Community equipment and housing adaptations: draft guidance

Care Homes

In 2012 the Convention of Scottish Local Authorities (CoSLA) and Scottish Government jointly issued a National Protocol for the Provision of Equipment in Care Homes, in order to provide consistency of service delivery across Scotland, and provide clarity of roles and responsibility for both private care homes and statutory organisations. The Protocol was developed and agreed with CoSLA, Scottish Care, local health & social care partners, and the Scottish National Association of Equipment Providers. The Protocol became a part of the National Care Homes Contract.

The Protocol reiterated that care homes are expected to provide a wide range of equipment to fulfil their obligations to their service users, and to their workforce.

More recent national policy has encouraged the further improvement and standardisation of social care provision, and it is essential that anyone who requires to be cared for within a care home setting, has the equipment they need to support their well-being and quality of life.

• In order to ensure equity, people who are self-funding, and have been confirmed as having an assessed need for specific equipment should not be charged for this essential equipment provision. Similarly, families should never be asked to fund equipment which has been assessed for, and identified as a requirement.
• Where partnerships have developed interim care home placement models, it is essential that appropriate arrangements for equipment are in place. Therefore, the approach is the same as for permanent care home placements, whilst acknowledging that timely provision of equipment to support more complex needs will be even more critical to the success of the transitional pathways. Commissioning contract arrangements should therefore ensure that the care home facilities have suitably resourced themselves with a stock of equipment which will support these needs e.g. including standard support seating to address essential postural management needs (see below).
• For day, and respite facilities, again it is expected, that the same approach will apply as for the other facilities, and that these settings are suitably resourced with appropriate equipment for the service users they are funded to support, and these requirements are built in to the contractual arrangements. It is however acknowledged that, similar to the arrangements for long term care homes, there may be some rare circumstances where it would be appropriate for service users with more specialist needs to have their existing equipment from home brought with them, and/or community services to provide additional equipment, as a loan, for the period of the service provision e.g. equipment to meet bariatric needs.

To support good practice, commissioning and equipment service leads within statutory providers (HSCPs) should work with their local care home sector to agree the most suitable makes and models of generic equipment e.g. modular support seating. This will assist the care homes in the cost effective procurement of appropriate seating to meet common postural management needs within the Care Home population. It will also assist local equipment stores to stock a range of suitable bespoke attachments to customise the equipment as required, to meet the assessed needs of an individual.

Standard support seating includes a range of products, designed to meet more complex but common postural management needs. It will support a range of service user's postural needs, and offer attributes which assist with tissue viability and the prevention of skin breakdown. The need for this type of seating is commonplace, and it is critical that these needs are addressed by the care home provider as an integral part of their care for the person, ensuring the optimum quality of life and well-being.

Poor seating can directly contribute to skin breakdown and compound postural issues, which then impact on the function of the person and their ability to carry out normal activities including social engagement and feeding.

This type of seating is available from many different suppliers and manufacturers, and are frequently modular, and can meet a wide range of needs and include tilt and space attributes. These chairs are cost-effective as they can be easily recycled and adapted with relevant accessories to meet the specific needs of different service users, and are readily available as pre-manufactured products, directly from suppliers ('off the shelf'). These types of chairs are generic and not for one-off use. Care homes should therefore be encouraged to have effective procurement arrangements in place which work across the sector to bring business efficiencies, allowing them to ensure efficient access to local stock. HSCP commissioners should be responsible for supporting the care homes to meet these obligations and ideally this should be taken forward at national level to encourage consistency across the sector, and assist the Care Homes to secure procurement efficiencies for all equipment provision.

For care homes providing nursing care, equipment will include equipment such as pressure reducing and relieving overlays and replacement mattresses to maintain tissue viability. That is, if a service user in a care home providing nursing care is assessed as requiring preventative care for pressure ulcers, the care home should provide for that service user

Where the needs of the individual require the provision of bespoke equipment or attachments the responsibility lies with the Health & Social care Partnership.

