Residential and nursing care home provision (aged 65+)

Introduction

The Department for Work and Pensions notes that “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”.

What do we know?

In Bracknell Forest people are supported to remain in their own homes as long as possible. The Adult Social Care, Health and Housing Directorate has a home-first policy that encourages people leaving hospital to return home before making any long-term decision. This aims to remove the pressure on individuals and their families to make decisions when they are in hospital. Instead people are supported to return home and 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 potential care homes and making the necessary arrangements which will ensure that s/he is at the centre of any such move.

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

Approximately 95 people aged 65 and over were admitted to permanent residential and nursing care in Bracknell Forest in 2013/14. This is 611 people per 100,000 population, which is similar to England's rate of 651 per 100,000 population (Public Health England, Adult Social Care Profile, 2015).

Pressures on permanent residential and nursing care

From figure 1 we can see that on 31st March 2014, approximately 245 older people aged 65 and over were in permanent residential or nursing care in Bracknell Forest. 5 were from a primary group of learning disabilities, 75 had physical disabilities and 165 had mental health needs. (All figures are rounded  to the nearest 5.) This is a rate of 1,580 per 100,000 population aged 18 to 64, compared to 145 per 100,000 nationally.

Figure 1 shows that the highest pressure on permanent residential and nursing care comes from mental health needs (primarily dementia) in people aged 65+. Mental health accounted for 1,075 per 100,000 population, over double that seen regionally and nationally.

Figure 1. Rate of people aged 65+ in Bracknell Forest in permanent residential and nursing care on 31st March 2014 broken down by client category, per 100,000 population.

Source: National Adult Social Care Intelligence Service (NASCIS)

Figure 2 shows the trend of the rate of people aged 65+ in permanent care in Bracknell Forest from 2012 to 2014. Rates have increased slightly since 2012 in Bracknell Forest. This is a contrast to the regional and national trends, which both show a downwards trend.

Figure 2. Number of people aged 65+ in Bracknell Forest in permanent residential and nursing care on 31st March 2014, rate per 100,000 population.

Source: National Adult Social Care Intelligence Service (NASCIS)

Adult Social Care users

In 2013/14, 78% of older people supported by Bracknell Forest's Adult Social Care Service received community-based services.14% were in residential care and 15% were in nursing care. (These figures do not equal 100% as some people will have received more than one type of service in the year) (National Adult Social Care Intelligence Service).

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

During 2013/14, supported residents aged 65 and over in Bracknell Forest spent 12,705 weeks in residential or nursing care. This was both for temporary and permanent care. The breakdown by care setting is shown below.

Table 1. Total number of weeks  that supported Bracknell Forest residents (aged 65+) spent in residential or nursing care in 2013/14 (temporary and permanent).

Residential care- LA own provision

2,000

Residential care- provided by others

4,390

Nursing care

6,315

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

Data for residents aged 18-64 in residential and nursing care can be found in under our 'People and Places' section.

National & local strategies (current best practices)

The Department of Health’s Draft Care and Support Bill (2012)

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 £72,000. However, people in 24 hour care will have to contribute £12,000 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 Bracknell Forest’s list of preferred providers. This involves not only checking their status with the Care Quality Commission and the Council’s safeguarding team, but also reviewing their 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 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 wellbeing 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. If concerns remain, a home will receive an amber flag rating and anyone placed there must receive a regular wellbeing visit until 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 Forest Council demonstrates 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 their local Council are currently subsidised by residents who fund their own care. They will often pay 50-100% more for their care.

Recommendations for consideration for other key organisations

Better information for individuals and families around paying towards residential and nursing care would be of use.

There would be advantages in having a shared understanding on the benefit of people returning home from hospital, even for a short time, to have the opportunity to choose a care home and put their affairs in order. This would help to avoid delayed transfers of care, which often arise because a patient is waiting in hospital for a bed in a particular care home.

 

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