The FACE Adults RAS Details & Configuration Guide V7

RAS Version 7 – Master Formula Version 1.7

London Borough of Hammersmith and Fulham, Royal Borough of Kensington and Chelsea, City of Westminster Council

Mark Rogers - FACE Implementation & Support Consultant

Document Owner - Malcolm Rose, City of Westminster Council

Contents

Version History

Introduction

Background Information

Local Rates and Configuration Decisions

1Input and Output Decisions

1.1RAS Forms

1.2RAS Outputs

2RAS Formula Summary (including specific rates and configuration decisions)

2.1Personal care – morning

2.2Personal care – evening

2.3Personal care – adjustment for mobility/positioning difficulties

2.4Personal care – adjustment for memory/acceptance of support difficulties

2.5Personal care – during day

2.6Personal care – support from family/friends/volunteers

2.7Preparing meals/snacks/drinks and Medication support

2.8Learning disability personal care/meals/medication adjustment

2.9Conversion to monetary allocation

2.10Ensuring safety – service users who cannot be left alone (waking hours)

2.11Combined allocation for personal care, medication, meals/snacks/drinks and safety

2.12Personal care – support of two

2.13Household tasks

2.14Social, leisure, cultural and spiritual activities

2.15Work, training, education and volunteering

2.16Total of daytime needs allocations

2.17Care home adjustment

2.18Night support allocation

2.19Living situation cap and addition

2.20Sustainability allocation (i.e. respite breaks)

2.21Overall high-end cap and minimum budget adjustment

2.22Adjustments relating to National Eligibility Framework

©2015 FACE Recording & Measurement Systems Ltd. All rights reserved.

This document is for licensed FACE customers only. No part of this documentation may be reproduced or
transmitted in any form, by any means, without the prior permission of FACE Recording & Measurement Systems Ltd.

Version History

Date / Name / Detail of changes
02/03/16 / Mark Rogers / Combined 3-Borough document created
05/04/16 / Mark Rogers / Updated following configuration meeting
20/04/16 / Malcolm Rose / Updated with LA rates.
21/04/16 / Malcolm Rose / Updated LA rates

Introduction

This document describes the workings of the FACE RAS and has been produced to reflect FACE’s commitment to transparency – the importance of which is emphasised in the Care Act 2014’s ‘Statutory Guidance for Implementation’ – which states:

‘11.4. It is vital that the process used to establish the personal budget is transparent so that people are clear how their budget was calculated, and the method used is robust so that people have confidence that the personal budget allocation is correct and therefore sufficient to meet their care and support needs. The allocation of a clear upfront indicative (or ‘ballpark’) allocation at the start of the planning process will help people to develop the plan and make appropriate choices over how their needs are met.’

The document also acts as a record for a Local Authority of the decisions they have made regarding the rates and configuration within their local RAS – showing where each decision or set of decisions is used within the RAS.

Background Information

The FACE RAS has been developed over a period of seven years and the development has involved over 40 councils to date. At the forefront of the development has always been the core aim of enabling personalisation to be realised in the context of accurate needs and outcomes-based targeting of resources, whilst ensuring financial sustainability.

The FACE RAS allocations are based on a national baseline model with adjustments applied to account for local costs and allocation practices. Effectively, the method of arriving at any single indicative budget figure can be described as ‘in line with what it costs to meet the needs of other comparable individuals locally, based upon a nationally-validated overall model’. The national model was developed and tested in conjunction with independent researchers at University College London.

It is sometimes incorrectly stated that the FACE RAS replicates existing costs and practice. In fact, the FACE RAS is based on standard costs rather than actual costs and is carefully configured during setup to ensure any undesired existing allocation practices are not perpetuated. What a council chooses to use as standard costs is up to them, but it can be, for example:

  • Actual costs (not recommended as these vary according to provider, e.g. in-house andexternal)
  • Average actual costs
  • External standard costs
  • PSSEX return costs
  • Anticipated or desired standard costs based upon service reconfiguration

The above leaves considerable room for flexibility. For example, if a council wished to use or move towards a single cost modelfor all, actual cost data for younger adults and adults with learning disabilities could be collected and then re-standardised based on standard older people costs, with the RAS then being recalibrated accordingly.

In all councils where the FACE RAS is in full routine use, it has been thoroughly tested through specific testing exercises or via pilot use before proceeding to this stage. This testing involves comparing indicative budgets produced by the RAS with the cost of support for sets of cases that were not used to calibrate the RAS initially – providing an independent test of accuracy.

Careful analysis is carried out on any cases where there is not a close relationship to ensure that the RAS is as accurate as possible for all types of cases.These financial auditshave consistently found high levels of accuracy.

