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. • Costs associated with Care Commission registration

Table 2: Care Unit Revenue Costs Based on nine existing Units - 1 Daytime Staff on Duty & 1 Sleepover, 90% Occupancy & Income based on Care Home Service Users Employee costs £1,152,038 Management Costs £12,000 Premises related expenses £37,122 Supplies and services £47,596 Transport related expenses £3,499 Additional costs & contingency £90,000 Total £1,342,255 Less projected income £465,747 Total net cost £876,508

6.7 Based on these assumptions it is estimated that the total net revenue cost, excluding capital and repairs and maintenance charges, of running the nine Units would be £876k (£97k per unit).

Option 2 – Client Group with Higher Level of Care Needs

6.8 The next option considered is meeting the needs of a more dependent client group and would require additional staffing. For illustrative purposes Table 3 demonstrates the cost of employing two members of staff during the day and a sleep over at night. As with Option 1 capital and revenue investment would be required in the units.

6.9 Based on similar assumptions as in Option 1 (achieving average occupancy levels of 90%), the total revenue cost of supporting the nine units would be around £2.5m, excluding repairs & maintenance and capital charges.

Table 3: Care Unit Revenue Costs Based on nine existing Units and 2 daytime Staff on Duty & 1 Sleepover, 90% Occupancy (Social Care Worker Grade) Employee costs £2,381,286 Management Costs £12,000 Premises related expenses £37,122 Supplies and services £47,596 Transport related expenses £3,499 Additional costs & contingency £90,000 Total £2,571,503 Less projected income £522,032 Total net cost £2,049,471

It is estimated that the cost of one care unit based on this model would be £228k

6.10 This model would have the advantage of offering care during the daytime at a level broadly similar to residential care. However, there would still be the requirement to call on the Mobile Overnight Support Service team to assist the one member of staff on duty if a resident had a fall during the night. It should be noted that a number of units are outwith the areas served by the MOSS teams and therefore cannot be supported by this team.

Option 3 – Extra Care Housing

6.11 The Newhaven Consultancy report of October 2008 on Extra Care Housing report suggested the option of converting the care units and adjoining sheltered housing to extra care housing would only be viable at a scale which was unlikely to be achieved within the Western Isles. Typically, Extra Care Housing is generally for greater levels of care than would be provided by ‘housing with support’ and would include permanently staffed accommodation. Given the level of complex home care packages that are now being delivered by the Comhairle, it is unlikely that a dispersed extra care housing model would meet a demand. Accordingly, detailed modelling of this option has not been undertaken.

Option 4 – Local Hubs

6.12 A number of service models were identified by ODS Consultancy in other rural areas operating on the basis of creating local service hubs combining residential, day and home care support. The review of the Comhairle Home Care service undertaken by Glasgow University in 2005 recommended this approach. If there was demand for this kind of service, a number of advantages could accrue. Not only could it improve the wellbeing of people attending day care but also provide a wider social mix for residents in the care units. It would also provide economies for other agencies, particularly within the NHS to deliver services.

6.13 However, there is evidence that the take-up of day care could be low. The experience of Alzheimer’s Scotland at South Dell and Carloway has not been encouraging. Conversely, Tagsa Uibhist suggests that there may be a demand for day care from vulnerable older people they are supporting in the vicinity of the Iochdar Care Unit, although there is insufficient evidence to support this proposal at the moment.

Option 5 – Area Care Units with a Three Shift Pattern Covering the Waking Day and Providing Sleep-in Cover Overnight

6.14 Having considered the range of potential options for the future of the Care Unit Service, taking into account the current budget provision, it is suggested that the most viable option in terms of demand and sustainability and the type and location of care unit accommodation is to focus the service on supporting older people who do not wish to leave their community. The overview of the cost of maintaining the care units for elderly care clearly demonstrates that it is not viable to retain nine units within the existing budget, therefore the service requires to be rationalised to match the available budget.

6.15 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 • 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 of the income received from Care Home Service Users in 2006/07.

