AGENDA ITEM
BOROUGH OF POOLE
COMMUNITY SUPPORT OVERVIEW GROUP
27 NOVEMBER 2007
REPORT BY HEAD OF ADULT SOCIAL SERVICES COMMISSIONING
SERVICE STRATEGY FOR PEOPLE WITH DEMENTIA
1.PURPOSE OF REPORT
1.1.To present to members the Commissioning Strategy for Residential and Nursing Care for People with Dementia until 2025 and to outline service and quality developments arising from it.
2.RECOMMENDATIONS
2.1.Members are asked to note the contents of the report.
3.BACKGROUND
3.1.Dementia has its origin in physiological changes in the brain, which lead to symptoms ranging from mild forgetfulness and occasional confusion, through persistent states of memory loss and confusion, to severe states in which personality is fundamentally damaged and behaviour can be very extreme. There are a number of different types of dementia, the most common of which is Alzheimer's affecting 55% of sufferers with the remainder being divided between vascular dementia (20%), Lewy body dementia (15%), frontal lobe dementia (5%) and other types of dementia (5%). Dementia is linked to the aging process (although cases in younger people are not unknown) and the incidence and prevalence of dementia increases with age. People with learning disability carry a higher risk of contacting dementia at a younger age than the rest of the population and in particular people with Down's Syndrome are susceptible.
3.2 The proportion of people suffering from dementia increases from 1 in 1,000 people aged between 40 and 65 to 1 in 5 people aged 80+. Incidence increases to 1 in 50 old people aged 65-70 and 1 in 20 of people aged 70-80. Borough of Poole has a projected population growth of older people over the next 18 years to 2025 which will mean that its population of older people becomes greater than that of Bournemouth. It is anticipated that the number of people aged 60+ in Poole will increase from 36,500 to 50,100 whilst the most significant increase is in the number of people aged over 85 which will grow from 4,000 in 2004 to 6,900. It is expected that this rate of increase will continue as the post war baby boomers reach their 80's from 2025 onwards.
3.3Adult Social Services Commissioning has in the accompanying Commissioning Strategy (Appendix 1) applied the population figures and prevalent data to the picture of services in Poole and reached the conclusion that in 2028 there will be 360 more people with dementia than there are today between 60 and 80 years old and 1183 more people who are over 80 with dementia.
4.PATTERNS OF SERVICE
4.1.In recent years, Adult Social Services have been increasingly successful in maintaining people with physical disability and disease in their own homes for much longer than was the case even 10 years ago. A series of improvements in the provision of home care and the provision of floating support to frail older people (through such initiatives as the Partnerships for Older People (POPP) programme and the commissioning of floating support services through the Supporting People Programme) mean that the numbers of people, whose disability is simply physical, having to move to residential care have been falling as a proportion of all admissions. The two Adult Social Services Units through their Intermediate Care and Wellbeing initiatives, will be promoting and developing a very wide range of services from minimal support to high intensity home care to enable older people to remain living in their own homes. Extensive consultation with older people in a number of different surveys always indicates that people wish to remain home if at all possible.
4.2Many such initiatives will equally apply to people in the early stages of Alzheimer's disease or people suffering from one of the less virulent forms of dementia. Borough of Poole has, therefore, taken similar initiatives to support people at home as long as possible and details are given below of a specialist floating support service commissioned through Supporting People, and the development of the specialist home care service contracted to Care UK. It remains the fact at present however, that despite extensive research, there is little that can be done to ameliorate the progress of certain types of dementia; once people's needs have reached a certain level, their own safety and that of their carers and neighbours often requires that they are looked after in a residential care setting.
4.3 The attached report details the current residential care home market in Poole and indicates that today there are approximately 103 people publicly-funded in specialist accommodation for people with dementia and approximately the same number in non-specialist settings. It is our expectation that by 2025, we shall need 360 specialist residential or nursing care beds for people with dementia, allowing both for the shift of frail older people to home based care and the development of further community based support for people with lower degrees of dementia. In addition the number of respite care beds which of course, help to keep people at home for longer by providing breaks for both them and carers, needs to rise from the present 7 specialised beds to approximately 18 over the same period, which leads to a total requirement of 378 specialist dementia beds, or 175 more than currently funded by the Borough.
4.4It is important to note however, that that figure refers only to people financially supported by Borough of Poole. Many older people in Poole fund their own care and it is anticipated that the proportion of pensioners owning their property will rise to over 80% by 2025, meaning that the number of "self funders" will also rise steeply. Borough of Poole, both as a Planning Authority and as a Social Services authority, is now required to take into account in its planning the needs of people for whom it is not directly responsible and best evidence at the moment indicates that the total requirement of specialist dementia beds in Poole will rise to 1200 in total, approximately 500 more than the current total number of beds available to people suffering from dementia (175 of these will be funded by Borough of Poole and 325 self-funded and provided by the market). The Borough of Poole will therefore need to adapt its policies both in planning for the built environment and in strategic planning to recognize the changes in the pattern of land use suggested by this figure.
