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Title:ProvidingPlannedShortBreakServicesfor AdultService Usersandtheir CarersPolicy-guidanceforstaff

Aim/Summary:Thisguidance setsouthowstaffshould implementtheProviding Planned Short BreakServices forAdult Service UsersandtheirCarersPolicy

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Author:Maggie Pape / Responsibleteam:Strategic
Commissioning
Contactnumber:0115977 4615 / Contactemail:

Pleaseincludeanysupportingdocuments
1. ProvidingPlannedShortBreakServicesforAdultServiceUsersandtheirCarers
Policy
2. NHS Short Breaks staff guidance – appendix 1
3.
Reviewdate / Amendments

1| Page

12.04.2016 / InclusionofServiceUserLevelofNeed–definitionsand removalof‘charging’reference when cancelling.
09.10.2017 / Inclusion of notes to alert that current document is under revision and is being updated.
NHS Short Breaks staff guidance document added in Appendix 1

Providing plannedshortbreak services foradult serviceusersand theircarers– staff guidance

Contents

1.Purpose ofthisguidance ...... 3

1.1Planned shortbreakservices ...... 3

1.2Shared Lives shortbreak ...... 4

1.3Learning disabilityshortbreaksunits ...... 4

2.Assessmentofcarers’ needs and eligibilityforaservice...... 4

2.1Annualfunding renewal ...... 5

3.The NHS Short BreaksScheme ...... 5

3.1Carer’sPersonalHealth Budgetthrough a DirectPayment(forNHS CarersBreaks)...6

4.Creating an indicative personalbudgetforplanned shortbreaks ...... 6

4.1Carer’srecord...... 6

4.2Service user’srecord...... 7

5.Planned Short Breaks Matrix ...... 8

6.Decidingtheappropriate levelofpersonalbudgetforplanned shortbreaks ...... 9

6.1Exceptionalcircumstances ...... 10

7.Booking the plannedshortbreak ...... 10

7.1Managedservice ...... 10

8.Usingadirectpaymentforaplanned shortbreak ...... 11

9.Whattodo ifthecombined cost ofthe service user’spersonal budgetandthepersonalbudgetforplanned shortbreaksisveryhigh 11

10.Chargingforplanned short breakservices ...... 11

11.Transition period ...... 11

12.Processmap1–requestingshortbreakallocationsetup ...... 12

13.Processmap2–checking levelofavailable shortbreakallocation ...... 12

14.Processmap3–requestshortbreakcommissioning ...... 13

*PLEASE READ FIRST*:

This version of the ‘PlannedShortBreakServicesfor AdultService Usersandtheir CarersPolicy-guidanceforstaff’ document is now under revision. This is due to changes as a result of the implementation of Mosaic, and also changes to the NHS Short Breaks funding for ‘high impact’ level which has reduced from £950 to £650 with effect from 1st October 2017.

Please refer to appendix 1 for more information regarding the NHS Short Breaksfor Carers.

A new version of this document is being drafted to accurately reflect changes and updates which apply to Short Breaks.

Any queries should be directed to Maggie Pape, Commissioning Manager 0115 977 4615, or Dan Godley, Commissioning Officer 0115 977 4596

Mosaic process queries should be directed to the Mosaic Development Team on 0115 977 3784 or via e-mail:

1.Purpose ofthisguidance

Thepurposeofthisguidance isto assiststaffin the implementation ofthe ‘ProvidingPlanned ShortBreakServicesforAdultService UsersandtheirCarersPolicy’.Thepolicygives definitionsofthetermscarer,service userandplanned shortbreaks.Thisguidance isonly aboutPLANNED shortbreaks.Foremergencyshort termcare,seethe Carers’CrisisPrevention guidance.

Thisguidanceexplainshowto:

  • Assess acarerandservice user toseeiftheyareeligiblefor fundingforaplanned shortbreak
  • Allocatefunding tothe service user(orcarers insomecircumstances)
  • Completeprocessesin Mosaic
  • Commissionthe planned short breaksduring theyear

Keypoints:

  • Thecarermustbe linkedtotheappropriateservice useron Mosaic.
  • Thebreakmustfollowthe principles ofthe AdultSocialCare Strategy.
  • An assessmentofthecarerisrequiredto accessthe shortbreaksservice.Seethe

Carers’ Assessmentguidanceformore information.

