The goal of this initiative was to support people to be discharged from hospital quicker and more effectively, whilst also avoiding people going into residential care. This example of a local initiative forms part of our managing transfers of care resource.
It is the priority of Kirklees Council, working with partners, to ensure people are healthier, live longer, have a better quality of life and remain independent for as long as possible.
We proactively work with people themselves, as well as partners and communities, to support individuals to make their own decisions, take control of their lives and to achieve the best possible outcomes. The centre of our vision for Social Care in Kirklees is to enable individuals to become or remain independent, self-reliant and an integrated part of their local communities. The Home from Home scheme is one of the many ways we are translating this vision into tangible outcomes for people.
The plan
The goal was to support people to be discharged from hospital quicker and more effectively, whilst also avoiding people going into residential care. This linked with some of council’s performance indicators, e.g. 90 days remaining at home after discharge, reducing delayed transfer of care. In addition, those taking up a temporary residential placement were at risk of losing their confidence and independence, meaning that they may not get back home or being reliant on larger care packages than would have been needed at the point of discharge from hospital.
The Home from Home (HfH) service provides seven accessible flats as temporary accommodation. These are for people awaiting adaptations in their own home or changes in accommodation, and prevents the need for them to remain in hospital or to be admitted to care settings whilst work and arrangements are completed. The comparison of the costs and outcomes of residential care compared with an adapted flat are significant- the flat is more cost effective for the health and social care system and the individual, enabling a higher level of independence.
The Clinical Commissioning Group (CCG) and both Health Trusts were financially supportive of the HfH scheme development in the first year. Now the Local Authority funds it, supported by assessed contributions from the recipient towards care costs and any housing benefit.
Implementation
The HfH flats are within Extra Care, Retirement Living and the independent sector. It has been designed like this so that people under the age of 60 who do not want or need to go into a residential care home have more options. Prior to the HfH scheme, a residential care home was the only option available. The service has a range of accommodation including two bedroomed properties, to include family members and carers in the relocation.
The flats are owned by Housing Associations and Kirklees Neighbourhood Housing. The Extra Care homes are owned and run by a housing association, with the Local Authority having allocation rights. Care and support are offered on site, enabling a quicker and more personalised discharge. The other properties in the scheme have care and support as needed from the authority’s contracted home support providers. The service is more focused on housing than support, as in many cases people need accommodation, but not necessarily a traditional care package.
The service is about supporting people to move on, not about them staying in temporary accommodation. In this service, clients have an allocated assessor who helps them to look at housing options if they cannot go back to their own home; for example, helping them to bid for properties.
There are community support and assessment officers in the authority, performing similar work to social workers (e.g. assessments, care packages). Two of these officers work in the supported living service, which includes overseeing all of the HfH and extra care properties (approximately 130 properties). They coordinate the referrals and transfers into HfH and extra care and work across housing and social care. Over the last five years, the people in these roles have developed their knowledge around housing issues by working closely with housing partners. They have received training around housing issues, for example; how to support people to complete housing applications and housing benefit applications.
Outcomes
The most important outcome is that people have a reduced stay in hospital or residential care. They can also be offered the re-ablement service to enable them to reach their optimum level of independence. It has also benefited the supported housing service. Once people experience these schemes through the HfH offer, many like the environment as well as opportunities for social activities and make an application to be rehoused within the schemes.
Cost savings are the number of patients who have been discharged through the HfH system that have not entered residential care. Current costs for HfH per week is £203.77, which can be claimed through housing benefit. However, if someone is in receipt of housing benefit in their own home they cannot claim on two properties, thus in this instance Adult Social Care stand this cost. The individual pays a £13 per week utilities charge.
The comparison for savings is the cost of a residential placement per week is currently £536.77 per week. Therefore, HfH is £333 per week cheaper. If the housing benefit is claimed then there is a saving of £536.77 per week.
In terms of quantitive outcomes, the scheme has seen several individuals regain or become independent. The support provided works with people to find solutions and outcomes which best suit their needs and goals.
What has been learnt?
Initially the scheme was not well resourced in terms of coordination, which created a cost that was not envisaged, as the turnaround of the empty properties was quite poor. This has now been addressed, by incorporating it into the role of the supported housing assessor’s and the focus of the multi-disciplinary steering group. Void turnaround has improved and the length of stay is now as predicted, which is approximately eight weeks.
The implementation was intense for all partners, as this was a new way of working and a new service. There was no known model or example operating in any other Local Authority. The positive aspect of this initiative is that it promotes a reduced length of stay in hospital, a timely discharge and enables people to maintain their independence. The initiative also promotes integrated and partnership working to ensure that people reach their identified outcomes.
One of the other learning points related to housing benefit and did take some time to resolve. This was not initially being applied for promptly and there are some barriers when a person was already claiming housing benefit on an existing property, leading to some arrears. We have worked with housing partners to resolve these issues.
The staff at first found this daunting as this was a very steep learning curve for them, but partners worked closely together to train staff where needed and provided extensive support and advice.
The key learning point from this service is the pivotal importance of the coordinators’ role within the scheme from the outset; adding it to roles such as Neighbourhood Housing Managers and Service Managers does not work.
Kirklees continue to work to improve and adapt the service to meet the needs of the public.
We do this through the Integrated Steering Group chaired by the Social Care Service Manager.
Next steps
The plan has developed further over the last five years; we have increased the number of flats to seven across Kirklees. We have improved the length of stay in the HFH flats to facilitate a timely transfer back to the person’s property or alternative property. We are reviewing the HfH pathway to streamline electronic referrals with Medical Housing Officer forming part of the decision making virtual panel.
Contact
Gail Addinall
Service Manager
[email protected]