Avoiding and reducing care home admissions on the Isle of Wight
Personal assistants (PAs) can enable people to be more independent and in control of their lives. The Isle of Wight Council has worked with partners to establish a personal assistant market that is well placed to support residents in their own homes and reduce avoidable admissions to care homes.
There was a range of issues facing the Isle of Wight:
- no oversight of PA market: numbers / services / hours
- no interaction with the local authority or support mechanisms for individual PAs
- no safe and established route to market for social workers and individuals, for example adverts in papers, no approved lists etc
- poor coverage – no PA presence in some geographical locations
- limited number of PA packages not being filled - anecdotal poor quality
- no training offer for PAs
- complete lack of confidence in PA provision by social workers.
In January 2018 the council agreed a vision and a plan to deliver it with partners.
To establish a robust and diverse PA market which could provide support to all of the Island, ensuring the people we serve receive better services and person-centred outcomes”
The Isle of Wight Council have developed the PA offer by:
- implementing a PA Market Development Team and PA Hub
- positive engagement and investment into the PA Market
- introducing bespoke systems including a PA notice board, Facebook, PA database and pre-paid card system
- joint working partnerships - Possibility People, Skills for Care and Think Local Act Personal
- working in partnership with the voluntary and community sector (VCS) hospital discharge scheme
The council has used PAs to avoid and reduce care home admissions by:
- increasing the number of PAs across the island, focusing on rural localities whereby historically home support capacity was limited and resulted in care home admission.
- ensuring that information for individuals and family members was readily available and easy to digest – previously recruiting a PA may have been a daunting task.
- providing training to PAs to support complex needs, for example, manual handling training, meds training etc
- developing support functions around the use of PAs – internal brokerage service supporting individuals finding PAs and an internet payment function to support payment of PAs
- implementing a specific PA scheme related to support hospital discharge to home and in addition utilised PAs to support crisis situations in the community whereby care home admission was often the default position.
Following the foundations being put in place to support individuals in accessing PAs, the council saw a dramatic reduction in admissions to care Homes. From a peak of 360 admissions to residential and nursing care for people aged 65+ in 2016/17, there was a reduction to 211 in 2019/20, a 41 per cent reduction. The Adult Social Care Outcome Measures Framework (ASCOF measure 2B) tracks progress and shows a reduction in long-term support needs met by admission to residential and nursing care homes for all ages. The Isle of Wight has seen the rate per 100,000 population aged 65+ reduce from 951.9 in 2016-17 to 509 in 2018-19; this is lower than the region at 521.2 and England score of 580 per 100,000 population aged 65+ respectively.
How is the new approach being sustained?
Isle of Wight Council supports hospital discharge and helps people to avoid care home admission from hospital by:
- working collaboratively with the local user led organisation to support the day to day management of the scheme
- identifying and creating a dedicated PA team that is responsive and person-centred.
- developing advice and guidance for individuals and families – creating support structures to facilitate informed decisions
- providing dedicated and specialist training, supporting hospital discharges.
Laura Gaudion, Interim Director – Adult Social Care and Housing Needs, Isle of Wight Council