Processes for Arranging All Support and Services

Reablement is a short-term service which is provided to a person to help them live as independently as possible by learning or relearning the skills necessary for daily living.

This service in Lincolnshire is provided by Libertas Care Services – a team of registered nursing and therapy staff, social care, reablement coordinators and support workers who work in teams to provide assessment, goal-led therapy and short-term support with activities of daily living to assist individuals in regaining previous levels of independence.

The home based reablement service is available to people in Lincolnshire who meet all the following criteria:

1. Assessed / identified by a health and / or social care professional as having potential to achieve an identified reablement goal(s) / an identified and achievable reablement need;
2. Over 18 years of age;
3. Ordinarily resident in Lincolnshire;
4. In need of short-term support to facilitate discharge from hospital or to remain in the community;
5. Consents to referral and participation in the service.

Note:  Only people who need short-term support to remain at or return home should be referred.

People will not be eligible where they do not fulfil all of the above criteria (a – e), and in particular:

• those in need of long-term support with no identified potential for improvement in their level of independence;
• those with severe dementia;
• those on the end of life pathway.

Adult care practitioners with access to Mosaic

Follow the workflow below:

1. Complete the Adult Referral to Reablement step in Mosaic.
2. The next action of Adult Referral to Reablement (assign to self) will be available from most Adult Care workflow steps.
3. Simply complete the referral form and send the next action Adult Reablement Triage to Reablement.

No access to Mosaic or health practitioners

Referrals via GPs, Community Nursing Teams, Community Mental Health Teams, Hospital (Acute/Non Acute) Ward staff, Transitional Care Teams (Health) without Mosaic access or Neighbourhood Teams must be made via telephone to the dedicated referral number:

Tel: 01775 888341

When someone is approaching the end of their reablement journey, and where ongoing care needs have been identified, the provider will take the following steps:

• The Service Provider will refer, via an Adult Conversation Record (New Cases) and Bring Forward Scheduled Review (Open Cases) in Mosaic, to the relevant Adult Community Transfer of Care Team;
• The Lead Practitioner will review the referral and allocate to a Practitioner for immediate completion of either an Adult Needs Assessment (New Cases) or Adult Review of Care and Support Plan (Open Case) if there is a requirement to do so;
• If a service via Brokerage is identified, the practitioner will complete a Purchase Service Request and send to Brokerage for procurement of the identified package of care.

Following a period of reablement, a person may require no ongoing support. However, where deemed appropriate, the Service Provider will signpost to other services as required.

The reablement service is not an Adult Care service; recipients will usually not be people using Adult Care services unless they are receiving reablement support on top of existing packages of care or where their social circumstances indicate the need for Adult Care intervention (for example, professional support of a social worker) in addition to the reablement services.

Any assessments undertaken by Adult Care practitioners which led to reablement services being provided will not progress beyond the assessment stage when being recorded in the person’s Adult Care record.

No information reflecting services provided by the reablement team should be recorded directly in the person's Adult Care record. However, any documentation received from reablement services should be stored in the person’s record.

Transitional care provides a period of recovery, rehabilitation, reablement and or assessment to an individual to determine immediate and longer term needs and or funding requirements.

It is designed to:

• promote faster recovery from illness;
• prevent unnecessary acute hospital admission;
• prevent premature admission to long-term residential care;
• support timely discharge from hospital; and
• maximise independent living.

There are four discharge pathways, from secondary care to community care:

1. Recovery and Assessment Pathway;
2. Rehabilitation/Reablement Pathway;
3. Adult Care Services;
4. Palliative Care/End of Life Pathways.

For further information see: Transitional Care Pathways

Assessment placements are available to patients who require a period of recovery or reassessment. These will be offered in community hospitals, and nursing and residential homes.

Access to all placements will be through the Flow Management Team except Louth Hospital which will require a medic to medic referral.

The Hospital Avoidance Response Team (HART) offers a flexible approach to delivering short-term care and support.

The service aim is to assist Lincolnshire County Hospitals in avoiding unnecessary hospital admissions and delayed hospital discharges, i.e. to help reduce attendance at A&E, emergency admissions, protracted hospital stays and other delayed transfers of care and, at the same time, to enable people to regain and retain independence.

HART provides up to 72 hours’ support at home where hospital admission is deemed inappropriate or avoidable, or after hospital discharge, when responsive or planned care can either bridge a gap until longer-term arrangements are established, or provide short-term support to sustain independence.

This is achieved via:

• provision and immediate installation of Telecare/lifeline personal safety alarms;
• Telecare monitoring and 24/7 response support;
• planned personal care, including medication support, bathing, repositioning, food preparation and shopping; and
• cross-referrals into the Wellbeing Service to support longer-term independence, where appropriate.

How HART helps:

• If deemed appropriate, contact emergency services;
• Empty catheter bags;
• Tilt or turn a person;
• Assist or prompt medication;
• Bathing or showering;
• Assistance with toileting;
• Assistance with dressing;
• Changing soiled linen;
• Support to get in and out of bed;
• Non-injury falls;
• Assist with mobility;
• Empower and enable;
• Food preparation;
• Help maintain a safe living environment;
• Ensure house is comfortable;
• Ensure daily essentials for living are available;
• Falls assessment;
• Provide access or signpost into support services.

What HART cannot do:

• Provide any medical intervention;
• Peg feeds;
• Assess blood sugar levels;
• Injections;
• Provide assistance with cannulas;
• Stoma care;
• Change catheter bag;
• End of life care;
• Dress or redress open wounds or sores;
• Administer medication;
• Act on behalf of the care provider, if applicable;
• Assist with feeding;
• General domestic chores.