6.16 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 framework • Costs associated with Care Commission registration

Table 4: Care Unit Revenue Costs Based on four Area Care Units – 1 Daytime Staff on Duty and 1 Sleepover, 90% Occupancy. Employee costs £512,017 Management Costs £12,000 Premises related expenses £16,499 Supplies and services £21,154 Transport related expenses £1,555 Additional costs & contingency £40,000 Total £603,225 Less projected income £218,178 Total net cost £385,047

These estimates have been produced at a high level, therefore there may be additional costs to the service, although it is anticipated this can be met from the £10k contingency within each unit. This option provides us with an estimated efficiency of £59k, the will contribute to the departments budget savings to meet their Cash Planning Limit in 2009/10.

6.17 Although Garrabost does not meet the test of supporting fragile communities, it is located within an area of significant population density compared to the remainder of the Western Isles and the demand for Care Unit Service from this area is reflected in the past and current occupancy of this unit. It is proposed that a model of service provision based on Area Care Units is the best outcome within existing resources in that it provides a geographical spread of service reflecting demand in the more densely populated areas. This option also maintains a service in fragile communities where there is evidence of sustained demand from people wishing to remain in their local area and, importantly, no other local option of residential care. 6.18 The option of Area Care Unit provision would be:

• Area Care Unit: East Lewis - Garrabost. (Stornoway, Broadbay and Lochs)

• Area Care Unit: West Lewis 1 – Carloway (Garynahine to Brue and Barvas to Ness)

• Area Care Unit: West Lewis 2 – Crowlista (Uig and Bernera)

• Area Care Unit: Uist – Iochdar – to remain open for a twelve month period to allow evaluation of projected demand for this facility (North Uist, Benbecula and South Uist)

The catchment areas for each Area Care Unit would not exclude admissions from other areas but it does describe the locality and population base from which they would principally draw their resident group.

6.19 The assessment of the Care Unit Service suggests that the impact of closing some Units would be greater than others. Back is located within a less fragile community and is closely connected to services in Stornoway. The closure of this unit would have less impact on community sustainability. It is in a suitable location for a variety of other uses ranging from supported to general needs social rented housing. The location of Back is also appropriate for ‘stepping down’ support and assessment in that it could provide a more centralised service for those being discharged from hospital living on Lewis or Harris as highlighted by the ODS Consultancy. NHS Western Isles was consulted throughout the research process undertaken by ODS Consulting. Given that a ‘stepping down’ facility would specifically focus on the transition of hospital patients back to the community, it is anticipated that the capital, revenue and management costs of a re- modelled unit would be met by NHS Western Isles. The objective of a stepping down facility would be to impact on hospital delayed discharges and the frequency of re-admissions to hospital.

6.20 Scalpay has the capacity for four residents and in November there was one permanent resident. The Unit has operated at around half of its capacity over the past three years. The construction of a fixed link has resulted in Scalpay being in easy travelling distance of Harris. Given the proposed redevelopment of Harris House residential care home by 2012, the impact of closure would be less significant than in other areas.

6.21 Gravir has the capacity for three residents and in November there was one permanent resident. The Unit was closed for a period during 2005/06 and has since operated at around two-thirds capacity. There is only one resident in the vicinity receiving more than 20 hours home care and therefore the predicted demand for this unit is low.

6.22 South Dell has the capacity for three residents and in November there was one resident. Historically there has been higher than average demand for this Unit so the long term impact could be greater. There are currently 12 people in the wider area receiving more than 20 hours of home care support. However, locally based contracted home care working arrangements and Mobile Overnight Service Provision enable care packages to be arranged and sustained. Also commencing December 2008, a localised management arrangement will be in place, following the re-location of an Assistant Home Care Service Manager to the Ness area. This will further support and sustain care at home arrangements. As a consequence there is likely to be less demand for care unit places. This unit will shortly close on the transfer of the current resident to housing in the community. This will achieve, along with the temporary closure of Back Care Unit, the efficiency saving approved by the Comhairle earlier in this financial year.

6.23 Dun Innes had two permanent residents in November. Historically there has been below average demand for this unit. There are two people locally who are receiving more than 20 hours of home care support.

Table 5: Current Care Unit Service Care Unit Number of Current Residents Garrabost 4 Carloway 2 Crowlista 3 Iochdar 1 + 1 respite Back 0 Scalpay 1 Gravir 1 South Dell 1 (to transfer to community shortly) Dun Innes 2

6.24 The impact of ceasing to use some of the care units for older people would vary dependent on the Units involved. However, they are likely to be threefold:

• The need to secure alternative accommodation for any existing residents affected and the consequential disruption to their lives • The consultations undertaken by ODS Consultancy suggest that most but not all residents would choose to move to care homes in preference to other care units although residents have not been consulted about this to date. • There would be a lack of choice for some residents in terms of the option to remain in their own community.