  • An assessmentoftheservice userisalso required unlessthe NHS CarersBreak Scheme isbeing used.See theAssessment,Eligibilityand Support Planningstaffguidance.
  • Iftheservice userisnotwillingtobeassessedforcare andsupport,thenthe Council

cannotallocatea personalbudgetforplanned shortbreakstotheservice user orcarer.Inthissituation,workersshouldconsiderprovidinginformation and advice, and,in exceptionalcircumstances,theuseofanon-going Carers’ Personal Budget.

  • Itisthe impactofcaring combined with thecomplexityofthe service user’sneedsthat

determinesthe shortbreak allocation

  • The NHS CarersBreakSchememustalwaysbe discussedfirst.
  • There isnochargeforany Carers’ PersonalBudgetorCarers’ PersonalHealth

Budget,which are commissioned in thecarer’sname.

  • TheAdultSocialCareand Health Committee hasdecided nottochargecarersfor carers’services during thefinancialyear2015 -16.Thiswill be reviewed.
  • Council planned shortbreaks,which arecommissioned in theservice user’sname, aresubjectto charging.
  • Ifthecarerisa Shared Lives carer, andthereforeisbeing paidfortheircaring role,an amountofshortbreaksisalreadyagreed within the Shared Lives contract.No additionalpersonalbudgetforplanned shortbreakswill need to be created.
  • Subjecttotherulesgoverning theuseofpersonalbudgets,anykind ofservice that gives thecarerabreakfromthe normalroutine ofcaringcanbefunded,as long as sufficientfunding is allocatedtothe persontocoverthe costs.Thecarercan also use Council funding andtopup iftheywanta break thatismore expensive than another appropriateoption.

1.1Planned shortbreakservices

Theseservicesmayprovide opportunitiesforplanned shortbreaks:

  • The NHS Short BreaksScheme
  • Residential and nursing homes
  • Dedicated shortbreakunits(e.g.runbythe Council)
  • TheShared Lives shortbreakscheme
  • ‘Sitting’ services provided byhomecareagencies

Morecreative arrangementsare possible aswell,perhaps using adirectpayment,for example:

  • A carercouldgoonholiday with the persontheycareforand use Councilfunding to

paytowardsthesupportcostsoftheservice userwhilston holiday.Thecostof accommodation andfood willremaintheresponsibilityoftheservice user.The Council wouldprovidethe usualleveloffundingforthe service user.Ifthere were additionalcostsdueto beingonholiday,theservice userandcarerwould be responsibleformeeting these.The Councilfunding could notbeusedtowardsany transportcostsrelatedtotheholidayoranyofthecostsincurred bythe carer.The holidaymustbe linkedtoan outcome inthe service user’scareand supportplan.

  • A carercouldgoonholiday withoutthepersontheycareforandthe service user’s personal assistant couldsupport theperson athome,usingCouncilfunding.
  • A carercouldstay intheirown homeandthe service usercould besupported inthe personalassistant’shome,usingCouncilfunding.

1.2 Shared Lives shortbreak

Iftheservice userisgoing tohave aSharedLives shortbreak,the SharedLives Team should completetheappropriatestep in Mosaictogothroughtothe DataInputting Team(DIT)to commission thebreak.TheShared Lives Teammustcheckthatthere is sufficientallocation ofpersonalbudgetavailable inMosaic.

1.3 Learning disabilityshortbreaks units

Iftheservice userisgoing tousethe learning disabilityshortbreakunits run bythe Council, thefamilyshould bookthe planned shortbreakasusualwith theservice.The service will completetheappropriatestep in Mosaictogothroughto DataInputting Team(DIT)to commissiontheplannedshortbreak.Theservice mustcheckthatthere issufficientallocation ofpersonalbudgetavailable on Mosaic.

2.Assessmentofcarers’ needs and eligibilityforaservice

Thepurposeofthecarers’ assessmentisto determine:

  • The impactofthe caring role onthe carer’shealth,well-beingandqualityoflife.
  • Whetherthe careriseligibleforservices in his/herown right.

Thecarermusthave eligible needsin orderto accessshortbreakservices.Funding levelswill be determined bythe outcome ofthecarer’sassessment.

Theremaybe some cases where theservice userhasnotagreedfortheirdetailsto beheld in Mosaic,butinformalcare isstill being provided.Inthese cases,thecarershouldstillbe assessed inthe samewayas foranyothercarer.The allocation ofapersonalbudgetin thissituation will need tobe discussed with theresponsible budgetholder.