For further information about the service and referral process see: HART

Wellbeing Lincs is a countywide service supporting adults across Lincolnshire to achieve confident, fulfilled, and independent living. The service is funded by Lincolnshire County Council and, delivered by all of Lincolnshire’s district councils working in partnership.

The key principles of Wellbeing Lincs are to:

• enhance wellbeing;
• improve people’s access to support services;
• reduce and delay escalation to statutory services; and
• provide direct support and signpost access to community resources.

The Wellbeing Service can support people with:

• loneliness and social isolation;
• disability;
• changes to financial circumstances;
• lack of family support;
• ill health;
• bereavement; 
• changing medical needs; and
• change in general situation circumstances.

Referral to the Wellbeing Service assists in early intervention and diversion at the point of entry to Adult Care. It can also be a joint assessment to reduce support needed from Adult Care, and potentially in appropriate cases, to step down out of Adult Care support.

The Wellbeing Service can:

• offer information and advice on housing, health, money advice and management;
• help identify and access education, training or work;
• engage with community services to reduce or prevent an escalation of needs;
• ensure arrangements are in place at home after leaving hospital;
• provide short-term support to ensure people feel safe at home;
• supply small aids, equipment and home adaptations (charges may apply); and
• provide a Telecare Response Service (charges may apply).

The Wellbeing Service cannot help with:

• getting up and/or going to bed;
• dressing;
• washing, bathing, using a toilet or other personal hygiene;
• eating and drinking;
• domestic help (such as washing up and laundry); or
• services provided by doctors or other medical professionals.

People must be aged 18 or over, live in Lincolnshire or be registered with a Lincolnshire GP, and meet four or more of the below eligibility criteria:

• Unable to manage long term health/medical conditions;
• Regularly visit the GP for the same medical condition or for non-medical reasons;
• Unplanned hospitalisation or A&E attendance in the last 90 days;
• Bereavement (spouse/partner) or divorce in the past 12 months;
• Had a fall in the past three months, either at home or away from the home;
• Unable to manoeuvre around the home safely;
• Lack social support and/or interaction with family, friends or carers, or feel isolated;
• Feel stressed, depressed or anxious;
• Unable to sustain work, education, training or volunteering;
• Unable to manage money or in considerable debt;
• Poor lifestyle management and behaviours which impact on overall health and wellbeing;
• Aged over 65 years old;
• Accessed social care services in the last 12 months including: assessment, reablement, day care, home care or residential care services.

Anyone living in Lincolnshire who uses telecare equipment can choose to have Wellbeing Lincs provide their response service. If the person raises an alarm, a Wellbeing Lincs Responder can be with them within 45 minutes in cases where there are no family member or other trusted support able to help.

This service runs 24/7, 365 days a year, at a cost of £2.50 per week.

The service includes support when:

• The person is on their own and has requested reassurance whilst awaiting attendance by the Ambulance Service;
• The person is distressed and has given consent to contact the Response Service;
• There are urgent basic lighting and heating issues (e.g. turning off stop cocks, offering help, reassurance and alternative heating advice in the event of a loss of power). The service is NOT to be used as an alternative for a plumber or electrician;
• The person has fallen and are uninjured, but need help to get up (including emergency personal care if needed, to make them more comfortable);
• There is no response from the person and all other avenues have been tried.

Wellbeing Lincs offers a Resettlement service for individuals either coming home from hospital or out of care. This service is accessible by health and care professionals by referral only, and not by members of the public in general.

Working with the hospital patient transport services, the Resettlement service is available to any individual who is unable to be discharged from hospital, or return home from a temporary care setting, due to lack of support mechanisms in place at home, or where professionals feel the individual needs some support on the day they return home.

The service is available from 10am to 10pm daily including weekends.

Some of the things the resettlement service can do:

• Ensuring the home is warm;
• Making a drink;
• Notifying care services that the person is home and clarifying when the next visit is going to be (if applicable);
• Helping unpack;
• Checking the individual has food and or arrangements for a meal;
• Notifying any family and friends that they are home (if this is what the person would like the service to do);
• Provide some basic provisions, such as milk, tea, coffee;
• In liaison with Wiltshire Farm Foods, get the person hot meals arranged; within 24 hours if the hospital discharge team have not arranged for anything;
• Undertake a basic holistic check of the person’s health and wellbeing needs and refer to Wellbeing Lincs for a thorough assessment of needs, should it be required.

The things the resettlement service cannot do:

• The service is not in a position to handle people’s money so is unable to do shopping;
• Planned personal care;
• As with other segments of Wellbeing Lincs, this service is person centred and the health and wellbeing of the individual is paramount at all times.

Wider Service 

Referrals are made through Lincolnshire County Council’s Customer Service Centre:

Tel: 01522 782140

Website: www.wellbeinglincs.org

• Within 24 hours: The person will receive a phone call to gather key information;
• Within 7 days: A trusted advisor will call to develop a support plan to meet individual needs;
• From 10 days of referral lasting up to 12 weeks: Direct support and signposting to  achieve individuals’ specific outcomes.

Telecare Emergency Support Service

Referrals are made through Lincolnshire County Council’s Customer Service Centre:

Tel: 01522 782140

Wellbeing Lincs Response Service number: 01507 613126

Website: www.wellbeinglincs.org

Resettlement Service

The referrer should ring LinCare control centre on 0300 303 4430 with the following information:

• Name;
• Address, including any access issues. If the property is hard to find, use the * what3words App, this can also assist in locating the property;
• Date of Birth;
• Any relevant medical conditions;
• Identification of any risks for the person and for visiting officers;
• The time the person is due to arrive home, so that officers are available;
• Any additional, relevant information.