For RAS Version 7, additional core requirements have been:

  • To ensure compliance with the Care Act 2014 – with the FACE V7 Overview Assessment having been specifically developed to meet these requirements, and the key principles of the new national eligibility framework having been incorporated into the RAS algorithm itself.
  • To increase transparency of the method of calculation – for which this document has been produced. The remainder of the document shows a summary of each of the steps in the FACE Version 7 RAS formula. In order to explain the approach fully, it is important to highlight that the overall RAS formula has two components:
  1. The council’s individual ‘configuration decisions’ – to be considered in two distinct parts:
  2. The standard rates that have been agreed locally for applying to ‘units’ determined by the core algorithm. For example, the cost per hour for meeting personal care needs; the cost per ‘session’ for meeting social participation needs; the cost per night for providing ‘sleep-in’ support; the cost of residential and nursing care home placements locally.
  3. A number of local decisions regarding how the RAS should operate that are linked to the paid and unpaid services available within the local marketplace, including consideration of any ‘in house’ services run by the local authority. For example: Should different rates be used for people with a learning disability or people with a mental health problem, compared to older people?; How should the RAS allocate budgets for people living in ‘Extracare’ housing (where cost models tend to be bespoke and therefore not comparable to the cost of meeting the same needs elsewhere)?
  4. The ‘core’ algorithm which calculates the indicative budget in a number of steps, using the local configuration rates/decisions above.

Local Rates and Configuration Decisions

During the implementation of the FACE RAS, information and intelligence must be collected on both the costs of different types of services locally and the local requirements for the configuration of the RAS model(s). This document is designed to capture all of the information required and therefore needs to be populated during the course of the implementation in order for FACE to set up the RAS model(s) in line with the requirements of the Local Authority being worked with.

Following ‘go live’ of the RAS, this document will act as a reference point for the decisions made during the implementation phase. It will need to be updated prior to each RAS update or recalibration to form the basis of configuration of the revised model(s) – reflecting any changes in local rates or policy since the last update.

1Input and Output Decisions

1.1RAS Forms

Overview Assessment, Carer’s Assessmentand ‘Joint Carer’s Supplement’

For the latest toolset version (V7) there is a single core social care tool in the FACE Toolset which links to the Adult’s RAS for calculation – the FACE Overview Assessment V7. In addition, the FACE Carer’s RAS can be optionally purchased – for which there are two tools that can be used – the standalone Carer’s Assessment and the ‘Joint Carer’s Supplement’ (for use alongside the Overview where a carer’s needs are to be assessed at the same time as the cared-for person).

Decision:
Not using FACE Carer’s RAS
Use FACE Carer’s RAS via standalone Carer’s Assessment only
Use FACE Carer’s RAS via standalone Carer’s Assessment and Joint Carer’s Supplement
Details:

1.2RAS Outputs

In addition to the output of the Indicative Budget itself, there are a number of other optional outputs that can be generated by the RAS from an Overview Assessment.

  1. Allocation Summary –a breakdown of the IB into high-level domains/units:
  • Key information regarding the IBcalculation (text statement; may be blank).
  • Carryingoutessential dailylivingtasks:
  • The overall allocation for personal care, meals/snacks/drinks preparation and medication (waking hours).Note: The amount here will reflect any reduction made due to visits not needed where the safety allocation is sufficient to cover this(where constant presence/supervisionis needed).
  • Carryingoutessential dailylivingtasks – number of hours per week.
  • Carrying outhouseholdtasks.
  • The overall allocation for keeping home sufficiently clean/safe, shopping for food/essentials and managing paperwork/finances.
  • Carryingouthouseholdtasks – number of hours per week.
  • Supplement forsupportof two carers.
  • This covers any additional allocation for personal care tasks requiring the support of two carers.
  • Supplement forsupportof two carers – number of hours per week.
  • Supplementfor nightsupport.
  • The allocation for support during the night.
  • Supplementfor nightsupport – type of support &number of nights per week.
  • Stayingsafe& socialactivities/relationships.
  • The sum of any allocations given for safety during waking hours (for service users requiring constant presence/supervision) and social activities and relationships. These areas are combined here due to the clear overlap between the two.
  • Stayingsafe& socialactivities/relationships – number of days/sessions per week and number of 1:1 presence/supervision hours per week.
  • Engagingin work,training, educationor volunteering.
  • This is the allocation for work/training/education/volunteering (where there is an amount remaining after calculating any ‘offset’ with the above domain).
  • Engagingin work,training, educationor volunteering – number of days/sessions per week.
  • Sustaining carer’s role(carer breaks allocation).
  • The allocation for ‘sustainability’ of the carer(s)’ role.
  • Sustaining carer’s role– number of nights per year.
  1. Automatic Quality Assurance –an auto-generated list of potential scoring errors from the completed assessment whichchecks scores in different areas against each other for common mistakes (e.g. ‘Undressing scored higher than Dressing’).
  2. CHC Checklist Mapping –a set of predictions in relation to potential eligibility for Continuing Healthcare funding, using a mapping to the national CHC Checklist.
  3. Global Need Band – an overall level of need for the assessed person using bands from 0 to 6 via the FACE Global Need Scale. The need band is generated regardless of any support.
  4. Prediction of Potentially Eligible Domains – an algorithm within the RAS uses the needs scores to identify each national domain as ‘potentially eligible’ or ‘no indication of eligibility’ – splitting the ten domains into two lists based on this.

