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Western Trust Board presentation: Older People's Residential Homes

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The Directorate is proposing to close four residential care homes for older people - Greenfield in Strabane, Rectory Field and William Street in Derry/Londonderry, and Thackeray Place in Limavady - as part of the Transforming Your Care initiative. This would involve consulting on closing 128 beds across the four homes. The proposal aims to cash release funds and reinvest in alternative community-based services for older people in line with changing needs and policies favoring aging in place.

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Transforming Your Care – Vision to Action May 2013 Primary Care & Older People’sPrimary Care & Older People’s Services DirectorateServices Directorate
ProposalProposal The Directorate seeks Trust Board approval to proceed to consult on the proposed closure of four Residential Care Homes for Older People in the Western Health and Social Care Trust area as part of the TYC Vision to Action Report. The Homes involved are: - – Greenfield Residential Care Home, Strabane – Rectory Field Residential Care Home, Derry / Londonderry – Thackeray Place Residential Care Home, Limavady – William Street Residential Home, Derry / Londonderry
Presentation OverviewPresentation Overview  This document is a summary of the proposals made by Trust officers in relation to Residential Care for older people.  It gives details of the rationale behind the proposal: - – Background & Drivers for Change – Summary of Proposal – Process – Priorities – Next Steps
Drivers for ChangeDrivers for Change  WHSSB’s “Meeting the Needs of Older People Locally”, 2007-2017  Transforming Your Care – Vision to Action Consultation Document  Demographic Profile  Dementia Prevalence  RQIA Standards
Meeting the Needs of Older PeopleMeeting the Needs of Older People LocallyLocally  Older people want to remain in their own homes for as long as possible.  Recommended reform of residential care.  Recommended development of alternative community supports.
TYC Vision to ActionTYC Vision to Action • The Policy of the Government at both national and local level is that more older people who require care should be looked after at home or as close to their own homes and communities as possible. • The overarching intention of community care is to help people to live at home with appropriate and timely support. • Re-shaping services to promote independence means less people will require institutional care. • There will be a reduction of at least 50% in the provision of statutory residential care.
Demographic Profile:Demographic Profile: The age profile of the Western & Social Care Trust is changing quite significantly, 65+ Cityside Wards Waterside & Limavady Fermanagh Omagh & Strabane Western Trust Crude Population Census 2011 6,572 10,515 9,844 11,682 38,613 Crude % 17.02% 27.23% 25.49% 30.25% 100% Age Needs Weighted Population 5,745 10,378 10,435 12,438 38,996 PoC 4 Age Needs based Formula 14.73% 26.61% 26.76% 31.90% 100% Age Needs Weighted Population adjusted for Rurality and EoS 5,685 10,280 10,524 12,506 38,996 PoC 4 Age Needs based Formula adjusted for Rurality and EoS 14.58% 26.36% 26.99% 32.07% 100%
The Split of the Older Population by Age Band
Increasing Needs Associated withIncreasing Needs Associated with Dementia DiagnosisDementia Diagnosis  Increasing numbers of residents with dementia  RQIA guidance given regarding placement of people with dementia  Implications for staffing, environment, safety and risk management  Registration status needs to be considered.
• The Review of Statutory Residential Care for Older People highlighted that in line with the RQIA standards regarding the current structure/layout of the homes, each home would require a substantial financial investment to bring them up to the identified “Minimum Standards”. • Calculations are highlighted in the following table. RQIA Standards
Home Total upgrade 2008 Total upgrade 2013 Greenfield 740k 858k Rectory Field 550k 638k Thackeray Place 520k 602k William Street 496k 575k Overall £2.673milion Table of Upgrade Cost Estimates for Residential Homes
What does this mean for theWhat does this mean for the Western Area?Western Area?  Older people’s population is growing  Older people who require care have a preference to stay in their own homes  Alternative care arrangements have been developed  The need for general residential care is declining  Over the last year there has been a further decline in the admission of permanent residents.
