Post on 28-Mar-2015
LINCOLNSHIRE ASSESSMENT AND
REABLEMENT SERVICE (LARS)
Part of our Putting People First Transformation: -
PREVENTION → REABLEMENT→ MAINTENANCE
1. Financial Model
2. Specification
3. Pathway
4. Monitoring outcomes
5. Roll Out
6. Lessons/ Issues Learnt
Financial Model
Critical Assumption Areas:Scenario 2: As scenario 1 with unproven
reduction in maintenance hours following reablement
Expected new entrants to service each week (no previous homeSupport or closed 3+ week ago)
70
Expected numbers re-entering reablement for coming from maintenance each week due to significant life event
30
% leaving without service each week (from new case population) 52%
Number to maintenance each week from new case population 48%
Re-entrants leaving without a service each week 0%
Growth in demand 3.5%
Average reablement weeks 6
Average reablement hours 7.5
Average hours for legacy long-term maintenance home care 7.2
Average hours for maintenance home care after reablement 6
Current cost per hour and assumed as continuing cost on legacy cases – independent sector £ 12.95
Future cost per hour on transfers from reablement only – independent sector £ 15.00
Future average cost of service 2009/10 - £ per hour
Future average cost of service 2010/11 - £ per hour
Future average cost of service 2011/12 - £ per hour
Future cost per hour – Direct Provision – per paid hour £ 24.50
Legacy Direct Provision hours reduction 1.45%
Financial Model
Financial - This scenario Projected 2008/09 Projected End 2009/10 Projected End 2010/11 Projected End 2011/12 Independent Annual Cost £ 14,814,178 £ 17,317,736 £ 17,482,604 £ 17,483,116 Directly Provided Services £ 9,635,654 £ 8,066,171 £ 7,027,462 £ 6,510,976 Totals £ 24,449,833 £ 25,383,907 £ 24,510,066 £ 23,994,092 This assumes an unproven Directly Provided Services target saving of: £ 1,569,483 £ 2,608,193 £ 3,124,678 Therefore: Total Cost if only 25% of Directly Provided Services savings realised £ 26,561,020 £ 26,466,210 £ 26,337,601 Total Cost if only 50% of Directly Provided Services savings realised £ 26,168,649 £ 25,814,162 £ 25,556,431 Total Cost if only 75% of Directly Provided Services savings realised £ 25,776,278 £ 25,162,114 £ 24,775,262 Financial - If we change nothing Projected 2008/09 Projected End 2009/10 Projected End 2010/11 Projected End 2011/12 (Allows average 3.5% demographic growth p.a.) Independent Annual Cost £ 14,814,178 £ 15,692,220 £ 16,430,037 £ 17,505,235 Directly Provided Services £ 9,635,654 £ 9,635,654 £ 9,635,654 £ 9,635,654 Totals £ 24,449,833 £ 25,327,874 £ 26,065,691 £ 27,140,889
Chart below assumes that reablement hours will be 4,5000 per week when service fully utilised and that these hours will be purchased from Directly Provided Services
Financial Model
2273222774
25326
4958
7258
27691
30103
33521
0
5000
10000
15000
20000
25000
30000
35000
07/04/2009 06/04/2010 05/04/2011 03/04/2012
Ho
urs
per
wee
k
Independent
Direct Provision
Total
Projection with noreablement and 3.5%demographic growth
Specification
LINCOLNSHIRE COUNTY COUNCIL ADULT SOCIAL CARE (ASC)
SERVICE SPECIFICATION FOR THE PROVISION
OF LINCOLNSHIRE ASSESSMENT AND REABLEMENT SERVICE (LARS)
Working Document version 3 .1 MAY 2009
LARS Working Service Spec ver 3 1 15/07/2009
Specification
• Key Issues
• A commissioned service
• Developed in partnership with in-house
• Service definition
• Outcomes
• Volume/ Price
• Workforce requirements
Pathway
Lincolnshire Assessment and Reablement Service (LARS)
First Contact / Initial Assessment Customer
Service Centre
NFAor advice/
Informationonly
LARS Service Case Management
Screening &Allocation
Referral fromWard
Hospital Discharge
Team
Health RehabServices
(eg Stroke)
Prevention Support viaVoluntary
Organisations
Intermediate Care(Community &
Beds)Reablement
Rapid Response and
Interim Care
Long-termAssessment(RAS) and Discharge
Clinic-basedAssessment(Equipment/
telecare)
Long-termAssessment(RAS) andDischarge
NFA servicescomplete
Transfer to Long-TermMaintenance
Assessment & Care ManagementBrokerage (support planning, review,Case management, reassessment)
Pathway
Lincolnshire Assessment and Reablement Service (LARS) Assessment Process
Allo
cate
d C
ase
Man
ager
Dut
y / C
onta
ct S
cree
ning
/ Al
loca
tion
Poin
t of C
onta
ct
Contact / Initial Assessment commenced
Dimension 1(basic referral information)
Dimension 2Scored ADL
section to support clinic
decisions
Low level needs?
Gather additional information to support screening as required.
No
End of assessment.
Close
Information, advice, signposting to low level preventative services.
Stay Safe at Home booklet.
Yes
Reablement AssessmentMay be commenced by
duty if required.
Workflow to Area Team
(email to duty box)
Moderate needs?
Simple service provision e.g..
