Understanding Care Services: NHS Continuing Health Care

What Is NHS Continuing Health Care?

In England, NHS Continuing Health Care (NHSCHC) is care funded by the NHS. It is available for people aged 18 and above and is provided to meet physical or mental health care needs that have arisen through disability, accident or illness. NHSCHC is care that takes place away from a hospital. Care can be provided in your home or in residential accommodation.

Who Qualifies for NHS Continuing Health Care?

You will qualify for NHSCHC if you are assessed as having a primary health need. The NHS Choices website provides a very unhelpful circular definition of this. A primary health need, it is explained, is one that is on-going and substantial and is related to your health. An assessment will take into account the nature and complexity of your needs; the intensity and severity of your needs, and the unpredictability of your needs.

How Do You Get NHS Continuing Health Care?

In short, you need to be assessed. The assessment is carried out by a multidisciplinary NHS team. There is no right to an assessment, but if it seems that you might need NHSCHC then the Clinical Commissioning Group (CCG) for your area must carry out an assessment.

The fact that you have a long term medical condition is not, of itself, a qualification for NHSCHC. However, the following circumstances are likely to suggest that an assessment is appropriate. 1. Where  you are due to be discharged from hospital and you have long term needs, 2 Where a period of intermediate care has come to an end, 3. Where your health declines significantly, 4. Where you are approaching the end of your life, 5. Where you reside in a nursing home and your health care needs are under review and 6. Where your health and social care needs are being assessed as part of a community care assessment.

In most circumstances, there is a two stage assessment process. The first stage is an initial assessment. The purpose of this is to decide if you need a full assessment. The initial assessment may be completed by a doctor, social worker or other health care professional.

The full assessment is carried out by two or more health and/or care professionals. The assessment looks at the following criteria: behaviour, cognition (understanding), communication, psychological/emotional needs, mobility, nutrition (food and drink), continence, skin (including wounds and ulcers), breathing, symptom control through drug therapies and medication, altered states of consciousness, other significant needs.

Each of those criteria (or domains) is assessed on the following scale: no needs, low needs, moderate needs, high needs, severe needs or priority needs. The criteria in bold are assessed, on the full scale, from low through to priority. The criteria in italics are assessed from low to severe. The remainder are assessed from low through to high.

You will be eligible for NHSCHC if one or more criteria are assessed at the priority level or two or more criteria are assessed as severe. You may also be eligible if one criteria is assessed as severe and you have needs assessed in a number or other criteria or a number of criteria are assessed as high and/or moderate.

A two stage assessment is obviously a little time consuming. It can take 28 days from the initial assessment to determine you eligibility by way of a full assessment. Clearly in some cases this is far too slow. There is, therefore, a fast track procedure that can be used where your condition is worsening and/or you are terminally ill.

What Is the Cost of NHS Continuing Health Care?

There is no cost to you if you qualify for NHSCHC.

Who Provides NHS Continuing Health Care Services?

NHSCHC services can be provided by any number of health professionals including physiotherapists, occupational therapists, speech therapists and domiciliary carers. When you are assessed as being eligible for NHSCHC, you will be allocated a personal health budget. This is an amount of money that is used to support the needs that you have. It is similar to the personal budgets allocated by social services to support social care needs.

Just as with a social care personal budget, you can ask for your personal health budget to be paid to you in the form of a direct payment. A direct payment puts you in control of choosing who supplies your services. You don’t have to do this. You may, however, enjoy the freedom and choice that direct payments give you. You can find out more about personal health budgets and direct payments on this page.

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.

Understanding Care Services: Intermediate Care

What Is Intermediate Care?

Intermediate care covers a range of short term care services including reablement. You can find out more about reablement by going to my article here. Intermediate care is short term support. It can last for a period of up to six weeks. It may, in certain circumstances, be extended beyond that six weeks’ period. Intermediate care is one part of an overall care package provided to you.

What Is the Purpose of Intermediate Care?