What Does this Mean for theWhat Does this Mean for the Western Area?Western Area?  Cash Releasing & Reinvestment  Process  Alternatives to Statutory Residential Care  Priorities
Reform to DateReform to Date  Closure of Statutory Residential Care Homes: - – Foyleville, Derry / Londonderry – Drumhaw, Lisnaskea – Gortmore, Omagh
Current Beds Status Information (as at 29 April 2013) Home Bed establish- ment No. of beds occupied No. of vacant beds No. of perm residents No. of temp residents No. of respite residents No. of step down residents How many admissions in last week How many discharges in last week Greenfield 34 24 10 19 5 0 0 0 0 Rectory Field 35 22 13 14 6 0 2 1 2 Thackeray Place 32 30 2 26 4 0 0 0 0 William Street 27 20 7 15 5 0 0 0 0 TOTALS 128 96 32 74 20 0 2 1 2
Occupancy Levels (as at last day of month) From 30th April 2012- 31st March 2013 William Street (bed estab. 27) Rectory Field (bed estab. 35) Greenfield (bed estab. 34) Thackeray Place (bed estab. 32) Perm Temp Perm Temp Perm Temp Perm Temp April 12 24 0 17 10 24 5 29 1 May 12 24 0 17 9 25 5 27 1 June 12 24 0 18 8 23 4 27 1 July 12 22 0 18 9 21 4 28 1 August 12 20 1 17 8 21 4 27 1 September 12 19 0 15 9 19 7 24 1 October 12 19 1 16 8 18 6 23 4 November 12 16 2 16 10 20 4 25 4 December 12 16 1 17 9 19 5 23 4 January 13 16 3 16 5 18 6 22 5 February 13 15 5 13 6 19 7 24 4 March 13 15 5 13 6 18 5 26 3 Occupancy Levels Residential Homes
Dependency Scales (as at 31 March 2013) Independent Low Medium High Max Dependency Greenfield 1 11 12 1 0 Rectory Field 0 0 9 8 1 Thackeray Place 2 7 6 8 4 William Street 0 3 4 4 9 TOTALS 3 21 31 21 14
Dependency Scales Level ofDependency Scales Level of People in Residential CarePeople in Residential Care On review of the current dependency scales we can see there are increasing numbers of residents in the high to maximum category. This would indicate the residents in these homes are moving towards requiring nursing home care, which will result in a further reduction in demand for residential care homes.
Cash Releasing & ReinvestmentCash Releasing & Reinvestment  Potential savings of £1.313m  We are planning to cash release £313,000 for TYC.  The remainder, circa £1m, of the combined finances from the proposed closure of these homes will contribute to the re-provision costs in providing alternatives for the existing residents within the homes.
ProcessProcess  EQIA 13 week full consultation  Relatives’ and Residents’ meetings  Staff / Trade Union meetings  Inviting written and oral submissions  Public Representatives
Alternatives to StatutoryAlternatives to Statutory Residential CareResidential Care  Reablement  Flexicare  Supporting People Schemes  Independent Sector Provision  Domiciliary Care  Day Care  Integrated Service Delivery Teams including: District Nurses, Social Workers & AHPs  Rapid Response Nursing  Active Living Schemes  Community Challenging Behaviour Service
ReablementReablement This service provides the opportunity to allow people to learn or re-learn the skills necessary for daily living, which have been lost through deterioration in health and well- being and/or increased support needs. A focus on regaining physical ability is central as is active re- assessment, reducing ongoing support needs through sustaining independent living.
FlexicareFlexicare  A service made up of a partnership approach with a range of local community and voluntary groups to enable people to live within their own homes for as long as possible.  Flexicare provide services such as: - – Befriending – Assisted Shopping – Handy Help for odd jobs around the house – Chaperones to help people attend appointments – Additional services relate to affordable cleaning / gardening services.
Supported LivingSupported Living A service that enables vulnerable people to access and maintain accommodation suitable to their needs and help them to live as independently as possible, through working in partnerships with local Government, service users and supportive agencies to allow services to visit their home in the forms of personal care and clinical care.
Independent Sector ProvidersIndependent Sector Providers A number of local independent sector providers have approached the Trust indicating plans for provision of a number of residential / nursing bed within the Western Trust area in the next 12 – 15 months: - 160 beds in Cityside / Waterside 50 beds in Limavady
Alternative Care ProvidersAlternative Care Providers Strabane Area Through the Western Area Supporting People Partnership, the Directorate is exploring the potential for the provision of a Residential and Housing with Care Supported Accommodation Facility for Older People with Dementia in the Strabane area. The Trust will engage with the independent sector with a view to encouraging the development of additional accommodation in the Strabane area.
Strabane area continued There currently 23 individuals placed in a private facility within the Strabane area. These individuals are from the Derry / Londonderry and Limavady areas. It is anticipated that when alternative options become available in these individuals’ own areas the Trust will engage with those residents to facilitate transfers back into their own areas if they wish. This will then create capacity within the private sector within the Strabane area. Currently in Greenfield there are some residents with a diagnosis of dementia whose needs would be better met in a dementia specific facility.