Option 5 – Closure of Nine Care Units

The closure of all nine units was not considered feasible because there is a major lack of capacity within the care home sector which is evidenced by the waiting list of 20 people for care home vacancies. Similarly, there is major pressure on the home care service to meet the level of current demand. Accordingly, discontinuation of the care unit service would seriously impact on the Comhairle’s capacity to meet the assessed needs of older people, and the remaining service provision could not fill the gap left by the Care Unit Service

PROPOSAL

7.1 The four units that have been identified as forming the basis of Area Care Unit Service are Garrabost, Carloway and Crowlista and Iochdar - the Iochdar unit to remain open for a twelve month period, subject to evaluation of projected demand for this unit. The consequence of the closure of the remaining five units is that four people will transfer either to vacancies in an Area Care Unit or to an appropriate Care Home. The choice and decision with respect to a new placement for these individuals will be based on individual meetings with clients and their families, informed by a review of their individual care needs.

Garrabost currently has four residents, three of whom are permanent. Over the past two years there has been a high level of demand for the service.

Carloway has capacity for four residents and in November there were two permanent residents. Historically it has operated at two-thirds or greater occupancy.

Crowlista is operating at full capacity with three permanent residents and has experienced rising demand over the past three years.

Iochdar has capacity for four residents. Occupancy has been around one quarter of capacity over the past three years and in November 2008 there was one permanent resident and one respite. It is the only care unit in the Uists and is located in an area where a significant number of residents receive extensive home care packages. The model of day care at Iochdar suggested by the ODS Consultancy, is not supported by evidence of demand for this service. Given the volume of high level home care packages in the Uist area there would appear to be a reasonable case for retention of this unit for a further twelve months to test and evaluate demand from the Uist area for day care, respite and permanent placements for older people. The Mobile Overnight Support Service is available in North Uist and Benbecula and along with the introduction of contracted home care arrangements; this may reduce the demand for care unit placements.

7.2 The location of these Area Care Units to the main centres of population they would serve indicates they are within reasonable travel distance of local communities and would enable residents, family and friends to maintain regular contact and support. The proposed Area Care Units are co-terminus with the three Mobile Overnight Support Service teams currently in place in Lewis and Uist which offers a degree of back-up support overnight should a staffing problem arise at short notice within an Area Care Unit, for example, the need for additional support in the event that a client has had a fall. However, this should not be viewed as an adequate substitute for sleep-in cover, since a visiting team from the MOSS service would not meet requirements in respect of fire safety. During the waking day, support would also be available for Area Care Unit staff through the local home care service in the event that a client had a fall or for other reason required the assistance of two workers.

7.3 The proposed Area Care Unit Service is also co-terminus with Assistant Home Care Service Manager arrangements which, effective from 1 December 2008 will be re-located to patch office bases in Carloway and Ness. It is planned to roll out contracted home care working arrangements in each area where a local manager is based, given the need to manage and support these developments. Contracted working arrangements will offer reliable support arrangements to Area Care Units should there be a need to supplement staffing arrangements.

7.4 The four units which will form the proposed Area Care Unit service have also maintained a higher level of occupancy than the remaining units; therefore there is evidence to suggest that these units are potentially viable for at least the next three to five years. It is important to recognise that there is inevitably an element of risk attached to realigning the Care Unit Service and therefore it is essential that there is ongoing monitoring and evaluation of the service to ensure that it is meeting a need and performing as predicted. If demand did drop for any of these area units, then consideration would have to be given for further rationalisation of the service.

ODS Consulting Proposals

7.5 The factors which ODS Consulting considered in respect of priorities of a re-modelled care unit service are, as acknowledged in the report, not mutually exclusive and can lead to contradictory conclusions.

ODS Consulting concluded that Carloway, Crowlista and Iochdar should be the priorities for delivering a re-modelled service and the recommendations of this report are in line with this proposal.

The ODS report proposes that Iochdar be used as a pilot for a hub which includes day care and residential services. Occupancy has been low at Iochdar over the last three years and therefore it seemed prudent for this unit to remain open for a further twelve months to establish whether there is demand and the cost effectiveness of such a service and to consider alternative uses.

