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LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENTMAINTENANCE

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Page 1: LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENT MAINTENANCE

LINCOLNSHIRE ASSESSMENT AND

REABLEMENT SERVICE (LARS)

Part of our Putting People First Transformation: -

PREVENTION → REABLEMENT→ MAINTENANCE

Page 2: LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENT MAINTENANCE

1. Financial Model

2. Specification

3. Pathway

4. Monitoring outcomes

5. Roll Out

6. Lessons/ Issues Learnt

Page 3: LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENT MAINTENANCE

Financial Model

Critical Assumption Areas:Scenario 2: As scenario 1 with unproven

reduction in maintenance hours following reablement

Expected new entrants to service each week (no previous homeSupport or closed 3+ week ago)

70

Expected numbers re-entering reablement for coming from maintenance each week due to significant life event

30

% leaving without service each week (from new case population) 52%

Number to maintenance each week from new case population 48%

Re-entrants leaving without a service each week 0%

Growth in demand 3.5%

Average reablement weeks 6

Average reablement hours 7.5

Average hours for legacy long-term maintenance home care 7.2

Average hours for maintenance home care after reablement 6

Current cost per hour and assumed as continuing cost on legacy cases – independent sector £ 12.95

Future cost per hour on transfers from reablement only – independent sector £ 15.00

Future average cost of service 2009/10 - £ per hour

Future average cost of service 2010/11 - £ per hour

Future average cost of service 2011/12 - £ per hour

Future cost per hour – Direct Provision – per paid hour £ 24.50

Legacy Direct Provision hours reduction 1.45%

Page 4: LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENT MAINTENANCE

Financial Model

Financial - This scenario Projected 2008/09 Projected End 2009/10 Projected End 2010/11 Projected End 2011/12 Independent Annual Cost £ 14,814,178 £ 17,317,736 £ 17,482,604 £ 17,483,116 Directly Provided Services £ 9,635,654 £ 8,066,171 £ 7,027,462 £ 6,510,976 Totals £ 24,449,833 £ 25,383,907 £ 24,510,066 £ 23,994,092 This assumes an unproven Directly Provided Services target saving of: £ 1,569,483 £ 2,608,193 £ 3,124,678 Therefore: Total Cost if only 25% of Directly Provided Services savings realised £ 26,561,020 £ 26,466,210 £ 26,337,601 Total Cost if only 50% of Directly Provided Services savings realised £ 26,168,649 £ 25,814,162 £ 25,556,431 Total Cost if only 75% of Directly Provided Services savings realised £ 25,776,278 £ 25,162,114 £ 24,775,262 Financial - If we change nothing Projected 2008/09 Projected End 2009/10 Projected End 2010/11 Projected End 2011/12 (Allows average 3.5% demographic growth p.a.) Independent Annual Cost £ 14,814,178 £ 15,692,220 £ 16,430,037 £ 17,505,235 Directly Provided Services £ 9,635,654 £ 9,635,654 £ 9,635,654 £ 9,635,654 Totals £ 24,449,833 £ 25,327,874 £ 26,065,691 £ 27,140,889

Chart below assumes that reablement hours will be 4,5000 per week when service fully utilised and that these hours will be purchased from Directly Provided Services

Page 5: LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENT MAINTENANCE

Financial Model

2273222774

25326

4958

7258

27691

30103

33521

0

5000

10000

15000

20000

25000

30000

35000

07/04/2009 06/04/2010 05/04/2011 03/04/2012

Ho

urs

per

wee

k

Independent

Direct Provision

Total

Projection with noreablement and 3.5%demographic growth

Page 6: LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENT MAINTENANCE

Specification

LINCOLNSHIRE COUNTY COUNCIL ADULT SOCIAL CARE (ASC)

SERVICE SPECIFICATION FOR THE PROVISION

OF LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS)

Working Document version 3 .1 MAY 2009

LARS Working Service Spec ver 3 1 15/07/2009

Page 7: LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENT MAINTENANCE

Specification

• Key Issues

• A commissioned service

• Developed in partnership with in-house

• Service definition

• Outcomes

• Volume/ Price

• Workforce requirements

Page 8: LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENT MAINTENANCE

Pathway

Lincolnshire Assessment and Reablement Service (LARS)

First Contact / Initial Assessment Customer

Service Centre

NFAor advice/

Informationonly

LARS Service Case Management

Screening &Allocation

Referral fromWard

Hospital Discharge

Team

Health RehabServices

(eg Stroke)

Prevention Support viaVoluntary

Organisations

Intermediate Care(Community &

Beds)Reablement

Rapid Response and

Interim Care

Long-termAssessment(RAS) and Discharge

Clinic-basedAssessment(Equipment/

telecare)

Long-termAssessment(RAS) andDischarge

NFA servicescomplete

Transfer to Long-TermMaintenance

Assessment & Care ManagementBrokerage (support planning, review,Case management, reassessment)

Page 9: LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENT MAINTENANCE

Pathway

Lincolnshire Assessment and Reablement Service (LARS) Assessment Process

Allo

cate

d C

ase

Man

ager

Dut

y / C

onta

ct S

cree

ning

/ Al

loca

tion

Poin

t of C

onta

ct

Contact / Initial Assessment commenced

Dimension 1(basic referral information)

Dimension 2Scored ADL

section to support clinic

decisions

Low level needs?

Gather additional information to support screening as required.

No

End of assessment.

Close

Information, advice, signposting to low level preventative services.

Stay Safe at Home booklet.

Yes

Reablement AssessmentMay be commenced by

duty if required.

Workflow to Area Team

(email to duty box)

Moderate needs?

Simple service provision e.g..

