Cost Benefits of Providing Equipment

Cost Benefits of Providing Equipment

AIM: This session summarises key points from an extensive review of literature to identify: The existence of any legal recommendations for the prescription of double handed care when using a hoist The possible cause of misinterpretation of legislation resulting in blanket policy application Possible advantages and disadvantages for the client, care providers and the commissioners of services

Introduction and Background

Over 50% of injuries arise from the moving and handling of people (HSE, 2013).

The Cost of Back Injury Angela Knott wins 420.000 for the appalling injuries sustained whilst working for Newham NHS Trust

Why does it take 2?

The Health and Safety Executive (HSE) state quite clearly that there should be no blanket solutions routinely applied to all clients (HSE, 2001).

here is a range of relevant legislation which provides information and uidance to ensure good practice and safer systems of work. Health and Safety At Work Act (1974) Management of Health and Safety At Work Regulations (1999) Manual Handling Operations Regulations (1992 revised 1998 and updated 2004) Provision and Use of Work Equipment Regulations (1998) Lifting Operations and Lifting Equipment Regulations (1998) Care Standards Act (2000) The Human Rights Act (2000) Health and Social Care Act (2008)) Domiciliary Care National Minimum Standards Regulations (2003) Workplace (Health, Safety and Welfare) Regulations (1992) Care Quality Commission Requirements NHSLA, Risk Management Standards (2012-2013)

Risk Assessment/Managing Risk

isk Management Models

12.8 Two people fully trained in current safe handling techniques and the equipment to be used are always involved in the provision of care when the need is identified from the manual handling risk assessment. (The Domiciliary Care, National Minimum Standards Regulations (2003) p. 24) What is important to note within this standard is the latter wording: when the need is identified from the manual handling risk assessment.

This could be the key to the misinterpretation and subsequent application of blanket policies imposed by care providers who are using the guidance incorrectly. a contravention or failure to comply with regulations 4 to 6 and 11 to 25 shall be an offence under the Care Standards Act (2000).

With the changes towards personalisation, self directed support and personal budgets (SCIE 2011), appropriate equipment solutions can improve productivity, enhance comfort, reduce costs and increase client independence (Sturman- Floyd 2011). Working in partnership to adapt a disabled person s environment in order that they can remain in their own home can reduce the need for complex care packages and daily visits.

A review of such cases by Heywood and Turner (2007) identified that these savings could range from 1,200 to 29,000 per year per client.

With moving and handling issues in mind these adaptations can reduce the need for some daily visits therefore reducing the costs of providing home care whilst maintaining client and carer safety and dignity.

It has been estimated that just one years delay in providing an Adaptation to an older person costs up to 4,000 in extra home care costs (Audit Commission, 1998).

According to a study by the College of Occupational Therapists, exploring the relationship between provision of equipment and reduction on care package costs and residential care, it was found that over an eight week period cost savings to care packages through the provision of equipment were over 60,000 (Hill, 2007).

Already overstretched Local Authorities across the UK are having to find ways to make savings following the Comprehensive Spending Review in 2010. Older people currently account for nearly 60% of the 16.1 billion cost of social care. It is estimated that spending on social care will need to triple over the next 20 yrs to keep pace with the demand for its services.

The Barnet Graph of Doom

irmingham Jaws of Doom

Smith and Orchard (2009) identified an invest to save potential in Somerset and report that 37% of service users who were reassessed are now only assisted by one carer (instead of two), citing additional benefits of maintenance of dignity and comfort together with increased flexibility of provision of only one carer. 125 S/U s were assessed; 37% (46) of them now are only assisted by 1 carer (instead of 2), with savings of 270,000 achieved. The average initial investment in equipment 763 per service user. (OTN April 2010).

The initial investment is recovered over time as care provision is reduced or even avoided. Cost profile when using 1 carer to assist Service User Potential Savings Cost The breakeven point will move dependant on whether new or second user equipment is used Initial investment in equipment Cost profile when using 2 carers to assist Service User Time

ssential Equipment enabling single handed care include: The Prism Community Bed The Prism Classic Low Bed

The 4 Way Glide In-Bed Management System from Prism Medical

obile Hoists Vs Overhead Track Hoists Advantages of a Mobile Hoist Cost Speed of delivery Ability to move from room to room if required. Disadvantages of a Mobile Hoist Can require 2 carers to use it, following a detailed risk assessment. It can be difficult to manoeuvre particularly on plush carpets. The environment may make it difficult to move the hoist around i.e. narrow doorways, tight turns, small or cluttered rooms. Can be difficult to store.

Advantages of ceiling track hoist It is out of the way as fixed to ceiling so it does not impact on the environment. It does not require manoeuvring. In most circumstances it can be operated by one carer and in some instances by the client themselves (a risk assessment would need to determine if this is safe). It will always be charged and ready to use. It is much easier and quicker to use than a mobile hoist. Disadvantages of a ceiling track hoist It does have to be a fixed piece of equipment while required.

Prism Gantry Systems and Examples of Fixed Ceiling Track The Prism Free Standing Gantry The East Fit System

The Prism Comfort Recline Sling an insitu sling

he Client at the Centre of the Assessment

Reducing Carer Numbers

Conclusion Enabling Single Handed Care Individual Risk Assessments by a professional competent person Training of carers to use and feel confident using new equipment and techniques Client/family centred approach, increasing independence and control Short term investment, will give long term gain Remember the Graph of Doom and the Jaws of Doom!!!