The Brokerage Team is responsible for arranging community support for older people and people with physical disabilities across the whole of Lincolnshire. Brokerage works closely with other Adult Care teams to ensure that service deficiencies or unavailability informs future commissioning and contracting activity. 

Brokerage procedure

• If directly provided support has been decided on by the person and practitioner, the Care and Support Plan and Brokerage Request Form should be completed on the person’s record. The personal outcomes on the Care and Support Plan should reflect the support required.
• It is important that the details of the service provision as entered onto the person’s record regarding the frequency and time of calls are correct. Incorrect information will impact on the contribution the person will pay and the payment made to the provider.

• Where a person receives their personal budget as a Direct Payment and their arrangements break down, the Brokerage Team can be contacted directly by the person or practitioner for support in identifying a care agency.
• Where the Brokerage Team determine that there has been a change in need or if the person’s budget is insufficient to purchase alternative support through a care agency, the fieldwork team will be contacted for support.

Further information on the Brokerage procedure can be found in the Direct Payments Flowchart. This can be found in the Local Resource Library under Direct Payments (Section 10).

Homecare packages will no longer be brokered according to a specific time. This system is intended to allow greater flexibility for providers to pick up care packages.

Time bandings are split into two tiers in recognition that, for some individuals, calls are more urgent as a result of medication timings and mobility needs. Second tier time bandings, for more urgent calls, are reduced in size.

We expect that providers will ensure that there is a reasonable amount of time given to the spacing of calls throughout the day. The initial six weeks of the time banding approach supports with building capacity in that area, recruiting staff or building time into existing rounds.

During these six weeks, visit times may fluctuate from day to day, however, the provider should aim for regularity where possible. After this transition period, the provider is expected to maintain a high level of consistency and punctuality and changes must be kept to a minimum.

Time Bandings Tier One:

Time Bandings Tier Two (more urgent calls):

If a person needs a specific time

There are reasons why a person may require a call at a specific time, and we must ensure that, where there is a specific need, we continue to meet these requirements. However, there may be cases where a specific time is only requested because it is an expectation rather than a need; this should be avoided.

Maximising Independence seeks to promote independence and reduce the reliance on long-term support services. The Maximising Independence Team works with: vulnerable adults, adults with learning disabilities, autistic adults, adults with physical disabilities, adult frailty, and adults with acquired brain injuries, in various care settings and the community. They do this by enabling people to reach their full potential by maximizing their independence and quality of life, and assist practitioners to make informed decisions about support needs. Types of referrals include: assessment of life skills, development of life skills, community inclusion, and observation and evidence gathering. Referrals to Maximising Independence workers are made via the person’s record.

To access the referral guides, see: Referring to maximising independence – Professional resources (lincolnshire.gov.uk)

Standard 4 is the Quality Practice Assurance Standard which underpins our practice in maximising a person’s independence – see Maximising Independence.

Key safes can be a vital aid to people receiving support in their own homes. They are secure units for household keys enabling trusted people e.g. carers, to enter the property where the householder has difficulty getting to the door to let them in. Effective communication of key safe numbers, particularly at the start of a support package, is important. Key safe combinations are extremely sensitive pieces of a person’s information and should be recorded with extreme care.

In the event of the death of a person, it is important that Practitioners should ensure the Brokerage Team is notified as soon as possible via a Brokerage Request Form that the person has passed away, so they know to close brokered services.

Extra Care Housing is accommodation that has been designed for people who are aged 55+. It is a flexible approach to the provision of housing and homecare that aims to achieve positive outcomes for the person.

There is substantial evidence supporting the positive impact that an individual’s home environment can have on their health, independence, and wellbeing. Unsafe or unsuitable homes can increase the risk of injury, cause the exacerbation or deterioration of existing mental or physical health conditions, and can lead to social isolation and loneliness; subsequently resulting in increasing demands on the NHS and care services.

Extra Care Housing is proven to enhance the quality of life by offering individuals the opportunity to connect with others, to live in a community of their choosing, and in a home that will enable their continued independence, with the added reassurance of access to support where required.  It is essential to understand that Extra Care Housing is not the same as a residential care home or a nursing home, and the support within Extra Care Housing will be very different from these facilities.

Extra Care Housing is rented accommodation that the individual and the person they live with are responsible for. The person will need to have mental capacity to understand the content of the tenancy agreement and will need to be able to meet the requirements set out within the agreement.

There are numerous benefits of Extra Care Housing, some of which are listed below:

• Security and privacy;
• Safe accessible accommodation;
• Promotes social inclusion through a range of facilities and activities;
• Reassurance of 24-hour access to care and support services;
• Increases potential that focusses on the person’s strengths and abilities for promoting continued independence where possible;
• Provides a positive environment that is beneficial to health and wellbeing; and
• Increases the potential towards an improved quality and increased longevity of life.

The facilities offered will vary at each scheme and contact with the relevant scheme manager will provide confirmation of what they have available at their scheme. Some examples are listed below:

• Main reception area;
• Secure access to flats;
• 24/7 emergency support;
• 24/7 on-site care team;
• Restaurant;
• Hairdressers;
• Shop;
• Laundry;
• Mobility store and charge area;
• Meeting and hobby rooms;
• Library and computer room;
• Therapeutic activities;
• Assisted bathrooms;
• Communal seated areas to meet for coffee and conversation;
• Garden with raised flower beds;
• Fitness facilities such as outdoor exercise equipment.