Telecare, frozen meals

Enter low level review cycle

(Business Support)

Smartcare clinic

appropriate?Yes No

Arrange Clinic AppointmentNo

AllocateTo

Practitioner

Are reablement / crisis

intervention services

indicated?

Yes

RAS / Self Assessment

No - Maintenance needs indicated

Reablement AssessmentFunctional needs assessment to support reablement / crisis

planning. Contact Assessment copied forward and updated

as required. Validated scales and specialist assessment

triggers included.

Outcome Focused

Reablement Plan

implemented

Yes

Review / Reassessment.

Reablement Assessment

copied forward and revisited.

Validated scale re measured

Maintenance needs identified

or required?

Yes

Monitor reablement

Support Planning

Information, equipment signposting

CloseNo

Page 10: LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENT MAINTENANCE

Monitoring Outcomes Initial Assessment and Reablement / Crisis Plan

Summary of Presenting Situation: Include informal care arrangements Activities of Daily Living Scale: The following section is intended to record and measure how well you are able to manage daily activities. This will be looked at again when we review your support to measure any improvements ADL Scale Key

0- independent (on own without help) 1- on own with difficulty or discomfort 2- only with help from someone else 3- not at all

Personal Care

Assessment Reassessment

Washing face and hands (shaving if relevant)

Bath, shower or wash all over Getting dressed and undressed Using w/c Toilet Eating and Drinking

Able to prepare a meal Able to make a snack Able to eat and drink Practical Needs

Laundry Cleaning Shopping Managing Finances Getting around indoors

Getting on and off chairs Getting in and out of bed Getting up and down stairs Getting around outdoors

Access/ steps to house Walking Using public transport Car ADL TOTAL

Page 11: LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENT MAINTENANCE

Monitoring Outcomes Initial Assessment and Reablement / Crisis Plan

Supplementary Scales: These additional questions are to help identify if further assessments are neeed from other services HEALTH 0 - in good health 1 - occasionally feel unwell 2 - some moderate health problems that require some monitoring and support 3 - complex health problems that require a lot of monitoring and support MEDICATION 0 - fully competent, independent and self medicating 1 - needs prompting and reminding 2 - needs someone to administer medication MEMORY – Please record any issues or concerns regarding cognitive impairment or mental capacity 0 - complete 1 - occasionally forgetful 2 - short term memory loss 3 - short and long term memory loss FALLS 0 - none 1 - Occasional trips 2 - more than 4 in the last 12 months WELLBEING Assessment 0 - positive outlook every day 1 - variable, good days and bad days 2 - appears depressed and lacking motivation all the time SOCIAL CONTACTS Assessment 0 - lots of contacts with family, friends, neighbours and community 1 - lives alone but has lots of contact 2 - would like more contact 3 - lonely and socially isolated CONFIDENCE Assessment 0 - more confident than before 1 - the same ... no more or less confident than before 2 - less confident than before 3 - much less confident than before

Page 12: LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENT MAINTENANCE

Roll Out

Page 13: LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENT MAINTENANCE

Roll Out

Grantham Sleaford

Establish local implementation team Briefing/ training sessions for staff in house home care and local Ass and Care management Team Home Briefing sessions for relevant IS providers Start change of flow re orders for home care to create in house capacity for LARS (i.e. new requests for home care to go direct to IS) Start new LARS service Weekly action meetings of local project team to monitor/ problem solve Sign off project as successfully implemented in locality

6th April 2009 Wb 20th April 2009 Wb 20th April 2009 8th June 2009 6th July 2009 24 August 2009

Page 14: LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENT MAINTENANCE

Roll Out

DIRECTLY PROVIDED SERVICES

CRISIS & REABLEMENT SERVICE - PERFORMANCE

REPORT FOR JUNE 2009 [Week Ended 26th June]

SKEGNESS BOSTON LOUTH & HORNCASTLE

SPALDING STAMFORD (Sleaford

Office)

STAMFORD (Grantham

Office)

SLEAFORD GRANTHAM LINCOLN WEST LINDSEY

TOTAL

Current Month's Performance [June]

Ave. weekly No of Individuals in Service 35 44 51 8 2 0 1 141

Hours of Service provided in Month 683 778 1225 143 5 0 1.17 2835 Budgeted Contact Hours 715 978 1341 Ave hours per individual 4.88 4.42 6.00 5.96 1.25 1.17 5.03

Previous Quarter's Performance [13 weeks] (3

weeks) (2 weeks) (1 week)

Ave. weekly No of Individuals in Service 33 22 32 87

Hours of Service provided 2015 1319 2255 5589 Budgeted Contact Hours 2155 1612 2418 Ave hours per individual 4.70 4.61 5.42 4.91 NO. OF OPENED CASES since start of service 162 84 138 42 9 5 3 443

New this month 38 42 69 42 9 5 3 208 CLOSED CASES No of closed cases 126 44 70 12 2 0 1 255

Closed this month 39 35 50 12 2 0 1 139 Ave time in Service (days) 27 25 27 5 1 0 0 28 Ave Service provided (hours) 20 19 22 5 1 0 0 22 Ave hours of service/week 5.19 5.32 5.70 7 7 6 NO. OF CURRENT CASES 36 40 68 30 7 5 2 188

Change since last month -1 7 19 30 7 5 2 69

Page 15: LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENT MAINTENANCE

Issues

• Action learning approach

• Role between ASS/ C Management and in-house Home Care co-ordinators

• Fit with overall system/ intermediate care

• Charging

• Hospital discharge

Page 16: LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS) Part of our Putting People First Transformation: - PREVENTION REABLEMENT MAINTENANCE

Issues

• Balance and capacity

• Generic workers

• Whole system impact

• Better outcomes for people