips
Reusable or disposable insulin pens / Prescriber will prescribe following a nursing/ medical assessment
Tracheostomy appliances e.g.
Brushes
Replacement tubes
Dressings
Protectors etc / Appliances specific to patient will be recommended following assessment. Items listed in the Drug Tariff can be prescribed on FP10
For administration of medicine
Medication / CES / Care Home / Care Home (with Nursing) / Comments
For administration of oral medicine e.g. syringes, pots and spoons / No / Yes / Yes / Care Homes to bear the costs themselves.
Spoons and oral syringeswillbe dispensed for patient specific medicines from pharmacies
For administration of rectal medication e.g. gloves / No / No
* / Yes / Powder free latex or latex free gloves to be available
* Yes - If trained to do so
For administration of medication by injection / No / No / Yes / A range of equipment would be kept for general use, some individual needs may be met by an FPIO
Intravenous therapy
Antibiotics
Flushes
PICC
Hickman / No / No / No / Bolus IV antibiotic therapy for care homes (residential) through DN service.
Syringe drivers and consumables / No / No / Yes / For emergency use - Loan drivers and initial consumables available through St Lukes at Pearn (deposit and charge applicable).
Cytotoxic drugs / No / No / No
Help with Feeding
PEG feeding equipment and consumables / No / No / No / All equipment and consumables supplied through commissioned provider, organised by dietician
Intravenous therapy
Fluid
Consumables
Drip stand / No / No / No
Medication / CES / Care Home / Care Home (with Nursing) / Comments
Subcutaneous hydration
Fluid
Consumables
Drip stand / No / No / Yes / Nursing care homes only. Medication available on FP10.
Drip stand and consumables to be supplied by care home.
Venepuncture equipment
Needles
Blood collection system (butterfly)
Vacutainer holder
Bottles / No / No / Yes / Needles and butterflies supplied by care home.
Needle exchange scheme for drug users
Sharps boxes / No / No / Yes / District nurses providing a service will carry their own sharps box. (Care home -residential only).
Dressings
Dressings, creams and lotions for individuals
Aseptic and clean procedures / No / No / No / Expectation for all care homes to have an emergency supply of dressings for first aid.
FP10 on individual patient basis.
Routine nursing procedures
Testing urine / No / No / Yes / Some of this may be available under individual prescription.
Scales / No / Yes / Yes / Home to have scales to enable patient weighing.
Continence supplies
Catheters and consumables / No / No / No / Catheters and consumables as listed in Drug Tariff available on FP 10
Catheter stand / No / No / No / Stands provided by companies
Continence products e.g. pads / No / No / No / Following continence assessment supplied through health.

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