In addition, activities and community are very much part of the ethos of Extra Care Housing. If the person requires assistance to be able to attend, then it is important to include what support they require within their Care and Support Plan.

• Tenants are encouraged to be involved in arranging activities and events;
• The person may have hobbies, talents and knowledge in a particular area that they may be willing to share with their neighbours;
• The scheme managers actively seek to invite local health support services and encourage local communities to visit;
• Day support groups may be available and there are often musical and seasonal events.

The accommodation 

• Each flat has its own letterbox and Royal Mail delivers the person’s post directly to them;
• Each flat has its own doorbell and intercom system;
• Lifeline is in place with a direct link to the on-site staff;
• The sitting room and kitchen are open plan;
• The flats are predominantly one bedroom with some two bedrooms available – be aware if the person is below retirement age and in receipt of housing benefit because there may be a top up cost that they will have to pay towards the rent. There will also be a limited amount of two bedroomed accommodation available and further justification for allocation may be required;
• The bathrooms are usually wet rooms, but some do have low threshold shower trays with half height doors.

The accommodation has been developed to be as accessible as possible in order to meet the variety of physical needs, but each person’s physical abilities are very different and it would be difficult to ensure that the accommodation meets every possible need. However, there may be potential to adapt with consent obtained from the landlord.

Extra Care Housing aims to encourage individuals to remain as independent as possible with support provided by the onsite care team where needed. Care and support are available 24 hours, 7 days a week, and 365 days a year; but there will only be one carer on duty through the night from 10pm until 7am.

Each applicant must have a minimum of one hour of care per week. Care provided across the scheme is organised by a percentage within each banding; this is to ensure that timely care is met across the scheme:

• Low: 1-5 hours of care per week;
• Medium: 5 -10 hours of care per week;
• High: 10+ hours of care per week.

Before the person can be considered for accommodation at the Extra Care Housing scheme, the person (or their deputy) must submit a housing application with the registered housing provider and have had an Adult Care needs assessment completed by an adult care practitioner.

The Extra Care Housing Principles will provide guidance on the process involved and each area’s responsibility with the application process. These can be found in the Local Resource Library under Service Specific Procedures (Section 11).

The Mosaic Extra Care referral must also be completed at the time of application. When completed, a copy is sent to the relevant Housing Provider to support their application and is also allocated to the relevant Mosaic virtual worker. The virtual worker will complete the referral once the outcome of their application has been achieved.

See: Mosaic Extra Care Referral

It is important to keep the scheme manager updated if things change for the person whilst waiting for accommodation; not doing so could result in a delay of potentially achieving allocation of accommodation. A decision cannot be made until clarification of the person’s circumstances has been achieved.

The organising of a panel meeting will depend on when there is a vacancy at the Extra Care Housing scheme. When there is a vacancy, the process of allocation will happen very quickly and therefore it is a good idea to apply when there are no vacancies to give the person time.

The Extra Care Housing Principles will provide guidance on the process involved and each area’s responsibility with the panel process. These can be found in the Local Resource Library under Service Specific Procedures (Section 11).

The panel consists of:

• Specialist Housing Manager;
• Scheme Manager;
• LCC Adult Care Representative; 
• Care Provider – Team Leader;
• District Housing Department Representative.

Each application is discussed, and thorough consideration is given based on the information provided. Further supporting documents can be provided to highlight a person’s strengths and abilities, which will also help to ensure a fair outcome is achieved.

• Applications are not based on a first come basis; allocations are based on the availability to accommodate the assessed needs of the applicant at the time of the vacancy;
• Additional information may be required from the LCC representative to clarify if Extra Care Housing will work for the person, to gain further understanding of the person’s care needs, independence and support requirements; 
• All Members will need to be satisfied with the information presented to achieve an agreed outcome. The housing provider will make the final decision of who the successful applicant will be, and the person and practitioner will be informed.

The Extra Care Housing Principles will provide guidance on the process involved and each area’s responsibility with next actions once outcome at panel has been achieved. These can be found in the Local Resource Library under Service Specific Procedures (Section 11).

“A lady moved in who loved to be active; she organised numerous activities including getting the ladies knitting hats for premature babies, she then befriended a gentleman that moved into the scheme and they ended up getting married”.

“A couple moved in, the gentleman had dementia, his wife had no care needs but wanted to be with him and help look after him along with the care support. Unfortunately, he passed away, but as his wife felt so happy living in the scheme and had made some good friends and felt safe she decided to stay rather than return to the bungalow they rented out as she knew it wouldn’t be long before she needed support too”.

“A gentleman moved in a few years ago, as he lived out in a small village with very few facilities and because of his health issues he couldn’t get out anywhere due to mobility issues and became quite isolated and lonely. He moved in and has never looked back. He has a scooter, which enables him to go into town and visit his friend who lives locally. He also goes to the local theatre on a regular basis and other community events. He has a busy social life now and is very happy and says it’s the best thing he ever did.”