Derry / Londonderry The Trust has been approached by an independent sector provider who will open a 46 bedded care home on the Culmore Road area of the City in December 2013. There is also a plan within the following 12 months to increase capacity by an additional 34 beds (making 80 in total).
Derry / Londonderry continued The Trust has been approached by an independent sector provider indicating plans to open an 82 bedded facility in the Trench Road area with a mixed provision of dementia care, residential, intermediate and nursing care. There are currently some residents within the Rectory Field and William Street with a dementia diagnosis whose needs would be better met in a dementia specific facility.
Limavady area An independent sector provider has advised the Trust it will be increasing its current bed capacity by 50. A further proposal for Limavady will be the subject of a SOC (Strategic Outline Case) and will be submitted via the WASPP (Western Area Supporting People Partnership) for consideration. There are currently some residents in Thackeray Place with a dementia diagnosis whose needs would be better met in a dementia specific facility.
PrioritiesPriorities – Supporting Residents and Families through this difficult period including Independent Advocacy. – Supporting Staff through the change process and securing suitable alternative employment – Securing Supporting People funding to develop some alternative accommodation. – Keeping the public and service users aware of direction and developments. NB: No closure would happen unless a suitable alternative is in place.
Summary of ProposalSummary of Proposal  In summary the Directorate currently provides statutory residential care for Older People in 5 homes with a total bed complement of 153.  The Directorate proposes to complete a full EQIA Consultation over a 13 week period.  Homes subject to consultation are: Greenfield, Rectory Field, Thackeray Place & William Street Residential Care Homes involving 128 beds.  The exception is Seymour Gardens Residential Care Home which is a Dementia Care specific home  The consultation would commence on 1st June 2013.  Proposal if agreed – homes would close 12 months following decision being made, subject to suitable alternatives being in place.  Subject to Trust Board approval  Subject to Ministerial approval
Next StepsNext Steps  The Directorate submits this proposal to Trust Board for approval to proceed to consult on the proposed closure of four Residential Care Homes for Older People in the WHSCT area as part of the TYC Vision to Action Report.

More Related Content

Western Trust Board presentation: Older People's Residential Homes

  • 1. Transforming Your Care – Vision to Action May 2013 Primary Care & Older People’sPrimary Care & Older People’s Services DirectorateServices Directorate
  • 2. ProposalProposal The Directorate seeks Trust Board approval to proceed to consult on the proposed closure of four Residential Care Homes for Older People in the Western Health and Social Care Trust area as part of the TYC Vision to Action Report. The Homes involved are: - – Greenfield Residential Care Home, Strabane – Rectory Field Residential Care Home, Derry / Londonderry – Thackeray Place Residential Care Home, Limavady – William Street Residential Home, Derry / Londonderry
  • 3. Presentation OverviewPresentation Overview  This document is a summary of the proposals made by Trust officers in relation to Residential Care for older people.  It gives details of the rationale behind the proposal: - – Background & Drivers for Change – Summary of Proposal – Process – Priorities – Next Steps
  • 4. Drivers for ChangeDrivers for Change  WHSSB’s “Meeting the Needs of Older People Locally”, 2007-2017  Transforming Your Care – Vision to Action Consultation Document  Demographic Profile  Dementia Prevalence  RQIA Standards
  • 5. Meeting the Needs of Older PeopleMeeting the Needs of Older People LocallyLocally  Older people want to remain in their own homes for as long as possible.  Recommended reform of residential care.  Recommended development of alternative community supports.
  • 6. TYC Vision to ActionTYC Vision to Action • The Policy of the Government at both national and local level is that more older people who require care should be looked after at home or as close to their own homes and communities as possible. • The overarching intention of community care is to help people to live at home with appropriate and timely support. • Re-shaping services to promote independence means less people will require institutional care. • There will be a reduction of at least 50% in the provision of statutory residential care.