2.1Annualfundingrenewal

Thepersonalbudgetforplanned shortbreaksisan annualamount,created as a lumpsum and itexpires 12monthsafteritisfirstcreated.Ifthere isanymoney leftover,itisnotcarried forward.Thestartdate isthedatewhen the allocation issetup;thiscouldbe anydate inthe year(itisnot alignedtoafinancialyear,orJanuaryto January).Anotherlumpsumwill need to becreatedforeachservice user,toenable anotheryear’sworth ofplanned shortbreaksto be taken.

However, for learningdisabilityshortbreaksONLY,theperiod isfrom1st Apriltothe31st March.

Itisimportantthatstaffchecktheamountand levelofusagewhen the person hastheirCare and SupportReview.

3.The NHS ShortBreaksScheme

Ifthecareriseligibleforaplannedshortbreak,workersneedtodiscussthe NHS Carers Breaksscheme,using theapproved providerlistorthe Council’sCare Directory,with the carerfirst.Staff mustcompletethe NHS CarersBreakFundingReferralform(onMosaic) and sendthis,along with thecurrentcarers’ assessment,tothe NHS CarersBreaksteamat so thatfundingcanbeconfirmed.

Tocostupa NHS CarersBreak,staffmust:

  • CompletetheAssessmentofCarers Need(step/form)
  • SelecttheoutcomeCarersPlannedShort Breaks
  • Start thestepCarersPlanned Short Breaks
  • Completetheforminthisstep–section2refersto NHS Carers Planned Short Breaksandstaffshouldputthe costs in there
  • "High ImpactLevel"UPTO£650
  • "Extremely High ImpactLevel"UP TO£1300

The NHS CarersBreaksteamwill then sendan email totheworkerconfirming thatthecarers breakcantake place.The agreedamountshouldbe noted within the casenotes.Amaximum amountofNHSfunding is available to an eligiblecarerin any12monthperiod.

Please see appendix 1 – ‘NHS Funded Carers Breaks Service: Staff Guidance’ document for more information

Thefunding allocation iswithin afinancialyearbuttherewould be norequirementtomake anewreferral ifa shortbreakathomewentbeyondthe 31stMarch.Forbudgetmonitoringpurposesthe expenditurewould be splitacrosstwofinancialyears.However, for new assessments or reviews undertaken after the 1st October 2017, the NHSfunding allocation is now in line within the 12 months of the date of the carers assessment or review.

3.1Carer’sPersonalHealth Budgetthrougha DirectPayment(forNHS Carers Breaks)

Ifthecareriseligible andrequestsaplanned shortbreakaspartofmeeting theiroutcomes in theirsupportplan,theymaybe entitled toa Carer’s PersonalHealth Budget.

Ifthecarerandservice userare bothregistered with aGP inBroxtowe,Gedling,Rushcliffe, Mansfield,Ashfield,orNewarkandSherwood,BUT thecarerdoesnotwantto useone ofthe NHS Scheme’sapproved providers,thenadirectpayment can beusedtoenable themto arrangea breakoftheirchoice.

There will need to besound reasonsforthecarernotto usean approvedprovidere.g.carers ofpeople with dementiawho do notwantthecared-forpersonto bedistressed bygoing into a strange environment.The reasons needtoberecorded inthesupportplan.

Ifthecarerandcared-forpersonarebothregistered with aGPin Bassetlaw,the onlyoption foran NHS Carers’ Breakisadirectpayment.

Workersshouldnotcontactthe NHS CarersBreaksteamforthese breaksastheteamare notadministering thedirectpayments.The directpaymentsareadministered bythe Council usingNHSfunds.

Mosaicallowsworkersto costupthe Carers’PersonalHealth Budget(directpayment)to accessa NHS Carers’ Breakbecausetherates are amaximumthatcanbe paid and arenotfixed allocations.Ineachcasetheworkershouldcostupashortbreakand theamount should be noted within the case notes.

Iftheeligible carerneedsmore ofabreakthan isavailable underthe NHSCarers

Breakscheme,staffshouldfollowthe processtocreatean indicative personalbudgetfor planned shortbreaks. Please see appendix 1 for more information.