See: Extra Care Housing

Listed below are the Extra Care schemes currently available across Lincolnshire:

Brick Kiln Place

Caunt Road, Grantham NG31 7GJ

Tel: 01476 516358

Email: brickkilnplace@lacehousing.org

Olsen Court

Olsen Rise, Lincoln LN2 4UZ

Tel: 01522 522458

Email: olsencourt@lacehousing.org

Worth Court

Willoughby Road, Bourne PE10 9LD

Tel: 01778 423138

Email: worthcourt@lacehousing.org

Barratt Court

Lyndhurst Avenue, Skegness PE25 2PQ

Tel: 0333 200 7304

Elizabeth Court

Church Street, Louth LN11 9BP

Tel: 0333 200 7304

Rev Bill Baker Court

Broadway, Sutton on Sea, Mablethorpe LN12 2FN

Tel: 01507 443431

Mayfields

Broadfield Lane, Boston PE21 8DY

De Wint Court

Bowden Avenue, Lincoln LN6 7NG

Tel: 01522 873 777

For additional information see:

Care Choices Directory

Thinking about Extra Care Housing Fact Sheet (in the Local Resource Library) under Service Specific Procedures (Section 11))

Extra Care Housing – Flowchart (in the Local Resource Library) under Service Specific Procedures (Section 11))

For some people, living in the community is not a safe and viable option. Residential care provides a safe environment in which to live when all aspects of support in the community have been exhausted.

Practitioners will need to determine the level of care needed using the criteria below and the outcome of Continuing Healthcare Assessments.

Lincolnshire County Council contracts with residential care homes based on three standard levels of need, each with a standard expected cost. The three levels of need are:

• Standard Residential;
• High Dependency;
• Nursing Care.

Standard residential criteria

Points 1, and either 2, 3 or 4 below must apply to the individual to satisfy the criteria for residential home care.

Maintenance in the community is no longer a viable option because:

1. Network support/carer function: Breakdown of care, domestic or environmental functions, and support systems cannot be sustained. Community support is inadequate, for example, existing accommodation is insufficient to meet the need, or isolated location without access to local services;
   The person or carer networks are unable or unwilling to sustain the environment creating unacceptable levels of risk to self and others;
2. Individual ability: The person lacks the ability to carry out personal care tasks which would allow them to remain in their own homes and their health or welfare is seriously at risk if a care home placement is not provided;
3. Individual motivation: The person lacks appropriate motivation to care for themselves under their present circumstances and their health or welfare is seriously at risk if residential home care is not provided;
4. Individual behaviour: The person’s behaviour is such that their health or welfare is seriously at risk if residential care is not provided.

High dependency 

Older people who meet the requirements for standard personal care in a care home and have one or more of the following characteristics, necessitating additional staff input as the result of a specific and substantial condition:

• Problem of mobility, requiring two staff on the majority of occasions to help with activities such as getting up or going to the toilet;
• Degrees of wandering, especially at night, and physical frailty that places the person at unacceptable risk, which requires particularly close supervision;
• Behaviour which has not responded to staff and professional intervention which, if not supported by staff presence or input, would have an adverse effect for self or other residents.

Nursing care

In addition to meeting the requirements of residential care, the individual will need to have a nursing assessment, as detailed in the NHS Continuing Healthcare (CHC) section, which indicates the need for care which can only be provided in a nursing home setting.

• Clinical nursing intervention is necessary 2.5 hours daily and the period of intervention exceeds two weeks in duration;
• Where a person’s general health has deteriorated to a level that needs constant nursing care or where a person’s health is such that one or more of the following procedures is required periodically during 24 hours:
  • Administration of medication by injection;
  • Dressing to an open or closed wound;
  • Feeding requiring nursing skills;
  • Basic nursing care of the type given to bedfast or predominantly bedfast persons;
  • Intensive rehabilitation measures following surgery of a debilitating disease, which is likely to continue for more than a short period;
  • Management of complex prostheses or appliances;
  • Management of complex psychological or aggressive states, which could not be met through HD requiring medical supervision.

Temporary residency (short term care, or respite) is a time limited stay in a residential or nursing home. This is usually part of an agreed Care and Support Plan designed to help the person to remain in the community, and where the situation of the person and their carer would deteriorate if the service was not provided.

A temporary breakdown in support systems or the capacity to be able to self-care may also indicate needs for temporary residency. Whether residential or nursing care is the most appropriate will be indicated by the consideration of the person’s nursing and medical needs.

If temporary residency is required for the safety of the person whilst they are awaiting a package of care, practitioners will need to complete the Interim Bed or HCS Request Form which can be found in the Local Resource Library under Providing Support and Personal Budgets (Section 8).

Direct Payments – short term care

In accordance with Chapter 12 of the Care Act (2014) Statutory Guidance, a person can use their Direct Payment to purchase a short stay in residential care, provided the stay does not exceed a period of four consecutive weeks in any 12 month period. Where the interim period between two stays in residential care is less than four weeks, then the two stays should be added together to make a cumulative total, which should also not exceed four weeks if it is to be paid for with Direct Payments.

Please note: if two stays in residential care are more than four weeks apart then they are not added together and can both be purchased using the Direct Payment.

It is the policy of Adult Care that everyone should be supported to live in their own homes whenever possible. Therefore we should only make permanent placements in care homes where we are satisfied that people’s support requirements and circumstances mean they can no longer live in a community setting. 

Choice of accommodation

The guidance from Annex A – Choice of accommodation and additional payments of the Care and Support Statutory Guidance is that where the care planning process has determined that a person’s needs are best met in a care home, the local authority must provide for the person’s preferred choice of accommodation, subject to certain conditions. This also extends to shared lives, supported living and extra care housing settings. Determining the appropriate type of accommodation should be done with the adult as part of the Care and Support Planning process. The person’s preferred choice of accommodation only applies in the type of setting identified in the assessment. The local authority must ensure that the person has a choice and must ensure that at least one option is available and affordable within a person’s personal budget. However, a person must also be able to choose alternative options, including a more expensive setting, where a third party (or in certain circumstances, the resident) is willing and able to pay the additional cost (top up).