5.DEVELOPMENT OF SPECIALIST SERVICES FOR PEOPLE WITH DEMENTIA
5.1.Adult Social Services Commissioning have sought to anticipate some of these changes required by the developments and changes in population structure:
5.2Specialist Floating Support Services. As indicated above the range of support services needed by people with dementia will in many ways mirror the wide range of support and wellbeing services developed for the population of older people as a whole. People in the early stages of dementia or with more slowly progressing varieties of the disease can be supported at home and helped to remain at home longer, the longer they have low level support. The Supporting People Commissioning Body therefore decided in its five year strategy to invest more heavily in older people and in particular, older people who do not live in sheltered accommodation but who require similar levels of support and oversight as people who do live in such settings. During 2007/08 therefore, two quite separate floating support services have been developed, one of which specialises in dementia and this has been contracted to Rethink following a sub-regional tendering exercise involving Somerset, North Somerset and Bournemouth as well as Poole.
5.3The service, which will be locally based, will aim to provide 220 hours per week of staff availability to offer housing related support to people with dementia of all ages. Housing related support does not mean that people will have such activities as shopping or cleaning or gardening carried out for them, but rather that they will be assisted to organise such things for themselves and in particular that the resources of the community as a whole are made available to people at an early stage. It is intended that a proactive "case-finding" approach is adopted, not unlike that developed by the POPP project. It is also anticipated that if it is successful, the number of hours initially commissioned will need to be reviewed, and the Supporting People Commissioning Body will need to consider whether the service should be sustained and developed. This will depend on its relative priority in the light of the resources available and the other 20 user groups for which it has responsibility.
5.4Specialist Home Care. Following the Best Value review of Home Care in 2000, the Adult Social Services Units were given the best value performance indicator of 650 hours per week of specialist home care. It has taken some years to achieve this target, but following the outsourcing of part of the home care service to Care UK in 2006, the service grew from 450 hours in April 2006 to the current level of 780 hours in October 2007. The contract with Care UK provides for the service to grow further so as to meet specialist demand.
5.5Day Care Services. Another area which enables people to remain living at home for longer and which also supports their carers with the provision of specialist day services. The Day Centre at Garland Road was outsourced to Care UK as part of the re-provision of dementia services. At that point, the numbers increased from 12 places per day to 20. The phase 2 development of this contract which will see the replacement of Mitchell House will also see the replacement of the Garland Road day centre with a specialist day unit on the same site as the new Mitchell House and it is anticipated that the number of spaces will rise further to 40. This will enable more specialist care to be provided and will enable some people who are currently obliged to attend Poole Day Centre because of the shortage of specialist day places, to be enabled to attend a specialised service.
5.6 Residential places. To some extent the Care Home market is expected to respond to demographic pressures by conducting its own market analysis and research and developing its own plans for expansion. It is clear however, that Adult Social Services Commissioning cannot rely simply on market mechanisms to meet its requirements for residential care. As the major Commissioner in this area, it needs to state what particular types of residential and nursing care it requires and it also needs to establish resources which, whilst of good quality, are nevertheless affordable (the levels of support needed by people with severe dementia in residential care are already such that average prices are £490 per week in publicly funded care and anything up to £850 locally in the private market). The Unit's Commissioning Strategy therefore has been to work firstly with Care UK in replacing Mitchell House with a brand new facility which is designed specifically for people with dementia and which will more than double the number of beds available. 20 of the proposed 116 beds in the new Mitchell House will be registered for nursing care, thereby meeting a particular pinch point in the current local market. Care UK are still having difficulty in sourcing a suitable site and have a planning application currently undergoing appeal, but they remain committed to developing their services in Poole in a high quality specialised building.
5.7At the same time, Care South which operates Heathlands Residential Home on the Fourways Site are in discussions with the Council to acquire a long lease on that site and re-build Heathlands as an 80 bed residential home, again with 30 nursing beds as part of the complement, all of which will specialise in dementia. Both the Care UK and Care South projects will result in contracts with the Borough of Poole for the purchase of all available beds on a block contract basis. This will, on the one hand, assure supply at an agreed price but on the other give people a degree of choice between the two block contracts, as well as allowing people also to choose to be funded by Borough of Poole on a spot purchase basis at another home offering specialist care locally. It is thought that the total of 196 specialist beds to be contracted in both these schemes will offer a fair
balance between a block contracted service on the one hand and the required
element of choice (as set out by Department of Health and Commission for Social
Care Inspection) on the other.
5.8Adult Social Services Commissioning will of course monitor actual demographic change over the medium and long term and compare it to the estimated changes indicated above. These will adjust its commissioning intentions accordingly. Present indications allow us both to make short to medium term commitments to enable the right level of care to be available to Poole residents, whilst not over committing the Council to particular courses of action towards the end of the 2007-2025 planning period.