Intermediate care aims to keep you living in your home independently for as long as possible. By providing you with the right support you may be able to:

avoid having to go into residential accommodation

avoid having to be admitted to hospital,

be supported on discharge from hospital

recover more quickly from illness

Who Qualifies for Intermediate Care?

Intermediate care is an option for any adult who may benefit from it. An adult is anyone aged 18 or over. The aim of intermediate care is to help you to maintain, or regain, your independence to continue, or return to, living in your home. Therefore, you are likely to be offered intermediate care in the following circumstances.

To help you avoid admission to hospital. For example, you have a fall at home, with the right, timely support, it may be possible for you to avoid the need to be admitted into hospital

To support your discharge from hospital. If you have had a stay on an acute hospital ward you may need a little help to regain your confidence and skills to continue living independently at home. Intermediate care can allow this support to be provided in your home upon your discharge from hospital or in a rehabilitation home (sometimes known as bed-based accommodation) prior to your moving back into your home.

Before you move into long term residential care. Typically, intermediate care is offered as a stepping stone between hospital discharge and admission to long term residential care.

To support people who you have dementia or other mental health needs. In these circumstances, avoiding hospital admission in the first place is the ideal. If this is not possible, timely discharge should be the aim. Intermediate care may be available to support either of these goals.

End of life care. People who are being cared for at home during their last days may have the quality of their lives enhanced by some simple adaptations. This could involve, for example, helping carers learn different ways of doing things. In such circumstances, intermediate care may be available.

How Do You Get Intermediate Care?

In the ideal world, you would be automatically referred for intermediate care if ever you found yourself in one of circumstances outlined in the previous section. However, the world is not ideal and it may well be the case that you will need to prompt a health care professional to refer you to the intermediate care team. Suitable health care professionals to prompt might be your GP, a district nurse, the discharge team in a hospital, staff attending to you on an A&E ward, paramedics attending at your home or an out of hours GP. Alternatively you may refer yourself.

Once a referral has been made you will require an assessment from the intermediate care team. The contact details of Thanet’s intermediate care team are:

Westbrook Integrated Care Centre 
150 Canterbury Road 
Margate 
Kent
CT9 5DD

Telephone: 01843 254134

The East Kent Intermediate Care Team’s website address is: http://www.kentcht.nhs.uk/home/our-services/intermediate-care-east-kent/?entryid109=228837

What Is the Cost of Intermediate Care?

Intermediate care is free for up to six weeks. It may in certain circumstances be extended beyond this period.

What Does Intermediate Care Involve?

There are four types of intermediate care.

The first type is referred to as crisis response intermediate care. This is very short term care – usually for a period of up to 48 hours. A health care professional will make a referral to a crisis response team who can rapidly ensure that you receive an assessment and receive the support you need. The support can be provided in your home or in residential accommodation.

The second type of support available is called home-based intermediate care. So called for the simple reason that the support is provided in your home.

The third type is known as bed-based intermediate care. This involves support provided in a setting away from your home – for example in a residential home.

The final type is reablement. The approach underpinning reablement is aimed at helping you to live your life independently. Reablement workers are not charged with the responsibility of doing things for you; they are responsible for helping you become confident and competent in doing things for yourself. You can find out more about reablement by going to my article here.

Who Provides Intermediate Care Services?

There are many health and social work professionals who may be involved in supporting your intermediate care needs. These professionals include: doctors, nurses, occupational therapists, social workers and care and support workers.

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.

Understanding Care Services: Reablement

What Is Reablement?

Reablement is a service offered to you to help you regain or maintain your independence and thus continue living safely in your home. Typically, it is offered to you after you have spent a period of time in hospital or where you are recovering from injury or illness.

The approach underpinning reablement is aimed at helping you to live your life independently. Reablement workers are not charged with the responsibility of doing things for you; they are responsible for helping you become confident and competent in doing things for yourself. Therefore, reablement workers should not be coming into your home to cook a meal for you; they should come in to help you learn or relearn the skills to do this for yourself.

