Often due to pressures and trouble identifying someone at the home who could carry out assessments, it took up to a week for a home to visit. Lincolnshire introduced a care home trusted assessor role, which would not only enable assessments to be carried out more quickly, but would also help to develop relationships and trust across the system. This example of a local initiative forms part of our managing transfers of care resource.
In many health and care systems, there has been a loss of trust between acute sector assessment teams and care home managers, leading to significant delays in transfers of care. In Lincolnshire, a number of delays were occurring while waiting for care homes to visit the acute hospital to carry out assessments. Often due to pressures and trouble identifying someone at the home who could carry out assessments, it took up to a week for a home to visit. Lincolnshire chose to address this through the introduction of a care home trusted assessor role, which would not only enable assessments to be carried out more quickly, but would also help to develop relationships and trust across the system.
In September 2015 a pilot project was agreed for an assessor to be employed by the care home sector and located within the discharge hub at Lincoln County Hospital. Working in partnership with care homes and the hospital to find solutions to current challenges, the role was established to:
- support and facilitate timely and safe discharges from hospital to care homes
- undertake assessments and re-assessments on behalf of the care homes
- ensure the discharge documentation was complete to accompany the resident on discharge
- liaise with the care homes about the discharge arrangements to streamline processes
- act as a point of contact when residents were admitted to hospital to monitor progress.
- working in partnership with care homes and the hospital to find solutions to current challenges
The people identified to undertake the role were fully independent, employed by the Lincolnshire Care Association. They have been given access to the bed management system and to the trust’s IT systems, and there is a strong focus on regular communications with care homes. Until the role became business as usual, Lincolnshire ensured there was consistent communication and wrote to the care homes on a monthly basis to keep them up to date with progress,. The homes have been encouraged to contact one of the trusted assessors when any of their residents have been admitted to hospital to allow them to track progress.
In its first full year, the service made 439 referrals and completed 340 assessments, which saved a total of 735 days leading to a total net saving of £400,000. Key learnings from the introduction and development of trusted assessors in Lincolnshire over the last few years has been:
- Start small and grow slowly. Rebuilding trust in the key to success and therefore one poor assessment could jeopardise acceptance of the service. Consider starting with residents returning home before assessing new residents.
- Accept that the trusted assessor will not “solve DToC”, but is a key piece in the patient flow ecosystem and will get most people home 1-3 days faster.
- Generic assessment documentation is not essential at the start of the service, however will likely develop as the service becomes embedded.
- To start with, Trusted assessor should be a service which care homes can choose to use, rather than mandatory, and is better for the system if it is offered to all homes instead of a few. As the programme becomes more established the service can develop so that trusted assessment is used if a care home cannot complete an assessment within 24 hours.
Plans are now in place to develop a new Community of Practice, which will support Trusted Assessors to provide a platform to share best practice, provide informal mentorship for Trusted Assessors new to post, and encourage the development of the trusted assessor role to support all managers of care and housing services.
Chair Lincolnshire Care Association