JOINT SERVICES COMMITTEE 12 DECEMBER 2008 POLICY AND RESOURCES COMMITTEE 18 DECEMBER 2008 CARE UNITS – OPTIONS FOR FUTURE SERVICE DELIVERY Report by Chief Social Work Officer PURPOSE OF REPORT To set out a range of options for a sustainable Care Unit Service. COMPETENCE 1.1 There are no legal or constraints to the recommendations being implemented. The financial aspects of the report are contained within the body of the Report. SUMMARY 2.1 This report provides a detailed analysis of the future options for the Care Unit Service on the basis of the available budget, demographic factors and the known and projected demand for the service. A Best Value approach was taken, considering the most effective and economic option, which includes disposal of properties which are surplus to requirements and utilising capital receipts to meet one-off repairs and maintenance revenue requirements. 2.2 The report proposes an Area Care Unit Service which offers residents a 24 hour staffed service with a maximum ratio of staff to residents of one to four. The new 24 hour staffed service also meets the requirements of fire safety and, in particular, safe evacuation of buildings. 2.3 The report proposes a detailed Action Plan outlining a phased process to implement an Area Care Unit Service. RECOMMENDATIONS 3.1 It is recommended that (a) Garrabost, Carloway, Crowlista and Iochdar units should be the basis of the future Care Unit Service through the model of Area Care Units, and the remaining five care units be closed by 31 March 2009 namely, Back, South Dell, Gravir, Scalpay and Dun Innes; (b) the weekly charge for a care unit placement, effective from 01 April 2009 be amended to the Scottish Government ‘charging for residential accommodation guidance’; (c) Iochdar Unit remain open for a further twelve months until March 2010 and a report on this unit to be submitted to the February 2010 Committee series; (d) a report on the potential for a ‘stepping down’ facility at Back Care Unit as detailed at para 6.19 be submitted to the February 2009 Committee series by the General Manager, CHaSCP; (e) the sheltered housing complexes as shown in table 8 which are adjacent to the existing care units and free-standing sheltered schemes be de-sheltered, and support offered to tenants through the Faire Careline Service; (f) the surplus Care Unit and Tigh Ceilidh facilities be disposed of according to the terms of the Comhairle’s Contract Regulations. The capital receipts accruing from the disposal of Care Unit and Tigh Ceilidh provision to meet the one year only shortfall in repair and maintenance revenue costs for the remaining care units; (g) Warden staff in care units and sheltered housing affected by these changes be offered re- deployment within the Comhairle Home Care Service or to appropriate vacancies within Care Homes in line with Comhairle policy and in consultation with the relevant Trade Unions. Contact Officer: John Edward, Post: Service Manager, Community Care BACKGROUND 4.1 During the 1980s the Comhairle developed nine small care units in predominately rural areas to cater for the accommodation and social care needs of older people. Each contains three or four bedrooms with staff cover for seven waking hours of the day to provide meals and meet the care needs of residents. 4.2 Over time a fall in demand as a result of policies focussed on supporting people to remain in their own homes has led to low occupancy levels. At the same time regulation has increased, particularly in terms of the need to provide additional staffing cover to meet fire safety requirements. The Comhairle cannot meet these requirements for nine care units within the existing net budget of £284k. 4.3 There is a shortfall of permanent residential care accommodation on Lewis for older people who cannot remain in their own home as evidenced by the waiting list for vacancies within Care Homes. In addition, the ODS Consultancy identified that there is a shortfall in respite, assessment and ‘stepping down’ care on Lewis, Harris and in the Uists. THE CONTEXT OF CARE UNITS 5.1 Whilst increased regulation and, particularly, the need for a greater staff presence is having a significant impact on the viability of the care units, low demand is the biggest issue they face. Improvements in the quality of private sector housing and the introduction of home care packages have been the key factors in undermining their historic role. However, they provide an important resource in remote communities for those who require residential support and do not want to move away from their locality. 5.2 ODS Consulting undertook a consultation process during July and August 2008 with a wide range of stakeholders and identified options for the future of the Care Unit Service namely: • Care and support for older people • Respite care for older people • Delayed hospital discharge, step-down and intermediate care • Care and support for people living in their own homes • General needs housing • Care and support for people with complex needs • Care and support for people with learning disability • Care and support for people with addiction problems 5.3 Having considered the relative merits of this range of options, the most viable on-going role for the Care Unit Service is to meet the current identified needs for older people who require residential care. This will require the Comhairle to realign the service to meet the needs of potential service users and be supported by sustainable and affordable staffing arrangements. The challenge is to identify a model of care that addresses these needs, demonstrates that providing local solutions provides a viable alternative to centralised services and is cost effective. However, it is also important to recognise that the Comhairle is not starting with a ‘blank sheet of paper’. There is already a network of care unit accommodation in place with residents living in them. Reconfiguring the service to address current needs must take account of this and the pressure that exists between resolving budgetary pressures with meeting longer term strategic objectives. Any future role for the care units must fit within a continuum of care for older people and be based on the most effective harnessing of resources that all partners potentially have to offer. FUTURE OPTIONS Criteria 6.1 Consideration of options from a Best Value perspective, optimising the available budget in the context of the known and projected demand for this service. On the basis that no additional resources are available, it is proposed that the under noted factors are taken into account in reaching a decision over which care units to prioritise: • Ability to contribute to community sustainability, support fragile settlements and provide an alternative to centralised services • Previous and current occupancy; and predicted future demand • Suitability for new and appropriate uses. Table 1: Current Budgets for Care Units 2008/09 Current Care Unit Net Budget £284k Sheltered Housing Budget (Includes Tigh Ceilidhs, excludes Care Home attached properties, and includes former Supporting People funding) £153k Single Status Contribution to Current Service £12k Estimated loss in income from Sheltered Housing (Housing Support) -£5k Total £444k Option 1 – Retention of Nine Care Units with a Three Shift Pattern Covering the Waking Day and Providing Sleep-in Cover Overnight 6.2 The first prerequisite of any viable option is to meet the requirement that “a sufficient number of competent persons should be employed at all times to enable the safe and effective evacuation of the relevant premises”. As a minimum this would require one member of staff to be on waking duty during the whole daytime period and sleeping over at night. Home care staff and mobile overnight support staff would require being available in the event of a resident falling, and close working would need to be developed with the District Nursing service and other NHS staff. There may also be opportunities to partner with voluntary sector organisations. This would meet the needs of older people requiring permanent, respite care or assessment who still have a degree of mobility. However, it would not provide a service to an equivalent level of a residential care home. It would therefore be unsuitable for service users who require the on-going assistance of two staff (double handling) in respect of care interventions. 6.3 The proposals would need to be accompanied by capital and revenue investment in the units. This would include addressing the issues identified in inspection reports including installing assistive technology, hoists and possibly sprinkler systems. 6.4 The work undertaken by ODS Consultancy suggests that, with 24 hour staffing and associated investment, a need for older people could be met and demand stimulated. This would require to be accompanied by appropriate management and effective promotion of the units. The precise impact on individual units is more difficult to predict. 6.5 This model assumes that there would be three staff working shifts over a 24 hour period including a night time staff member sleeping over. It also assumes that: • Wardens cease to provide a service to the adjoining sheltered housing on the basis that the service will be phased out over time • The increased staff cover leads to an occupancy level of 90 per cent; and • The personal contribution made by residents is based on an average income from service users within the Comhairle Care Homes in 2006/07. 6.6 Given that the Comhairle’s budgets are based on historic costs, a factor of £10k per Unit has been added to take account of additional costs and variables including: • An allowance for a staff training programme which will be a pre-requisite to meet the regulatory and inspection framework.