What Is the Purpose of Reablement?

If things go well everyone benefits from reablement. You gain the skills and confidence to continue living in your home independently. You may still need home care from a home care provider; however, there is evidence to suggest that this is at a much lower level than it might otherwise have been.

Who Qualifies for Reablement?

This varies from area to area. The aim is to provide reablement services to people who will benefit from it. It is Local Authorities who oversee reablement and, as with all types of health and social care, there are limited resources available to provide the service. Some hard decisions will have to be made, therefore.

If you live in Kent, reablement is called enablement. You can find out more about what is available from Kent Social Services here and here.

How Do You Get Reablement?

The first step is to get yourself referred to the Local Authority. In Kent you can make a referral yourself; for more information go to this page. You will then need to have an assessment. The purpose of the assessment is to determine what help you need to be able to continue living your life in your home as safely and independently as possible for as long as possible.

What Is the Cost of Reablement?

Reablement is free for a period of up to six weeks. This is the case even if you normally have to pay wholly or partly for care that you are receiving. In certain circumstances, reablement may continue beyond the period of six weeks.

What Does Reablement Involve?

Everyone who has reablement is different; therefore, the detail of the service you receive will be tailored to your needs. There are, however, some common features of enablement.

The aim is always to help you regain your confidence by learning or relearning important skills to help you live independently for as long as possible. There should be a reablement plan in place that both you and your reablement workers are working to. This plan will include goals for you to aim for. These goals could include such things as walking up and down stairs and/or preparing a meal.

Who Provides Reablement Services?

It is local authorities that run the service. They may sometimes be run in conjunction with NHS Continuing Care. Local Authorities may have their own reablement workers. Alternatively, Local Authorities may use private suppliers to provide the services. It is probably that other health professionals, like occupational therapists and physiotherapists, may be involved with your reablement service. You are entitled to sort out your own enablement provider.

Whilst you are receiving reablement support, social services should be working with you to determine the care you will need when reablement finishes. Such other people as your carers and family should be involved in this planning also.

If you would like any further advice about reablement or any aspects of domiciliary care, please contact me on the telephone number or at the email address below.

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.

Kent County Council Parts Company With One of Its Three Chosen Home Care Providers for Thanet

If you live in Thanet and receive domiciliary care through social services you could hardly fail to be aware of the controversial change that came into effect last year, 2014.  

Home care in Thanet, like home care throughout Kent, is provided by a number of private companies. Until last year, many of these companies would have provided home care under contract with Kent County Council (KCC). Prior to June 2, 2014, KCC worked with over 120 providers throughout Kent. From 2 June 2014, that number fell to 23. In Thanet, the number fell to just 3 home care providers. You can see the providers for each area in Kent here.

There can be little doubt that local authorities throughout the country were looking at the Kent experiment. If it was successful and saved money, you can bet that something similar would be adopted all over the place. It would appear, though, that things have not gone quite as well as might have been hoped.

When the experiment in Kent was being implemented there were many voices warning that this might not be an especially good move. One particularly prescient voice was Bridget Warr’s from the UKHCA. She is on record as saying that her concern was  “… that what we’ll end up with is vulnerable people not getting the support they need at the time they need it.”

Today, 28 May 2015, The Thanet Gazette has reported that KCC has decided to cease working with one of its three chosen providers in Thanet when the current contract comes to an end on 1 June 2015.  Amongst other things, it is said that a significant amount of negative feedback has been received about this particular provider. You can read the Thanet Gazette report here.

Many social services customers are under the impression that they have no choice but to have their care delivered to them by the company that KCC chooses for them. This is not the case. Anyone who receives social services funding is entitled to receive a direct payment. I have written about this extensively in previous articles that you can find here, here and here. What direct payments mean is that you are given a sum of money that allows you to buy your home care from a provider of your choice. And there is plenty of choice in Thanet.