If the person expresses a preference for particular accommodation within the UK, the local authority must arrange for care in that home, provided that:

• the accommodation is suitable in relation to the person’s assessed needs;
• to do so would not cost the local authority more than the amount specified in the person’s personal budget for accommodation of that type;
• the accommodation is available;
• the provider of the accommodation is willing to enter into a contract with the local authority to provide care at the rate identified in the person’s personal budget and on the local authority’s terms and conditions.

A person can only exercise their rights if the preferred accommodation is available. If a person indicates a preference for a chosen home where there is not an available place, they cannot use their rights in that instance.

If Lincolnshire County Council refuses to arrange a place in the preferred accommodation, there must be clear, justifiable reasons for doing so, and these reasons should be set out in writing.

Direct Payments: permanent residency (long term care)

Direct Payments cannot currently be used to secure permanent stays in a care home. However, the Government is reviewing the use of Direct Payments in care homes. 

Permanent residency verification happens for two main purposes:

1. To provide assurance that our assessment and practice is consistently robust in all cases where there is a possibility of permanent residency placement:
   • Assessments have been thorough and have fully involved the person and their representatives, all relevant disciplines and agencies;
   • Meaningful exploration of alternatives to permanent care can be evidenced;
   • Clear rationale exists for why the placement is required;
   • The category of the proposed placement is appropriately reflected in the assessment and support plan;
2. To provide assurance that the required work has been undertaken to determine the nature and the extent of the local authority’s financial responsibility in relation to the placement:
   
   • Eligibility for funding from all funding streams has been fully determined;
   • The person’s financial circumstances have been assessed and are known at the point the placement is made;
   • The proposed placement is at the appropriate cost and the contractual arrangements are in place with the home.

The process assumes the above is integral to our practice, and work undertaken to provide this assurance is routinely evidenced in case recording. The purpose of the Permanent Residency Request is to summarise and bring together the key elements of case work relevant to the request, and provide reassurance that a funded placement is the correct course of action. Permanent residency placement requests should not be made unless the assessor and their Lead Practitioner are satisfied this work has been done and can be evidenced.

The Permanent Residency Request Form in Mosaic has been designed to enable the relevant information to be clearly presented. The form is not intended to duplicate assessments, plans or case notes. Practitioners should use their judgement about the depth of detail required to provide the necessary assurance to the Area Manager. If it is not relevant to the permanent residency placement, do not include it. 

See: Permanent Residency Process

Reasons why the person needs a permanent placement – Provide a concise summary of the person’s current circumstances and why their needs can no longer be met in their own home or in a community setting. Include a summary of the relevant diagnosis, conditions or impairments.

Options considered and tried to meet support needs at home – Placements should only be authorised where the Area Manager is satisfied that opportunities to provide alternative interventions and use additional community based services have been meaningfully considered. It should be clearly stated where it has not been possible to try alternatives.

Identified significant risks – This section does not need to include every element of need or risk for the person. It is most important that the risks and needs that cannot be met in the community are highlighted here, e.g. risk of falls due to attempting to use the toilet during the night. The prompts within the Mosaic form serve as a guide for practitioners.

Chronology of relevant significant events – This section is to highlight the events that are significant to the breakdown of support in the community or an acute incident. The chronology should also provide assurance that opportunities have been taken along the way to maximise the chances of remaining at home. Reasons for any episodes of inactivity should be given.

Financial considerations – This section should include any relevant information in relation to the person’s financial circumstances, ownership of property, previous ownership of property, shared ownerships etc., which may impact on whether the local authority should be financially liable for funding the placement. Where there are ongoing complex financial issues, these should be advised in this section. Details of the proposed placement, level, prices and contracting details should also be included.

Outcome – This part of the Mosaic form should be completed by the Area Manager or Locality Lead, and should record their decision and any notes of rationale for the decision or actions required.

People entering residential care who are eligible for financial assistance from Adult Care will make contributions towards the cost of care in accordance with the Care Act 2014 and its associated guidance.

Third party top ups 

Care home providers who contract with Lincolnshire County Council are required to submit a schedule of their charges for each of their rooms. Where their charge exceeds Adult Care’s expected cost, a top up, paid by a third party, should be put in place with a formal agreement.

However, the Care Act 2014 does allow, in certain circumstances, for an individual or their representative to pay a top-up from their own funds when they choose more expensive accommodation than the local authority will fund. This is called a First Party Top Up and also needs a formal agreement to be completed. There are only three occasions when the Care Act says a First Party top up can apply:

• During the 12-week property disregard period
• When the universal Deferred Payment Scheme is in place
• Where an individual receives accommodation under section 117 aftercare of the Mental Health Act.

See. Practitioner Factsheet – First and Third Party Top Ups available in the Local Resource Library under Customer Finances (Section 9).

Details of financial assessment processes, guidance and forms can be found in the Charging and Financial Assessment Procedure.

It is important that when making any placements that you first check to ensure we have a contract in place.  You should also be checking to see if the residential/nursing home charges a third party top up (TPTU). No new placements should be made without a contract being in place.  Even though a Care Home exists in Mosaic it does not necessarily mean there is a current contract in place.

If you find that a contract is not yet in place, then please contact the Commercial Team Business Support Team - commercialteampeopleservices@lincolnshire.gov.uk.  In instances where you are looking to make a placement with a particular Care Home then this can help us expedite the contract signing.

There are several ways to check if a contract is in place and to confirm what the maximum TPTU amounts are. The best way is to access the new Care Home Contract Information tool – which can be found here: Commercial Team- People Services: Practitioner Resource (sharepoint.com). 

