Care Home Closure: Supported Transfers for Older People PROTOCOL July 2016 1
Contents 1. Introduction 3 2. Key Principles 3 3. The Pre-Closure Discussion 4 4. Consultation and Communication 5 5. Social and Health Care Assessments 6 6. Risk Management: Transfers 7 7. Post transfer 9 8. Reporting, Debrief and Learning 9 9. ADDITIONAL READING 10 Appendix 1 Overall Framework 11 July 2016 2
1. Introduction Care home closures can occur for a variety of reasons and are often complex. This protocol aims to ensure that the needs of residents and their representatives are consistently met by placing an emphasis on the responsibilities and actions of key staff involved in the relocation programme. Through this protocol s objectives, we aim to: ensure efficient and effective actions are taken in response to individual needs and circumstances; provide an evidence based framework to support successful and person centred transitions; safeguard the wellbeing of residents. This document outlines the underlying principles and procedures which will be followed in the event of care home closure within the London Borough of Southwark. This protocol also applies: where Southwark residents have been placed in care homes outside Southwark. In such cases Southwark staff will liaise fully with the host borough; to self-funding residents. This protocol draws on experiences within Southwark alongside other local and national experience, research, regulations and case law. This protocol will be shared appropriately with relevant partner/stakeholder organisations on implementation. 2. Key Principles Southwark Adult Services recognise the impact of care home closures on residents, relatives and staff. Local Authorities are required to safeguard all residents in care homes within their area, irrespective of funding arrangements and regardless of which local authority commissioned the placement. A shared goal between all parties is that the residents receive a safe quality service. Where the relocation of residents is required, Southwark Adult Services will work in partnership with the CCG to assess the needs of all Southwark residents irrespective of funding arrangements, and have regard for the needs of residents commissioned by other authorities. While the circumstances of care home closures can provoke anxiety and distress, positive outcomes can result from careful planning, effective support provision and a positive approach. Each resident will have their own previous experiences of change; identifying and supporting the positive aspects of residents coping strategies (along with the provision of quality information and practical help), can produce an opportunity for positive adjustment and the acquisition of new skills and relationships. The overarching principles guiding this protocol are outlined below. Southwark (working in partnership with the CCG where required) will Assess the needs of all Southwark residents irrespective of funding arrangements. Implement a person centred approach in circumstances of care home closure. Ensure that the dignity and welfare of residents is considered at all times. Embed a culture of engagement by promoting the involvement of Adult Social Care staff, residents, relatives and other stakeholders in decision making about the future of services. July 2016 3
Communicate decisions to stakeholders in a timely, effective and transparent manner. Minimise disruption and distress to residents and relatives, and promote familiarity and consistency of care wherever possible. Ensure timescales are appropriate to the needs of residents where decision making has resulted in home closure. Work collaboratively with partners to promote effective communication, timely processes and effective use of shared resources. Ensure that any individual assessment or decision meets the requirements of the Mental Capacity Act 2005. Consider equality and diversity issues, and respect the needs of residents and relatives, and use advocates, interpreters and reasonable adaptations wherever necessary. Develop good practice by monitoring and reviewing processes, and ensure feedback informs future learning. work in accordance with the principles of the Data Protection Act 1998. The transfer process will be person centred, consider choice, needs, rights, and offer clear practical arrangements agreed with residents and relatives. Planning will include the opportunity for residents and relatives to view alternative homes. Where possible visits will be accompanied by family, advocates, volunteers, Social Work staff and/or care staff from the closing home. Where a partner local authority is responsible for meeting a resident s needs, we will contact the authority, notify them of the care home closure, and require a response within 10 working days with regards a plan of action for the resident in question. If we do not receive a satisfactory response from the local authority we will escalate our concerns. 3. The Pre-Closure Discussion Prior to closure decisions there will likely be an accumulation of issues within the closing home which has affected both residents and staff. If care quality is an issue, there has probably been an improvement process in place. If there have been financial issues for the provider, these may have impacted staffing or equipment provision. Where there are issues of significant harm, an emergency closure may be required (see the Provider Failure and Other Service Interruptions Policy). Each situation is unique, however the process for negotiation and the framework for transfer must be anticipated at this stage, and consider: how the decision is discussed with/communicated to residents, relatives and staff; how support will be provided to residents, relatives and staff; what the timescales are; what support the the outgoing provider will provide to staff, residents and relatives. The timing of communication with residents and relatives is critical. Experienced Adult Services staff will be identified and available to support the impact of information and provide reassurance. Building in enough time to be used flexibly through the stages of the process, is essential. If a resident is unable to consent or make important decisions because of concerns around mental capacity, the Mental Capacity Act 2005 and its code of practice and regulations will July 2016 4