Not everyone will want the responsibility of taking control of buying their home care: but many will. Under normal circumstances, if you receive financial support from KCC for your home care you have a right to have direct payments. All you have to do is ask. Direct payments put you in control. You choose your home care provider. If that provider does not deliver a quality service you go somewhere else. In most cases, that has to be a very good thing indeed.

If you want advice about direct payments or any aspects of domiciliary care, do not hesitate to contact me.

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.

How You Can Change Home Care Providers

Caremark Thanet: Excellence in domiciliary care

If you receive home care through Social Services, you probably had little involvement with how your home care provider was chosen. Everything would have been done for you, and there’s not too much wrong with that so long as you are happy with the service that you are being provided with.  You may, however, have decided that it is time to change your current home care provider, and you can do this very easily by getting direct payments from Social Services. 

Under normal circumstances, you have a right to receive direct payments. All you have to do is ask; indeed, you should be informed that you have the right to receive direct payments when you have a Social Services assessment. For more information; go to this page. 

If you are receiving care through Social Services, you will have been awarded a personal budget. (For more information on personal budgets, go to this article.) When you have a direct payment, your personal budget is paid to you. This allows you to choose the home care provider that you want to provide your care. If you do not want to take on the responsibility of the direct payments, you can allow someone else (a relative or friend) to do this for you. 

Direct payments work in a very straightforward way. Kent County Council pay an amount of money into your bank account or onto a Kent Card. The Kent Card is a Visa debit card and you can find out more details here. You then use this money to buy your care from a provider of your choice.

Direct payments put you in control. If you should like further advice about direct payments, or, indeed, any aspect of domiciliary care, please do not hesitate to contact me. My contact details appear below.

Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.

Do You Want to Work in Domiciliary Care?

Caremark Thanet: Providers of Outstanding Domiciliary Care to the Residents of Thanet

We are looking recruit a small number of care and support workers to supplement our existing team. We are looking for people to cover: Margate, Ramsgate, Broadstairs, Westgate, Birchington and Sandwich.

If you would like to find out more about the opportunities that are available with us please telephone me on 01843 235910. However, before you do that, please read the following article:

http://thanetcare.blogspot.co.uk/2015/03/what-do-we-look-for-in-potential.html

This article tells you a great deal about the type of company we are and what we look for in care and support workers.

You can also visit our website: www.caremark.co.uk

and Facebook page: facebook.com/caremarkthanet

If you feel that we are the type of company that you would like to work for: telephone me now.

What Do We Look for in Potential Domiciliary Care Workers?

A Very Brief Overview of Domiciliary Care

Domiciliary care, or home care as it is often called, is care provided in customers’ homes. In England alone there are some 7000 domiciliary care providers and around 350 000 people delivering care to the customers of those providers.

                                       

I’m the managing director of a domiciliary care company, Caremark Thanet. We are a company that is growing steadily. For that reason we are always looking to recruit outstanding carers. Not everyone who wants to work for us is suitable. And, let’s be perfectly candid here: we are not suitable for everyone.

A question that we are sometimes asked is what we look for when we recruit care and support workers. Customers often ask about the experience that our carers have. Some are very experienced, indeed. However, there are things other than experience that we look for.

This post is written for a general readership; however, if you are reading this and you’d like to work in domiciliary care; we’d like to hear from you. Keep reading and you’ll find out a little about us so that you can decide whether we are the type of company you’d like to work for.

About Us

We are a domiciliary care provider serving the Isle of Thanet. We have been providing home care services to the residents of Thanet since 2012. In that short time we have developed a reputation for the outstanding quality of the services we provide.

There are two of us (my wife and I) at the head of the company: Jayne Costain is the Director of Care and Registered Care Manager. I’m Garry Costain, the Managing Director. Jayne has gained a wealth of experience in health care from working as a nurse for over fifteen years. My background lies in education and management.