Decision:
‘Allocation Summary’ required:
Key information regarding the IB calculation
Carrying out essential daily living tasksEssential daily living tasks (hours/week)
Carrying out household tasks Household tasks (hours/week)
Supplement forsupportof two carersSupport of two carers (hours/week)
Supplement fornight support Night support (type and hours/week)
Stayingsafeand socialactivities Safety/social (days/activities and 1:1hours / week)
Work/training/education/volunteering Work/training/education/volunteering (activities/week)
Sustaining carer’s role(carer breaks)Sustaining carer’s role (nights/year)
‘Automatic QA’ required ‘CHC Checklist Mapping’ required
‘Global Need Band’ required ‘Prediction of Potentially Eligible Domains’ required
Details: Allr required with exception of Global Needs Bands which carries the risk of being confusing to assessors/customers

2RAS Formula Summary (including specific rates and configuration decisions)

The sections that follow explain how each element of the allocation works in the context of the two core components (standard rates; local configuration decisions) – with space to record local rates and configuration decisions in each relevant section.

2.1Personal care– morning

The independence scores for personal care morning tasks (‘Dressing’, ‘Washing whole body’, and ‘Using the toilet’) are used to determine whether a base allocation of 30 minutes daily for support with morning personal care routines is required.

  1. If the only identified morning need here is for Washing whole body and the ‘How often’ score is less than daily (e.g. 3 times a week), the 30 minutes per day allocation is only given for the number of days per week needed.

2.2Personal care –evening

The independence score for ‘Undressing’ and the independence/how often scores for ‘Using the toilet’ and ‘Washing whole body’ are used to determine whether a base allocation of 30 minutes daily for support with evening personal care routines is required.

2.3Personal care – adjustment for mobility/positioning difficulties

Here, the total hours per week for personal care support allocated for morning and evening are totalled. An adjustment is then made to the combined hours where:

  • Support is needed with mobility transfers; or support is needed with staying comfortable/repositioning; or there is a risk to self/others during transfers; or the person’s weight means mobilising takes longer.

2.4Personal care – adjustment for memory/acceptance of support difficulties

Here, an adjustment is made to the total hours so far where:

  • There are often, usually or always difficulties with the person’s acceptance of support; or
  • There are moderate, severe or very severe difficulties with the person’s memory/orientation.

2.5Personal care – during day

The independence/how often scores for ‘Using the toilet’ are used to determine whether additional allocations need to be added for support with using the toilet/managing continence through the daytime – for example, if the ‘How often’ score is ‘Four times a day’ an allocation to cover the additional two visits needed per day will be added here.

Note – the base visit length for personal care support within the RAS is set to a default of 30 minutes, in line with Department of Health recommendations against using ‘shorter’ care visits. This default can be overridden if the local decision is that shorter visits are appropriate (for example, 15 minute daytime visits where the only need is for toileting support).

2.6Personal care – support from family/friends/volunteers

The ‘Ongoing support’ scores for personal care (no. of mornings/daytimes/evenings per week) are then used to reduce the personal care allocation where family/friends/volunteers are providing support. The overall percentage reduction made varies depending on the expected number of visits required each day.

2.7Preparing meals/snacks/drinks and Medication support

Due to the clear overlap between support to meet personal care needs, support with preparing meals and eating/drinking, and support with medication, the algorithm does not make a separate allocation for the latter two areas.

Instead, the algorithm calculates:

  • Whether the duration apportioned for support times already allocated needs to be increased due to the need to prepare a meal or provide support with eating and drinking at these times (in addition to personal care) – extending the duration for these visits depending on the additional tasks needed.
  • Whether additional visits will be needed based on the ‘How often’ scores for ‘Preparing meals/snacks/drinks’ and ‘Taking/applying medication’ – adding an allocation to cover additional visits required for these tasks – e.g. where personal care is required in the morning only, but support with meals is needed twice/day.

For individuals who require meal/snack/drink preparation support but not personal care alongside this, a decision is needed as to the minimum duration for each instance of support.
Decision:
Minimum meal/snack/drink preparation support duration: No allocation 15m 30m
Details (including rationale if no allocation):
The policy around funding of the need for ‘medication pop-in’ visits varies significantly between different Local Authorities. In some cases, there is a local agreement between Social Care and Health that one or the other will provide for and fund the service to meet this need. If the LA’s policy is that they would not provide funding for situations where visits are required for medication support only, then a discussion will be required regarding whether the item ‘Taking/applying medication’ within the assessment should be weighted at zero. Analysis of sample cases will help to establish whether the LA does routinely fund this need.
Decision: Include medication only visits? Yes No
If yes: Minimum medication support duration 15m 30m
Details (including rationale if no allocation):

Support from family/friends/volunteers with these tasks is factored in within this step.

2.8Learning disability personal care/meals/medication adjustment

Within the RAS, there is the option for allocations to be adjusted where a service user’s predominant need arises from a learning disability. If there is a local decision in favour of this, the existing allocation for personal care, medication and meals/snacks/drinks is adjusted here using a weighting set during the calibration process based on the local data sample analysed.