John Dermody
Head of Adult Social Services Commissioning
Contact Officer:Nick Molland
Telephone No:01202 261144
Date:26 October 2007
Report Ref: zzsues/reports/Service Strategy/Nov 07 - Report to CSOG
Commissioning Strategy
for Residential and nursing Care
for People with Dementia
to 2025
PART ONE
NEEDS ASSESSMENT
EXECUTIVE SUMMARY
Executive Summary
In 2003, there were an estimated 501,900places in residential setting for long stay care of elderly and physically disabled people across all sectors (private, public and voluntary) in the UK.
Prevalence of dementia in care homes is 70%+. Care homes for older people are primarily homes for people with dementia.
Dementia affects 5% of those aged over 65 years, and 20% of those aged over 80 years.
It is estimated that by 2025 there will be over 1 million people with dementia in the UK. This is expected to rise sharply to 1.7m million people with dementia by 2050.
The proportion of people with dementia doubles for every 5 year age group.
Poole (whole population, publicly-funded and self-funded)
Based on local planning records, there has been a loss of 189 care home bed spaces between 1999-2006 in Poole. There are 36 care homes in the Borough of Poole, providing 1,150 bed spaces. There are currently 222 beds in the category of care home reserved for specific dementia or mental disorder care.
By 2025 there is a projected potential shortfall of up to 720 care home beds within the town: this number includes both self-funding residents and people funded by Borough of Poole. This is as a result of an ageing population and based on current bed capacity that is available within the community.
Of these 720 care home beds, 500 is a shortfall in accommodation specifically for people suffering from dementia.
Developments in health care will lead to most physically frail people being cared for at home. Residential and nursing care will therefore predominately be an option for people with dementia.
Care Commissioned by Borough of Poole for publicly-funded residents
Currently the Borough of Poole support altogether 411 older people in residential or nursing home accommodation. Of these 103 are in residential or nursing home accommodation specifically for people with dementia, and a further 100 or so are in non-specialist accommodation, a total of 203 people with a primary diagnosis of dementia.
By 2025 the number of residents in residential or nursing accommodation for people with dementia, matching population increase and disease incidence, financially supported by the Borough of Poole will rise to 450.
This number may be alleviated as a result of mitigation by new pharmaceutical developments and further as a result of new services such as Assistive Technology and Extra Care developments in people’s own homes, as well as supporting people floating support which commences shortly, delaying admission to residential care. It is estimated that together these will decrease the impact by some 20%.
This leads to an estimated requirement of 360 (190 Nursing, 170 Residential) accommodation for people with dementia funded by Borough of Poole.
Additionally, each respite bed currently supports 30 people, leading to an estimated requirement of 18 (split between nursing and residential) block contracted beds by 2025.
Conclusion
Borough of Poole therefore will need to commission in the region of 190 + 170 + 18 = 378 rooms for publicly funded residents, or 175 more than at present.
As a Planning Authority, it will need to strategically plan for 500 more beds in total, 175 publicly funded as above and 325 (approximately) self-funded and provided by the market.
DRAFT
Commissioning Strategy
for Residential and nursing Care
for People with Dementia
to 2025
PART ONE
NEEDS ASSESSMENT
Contents
Section 1
1 / Introduction / 3
2 / Quality / 3
3 / National & local priorities & targets / 4
4 / National Care Homes and dementia / 5
5 / National statistics of dementia / 5
6 / National projected growth of dementia / 6
7 / People with learning disabilities & dementia / 6
8 / Mortality rates / 7
9 / Local social services clients / 7
10 / Impact of demography / 7
11 / Local statistics of population growth / 7
12 / Local population projections of people with dementia / 8
13 / Incidence data of local population / 9
14 / Local statistics of current population with dementia / 9
15 / Local Statistics of current population with dementia known to Bournemouth & Poole Primary Care Trust / 10
16 / Diagnosis / 11
17 / Residential care home provision for clients with dementia / 11
section 2
18 / Current care home provision in poole / 14
19 / Loss & creation of care home capacity / 15
20 / Older People’s Housing & Housing related support strategy / 16
21 / Current housing provision & gaps in supply: conclusions / 16
section 3
22 / Care homes for dementia clients – block contracts / 17
23 / Care homes for dementia clients – spot contracts / 17
24 / Location of clients / 17
25 / Commission for Social Care Inspectorate / 18
26 / Flexibility of accommodation / 18
27 / Severity of disease – challenging behaviour / 19
28 / Dorset Healthcare Foundation Trust / 19
29 / Joint commissioning / 19
30 / Assistive technology / 19
31 / Carers support / 19
32 / Respite / 22
33 / Conclusion / 23
References / 24
Commissioning Strategy for Residential and nursing Care for People with Dementia to 2025