apply. An Independent Mental Capacity Advocate (IMCA) will be accessed where there is no next of kin or advocate. Citizen Advocacy support will also be made available. If the home closure is undertaken as an emergency and there is not enough time to commission an IMCA to support decision making, an IMCA will be requested following the transfer to audit the decision making process and ensure decisions were made in the resident s best interests. 4. Consultation and Communication At the transition planning stage, a formal reporting structure will be established to underpin the managed closure process. This will involve: Directors Assistant Directors Cabinet Members Quality Assurance Heads of Service Managers Commissioning Brokerage Press Office Legal department Health partners A dedicated resource (small team of experienced Social Workers and a Manager) will be identified to provide support, information and advice to residents, relatives and staff throughout the process. Residents will be offered an advocacy service in addition to their dedicated Social Worker throughout the whole decision making process. The wellbeing, needs and rights of residents cannot be assured without appropriate communication and consultation with family and other formal and informal representatives (consultation with other parties is subject to obtaining informed consent from residents). The process of consultation and decision-making will be open and transparent. Southwark staff will ensure that residents, relatives and staff are informed of developments at each step. The situation will be communicated in a straight-forward way, and important information will be clear and easy to understand while communicating the facts directly. Following the closure decision, Social Work staff will complete a 1:1 consultation with residents and relatives on the process involved in order to provide residents, relatives and advocates with the opportunity to contribute their views and suggestions. A named Social Worker will be available for each resident and their relatives to provide advice and support on vacancies, preferred area and choice of accommodation. All residents and relatives will be advised of timescales and contribute to transfer planning. Comprehensive and organised records will be maintained throughout the process. Communication with residents must: be carried out on an individual basis once initial and general information is provided; take account of the language and communication needs of each individual; be available in a written format where possible; be consistent, accurate and timely to promote confidence and minimise anxiety; seek residents views, and take account of their fears, wishes and needs; seek to understand friendship groups (and maintain these where practicable); promote realistic expectations; happen throughout the closure process. Communication with relatives, friends, and advocates must: July 2016 5
encourage them to provide a personal history of the resident (following Herbert Protocol guidelines); keep them appropriately involved throughout the closure process. With regards communications with the press and members Press releases or responses to media enquiries must be drafted in consultation with the Clinical Commissioning Group and the provider wherever possible. Member updates must be completed by the council in consultation with the Clinical Commissioning Group. 5. Social and Health Care Assessments Pre-assessment considerations A range of practical considerations must be addressed prior to moving residents to their new homes. Considerations and actions may involve: prioritising assessments for residents who may be more vulnerable (e.g. those with medical conditions requiring health care interventions and/or equipment); seeking assurance that the new provider is able to meet the resident s needs; keeping friendship groups together. Awareness of alternative vacancies in other establishments that would accommodate friendships is essential. Good quality and comprehensive assessment and care planning is essential to ensure that the best interests of each individual resident are met, and that wherever possible, residents are assisted to make as informed a choice as possible over where they will next live. Existing care plans held by the closing home will be carefully reviewed as their quality may vary considerably, particularly where closure has been enforced because of poor care practices. Mental Capacity considerations Where it appears that the resident or their representative appears to have difficulty understanding the transfer process an advocate must be appointed to assist them, irrespective of whether they do or do not lack capacity. Where there are concerns that the individual lacks mental capacity the following factors must be considered Has a formal mental capacity assessment been carried out? (See the Mental Capacity Act Code of Practice for guidance and forms here) Known legal status of the resident - is there a lasting Power of Attorney in place for welfare and/or financial matters? The resident s ascertainable past and present wishes and feelings, and the factors they would consider if able to do so. The need for the resident to participate, or to improve the resident s ability to participate as fully as possible in anything done for and any decision affecting him/her. The views of other people with whom it is appropriate and practical to consult about the person s wishes and feelings and what would be in his/her best interests. Whether the purpose for which any action or decision is required can be as effectively achieved in a manner less restrictive of the person s freedom of action. Whether there is a reasonable expectation of the person recovering capacity to make the decision in the reasonably foreseeable future. The need to be satisfied that the wishes of the person without capacity were not the result of undue influence. July 2016 6