The ODS Consulting report places emphasis on the contribution to community sustainability, fragile communities and alternatives to centralised services. The recommendations of this report are consistent with that objective, in that Carloway, Crowlista and Iochdar are all located in such settings.

However, the ODS Consultancy report also notes that there are currently 20 people waiting for care home accommodation and that demand for residential respite in care homes has increased by nearly one quarter over the past three years. Respite care is a key element of support to family/informal carers. Places are now routinely booked twelve months in advance. Delayed hospital discharges also average four to six people at any given time throughout the year, whilst the target position set by the Scottish Government is a nil return.

Between 1991 and 2001 the proportion of the population of the Western Isles aged 65 and over increased from 18 per cent to 21 per cent, with the result that Western Isles now has the highest proportion of residents in this age group in Scotland. At the 2001 Census, lone pensioner households accounted for 17 per cent of total households compared to 15 per cent across Scotland.

Recent research highlights regional differences in ageing across Scotland and identifies the Western Isles as being projected to have a particularly high proportion of its population composed of older people. Whilst projections indicate that there will be a 36 per cent decrease in age groups under 50, age groups of 65 and over are expected to increase by 29 per cent over the same period, accounting for 31 per cent of the population in 2024, compared to 23 per cent for Scotland. Of particular significance is the 85 and over age group which is projected to increase by 55 per cent between 2006 and 2024. These projections present serious challenges to the Comhairle and its partners for the future provision of housing, care and support services.

In the context of the demand for care home places and demographic factors, consideration was given to an Area Care Unit model and, in particular, retaining a care unit within the Stornoway / Broadbay area to meet the known and projected needs of the most densely populated area of the Western Isles.

The Area Care Unit model as described in this report identifies an East, West, outlying West and South catchment areas, represented respectively by Garrabost, Carloway, Crowlista and Iochdar. Ideally, to complete this model, a unit would be in place for the North catchment area. Historically there has been demand for South Dell Unit but the introduction of contracted home care working arrangements and coverage of the area by the mobile overnight support service have all contributed to sustaining people at home consequently reducing demand for Dell Care Unit. Financial considerations also preclude the retention of South Dell Care Unit, since the budget identified in this report will support only four units.

In conclusion, the recommendations within this report are, in the main, consistent with those proposed in the ODS Consulting report. However, greater emphasis has been placed, in this report on the known demand and demographic factors and how these factors impact on the future of the Care Unit Service and, in particular, the argument for the retention of care unit in the Stornoway/Broadbay area.

Staffing Re-deployment

7.6 The proposal to close five care units and to de-shelter housing adjacent to care units, will impact on the staff numbers shown in the under noted table. For both sets of workers the opportunity of transferring to the home care service or to any vacancies within the Care Home sector exists. However, for those electing not to accept re-deployment, the option would be voluntary redundancy. The costs associated with redundancy at this stage have not been calculated.

Table 6: Staff Re-deployment Care Unit Number of Staff to be Re-deployed 0 ( Warden resigned to take up a new post Back and Relief Warden already redeployed due to closure of unit) Scalpay 2 Gravir 2 South Dell 2 Dun Innes 2 Free-Standing Sheltered Housing Scheme Number of Staff to be Re-deployed Heatherhill, Barvas 1 Tolsta 1 Murray Place 1 0 (no sheltered housing tenants and worker Leurbost has already been re-deployed) Leverburgh 0 (worker has resigned to take up new post) North Uist 0 Benbecula 0

Staffing Arrangements

7.7 Since the introduction of sleep-in arrangements in each unit covering seven nights per week, it has clearly been evidenced that it is not sustainable to maintain this level of cover from the existing care unit warden staff. The introduction of a three shift pattern namely, two waking day shifts covering 8.00am to 10.00pm and a sleep-in shift 10.00pm to 8.00am will hopefully reduce the pressure on the limited number of care unit staff available. The introduction of a specific sleep-in shift carries a degree of risk because the payment for this task is fixed at £31.86 per night and may prove unattractive as remuneration for potential applicants.

7.8 If sleep-in arrangements within a three shift pattern cannot be maintained without a break in service provision in order to ensure fire safety compliance, this would necessitate a further evaluation of the sustainability of this model provision, since the alternative to sleep-in cover is a waking member of staff on duty overnight.