4.Creatinganindicativepersonalbudgetforplanned shortbreaks

PLEASE NOTE: The details below refer to processes in Framework – these may have changed since the implementation of Mosaic. Please contact the Mosaic Development Team, if you require assistance

In ordertocreate an indicative personalbudgetforplanned shortbreaks,the carer’s assessment/reviewandtheservice user’scareand supportassessment /reviewmustbeno morethan12months’old.Thefollowingprocessmustbefollowed.

4.1Carer’srecord

  • On completion ofthecarer’sassessment,thesystem providesa“levelofcarerneed” score. Pointsareawarded,dependingontheresponsesgiven bythe carer,to determine theseverityoftheimpactofhis/hercaring responsibilities on him/her,e.g.1 pointforlowimpact,5pointsformostsevereimpact.The sumofallthepointsresults in the carerbeingallocated toone of4“bands”.
  • Ifthere are 2carersbothcaring forthesameservice user,staff can eitherchoose to use thescoreforthemain carer,orusethescorethatbest reflectsthe levelofimpact thatthecaring role ishavingon bothcarers(forexample,ifonecarerhasa scoreof2 and theothercarerhasa scoreof3).
  • Workersmustnote down thisscoreas itwill need to bemanuallyinputted intothe nextMosaicprocessonthe service userrecord.

4.2Service user’srecord

  • Theprocessstaff follownextdependsonwhetherthe care andsupportassessment orreviewforthe service userhasbeencompleted ornot.
  • Ifstaff are inthe processofdoing the care andsupport assessmentorreview,they need togotothe“planned shortbreaks”section ofthe CareandSupportPlan (or ReviewofCareandSupport Plan)formandenterdetailsofthe plannedshort breaks
  • Ifthecareandsupportassessmentor reviewhasalreadybeen completed,createa“Review– CommunityBased Services” step,go tothe“plannedshortbreaks” section ofthe Care andSupportPlan(orReview ofCareandSupport Plan)formand enterdetailsofthe planned shortbreaks.
  • Opentheform“PlannedShortBreaksAllocation”

Section 1

Enterthecarer’sdetailsusing‘Find Person’.Selectthe ‘CarersAssessmentImpactBanding’ fromthe drop down list

Section 2

Determinethe levelofneed thatbestreflectstheservice userbeingcaredfor.A setof descriptions hasbeenagreedforpeople who would beclassed ashaving low,medium, high orcomplexneeds.This includes all aspectsofcare neededand supportduring thenightas well as in theday.Staffmust choosethemostappropriate levelthatrepresentstheservice userandenterthe levelintoMosaic. Forexample,

Section 3

Thesystemwill allocatea particularlevelofindicative personalbudgetforplannedshort breakstotheservice user.The value ofthisisbased on acombination of:the levelof“impact ofcaring”onthe carerandthe leveloftheservice user’sneedsin line with thePlanned Short BreaksMatrix(see below).The NHS ShortBreakexpenditurewill be subtractedfromthe overall allocation,determined bythePlanned Short BreaksMatrix.

Ifan additionalamountoffunding isrequired inexceptionalcircumstancesthiscan beadded alongwith an explanation,inthissection.This mustbeapproved byyourmanager.(Please see Section 6forfurther explanation ofexceptional circumstances)

5.Planned ShortBreaksMatrix

The,ProvidingPlannedShortBreakServicesforAdultServiceUsersandtheirCarersPolicy, explainsthatthetotalamountofpersonalbudgettobeawardedto fund plannedshortbreaks isdeterminedbycombiningthelevelof“impactofcaring”onthecarerandthelevelofthe serviceuser’sneeds.(SeeSection15for‘ServiceUserLevelofNeed–definitions’)Theresult producesanindicativeallocationofoneoffourbandsofpersonalbudget,tobecommissioned as alump sumintheservice user’sname.

  • Thecarer’sbandingdeterminesthenumberofweeksfunded
  • The leveloftheservice user’s needsdetermines the amountoffundingallocated per week.