Alternatively, you can:

• Email commercialteampeopleservices@lincolnshire.gov.uk and the Commercial Team Business Support will check for you
• Or, phone 01522 555043, leave a message and the Commercial Team Business Support will check for you

Connect to Support

The Connect to Support website can be used to search for care homes near to a location or by services offered. The ‘Home Care Agencies and Care Homes’ tab has a list of all CQC-registered care homes in Lincolnshire.

If you wish to make a placement with any Care Home or Home Care provider listed on the Connect to Support website, you must still check that there is a contract in place prior to making any arrangements.

If a person chooses to be placed in a setting that is outside the local authority area, the local authority must still arrange for their preferred care. In doing so, the local authority should have regard to the cost of care in that area when setting a person’s personal budget. The following must also be considered:

• There may still need to be a third party top up;
• Check with the Commercial Team to ensure there are no safeguarding concerns with the care home;
• LCC will need to obtain a contract with the home to enable a placement to be made, even if there is already an LCC funded placement in the home;
• Once the room price and top up have been agreed, the Commercial Team will need to be contacted so they can set up the contract;
• No placement should commence without appropriate authorisation;
• Until the Framework Contract is signed and returned you will be unable to complete the Purchase Service Request as the care home will not be authorised for use.

Relevant procedures:

Cross Border Placements

Continuity of Care Arrangements

Placements in Scotland 

Please note that it is not possible for English authorities to place directly into a private care home in Scotland. This has to be arranged through the relevant Scottish authority. If you need to arrange such a placement, contact the Commercial Team for further guidance. 

Planning and lead times

If the placement you wish to make is an emergency or subject to acute hospital delayed discharge, please let the Business Support Team know as soon as possible and, with the co-operation of the provider, they will try to complete the process as quickly as possible.

Please note: unless you have received confirmation from the Business Support Team that the placement can go ahead, no person should enter a home without a Framework Agreement being in place; this puts the person and the local authority at risk and means that no payment will be generated.

Room availability and home registration

As the placing officer, you will need to contact the home of choice to find out whether there is a room available, the bed price, and that the home is registered to meet the person’s needs. Please check the host local authority’s expected cost for the home and that the home is registered with the Care Quality Commission (CQC).

When obtaining a price for a care home with nursing, please remember that any agreed fee must be excluding any NHS Funded Nursing Care determination and that the relevant NHS authority (within the area you are placing in) is responsible for payment of that determination.

Determine price of bed 

• If it is the person’s choice to move to more expensive accommodation and the price quoted is above Lincolnshire’s expected cost but within the host authority’s expected cost, a Third Party Agreement to fund the difference will be needed. If there is no Third Party available and there are specific service needs or circumstances that require a specific placement, then written approval for Lincolnshire County Council to fund the difference is required from your Head of Service;
• If it has been specifically identified that there is an assessed need to place out of county and not just a person’s personal wish, then we must pay at the host authority’s expected cost;
• A person who is in receipt of a 12 week Property Disregard or who has agreed to enter into a Deferred Payments Agreement can act as their own Third Party and their Third Party payment (known as First Party) is added to the debt;
• The Third Party Agreement must be completed and signed by all parties before the placement can go ahead. A copy of this must be sent to Commercial Team upon completion;
• The cost of learning disability placements will be determined by use of the National Care Funding Calculator and must be agreed with the provider before the placement can go ahead.

Issue contract documentation and complete Pro Forma part 1

Once everything is confirmed, you should have enough information to complete Part 1 of the Pro Forma for the placement of persons out of the county, which will give the Business Support Team all the information necessary to issue contract documentation to the provider. Once completed, the Pro Forma should be emailed to the Commercial Team so that contract preparation checks can begin. A summary of the steps taken can be found in the Supplier Set-up Process (The Pro Forma and Supplier Set-up Process can be found in the Local Resource Library) under Providing Support and Personal Budgets (Section 8)).  

Please ensure that a report and authorisation from either the Area Manager or Head of Service, as referred to in parts 1 and 2 (section 6.4), any Third Party Agreement, and the correct receipt address for the Framework Agreement pack is included with the information sent to the Commercial Team.

References and Care Quality Commission (CQC) Inspection Reports 

Once the correctly completed Pro Forma has been received, the Business Support Team will run a series of checks to ensure we have a satisfactory reference from the host authority and that there are no outstanding issues from the last two CQC Inspection Reports (see the CQC website). When the reference is returned, the Framework Agreement can be sent out to the provider. If there is any problem with the placement or authorisation, the placing officer will be contacted and advised of what further information or authorisation is required in order to allow the placement to go ahead.

Confirmation of placement

When the executed Framework Agreement has been returned to the provider, the Business Support Team will contact the placing officer by e-mail to confirm that the placement can go ahead. At this stage, steps will also be taken to add the provider as a supplier on our systems. Once the provider has been set up as a supplier, the Purchase Service Request can be completed.

Pro Forma Part 2

The Business Support Team will then complete Part 2 of the Pro Forma, which will include such tasks as informing the host authority that Lincolnshire has made a placement to a care home in their area.

Local authorities have been charged with ensuring that information is passed on about any people known to them who move to another area.

If a local authority places someone in accommodation provided by the independent sector, which is outside Lincolnshire, they should always inform the host authority of the placement. This is to ensure the host authority is aware of the person in their area and to enable both authorities to agree on the suitability of the placement.