Capital and Revenue Investment Programme

7.9 It is proposed to underpin the Area Care Units by a capital investment programme. The Comhairle has a budget of £400k within its 2008-12 capital programme to invest in the care units.

Previous estimates have identified the cost of addressing health and safety issues, renewal, redecoration to be: Table 7: Care Unit Capital Revenue Crowlista £22,000 £8,000 Garrabost £27,000 £15,000 Iochdar £12,000 £16,000 Carloway £19,000 £15,000 Total £80,000 £54,000

7.10 In considering which units would be identified as suitable Area Care Units, it was recognised that Carloway, Garrabost and Iochdar are four bedded units and were built later than the original three bedded units such as Crowlista. However all four units which are proposed to form the basis of an Area Care Unit service require a range of works However these estimates were prepared when the future of the care units was unknown. It is proposed that the estimates are reviewed to ensure that they are comprehensive and accurate. Significant renewal of fittings and furnishings is required to present a new image and address historical under-investment.

Charging Policy for Care Unit Clients

7.11 The current maximum charge for care unit residents is £265 per week for a permanent resident and £102.90 per week for respite care. The latter is the charge applied to residents receiving respite care in any of the Comhairle’s care homes. However, the charge for permanent residents within care units is significantly lower than the £683 (Weekly unit cost less Free Personal Care Allowance) charged to the Comhairle care home residents, reflecting the lower level of staff cover currently provided. The charge levied is means tested. The current budget for 2008/09 assumes that personal contributions will total £168,297. This is based on an average occupancy rate of 12 permanent and five respite residents as occurred in December 2007.

7.12 The weekly charge for an Area Care Unit placement will be matched to the Comhairle Care Home charging policy, given that the proposed new service will offer 24 hour staffing cover and a ratio of staff to residents of 1 to 4. Currently, the care home unit cost is £832. The new charge for the Area Care Unit Service to be effective from 01 April 2009.

New Use for Surplus Care Units

7.13 The units were designed to allow their conversion to general needs housing. Information received from Hebridean Housing Partnership indicates that demand is ‘high’ in the vicinity of Back and Garrabost, ‘medium’ in the vicinity of Dun Innes and Iochdar, and ‘low’ in the remaining areas.

7.14 The assessment of the opportunities of using the Units to provide supported accommodation for other client groups suggests this is most likely to be successful at Back and Garrabost given their proximity to Stornoway. Particular needs identified include people with learning disabilities, mental health problems and people with alcohol related conditions. However, given the co- location of care units with sheltered housing for older people there is an issue as to whether this mix of user groups would be successful.

7.15 The proposal for a ‘stepping down’ facility at Back Care Unit to be the subject of a separate report to be submitted to the February 2009 Committee series.

Sheltered Housing and Tigh Ceilidh Provision

7.16 Sheltered housing tenants electing to have a warden service receive a daily visit from the warden. They pay an additional service charge of £25.49 per week. Many of the tenants are also linked to the Faire service which costs £1.25 per week.

7.17 Wardens providing a service to tenants in the sheltered housing adjacent to the care units and care homes do so as part of their duties in the units or care homes. In the ‘freestanding’ developments, wardens live in tied or private accommodation and are contracted to work an agreed number of hours each week based on the number of tenants receiving a service.

7.18 As can be seen in table 8, it has been identified that there is significant fall in demand for sheltered housing for older people. The service historically provided by sheltered housing wardens has, to a large degree, been supplemented by telecare and home care services.

Table 8: Sheltered Housing Accommodation & Services Received by Tenants, November 2008 Tenants Tenants Tenants Original Current Tenants Receiving Receiving Receiving Sheltered Sheltered Receiving Location Warden Warden & Other Housing Housing No Service Other Services Stock Stock Services only Services* Only Sheltered Houses adjacent to Care Units Back 3 3000 3 Carloway 6 0 0 0 0 0 Crowlista 6 1 0 1 0 0 Garrabost 3 3 2 1 0 0 Gravir 5 2 0 2 0 0 Dun Innes 5 0 0 0 0 0 South Dell 7 0 0 0 0 0 Scalpay 5 1 1 0 0 0 Iochdar 3 2000 2 Freestanding Sheltered Housing Barvas 12 5 3 2 0 0 Murray Place 24 23 3 7 3 10 Leurbost 3 0 0 0 0 0 Tolsta 6 0 0 0 0 Leveburgh 6 3 3 0 0 0 North Uist 8 0 0 0 0 0 Benbecula 7 0 0 0 0 0 Total 109 43 12 13 3 15

7.19 It is proposed that sheltered housing adjacent to care units and free standing units be ‘desheltered’ and the Faire community alarm service provided as an alternative to warden services. Withdrawing these services is estimated to amount to £153k, which is included in the current budget in Table 1.