Where the resident is unlikely to regain capacity and is unable to make an informed decision with regard to the transfer, we will ask the receiving home to complete a Form 1 requesting an assessment for a DoLS authorisation to commence from the date of admission. Pre-transfer assessment of needs The Council has a duty to ensure that the needs of all service users effected by the closure are assessed, irrespective of funding arrangements, however assessments may be conducted by other local authorities and/or statutory bodies (such as the CCG). Relevant professionals should be involved in the assessment: multi-disciplinary working should be facilitated where possible, including joint assessments and supporting arrangements for partners to carry out their own assessments. A comprehensive and up-to-date assessment will be completed for each resident. The Care and Support plan will be developed jointly between the Social Worker, the current home and any new provider. Assessments should address personal histories, likes and dislikes, and must also take account of the following: Safety Safeguarding Health and wellbeing Dignity Each resident s full potential Choice Least restrictive options Respect for family life Equality and Diversity Privacy Advocacy Minimum distress and disruption of services Staff will monitor residents throughout the process in order to identify if they become withdrawn, depressed or anxious about the move. Working with staff from the closing home, Adult Social Care staff will ensure effective support is provided to minimise distress. The Social Work Manager will retain oversight of the arrangements to ensure that it remains appropriate for the resident to transfer and that their needs continue to be met. Comprehensive assessments (health and social care) will be forwarded to the new provider prior to placement. In addition, the new provider will complete their own pre-admission assessment. Following assessment (including the appropriate risk assessments), Care and Support Plans will be reviewed within 1 week prior to the transfer to ensure that it is completely up-to-date. 6. Risk Management: Transfers Risk assessments will be completed with residents as part of the assessment process in preparation for the transfer to another home. Risk assessments will involve relevant professionals, including health professionals. Transfers to suitable placements must be carefully planned by the provider, Social Worker and the wider multi-disciplinary team. There is likely to be greater risk for people with significant dementia or confusion, in particular for residents who are frail and have co-existing clinical conditions (for example heart and lung disease, Parkinsons disease, previous mental ill health, great age, liability to falls or reduced mobility, incontinence, sensory impairments, anxiety, depression, obesity, multiple medication a history of chest infection). Residents who need specialist equipment may also be at an increased risk and particular attention will be provided July 2016 7
to planning for these needs. Residents with special dietary needs, particularly those who may need assistance with eating and drinking may also be at increased risk. The impact of the transfer is greatest immediately after relocation and during the first 3 months in the new environment, but may also be evident in the period of consultation and preparation for the transfer. Clear and up-to-date knowledge of each resident s medical conditions (psychological and physical) and their fitness to transfer is key, as is the handover of health needs and requirements between one practitioner and another. Discussions will take place between the Social Worker, home Managers (closing and receiving), residents and relatives regarding transfer arrangements. All practical arrangements will be commissioned by Brokerage, planned with Care Home Staff and Health Care Professionals, and coordinated by the Social Worker. When residents have very complex health needs appropriate staff will accompany them and ensure an up-to-date handover to the new care home. Planning must consider residents need for transport and support during travel (transport arrangements will be confirmed by the Multi-Disciplinary Team using appropriate vehicles suitably equipped to accommodate the needs of the individual resident), the maintenance of safe staffing levels in the home during declining occupancy, and the scheduling of transfers to minimize disruption. The pre-transfer assessment will specifically address residents fitness to transfer and any special precautions which may need to be taken for each resident. Advice regarding a postponement will be sought from the outgoing GP and any other relevant professionals for any resident who is considered not physically well enough to transfer. Ongoing contact will be maintained with the receiving care home as appropriate prior to the 6 week review. 7. Arrangements for Transfer A range of practical considerations must be addressed prior to moving residents to their new homes. Among other things, it will be necessary to list and prepare equipment and medication for each resident so that all items are ready for transfer; secure the contact details of GPs and relatives at an early stage to form part of the transition plan; check with the resident (and relatives) who needs to be informed of the change of address and new contact details. Finance If needed Client Affairs/the care home provider will liaise with the Department of Work and Pensions to aid the transfer of pensions and avoid delays following transfer (unless the resident or family/others with legal status prefer to manage all such arrangements). The Social Worker will liaise with the appropriate internal department to advise of transfer, and seek appointeeship, deputyship and resolution of any other financial issues as required. July 2016 8