  • 7. Demographic Profile:Demographic Profile: The age profile of the Western & Social Care Trust is changing quite significantly, 65+ Cityside Wards Waterside & Limavady Fermanagh Omagh & Strabane Western Trust Crude Population Census 2011 6,572 10,515 9,844 11,682 38,613 Crude % 17.02% 27.23% 25.49% 30.25% 100% Age Needs Weighted Population 5,745 10,378 10,435 12,438 38,996 PoC 4 Age Needs based Formula 14.73% 26.61% 26.76% 31.90% 100% Age Needs Weighted Population adjusted for Rurality and EoS 5,685 10,280 10,524 12,506 38,996 PoC 4 Age Needs based Formula adjusted for Rurality and EoS 14.58% 26.36% 26.99% 32.07% 100%
  • 8. The Split of the Older Population by Age Band
  • 9. Increasing Needs Associated withIncreasing Needs Associated with Dementia DiagnosisDementia Diagnosis  Increasing numbers of residents with dementia  RQIA guidance given regarding placement of people with dementia  Implications for staffing, environment, safety and risk management  Registration status needs to be considered.
  • 10. • The Review of Statutory Residential Care for Older People highlighted that in line with the RQIA standards regarding the current structure/layout of the homes, each home would require a substantial financial investment to bring them up to the identified “Minimum Standards”. • Calculations are highlighted in the following table. RQIA Standards
  • 11. Home Total upgrade 2008 Total upgrade 2013 Greenfield 740k 858k Rectory Field 550k 638k Thackeray Place 520k 602k William Street 496k 575k Overall £2.673milion Table of Upgrade Cost Estimates for Residential Homes
  • 12. What does this mean for theWhat does this mean for the Western Area?Western Area?  Older people’s population is growing  Older people who require care have a preference to stay in their own homes  Alternative care arrangements have been developed  The need for general residential care is declining  Over the last year there has been a further decline in the admission of permanent residents.
  • 13. What Does this Mean for theWhat Does this Mean for the Western Area?Western Area?  Cash Releasing & Reinvestment  Process  Alternatives to Statutory Residential Care  Priorities
  • 14. Reform to DateReform to Date  Closure of Statutory Residential Care Homes: - – Foyleville, Derry / Londonderry – Drumhaw, Lisnaskea – Gortmore, Omagh
  • 15. Current Beds Status Information (as at 29 April 2013) Home Bed establish- ment No. of beds occupied No. of vacant beds No. of perm residents No. of temp residents No. of respite residents No. of step down residents How many admissions in last week How many discharges in last week Greenfield 34 24 10 19 5 0 0 0 0 Rectory Field 35 22 13 14 6 0 2 1 2 Thackeray Place 32 30 2 26 4 0 0 0 0 William Street 27 20 7 15 5 0 0 0 0 TOTALS 128 96 32 74 20 0 2 1 2
  • 16. Occupancy Levels (as at last day of month) From 30th April 2012- 31st March 2013 William Street (bed estab. 27) Rectory Field (bed estab. 35) Greenfield (bed estab. 34) Thackeray Place (bed estab. 32) Perm Temp Perm Temp Perm Temp Perm Temp April 12 24 0 17 10 24 5 29 1 May 12 24 0 17 9 25 5 27 1 June 12 24 0 18 8 23 4 27 1 July 12 22 0 18 9 21 4 28 1 August 12 20 1 17 8 21 4 27 1 September 12 19 0 15 9 19 7 24 1 October 12 19 1 16 8 18 6 23 4 November 12 16 2 16 10 20 4 25 4 December 12 16 1 17 9 19 5 23 4 January 13 16 3 16 5 18 6 22 5 February 13 15 5 13 6 19 7 24 4 March 13 15 5 13 6 18 5 26 3 Occupancy Levels Residential Homes
  • 17. Dependency Scales (as at 31 March 2013) Independent Low Medium High Max Dependency Greenfield 1 11 12 1 0 Rectory Field 0 0 9 8 1 Thackeray Place 2 7 6 8 4 William Street 0 3 4 4 9 TOTALS 3 21 31 21 14
  • 18. Dependency Scales Level ofDependency Scales Level of People in Residential CarePeople in Residential Care On review of the current dependency scales we can see there are increasing numbers of residents in the high to maximum category. This would indicate the residents in these homes are moving towards requiring nursing home care, which will result in a further reduction in demand for residential care homes.
  • 19. Cash Releasing & ReinvestmentCash Releasing & Reinvestment  Potential savings of £1.313m  We are planning to cash release £313,000 for TYC.  The remainder, circa £1m, of the combined finances from the proposed closure of these homes will contribute to the re-provision costs in providing alternatives for the existing residents within the homes.
