Residential and nursing care home provision (aged <65)

Introduction

‘Care homes (sometimes called residential care homes or nursing homes) provide accommodation, meals, personal care and, in some cases, nursing care for elderly or disabled people or people who cannot manage at home because of some other condition’ (Department for Work and Pensions, 2013).

What do we know?

In Bracknell Forest people are supported to remain in their own homes as long as possible. Adult Social Care, Health and Housing (ASCHH) have a home-first policy that encourages people leaving hospital to return home before making any long-term decision about their future needs for accommodation.

This aims to remove the pressure on individuals and their families to make long-term decisions whilst in an acute setting (for example, in hospital). Instead people are supported to return home, experience in-home care, including live-in care in some cases or episodic support delivered day and night. Even in instances where it is clear that a person’s needs will be best met in 24 hour care, returning home first enables the individual to have choice. This includes visiting a potential care homes and to make the necessary arrangements which will ensure that s/he is at the centre of any such move.

However, more people, even those with very substantial care needs, are opting to be cared for in their own homes.

Facts, figures and trends

Admissions to permanent residential and nursing care

Less than 5 people aged 18-64 were admitted to permanent residential and nursing care in Bracknell Forest in 2013/14.

Pressures on permanent residential and nursing care

From figure 1 we can see that on 31st March 2014, approximately 50 people aged 18 to 64 were in permanent residential or nursing care in Bracknell Forest. 30 were from a primary group of learning disabilities, 10 had physical disabilities and 10 had mental health needs. (All figures are rounded to the nearest 5.)

This is a rate of 70 per 100,000 population aged 18 to 64, compared to 145 per 100,000 nationally.

Figure 1 shows that the highest pressures on permanent residential and nursing care homes comes from learning disability needs (45 per 100,000 population) in peopled aged 18-64. This is however, less than half that of the regional and national averages. This finding compares to that seen in those aged 65+, in which mental health (in particular dementia) is the highest pressure.

Figure 1. Rate of Bracknell Forest residents aged 18-64 in permanent residential and nursing care by primary need, 2014.

Source: National Adult Social Care Intelligence Service (NASCIS)

Figure 2 shows the rate of Bracknell Forest residents aged 18-64 in permanent residential and nursing care as a trend between 2012 and 2014. This trend has remained steady over the last 3 years and has remained much lower than the regional and national averages.

Figure 2. Rate of Bracknell Forest residents aged 18-64 in permanent residential and nursing care between 2012 and 2014.

Source: National Adult Social Care Intelligence Service (NASCIS)

Adult Social Care users

In 2013/14, 4% of people aged 18 to 64 supported by Bracknell Forest's Adult Social Care Service were in permanent residential care and 1% were in permanent nursing care. (Approximately 45 people for residential and 15 for nursing).

Number of weeks spent in residential or nursing care (temporary and permanent)

During 2013/14, supported residents aged 18 to 64 in Bracknell Forest spent 2,700 weeks in residential or nursing care. This was both for temporary and permanent care. The breakdown by client category and care setting is shown below.

Table 1. Total number of weeks  that supported Bracknell Forest residents (aged 18-64) spent in residential or nursing care in 2013/14 (temporary and permanent).

 

Physical disabilities

Learning disabilities

Mental health problems

Total

Residential care

200

1,725

265

2,190

Nursing care

230

50

230

510

Total

430

1,775

495

2,700

Source: Health and Social Care Information Centre (2014); Personal Social Services: Expenditure and Unit Costs, England (2013/14)

Data for residents aged 65+ in residential and nursing care can be found in our 'Ageing Well' section.

National & local strategies (current best practices)

The Draft Care and Support Bill

The government is currently seeking evidence around the following areas:

  • Working with local authorities, community sector and the financial services industry to raise awareness of how care works and how people can plan to pay for their care in future.
  • To ensure people receive sound financial advice around paying for care including residential and nursing care.
  • To establish a cap on what people will have to pay for their care, currently suggested to be £72K. However, people in 24 hour care will have to contribute £12K per year in room and board costs that will not count toward the cap.
  • Councils will have to offer deferred payments so that no one is forced to sell their home in order to fund their long-term care.

Bracknell Forest Council’s Care Governance

The aim of Bracknell Forest care governance is to ensure that all providers meet the highest standards of care delivery. This is of particular importance in terms of 24 hour care settings where some people may have little or no regular contact with family and friends.

All homes go through a vetting procedure before being accepted on to our list of preferred providers. This involves not only checking their status with the Care Quality Commission and the local authority safeguarding team, but reviewing of financial status, staff training policies and procedures and a visual inspection of the home wherever possible.

All safeguarding concerns are reported to the Care Governance Chair and Board and welfare checks carried out on all residents, whether or not the person is funded by the local authority. Bracknell’s Safeguarding Adults Team visits care homes to offer advice and support around improving and maintaining high standards and offers advice on Mental Capacity Act and Deprivation of Liberty Safeguards as well as general staff training. Bracknell provides training around safeguarding free of charge to all provider organisations.

Where there are concerns for the well-being of people living in a home, it is given a red flag status and no further placements can be made until lasting improvements have been demonstrated. Even then, if concerns remain, a home will receive an amber flag rating and anyone placed there must receive a regular well-being visit until such time as the home is once again green-flagged.

What is this telling us?

There is growing public concern that older people who have savings are not rewarded for their financial prudence and the pressures of an ageing population mean that a more equitable and transparent approach to funding long-term care is required.

Bracknell Council through its care governance is demonstrating that local authorities can take an active role in improving care home provision rather than remaining passive purchasers of sub-standard services.

What are the key inequalities?

Individuals whose care is funded by local authorities are currently subsidised by residents who fund their own care, who often pay some fifty to one hundred percent more for their care.

Recommendations for consideration by other key organisations

Better information for individuals and families around paying towards residential and/or nursing care would be helpful.

It is recommended that there is a shared understanding on the part of acute trusts that people benefit from returning home from hospital, even for a short time, just to have the opportunity to choose a care home for themselves and to put their affairs in order. This would do much to avoid delayed transfers of care, which often arise because a patient is waiting in hospital for a bed in a particular care home.

  • Bracknell Forest ProfileThis section contains the Bracknell Forest ward profiles and demographics.You are here
  • Starting WellThis section contains information on maternity and ages 0-4 years.You are here
  • Developing WellThis section contains information on young people's health and wellbeing.You are here
  • Living & Working WellThis section contains information on adult health conditions and lifestyle choices.You are here
  • Ageing WellThis section contains information on older people's health and wellbeing.You are here
  • People & PlacesThis section contains information on the wider determinants of health.You are here