Telecare, frozen meals
Enter low level review cycle
(Business Support)
Smartcare clinic
appropriate?Yes No
Arrange Clinic AppointmentNo
AllocateTo
Practitioner
Are reablement / crisis
intervention services
indicated?
Yes
RAS / Self Assessment
No - Maintenance needs indicated
Reablement AssessmentFunctional needs assessment to support reablement / crisis
planning. Contact Assessment copied forward and updated
as required. Validated scales and specialist assessment
triggers included.
Outcome Focused
Reablement Plan
implemented
Yes
Review / Reassessment.
Reablement Assessment
copied forward and revisited.
Validated scale re measured
Maintenance needs identified
or required?
Yes
Monitor reablement
Support Planning
Information, equipment signposting
CloseNo
Monitoring Outcomes Initial Assessment and Reablement / Crisis Plan
Summary of Presenting Situation: Include informal care arrangements Activities of Daily Living Scale: The following section is intended to record and measure how well you are able to manage daily activities. This will be looked at again when we review your support to measure any improvements ADL Scale Key
0- independent (on own without help) 1- on own with difficulty or discomfort 2- only with help from someone else 3- not at all
Personal Care
Assessment Reassessment
Washing face and hands (shaving if relevant)
Bath, shower or wash all over Getting dressed and undressed Using w/c Toilet Eating and Drinking
Able to prepare a meal Able to make a snack Able to eat and drink Practical Needs
Laundry Cleaning Shopping Managing Finances Getting around indoors
Getting on and off chairs Getting in and out of bed Getting up and down stairs Getting around outdoors
Access/ steps to house Walking Using public transport Car ADL TOTAL
Monitoring Outcomes Initial Assessment and Reablement / Crisis Plan
Supplementary Scales: These additional questions are to help identify if further assessments are neeed from other services HEALTH 0 - in good health 1 - occasionally feel unwell 2 - some moderate health problems that require some monitoring and support 3 - complex health problems that require a lot of monitoring and support MEDICATION 0 - fully competent, independent and self medicating 1 - needs prompting and reminding 2 - needs someone to administer medication MEMORY – Please record any issues or concerns regarding cognitive impairment or mental capacity 0 - complete 1 - occasionally forgetful 2 - short term memory loss 3 - short and long term memory loss FALLS 0 - none 1 - Occasional trips 2 - more than 4 in the last 12 months WELLBEING Assessment 0 - positive outlook every day 1 - variable, good days and bad days 2 - appears depressed and lacking motivation all the time SOCIAL CONTACTS Assessment 0 - lots of contacts with family, friends, neighbours and community 1 - lives alone but has lots of contact 2 - would like more contact 3 - lonely and socially isolated CONFIDENCE Assessment 0 - more confident than before 1 - the same ... no more or less confident than before 2 - less confident than before 3 - much less confident than before
Roll Out
Roll Out
Grantham Sleaford
Establish local implementation team Briefing/ training sessions for staff in house home care and local Ass and Care management Team Home Briefing sessions for relevant IS providers Start change of flow re orders for home care to create in house capacity for LARS (i.e. new requests for home care to go direct to IS) Start new LARS service Weekly action meetings of local project team to monitor/ problem solve Sign off project as successfully implemented in locality
6th April 2009 Wb 20th April 2009 Wb 20th April 2009 8th June 2009 6th July 2009 24 August 2009
Roll Out
DIRECTLY PROVIDED SERVICES
CRISIS & REABLEMENT SERVICE - PERFORMANCE
REPORT FOR JUNE 2009 [Week Ended 26th June]
SKEGNESS BOSTON LOUTH & HORNCASTLE
SPALDING STAMFORD (Sleaford
Office)
STAMFORD (Grantham
Office)
SLEAFORD GRANTHAM LINCOLN WEST LINDSEY
TOTAL
Current Month's Performance [June]
Ave. weekly No of Individuals in Service 35 44 51 8 2 0 1 141
Hours of Service provided in Month 683 778 1225 143 5 0 1.17 2835 Budgeted Contact Hours 715 978 1341 Ave hours per individual 4.88 4.42 6.00 5.96 1.25 1.17 5.03
Previous Quarter's Performance [13 weeks] (3
weeks) (2 weeks) (1 week)
Ave. weekly No of Individuals in Service 33 22 32 87
Hours of Service provided 2015 1319 2255 5589 Budgeted Contact Hours 2155 1612 2418 Ave hours per individual 4.70 4.61 5.42 4.91 NO. OF OPENED CASES since start of service 162 84 138 42 9 5 3 443
New this month 38 42 69 42 9 5 3 208 CLOSED CASES No of closed cases 126 44 70 12 2 0 1 255
Closed this month 39 35 50 12 2 0 1 139 Ave time in Service (days) 27 25 27 5 1 0 0 28 Ave Service provided (hours) 20 19 22 5 1 0 0 22 Ave hours of service/week 5.19 5.32 5.70 7 7 6 NO. OF CURRENT CASES 36 40 68 30 7 5 2 188
Change since last month -1 7 19 30 7 5 2 69
Issues
• Action learning approach
• Role between ASS/ C Management and in-house Home Care co-ordinators
• Fit with overall system/ intermediate care
• Charging
• Hospital discharge
Issues
• Balance and capacity
• Generic workers
• Whole system impact
• Better outcomes for people