Bespoke equipment can be defined as:

• Any item of equipment specifically manufactured to meet the unique needs of an individual. E.g. the Care Home would be unable to purchase the seating ready-made.
• Bespoke attachments or accessories for a standard piece of equipment, to meet the assessed needs on an individual (e.g. accessories for standard off the shelf seat to support complex postural management needs).
• An item of equipment that would rarely be required by the population within the care home, and unlikely to be used again for another service user, e.g. this mainly applies to bariatric equipment.
• *note: 'bespoke' does not apply to any of the standard support seating described above, including chairs with tilt and space attributes, as this is considered equipment which meets common and frequently occurring needs within the older and frail population.

This guidance lays out the key guiding principles in terms of the responsibilities for the provision of equipment in relation to care homes in line with the Care Homes Equipment Protocol.

• When a person is being considered for a Care Home placement, assessment of their needs should include consideration of the equipment that is needed to support their care and their postural needs. Care homes should not accept people whose assessed needs they are unable to meet, however, they should not refuse placements because they do not want to provide for that persons equipment needs.
• The Care Home Protocol defines the types of equipment which care homes are responsible for providing, and those which HSCPs should provide. Local HSCP commissioners are responsible for ensuring the care homes meet their contractual obligations.
• However, where the care home is temporarily out of stock of items of equipment for which it is responsible, and the provision of equipment would facilitate a discharge from an acute hospital bed, or enable the client to stay in the care home, the equipment may be supplied on loan from the relevant local community equipment service, for a period of up to four weeks following an appropriate assessment.
• When the requirement for equipment is 'bespoke' (as defined above), responsibility lies with the local HSCP for this provision.
• Where equipment has been loaned to a care home, as described above, and it is not the responsibility of the HSCP to provide, the Care Home must put in place arrangements to provide this equipment as quickly as possible, and before the end of the 4 week period. No equipment should be removed before an alternative, long term option has been identified.
• Care homes much ensure that their staff are appropriately trained in the use, cleaning and maintenance of equipment as set out in The Health and Safety Executive and MHRA regulations.
• Where equipment has been loaned to a care home, repair and service maintenance responsibility remains with the equipment provider, however the care home must ensure they regularly clean and maintain the equipment in a good condition.
• It is the responsibility of the Care Home to ensure they understand how to use the equipment, and to ensure that this training is cascaded to all staff likely to use the equipment.

Scenario One: Mrs A is assessed as requiring assistance with seating posture. The care home she resides in has a range of adaptable chairs to address postural issues but does not have the attachments necessary to fully adapt the chair to meet Mrs A's specific needs. The local HSCP via their community equipment service, loans the care home the necessary attachments – headrest, and pressure relieving cushion and the seat is adjusted by Mrs A's Occupational Therapist to her required specifications. Once Mrs A no longer requires the seating, the attachments are returned to the local community equipment service for decontamination and recycling, and the Care Home is able to use the seat for future clients with these assessed needs.

Scenario Two: Mr B, currently resident in a specialist Dementia unit, has deteriorated physically and due to his size the hoist, bed, mattress and slings used by the home are inappropriate. To avoid an unnecessary admission to hospital the HSCP assess the needs, and via the local community equipment service, loan the required bariatric equipment to the care home. Maintenance responsibility remains with the community equipment service. Clear protocols for returning the equipment for recycling are also agreed, once the equipment is no longer required by Mr A, and it is returned to the equipment service for decontamination and recycling.

A flow chart for the provision of seating in care homes is provided at the end of this section to assist local partners and their care home providers further clarify these responsibilities.

Key Actions

• Care homes should provide a wide range of equipment to fulfil their obligations to their service users and to their workforce, in line with the national Protocol for the Provision of Equipment in Care Homes.
• Services users who have been confirmed as having an assessed need for specific equipment should not be charged for this essential equipment, and families should not be asked to fund this provision, this includes people who are self-funding.
• Commissioning and equipment service leads within statutory providers should work with their local care home sector to agree the most suitable makes and models of generic equipment, and ensure this equipment is in place.
• These principles should also apply to interim care home models, and day and respite facilities.