Table 9: Tigh Ceilidh Usage (Adjacent to Care Units), November 2008 Daytime Use Evening Use Care Unit Occasional Use Per Week Per Week Crowlista 3 hours Every 6 weeks used by hairdresser for 3 hours Art Attack – 9.30am to 12.30pm Bernera Nil Nil Nil Gravir 2 hours 1 Hour 5 meetings held monthly South Dell 6 hours 2 Hours OAP Art Class Elderberry Club – 2.00pm to 4.00pm Back 2 hours per Junior Youth Club fortnight once every 2 months Cairdeas – fortnightly North Golden Oldies - fortnightly Tolsta Bayhead, Catholic Church – once a month North Uist GP Consultancy – 2.00pm to 2.30pm Older People Club – fortnightly Youth Group Barra Pensioner Club – 2.00pm to 4.30pm Drama Club – infrequent use Whist Drive Barvas and To remain open meantime to enable Daliburgh alternative arrangements to be made for current day care services.

7.20 Demand for Tigh Ceilidhs as shown in table 9 is limited and it is proposed, based on current usage by user groups, that this service be discontinued. However, Barvas and Daliburgh Tigh Ceilidh provision will remain open meantime until alternative arrangements are made for the day care services provided within these settings.

ACTION PLAN

8.1 In the light of the foregoing factors, it is recommended that Garrabost, Carloway, Crowlista and Iochdar (12 months) units should be the priorities for delivering a future Care Unit service through the model of Area Care Units and this option can be funded from the current budget provision supplemented by savings resulting from de-sheltering housing.

It if further recommended that the sheltered housing complexes which are adjacent to the existing care units and free-standing schemes should all be de-sheltered and 24/7 support offered to tenants through the Faire Careline Service.

In respect of Tigh Ceilidh provision throughout the Western Isles, it is recommended that these facilities are closed and are disposed of according to Comhairle contract regulations.

Communication and Consultation

8.2 The Acting Manager, Care Units and Housing Support has been assigned the responsibility to action the decisions taken by the Comhairle in respect of this matter.

The Area Care Unit model, de-sheltering of housing and closure of Tigh Ceilidhs will impact on existing service users and their families; care unit and sheltered housing staff; partner agencies and other stakeholders. It is proposed that communication with residents and their families will be undertaken locally and will be based on two principles which will underpin the process:

• Transparency – Comhairle decisions and the implications will be clearly presented and account taken of feedback offered. • Inclusiveness – every effort will be made to ensure that residents and their families, partner agencies and other stakeholders are provided with the appropriate information regarding the re-alignment of the Care Unit Service.

Implementation

8.3 During the period 5 January to 31 March 2009, it is proposed to undertake a phased process to implement the decisions of the Comhairle.

Phase 1 • Advise all parties in writing of the decisions taken and implications.

Phase 2 • Meet with residents and users to undertake re-assessment of care needs and discuss new placement arrangements • Meet with staff to advise regarding re-deployment arrangements • Joint working with Hebridean Housing Partnership and other key stakeholders such as user groups/organisations to take forward the de-sheltering of housing and the closure of Tigh Ceilidhs • Consultation with Care Commission over the detailed proposals to ensure compliance with regulatory requirements.

Phase 3 • Projected timescale to transfer the four care unit clients affected to suitable new placements is 1 April 2009 • The projected timescale for de-sheltering process and closure of tigh ceilidhs cannot be confirmed at this stage, since it will be subject to joint working with HHP, other external partners and departments within the Council.

Phase 4 • Implement Occupancy Agreement for shared housing to each care unit resident.

Phase 5 • Re-badge the service as Area Home Care Units and actively promote it.