1 weeks’ worth ofresidentialplanned shortbreaksforBand1 Carers(7nights) 2 weeks’ worth ofresidentialplanned shortbreaksforBand2 Carers(14nights) 4 weeks’ worth ofresidentialplanned shortbreaksforBand3 Carers(28nights) 6 weeks’ worth ofresidentialplanned shortbreaksforBand4 Carers(42nights)

Lowlevelservice users– funded at£600 perweek

Mediumlevelservice users– funded at£800 perweek High levelservice users– funded at£1200 perweek

Complex level service users–funded at£1500 perweek

SU Low / SU Medium / SU High / SU Complex
CarerBand 1 / £600 / £800 / £1,200 / £1,500
CarerBand 2 / £1,200 / £1,600 / £2,400 / £3,000
CarerBand 3 / £2,400 / £3,200 / £4,800 / £6,000
CarerBand 4 / £3,600 / £4,800 / £7,200 / £9,000

Althoughthese levelsare expressed asnights,thefundingcan beused inmorecreative waysas well (seesection1.1).

6.Decidingthe appropriatelevelofpersonalbudgetforplanned shortbreaks

See processmap 1– short breaksallocation setup.

  • Themostcost-effective form ofplanned shortbreakmust be offered.Thepersonmay notneedthewhole indicative budgettofundtheappropriate levelofplannedshort break,sostaffmust onlycommissionwhatleveloffundingisactuallyneeded and will be usedthroughouttheyear.There isnoneedforthefamilyto “save up”the money in case ofanyemergency;the pointofthisbudgetistouse itto have abreakandtake a rest.
  • Remember–this isaboutextraservice,ontop of(orinstead of)the normal routine of caring andservice.
  • Staff muststaywithinthe indicative levelofpersonal budget thathasbeen allocated fortheshortbreak.Ifthislevel isnotsufficienttofund thetype ofservice thatis needed,staff should referthe caseto Panelortheirgroupmanager,explainingwhat hasbeen allocated,whatleveloffundingisneeded andreasonssupporting this.Ifthe requestforadditionalfundingisagreed,acasenoteshould be enteredonto Framework,stating the datewhen thiswas agreed andthereasonswhy.
  • Oncethetype andcostofplanned shortbreakthatwill be fundedfortheyearhas been agreed,workersneed to enterthisvalue into thesupportplan in thePlanned

ShortBreaksectionanddescribethetype ofservice tobecommissioned.

  • TheShort BreaksAllocation Personal Budgetforthenext12monthswill then be “created”in Mosaicbythe DataInputTeam.
  • TheShort BreaksAllocation Personal Budgetwillnotbeusedforcommissioninguntil the actual planned shortbreaksaretakenand need tobe paidfor.

6.1Exceptionalcircumstances

Exceptionalcircumstances shouldbeexplored during thecarer’sassessmentorreviewand the serviceuser’scare and supportassessmentorreview,and discussedwith the authorised budgetholdertodetermine:

  • Anyplanned shortbreaksbeing allocatedtoanyserviceuser
  • Thecontextofthefamilysituatione.g.the intensityofthecaring situationand the carer’sindividualneedsrelated toage,orany ill health ordisabilities.

7.Booking theplannedshortbreak

7.1Managed service

Ifthecarerorservice usercontactstheCustomerService Centrewhen theywantto booka break,the Customer Service Centre will:

Step one

Checktosee ifthe carerhasa NHS Carers Breaksallocationandthen:

  • Ifthecarerhasnotbeenassessed/ reviewed fora Carer’s NHS break,theadvisorwill

completea CarerContactin Mosaicandpasstothe CarersSupport Service within the Adult AccessService

  • Ifthecarerhasanallocation outstanding fromthe Carer’s NHSBreak,theadvisorwill completea CSC updatemessageand passtothe CarersSupportService within the AdultAccessServiceforthemtobooka break.
  • IfthecarerhasusedtheirNHS allocation orthere isinsufficientfunding toproceed with thebreak,the advisorwill proceed tosteptwo.

Step two

Checktosee if the service user hasa Short BreaksAllocation in Mosaicandthen:

  • Iftheservice userdoesnothave an allocation,the advisorwill send an update messagetotheappropriateteamtobringforwardareview
  • Iftheservice userdoesnotexistonMosaicthe advisorwill completea Contact step in Mosaicand sendtothe appropriate team
  • Iftheservice userhasaShortBreaksAllocation the advisorwill proceed to stepthree.

Step three

  • Checkthetotalremaining allocation in thePersonal Budget
  • Completethe Planned Short Breakupdatemessage in Mosaicandsend through tothe appropriateoperationalteamorlearning disabilityshortbreaksunit
  • Ifthere is insufficientbudgetlefttofundarequested shortbreak,thenthesocialcare workermustinformthe carerofthissituationanddirecthim/herbacktothe case worker.

