Assessment, Care Package Review and Process

Transcription

1 Assessment, Care Package Review and Process Mainstreaming the Use of Video in Care for Learning Disability Clients Alexa Hazell Alasdair Morrison Adam Hoare

2 Introduction Present a project to holistically re-assess LD clients on high-cost care packages to use appropriate technologies to improve outcomes. Three major components: 1. Assessment holistic view and appropriate response 2. Care Package Review fitting technology to the needs of the client. 3. Process implementation and understanding of how mainstreaming would be achievable. Outcomes summary: client, financial, QIPP and health and social care frameworks.

3 Concerns identified Long established care packages in which support was out-dated and extremely costly. Families raising concerns about dependence and their family member becoming deskilled. Skills that service users had previously learned had been eroded, e.g. were no longer able to travel independently. Providers encourage service users to ask for more hours in support.

4 Project Brief High cost packages to be re-assessed with a view of reducing support costs and encouraging the use of technology. Promote independent living and positive risk taking. 60 Cases re-assessed aimed to challenge needs versus wants. 33 cases judged appropriate for a change in care package including appropriate use of technology.

5 Project Team West Midlands Improvement and Efficiency Partnership part funded the review. Dedicated Project Team included: Specialist Occupational Therapist Specialist Social Worker Project Manager Telecare Service Manager LD Commissioners LD Service Team Leaders

6 Process Reassessment of current support provision Case conference with project team, client and family Identification of Telecare needs and installation Evaluation Four weeks after installation review of equipment Begin process of care package reductions Review as agreed and final completion

7 Example Barriers Resisting Change 8 hours of additional support a day as a service user once fell at home 5 years ago. Medication visits paid for when service user self medicates when visiting family. Support workers trying to put up barriers to the introduction of technology stating service users would not be able to interact with it or encouraging service users to refuse technology.

8 Engagement to Overcome Barriers Case conferencing with family / advocates / support workers to explain what needs to happen and how technology will support and protect service users is a MUST. Service user visits to STAY (Sandwell Telecare Assisting You) offices to see how technologies work and understand how it will assist them with their day to day living. Allow all to touch / feel / play / use equipment in order to overcome barriers. Embed Trusted Assessor Training and Telecare provision within Social Worker s roles. Allow simultaneous provision of existing support and technology with clear timetable for removal of support elements identified. Timely reviews and case conferencing to ensure packages complimentary, allowing for identified reductions to be made

9 Culture Traditional approaches to mainstreaming the delivery of technology within service provision have proven difficult given the scale of the task. This project aimed to concentrate on a specific area of service provision, evidence the benefits and new working practices and then mainstream across the rest of the service area. This successful model will now be mirrored within Older People s Mental Health and Care Managed Services. Working with Children s Services to also utilise the model. Leadership decision to instil the ethos of technology as the default position across of elements of service provision. New training module for middle managers / lead practitioners and budget holders to ensure the ethos is understood and adhered to.

10 Experiences for service users/families By providing travel training, service users have been empowered to return to independent travel. The provision of virtual visiting has assisted with reduction of 24 hour support to enable service users to be alone and gain more confidence. Independence has been facilitated by supplying video support immediately when needed. Since reductions have taken place, service users have identified additional outcomes and the desire to acquire more skills.

11 Financial Impact Of the 60 cases considered 33 were re-assessed and considered appropriate for change as part of the project. Total savings against budgets for 33 cases over a period of twelve months: 514, At scale this could represent significant savings.

12 QIPP Outcomes The QIPP agenda is addressed as the proposed approach can be used across health and social care in an integrated way. Quality of the care experience has been increased for clients and their families. Innovation is possible if the engagement is handled sensitively and the client is reviewed holistically. Productivity outcomes could be substantial at scale as clients become more independent and resources are used more effectively. Prevention is at the heart of the expansion of the Sandwell assisted living approach. A care and support platform is being developed that focuses on proactive rather than reactive care.

13 Framework Outcomes The proposed process and use of technology addresses all five domains of the NHS Outcomes Framework. Specifically the video with other technology has addressed the four domains of the Adult Social Care Outcomes Framework: Client s lives have been enhanced. There has been a marked reduction in care needs and improved independence. The experience has been positive as reported by the qualitative analysis undertaken after twelve months. Connection to twenty-four hour support safeguards client s welfare and helps protect them from avoidable harm.

14 Final Word - Quotes From Service Users I feel that I am now able to do more for myself and really like it when someone talks to me when I get back from the disco Makes me feel safe (service user has door contacts that are set to alert after 9pm) I enjoy Friday s when I strip my own bed and put it in the washer then dry it ready to put back on with my carer, I feel like I am now helping her I am now able to get onto the bus and go to the local centre on my own, I really enjoy this, especially doing my shopping. I want to be able to go to more places I found the video very useful when I broke a glass in the kitchen, the lady told me what to do to clean it up and told me which bin to put the glass in as I was worried one of us would cut ourselves

15 Final Word Quote From Carer I have been very surprised and you did prove me wrong. I know in the beginning I felt that you were putting these boys at risk, however this technology has given them some independence back and allowed them to do tasks I felt they couldn t do. I am so proud of them both and I think it has been fantastic for them

16 Further Information Required? Any Questions?

17 Final Word Quotes From Project Staff It is pleasing to note that despite the difficulties we had with providers, the work that we did to breakdown the barriers has been successful. This has enabled service users to obtain additional skills and has significantly improved self esteem. Service users are now taking responsibility for their own lives and have reported that they feel more confident. The provision of Virtual Visiting has enabled service users to contact staff to reduce their fears whilst supporting them to achieve positive outcomes Specialist Social Worker I really think this technology has allowed these individuals to regain skills and has increased their independence and quality of life. The fact that they do have contact from a person on the screen does increase their compliance to use this. I especially like the fact that in a particular housing scheme, it has allowed service users in each property to be able to contact others, thus increasing their social network, vital for those who can not physically get outdoors without help from others. They are now able to communicate, reducing the feeling of isolation and also call for assistance when required Occupational Therapist

18 Final Word Quotes From Project Staff One of the biggest requests from people who use our service is to be helped to live as independently as they possibly can. Over the past year we have supported a number of people to move successfully into their own home and Telecare and other technologies has been a really important component in making this a reality for people Divisional Manager LD Lead Officer This project has really helped us to embed the use of Telecare and other technologies within service provision. Whilst we fully understand that One size does not fit all, our person centric approach to complimentary packages of care/support and technology demonstrates what can really be achieved. The introduction of video to support people who use our services signifies a new model of service delivery and benefits for service users to live independently and safely Telecare / Technology Lead