Transfer of Health Care Each GP (from the closing and receiving areas) will be involved in the arrangements for transfer as much as possible. As a minimum, the Social Worker will liaise with both GPs and ensure ongoing updates regarding the transfer situation and arrangements. Clear arrangements for the medical transfer of each resident will be confirmed prior to any relocation. Arrangements should include the provision of at least 2 weeks worth of prescribed medication to accompany the service user (in order to ensure the availability of sufficient medication during the switch from their current surgery to the new one). GPs (from the closing area) will also be asked to provide a short report regarding any identified issues or medical advice to accompany the resident on transfer, and will be asked to continue the care of the resident following their transfer where possible. Where applicable, a nursing transfer letter which identifies the critical issues relating to their nursing care and support will be prepared by closing home staff and sent with the resident (the Care Home Support Team and the relevant GP will be involved in assisting the Social Worker with this requirement). The Social Worker will ensure that this information is received and acknowledged by the receiving home. It is important that GPs understand the impact of the transfer for each resident and are involved in monitoring their health. Steps will be taken to ensure that the GP attending the receiving home is advised of the potential resident transfer as soon as the placement is confirmed. The receiving home will also ensure that the incoming resident is reviewed by the GP immediately following transfer. 8. Post transfer All residents, family/significant others and the new care home will have access to a named Social Worker during the first 6 week period to support settling in and to ensure the best possible opportunity for residents to feel supported and enabled to make a positive and successful transition. This will also support issues/concerns being addressed promptly and ensure that they do not escalate unduly. A review of each resident will be conducted by the Social Worker at approximately 6 weeks after transfer. A scheduled review will be undertaken within 12 months after transfer. As is standard practice for reviews, all relevant parties will be invited to be involved and adjustments will be made to the care plan if required. Where possible, care staff from the closing home will be encouraged to support residents at their new home for an initial fixed period to help them settle. 9. Reporting, Debrief and Learning Following the 6 week review period, the Manager will produce a summary report and arrange a formal debrief with the Senior Management Team. The formal debrief will take place within 3 months of any named home closure July 2016 9
It is recommended that this protocol is reviewed at least annually, following debriefing from residents, their representatives and staff. Learning points will be identified for action and will inform any amendments to this protocol 10. ADDITIONAL READING Further information is available on the following link: Social Care Institute for Excellence Short-notice care home closures: a guide for local authority commissioners http://www.scie.org.uk/publications/homeclosures/ At a glance 43: The Deprivation of Liberty Safeguards http://www.scie.org.uk/publications/ataglance/ataglance43.asp July 2016 10
Appendix 1 Overall Framework PRE-CLOSURE Senior Management Meeting Identify Closure Management Resource Clarify closure announcement details and Communication Plan Consider Other Boroughs involved Establish timescales CLOSURE MANAGEMENT RESOURCE Establish Designated Social Work Team with named staff ACTUAL CLOSURE ANNOUNCEMENT Consider formal meeting process for closure announcement Provide written information And face to face or immediate telephone contact for residents and relatives TRANSITION PLANNING Develop Transition Plan TO INCLUDE accurate currrent details for each resident accurate current detilas for resident representative Establish requirement for IMCA/Advocate Establish immediate Review schedule all residents IMMEDIATE COMMUNICATION Provide 1:1 sessions for residents and relatives Establish presence and on going contact in closing home ASSESSMENT Action Review and risk assessments Prioritise complex needs or particular frailty Liaise fully with Health partners including GP ALTERNATIVE ACCOMMODATION Identify alternative accommodation options Arrange and accompany residents and relatives to view all alternative accommodations Provide suitable transport for viewings Consider transport support options for relatives when new location further than current home Provide accurate information and fully discuss options with residents and relatives PRACTICAL SUPPORT Plan practical transfer arrangements Use suitable vehicles Assess risks to transfer and provide solutions Liaise with resident, relative/closing home/receiving home regarding dates/ timings Ensure possessions are documented and transported with the resident PAPERWORK Ensure continuous liaison with brokerage Complete all paperwork regarding new placement Ensure all documents and Observations are completed and uploaded to the database Review all finance issues and resolve as far as possible, liaising with Finance as necessary July 2016 11