PLEASE NOTE: The details referred to in the process maps are in relation to Framework – these may have changed since the implementation of Mosaic. Please contact the Mosaic Development Team, if you require assistance

See Processmap2– checking levelofavailableshortbreakallocation See Processmap3–requestshortbreakcommissioning

8.Using adirectpaymentfora plannedshortbreak

Iftheservice userdecidestotakethe personalbudgetforplanned shortbreaksasa direct payment,the lumpsumwill be paid outto him/herin 13 instalments;i.e.every4 weeks throughout the year.Ifthisdoes notsuitthefamilybecause ofwhen theyneed topayfora planned shortbreak,thecase workershould sendan email throughtotheACFSDP inbox,to requesthowmuch isneeded and when.

Thepreference isforservice-userstousepre-paymentcardstopurchase theirplanned shortbreaks;staff should toraise awarenessofpre-paymentcards andsupporttheirusage. See thefactsheetondirectpayments pre-paymentdebitcards.

9.Whatto doif thecombined costoftheserviceuser’s personalbudgetandthe personalbudgetforplanned shortbreaksisveryhigh

Atthepointwhen the costoftheservice user’spersonalbudget(includingplannedshort breaksduring the year)exceeds the expectedcostofsupporting thatperson in anotherform ofservice (e.g.residentialcareorsupported living),thendiscussions should be held with the familyto considerthe options.

10.Chargingforplanned shortbreak services

Whenthe personalbudgetforshortbreaks isused tofundresidentialcare,SharedLivesor communitybased services,the service userwill be chargedaccording tothe CareAct2014

– CareandSupportStatutoryGuidance,chapter8,charging andfinancialassessment,atthetime when theshortbreakistaken. Seethe Council’sContributionstowards a PersonalBudgetGuidance.

All staffneedtoremind carersthatiftheycanceltheirplanned shortbreak,theyneedtogive as much notice aspossible. Thisisto ensurethatthe LocalAuthoritydoes notlosemoney unnecessarily.

11.Transition period

Itisanticipatedthatmostcarersandservice userswill be moved ontothe newallocation immediately.

However,a transition period will be allowed forpeople who areallocated a SIGNIFICANTLY LOWER ALLOCATIONOF NIGHTSTHANTHEY CURRENTLYRECEIVE(thismayparticularlyaffectusersofthe Learning DisabilityShortBreaksunits).In these exceptionalcircumstances,ithasbeen agreedthataphasedapproachmaybetaken.There willbe a period of2-3yearsforthe allocation tobereducedforthosecarerswho wouldfind itdifficult financiallyoremotionallytoacceptthereduced amountimmediately.

PLEASE NOTE: The details referred to in the process maps on the following pages are in relation to Framework – these may have changed since the implementation of Mosaic. Please contact the Mosaic Development Team if you require assistance.

13.Process map2–checkinglevelofavailableshortbreak allocation

14.Process map3–requestshortbreak commissioning

15.Service UserLevelofNeed– definitions Low

1.People at thisleveldo nothave behaviouralissuesorcognitive impairmentwhich

affectthethingsthey wantto do.Generaloversightisneededwith minimal intervention.Peoplemayneed encouragementtodo tasksoractivities.

2.No regularsupportisneeded during the night,althoughan“on-call”systemmaybe in

place.

3.People at thisleveldo nothave physicalorsensoryorpersonalneedswhich affect thethingstheywantto do,althoughtheymayneed prompting toeat, drink and carry outpersonalcaretasks.

Medium

1.People at thislevelhave behaviouralissuesorcognitive impairmentwhichdirectly affectthethingstheywantto do,onoccasionsduring theday,butdonotcurtail or preventthem.

2.People at thislevelhave physicalorsensoryorpersonalneedswhich require changesorrestrictions to thethingstheywanttodo on aregularbasis.

3.Thepersonmayrequiresupportfromsomeone else during thenight(e.g.for reassurance,tohelp thembackto bed,to assistwith physicalcare,togive medication).

4.Continence care isroutine andmanaged onaday-to-daybasis,which could be with directsupportfromanotherperson.

5.Communicationaboutneedsisdifficultto understand orinterpretorthe individualis sometimes unabletoreliablycommunicate,evenwhen assisted.Carersorcare workersmaybeable toanticipate needsthroughnon-verbalsigns duetofamiliarity with the individual.