Authorisation 

If the bed price is above Lincolnshire’s expected cost, it is vital that you get appropriate authorisation from either the Area Manager or your Head of Service before a placement is arranged (see parts 1 and 2 in section 6.4) as the placement cannot go ahead without it.

Funding of out of county placements 

This applies to all placements (temporary and permanent residency) made in out of county accommodation.

1. Placements should normally be made at, or below Adult Care’s expected cost;
2. Where the Framework Agreement price for a placement is above Adult Care’s expected cost, a Third Party Agreement will normally be required before the placement can be confirmed; however, no Third Party or person may be charged a top up in circumstances where the accommodation is the only option available to meet the person’s assessed needs at the time of placement;
3. Out of county providers must agree to all terms and conditions of the Framework Agreement for the Provision of Permanent and Temporary Personal and Nursing Home Care before a placement may commence. Placements can only be confirmed where the provider has accepted these terms and conditions;
4. Where no Third Party is available and where an out of county provider has fees higher than Adult Care’s expected cost, or in circumstances where the person’s choice has been diminished due to the nature of their assessed needs, the appropriate Area Manager or Head of Service will need to approve the extra cost to be paid by Lincolnshire County Council on the Pro Forma;
5. Where the fees are higher than Adult Care’s expected cost but meet the expected cost of the host authority, written approval can be given by the Area Manager. Head of Service approval is required if the fees are higher than both Adult Care’s expected cost and the host authority’s expected cost;
6. If it has been clearly identified that there is an assessed need to place out of county, the availability of an in-county placement cannot be used as evidence of a place at Adult Care’s expected cost and Adult Care must pay the host authority’s expected cost;
7. If the appropriate Area Manager or Head of Service refuses a placement that has been chosen by a person, the reasons for refusal must be made in writing. Refusals should only be made on the grounds that a home has been deemed unsuitable in terms of meeting the needs of the person, or that the costs due to be incurred for a placement are financially prohibitive and that there is clear evidence that beds are available at a lower price in homes which meet the person’s needs.

To enable secure, appropriate, and cost-effective transport provision for people, it is important that the correct procedures are followed for ordering transport. This will enable the process to be more streamlined and help you to avoid unnecessary paperwork, and it ensures that invoices are sent directly to Business Support for efficient payment. Where possible, practitioners are encouraged to book in advance. If practitioners are booking at least five days in advance, they should make bookings using the Transport Referral Form. This must be agreed as part of the person’s Care and Support Plan and included in their personal budget calculation. Check the Approved Operators Database [Lincolnshire County Council intranet] to ensure that the vendor is an approved operator. The suppliers list constantly changes so please check before booking.

See: Transport Referral Form

If you have any further enquiries, please email the Transport Services Group at TSG@lincolnshire.gov.uk.

Shared Lives is a unique form of support and accommodation in which a person either lives with or regularly visits a Shared Lives carer in the carer’s home, and shares in their household and community life.  Shared Lives can be particularly suitable for people who wish to live more independently, but at the present stage in their life do not want to live on their own. Shared Lives is able to offer more immediate and consistent help, friendship and reassurance in contrast with what at times can be the transitory and changeable nature of support provided in other forms of supported living. It can help transform the lives of people with a wide range of eligible needs.

This type of support is highly valued by people who use the service. Shared Lives is one of the fastest growing forms of care, has the highest CQC ratings of any form of care in the UK and the lowest number of safeguarding issues. Section 4.41 of the Care Act Guidance refers to Shared Lives as a supported living option geared to improving people’s independence and wellbeing and promoting person-centred care.

Shared Lives support, provided with or without personal care depending on the person’s needs, is available in Lincolnshire in three forms:

• Live in Arrangements – support and accommodation for a person which is provided in a Shared Lives carer’s own home and which continues for as long as the arrangement meets the person’s needs and wishes;
• Sessional Day Support – support for a defined period during the day (3.5 hours or 7 hours) including weekends as required, offering the person choice over where and how they spend the day, at a time to suit them. Day Support must use the Shared Lives carer’s own home as a base and enable the person to access social activities, training and education as applicable;
• Short Breaks – support for a defined period of days and nights in the home of a Shared Lives carer, a minimum of a 24 hour stay, up to and not exceeding 28 days. For some people, a Short Break might lead on to a live-in arrangement.

Email: sharedliveslincs@pss.org.uk

Address: 10B Market Place, Sleaford, Lincolnshire NG34 7SR

Shared Lives Team Manager

Lucianne Hey 07342 998 849

Shared Lives Development/Area Supervisors

Troy Melvin 07595863158

Katie Reilly 07708835370

Angela Melvin 07926072551 

Shared Lives Recruiter/Development Worker

Giorgia Innes 07595863130

Service Coordinator/Administrator

Carla Blanksby 07731 591556 

Office 01529 400 967

Note: All the following documents can be found in the Local Resource Library under Service Specific Procedures (Section 11):

• Shared Lives Referral Form
• Shared Lives Essential Staff Guidance
• Shared Lives Referral Process

The Care Act 2014 sets out the local authority’s specific duties in relation to people who are deafblind.

People are regarded as deafblind “if their combined sight and hearing impairment causes difficulties with communication, access to information and mobility. This includes people with a progressive sight and hearing loss” (Think Dual Sensory, Department of Health, 1995).

We have a responsibility to ensure that needs assessments carried out under section 9 of the Act for people who are deafblind are carried out by people with the appropriate skills. To fulfil this duty, practitioners must refer the person to Lincolnshire’s sensory impairment service provider where it has been identified specialist support is required.

Referrals can be made direct from the Lincolnshire Sensory Services website.