We are a business. We are part of the service sector. We provide a very important service to some of the most vulnerable people in our society. We view our customers in the same way as any outstanding business should, which means that our philosophy is very simple. We aim to provide outstanding domiciliary care to each of our customers. On that we will never compromise. To achieve our aim we believe that our starting point is to recognize that:

Our customers are entitled to expect us to fit our services to their needs; we are never entitled to expect our customers to fit their needs to our services.

It is our duty to do all we can to help our customers remain independent and living in their homes for as long as they wish.

Upholding the dignity, supporting the independence and promoting the safety of each of our customers are paramount.

Without our customers our services would not be required.

We are only as good as the services provided to our customers by our care and support workers. For that reason, we have a right to be very selective in the people we choose to provide those services.

The people who provide our services to our customers are the most important people in our company.

In a sentence, what this means is that everything we do, we do for the benefit our customers.

What Do We Look for in Potential Carers?

What qualities, then, do we look for? There are two qualities in particular that we look for. There are, of course, many other skills and qualities that are needed. No-one will possess all of these and it is not necessary to possess them all.  However, we believe that the two qualities below are ones without which it is impossible to do the job. These qualities are small in number but infinitely large in importance.

Firstly, a carer has to be able to care. That, you may think, is stating the obvious. It is not. You only have to look at the number of horrendous cases of abuse by care workers to realise that the ability to care is not a quality that all people working in care possess.

People now talk about the mum test. This is a test that we have always applied when selecting care and support workers. We have always asked ourselves whether we would be happy for a potential carer to look after a member of our family. If we have any doubts then that person is not for us.

Secondly, a carer must be able to embrace our idea of customer service. The six points above give you quite a strong flavour of what customer service means to us. However, let me add some extra seasoning to our customer service dish so that you are left in no uncertainty about how important this is for us.

We are dependent upon our customers. Our customers can go elsewhere; there are plenty of other home care providers in Thanet. If we are providing an outstanding service for our customers; our customers will want to stay with us. As I never tire of saying, the quality of the service we provide is only as good as the carers who provide the service.

Providing a service to our customers is not an inconvenience for us. It is the reason we are here. If customers did not want our services we would not be needed. We take money from our customers to provide them with a service. That is not an inconvenience: that is a privilege.

Our customers’ needs change over time. When our customers contact us to make changes – even at short notice – even several times in a few days – we will do everything we can to accommodate them as quickly as we can. They are favouring us with their custom: we are not doing them a favour by responding to their requests. Any decisions we make will be guided by the principle that we will do all that we can to inconvenience our customers least. We may have to inconvenience ourselves, but that is why we are here.

Our reason for being in business is to meet the needs of our customers. We will always adopt the approach that it our job to look for ways to ensure that our customers’ needs are met. It is not our job to look for ways that will prevent us from fulfilling our customer’s needs.

In Conclusion

We have very high standards: we are proud of that. We have never compromised and will never compromise on the quality of the care that we provide: we are also proud of that. And we are equally proud of the high calibre carers that deliver our outstanding care. I have written before about carers being more than “just care workers”. In that article I spoke about how important our care workers are and said:

“That’s not to say that managers are not important: of course they are. That’s not to say that administrators are not important: of course they are. It is saying that without first class care staff who are manifestly MORE than just care workers, high class domiciliary care cannot be delivered. Businesses often pay lip service to the idea that their staff are their most valuable assets: domiciliary care companies do this at their peril.”

Not everyone who wants to work for us is suitable: but those who do work for us are manifestly more than care workers. They are our company’s most important people.

 Garry Costain is the Managing Director of Caremark Thanet, a domiciliary care provider with offices in Margate, Kent. Caremark Thanet provides home care services throughout the Isle of Thanet. Garry can be contacted on 01843 235910 or email garry.costain@caremark.co.uk. You can also visit Caremark Thanet's website at www.caremark.co.uk/thanet.