Remember it is not all doom and gloom!! With different and innovative thinking, investing in equipment and training staff can be cost effective as well as increasing the psychological, health and well being of the service user and their carers!

Any questions from the floor?

Contact details: norma.richardson@prismmedical.co.uk 07827 334698 j.mellson@salford.ac.uk

References Aronson,J.(2002) Frail and disabled users of home care: Confident consumers or Disentitled citizens? Canadian Journal on Ageing/La Revue Canadienne du Vieillissement, 21(1) Spring, P 11-25. Audit Commission (2002) Fully equipped:assisting Independence:Audit Commission update.london:audit Commission. Bracher, M., Brooks,A. (2006) in Moving and handling strategies in Curtin,M.,Molineux,M.,Supyk-Mellson,J. (Eds)(2006) Occupational Therapy and Physical Dysfunction: Enabling Occupation. Churchill Livingstone Elsevier. Boyd and Stevens (2009) Falls and fear of falling: burden, beliefs and behaviours in age and ageing (38) p 423 428. Cant, J., (2011) on line: Ask an OT available at http://askanot.com/feature/mobile-hoist-vs-ceiling-track-hoist accessed 08.02.2013 Cooper P, Gray D. (2002): Best Practice for Treating and Managing Pressure Ulcers. Clinical Practice Development. Corr,J.(2005) Electric profiling beds will improve care and save money in the ling term Nursing Times 2005 101 (48) 13, as cited in Fergusson, B.L.(2007): The potential benefits of he introduction of electric profiling beds in preference to manually height adjustable King s Fund beds within the NHS:A literature review. The column 2007 19 (2) 12. Dyack, I; Kontos, P; Angus, J, and McKeever, P. (2005): The home as a site for long term care: meanings and management of bodies and spaces. Health & Place: Vol. 11, Issue 2 June 2005. Elsevier Ltd. Glendinning, C., Clarke, S., Hare, P., Kotchekova, I., Maddison, J., Newbronner, L. (2006). Outcomes-focused service for older people. London: Social Care Institute for Excellence. Health And Safety At Work Etc. Act, 1974 HMSO Human Rights Act 1998 HMSO Website www.legislation.hmso.gov.uk/acts/acts1998/19980042.htm Health and Safety Executive,(2002) Handling Homecare, achieving safe, efficient positive outcomes for care workers and clients. HSE Books. HMSO, Norwich. HSE, (2011) Health and Safety Executive. Handling Home Care retrieved 30-11-12 from http://www.hse.gov.uk/pubns/priced/hsg225.pdf Heywood, F. & Turner, L. (2007) Better Outcomes, lower costs: implications for health and social care budgets of investment in housing adaptations, improvements and equipment: a review of the evidence. London: Her Majesty s Stationery Office Hill,S.(2007) Independent living:equipment cost savings. Chelmsford:Essex Learnung and Social care (Unpublished) Lifting Operations and Lifting Equipment Regulations 1998. [SI 1998 No. 2307]www.legislation.hmso.gov.uk/si/si1998/19982307.htm Management of Health and Safety At Work Regulations 1999[S.I.1999No.3242]www.legislation.hmso.gov.uk/si/si1999/19993242.htm Mandelstam, M,. 2011, In Smith, J (Ed): The Guide to the Handling of People. A Systems Approach (6 th Edition). Backcare, Middlesex. Manual Handling Operations Regulations 1992[S.I. 1992 No 2793] www.legislation.hmso.gov.uk/si/si1992/uksi_19922932_en_1.htm

References (continued) Mellson,J. and Richardson,N.(2012) The impact of hoist sling fabrics on gluteal interface pressure while sitting in a healthy individuals: a controlled pre-post test study. The American Journal of Safe Patient Handling and Movement Vol. 2, No. 3, 79-86. Mickel, A. (20100 A ticking time bomb. Occupational Therapy news 18 (5) p38-39. Provision and Use of Work Equipment Regulations 1992 [S.I.1992 No.2932] www.legislation.hmsogov.uk/si/si1992/uksi_19922932_en_1.htm Robinson, C., Arnold, Z., (2012): Double Handed Care: A leading role for O.T. Occupational Therapy News 20(12) December 2012. Smith, H., Orchard, S., (2009): The reduction of double handling in the community in The Column 23.3 Autumn 2009. National Back Exchange Sturman-Floyd, M., (2011): Reducing the incidence and risk of pressure sores, manual handling loading and carer costs using In-bed systems. Available at http://www.communityequipment.org.uk/wpcontent/uploads/sturman-floyd-paper-2011-complete-final-paper.pdf) Accessed 21 st January 2013 @14.00 hrs. SCIE (2011): Social Care for Excellence, Personalisation briefing: Personalisation, productivity and efficiency. January 2011 http://www.scie.org.uk The Health and Social Care Act 2008 (Regulated Activities), Regulations 2010 [S.I. 2010/781] Thomson S, Jevon P.(2009): Manual Handling using a sling hoist. Nursing Times 2009; 105(3):12-13.