  • 20. ProcessProcess  EQIA 13 week full consultation  Relatives’ and Residents’ meetings  Staff / Trade Union meetings  Inviting written and oral submissions  Public Representatives
  • 21. Alternatives to StatutoryAlternatives to Statutory Residential CareResidential Care  Reablement  Flexicare  Supporting People Schemes  Independent Sector Provision  Domiciliary Care  Day Care  Integrated Service Delivery Teams including: District Nurses, Social Workers & AHPs  Rapid Response Nursing  Active Living Schemes  Community Challenging Behaviour Service
  • 22. ReablementReablement This service provides the opportunity to allow people to learn or re-learn the skills necessary for daily living, which have been lost through deterioration in health and well- being and/or increased support needs. A focus on regaining physical ability is central as is active re- assessment, reducing ongoing support needs through sustaining independent living.
  • 23. FlexicareFlexicare  A service made up of a partnership approach with a range of local community and voluntary groups to enable people to live within their own homes for as long as possible.  Flexicare provide services such as: - – Befriending – Assisted Shopping – Handy Help for odd jobs around the house – Chaperones to help people attend appointments – Additional services relate to affordable cleaning / gardening services.
  • 24. Supported LivingSupported Living A service that enables vulnerable people to access and maintain accommodation suitable to their needs and help them to live as independently as possible, through working in partnerships with local Government, service users and supportive agencies to allow services to visit their home in the forms of personal care and clinical care.
  • 25. Independent Sector ProvidersIndependent Sector Providers A number of local independent sector providers have approached the Trust indicating plans for provision of a number of residential / nursing bed within the Western Trust area in the next 12 – 15 months: - 160 beds in Cityside / Waterside 50 beds in Limavady
  • 26. Alternative Care ProvidersAlternative Care Providers Strabane Area Through the Western Area Supporting People Partnership, the Directorate is exploring the potential for the provision of a Residential and Housing with Care Supported Accommodation Facility for Older People with Dementia in the Strabane area. The Trust will engage with the independent sector with a view to encouraging the development of additional accommodation in the Strabane area.
  • 27. Strabane area continued There currently 23 individuals placed in a private facility within the Strabane area. These individuals are from the Derry / Londonderry and Limavady areas. It is anticipated that when alternative options become available in these individuals’ own areas the Trust will engage with those residents to facilitate transfers back into their own areas if they wish. This will then create capacity within the private sector within the Strabane area. Currently in Greenfield there are some residents with a diagnosis of dementia whose needs would be better met in a dementia specific facility.
  • 28. Derry / Londonderry The Trust has been approached by an independent sector provider who will open a 46 bedded care home on the Culmore Road area of the City in December 2013. There is also a plan within the following 12 months to increase capacity by an additional 34 beds (making 80 in total).
  • 29. Derry / Londonderry continued The Trust has been approached by an independent sector provider indicating plans to open an 82 bedded facility in the Trench Road area with a mixed provision of dementia care, residential, intermediate and nursing care. There are currently some residents within the Rectory Field and William Street with a dementia diagnosis whose needs would be better met in a dementia specific facility.
  • 30. Limavady area An independent sector provider has advised the Trust it will be increasing its current bed capacity by 50. A further proposal for Limavady will be the subject of a SOC (Strategic Outline Case) and will be submitted via the WASPP (Western Area Supporting People Partnership) for consideration. There are currently some residents in Thackeray Place with a dementia diagnosis whose needs would be better met in a dementia specific facility.
  • 31. PrioritiesPriorities – Supporting Residents and Families through this difficult period including Independent Advocacy. – Supporting Staff through the change process and securing suitable alternative employment – Securing Supporting People funding to develop some alternative accommodation. – Keeping the public and service users aware of direction and developments. NB: No closure would happen unless a suitable alternative is in place.
  • 32. Summary of ProposalSummary of Proposal  In summary the Directorate currently provides statutory residential care for Older People in 5 homes with a total bed complement of 153.  The Directorate proposes to complete a full EQIA Consultation over a 13 week period.  Homes subject to consultation are: Greenfield, Rectory Field, Thackeray Place & William Street Residential Care Homes involving 128 beds.  The exception is Seymour Gardens Residential Care Home which is a Dementia Care specific home  The consultation would commence on 1st June 2013.  Proposal if agreed – homes would close 12 months following decision being made, subject to suitable alternatives being in place.  Subject to Trust Board approval  Subject to Ministerial approval
  • 33. Next StepsNext Steps  The Directorate submits this proposal to Trust Board for approval to proceed to consult on the proposed closure of four Residential Care Homes for Older People in the WHSCT area as part of the TYC Vision to Action Report.