6.Thepersonhasa levelofcognitive impairmentthatcould includefrequentshort-term memory issuesandmaybe disorientation totimeand place.The individualhas awareness ofonlya limited rangeofneedsand basicrisks.Althoughtheymaybe able tomakesomechoices appropriatetoneed on alimitedrangeofissues,theyare unable to consistentlydo so onmostissues,even with supervision,promptingor assistance.

High

1.People at thislevelhave behaviouralissueswhichcan severelyrestrictthethingsthey wantto do,suchthattheyneed close oversightforprolongedperiods.

2.Continence care isroutine butrequiresmonitoring tominimiserisks,forexample those associatedwith urinarycatheters,double incontinence,chronicurinarytract infectionsand/orthemanagementofconstipation.

3.Thepersonneedsone personto bedirectly involved with personalcaretasks.

4.Mood disturbance,hallucinationsoranxietysymptoms,orperiodsofdistress,happen on aregularbasisand have asevereimpacton the individual’shealth and/orwell- being.

5.Thepersonwill require supportfromone personduring thenight,morethan once each night(e.g.forreassurance,tohelpthembacktobed,toassistwith physical care,togive medication).

6.Thepersonhasa cognitive impairmentthatmay,forexample,include,marked short- termmemory issues,problemswith long-termmemoryorseveredisorientation to time,place orperson.

7.Physical condition :

a.Theperson iscompletelyunable toweightbearand isunableto assistor cooperatewith transfersand/orrepositioning,or

b.Due toriskofphysicalharm orloss ofmuscletone orpain onmovement,the person needscarefulpositioningand isunabletocooperate,or

c.Thepersonhasa highriskoffalls(asevidenced in afallshistoryandrisk assessment),or

d.Involuntaryspasmsorcontracturesplacing the individualorothersatrisk.

8.Thepersonhasdysphagia which requiresskilled interventiontoensure adequate nutrition/hydration andminimise theriskofchokingandaspiration tomaintain airway.

9.Thepersonrequiresadministration andmonitoring ofmedication regimebya registerednurse,carerorcare workerspecificallytrainedforthistaskbecause there arerisksassociated with thepotentialfluctuationofthemedicalconditionormental state,orrisksregarding the effectiveness ofthe medication orthepotentialnature or severityofside-effects. Evenwith suchmonitoring thecondition isusuallyproblematic tomanage.

Complex

1.Thepersonhas Continuing CareFundingfromHealth (100%),or

2.Mustmeet2 ofthefollowingconditions:

a.Riskassessmentidentifies thatthe person’sbehaviour(s)require(s)aprompt and skilled responsethatmightbe outsidetherangeofplanned interventions. Therisksaresoseriousthattheyrequire accessto an immediateandskilled response atalltimesforsafe care.

b.Cognitive impairment:The individual isunable toassessbasicriskseven with supervision,promptingorassistance,and isdependentonotherstoanticipate theirbasicneedsandtoprotectthemfromharm,neglectorhealth deterioration.

c.Thepersonwill require supportfromtwo people during thenight,morethan once each night(e.g.tohelp thembacktobed,to assistwith physicalcare,to give medication,pressure care).

d.Complexhealth needs–i.e.

•Continence care isproblematic andrequirestimelyand skilled intervention, beyond routine care (forexamplefrequentbladderwash outs,manual evacuations,frequentre-catheterisation),or

•Theperson iscompletely immobile and/orin suchpoorclinicalcondition that,in eithercase, on movementortransferthere is ahighriskofserious physicalharmandwhere thepositioning iscritical,or

•Theperson isunableto takefoodand drinkbymouth. All nutritional requirementstakenbyartificialmeansrequiring ongoingskilled professionalinterventionormonitoring overa 24hourperiod toensure nutrition/hydration,forexample I.V.fluids,or

•Thepersonhasa drug regimethatrequiresdailymonitoringbya registerednurseto ensure effective symptomandpain management associated with arapidlychanging and/ordeteriorating condition.

•Theperson isunableto reliablycommunicatetheirneedsatanytimeand in anyway,evenwhen all practicable stepstoassistthemhave been taken.The personhastohave mostoftheirneedsanticipatedbecauseof theirinabilityto communicatethem.