1. Commissioning home care for people experiencing dementia LUCIANNE SAWYER CBE UKHCA AND COMMUNITY CARE RESEARCH & CONSULTANCY

2. INVOLVE PROVIDERS From the beginning – not just to tell them what you’ve decided They will have ideas and experience and can contribute to the planning How well do you know/understand home care? With your providers on board, you’ll be more likely to achieve the kind of services you want Providers will already know more about self- funders and what they want, than you do

3. MAKE IT POSSIBLE FOR PROVIDERS TO DELIVER QUALITY SERVICES 1. Enough time: Building a relationship with the care worker which helps develop confidence and trust, is critical Communication is likely to be difficult – and will need patience and support ‘It takes me 10 minutes before I can even get her to let me into the house’ ‘Some days it takes him a while before he is sure who I am - and then more time before he will let me help him get washed and dressed’ ‘I can be half way through doing what I am meant to do for her and the time has run out. I phone my manager and she just says – ‘well you’ve done what you can, you’ll have to go now’ I worry about her all day’ care workers in focus group

4. ………TO DELIVER QUALITY SERVICES 2. Continuity – providers know this is their responsibility – BUT you can help ……. Home care provision often very volatile with expectations of immediate response – setting up small zoned teams with senior care workers who can respond quickly from within team is the best way of achieving reliability and continuity Guaranteeing at least some of the care staff’s work is another Both of these cost money

5. An example of home care volatility Caseload of one manager – provider SW London 55 service users – 783 scheduled visits in week (almost all for less than one hour) During the week – this is what happened….. 4 hospital admissions – 58 visits cancelled Other reasons - 36 cancelled Referrals + hosp. Discharge - 50 new visits arranged Average per day - 2 care staff off sick – 11 visits per day rearranged (some time critical) turnover of service users – 15% pm 180%pa

6. ………TO DELIVER QUALITY SERVICES 2. Continuity – providers know this is their responsibility – BUT you can help ……. Home care provision often very volatile with expectations of immediate response – setting up small zoned teams with senior care workers who can respond quickly from within team is the best way of achieving reliability and continuity Guaranteeing at least some of the care staff’s work is another Both of these cost money

7. …………………..TO DELIVER QUALITY SERVICES 3. Activities and interests Do you expect care homes to provide interests and activities? Older people at home rarely have any ‘quality of life’ time built into their care plan – they are often extremely isolated Evidence that participating in activities or interests tends to have a calming effect on people with dementia Providers know dementia training is very important but there is little point in training staff if they then have to go back to working in a situation where tasks and times are rigidly prescribed and the training cant be put into practice – you just get demoralised staff who leave

8. SO PLEASE …………… Introduce the principles of personalisation (with appropriate support for people with dementia) Move to an outcomes approach, build in some additional time – and give providers autonomy to respond flexibly to service users and to use their initiative to achieve the outcomes important to the individual service user Benefits: improved q.o.l for those receiving services improved staff retention Improved continuity of care

9. AND FINALLY…… ‘ You can’t make a silk purse from a sow’s ear’ Pursuing a policy of constantly pushing down the price of home care inevitably impacts on staff pay and terms Turnover of care staff is already over 24% Care agencies are wasting £78m pa on recruitment, induction, CRB checks, NVQ registration etc. If we want home care which promotes respect, dignity and confidence, and within which people feel valued, care staff must also feel valued, respected and well supported (see Nolan ref.)

10. SOME USEFUL REFERENCES Nolan M. et al (2006) The Senses Framework: Improving care for Older People through a Relationship-Centred Approach If you give me your email address – I will send this paper and Ryan T., Nolan M, et al Using the Senses Framework to achieve relationship-centred dementia care services: A case example http://dem.sagepub.com/cgi/content/abstract/7/1/71 Prof. Nolan writes compellingly about the importance of relational care and the need for service users, carers and staff to feel supported and engaged in the whole process Roger Rowett Associates on behalf of the Care Council for Wales (2009) Good Practice in Relation to Working with Older People Experiencing Dementia This is an excellent report on tools which were found to enable communication with people with dementia – tried and tested in a variety of different settings and situations. Could be very useful for assessment and choice of outcomes. http://www.taith.co.uk/Final%20Report%20CCW%20Dementia%20V2%201%2016% 207%2009%20CCW.doc http://www.taith.co.uk/Final%20Report%20CCW%20Dementia%20V2%201%2016% 207%2009%20CCW.doc