Archived decisions
Appendix 2
Intensive Care
Indicator C28 Intensive home care (BVPI 53)
Definition Households receiving intensive home care per 1,000 population aged 65 or over.
The numerator: The number of households receiving intensive home care (More than 10 contact hours and 6 or more visits during the week) during a survey week.
The denominator: Population aged 65 or over.
Indicator B11 Intensive home care as a percentage of intensive home
and residential care
Definition: The number of households receiving intensive home help/care as a percentage of all adults and older people in residential and nursing care and households receiving intensive home help/care.
The numerator: The number of households receiving intensive home care (More than 10 contact hours and 6 or more visits during the week) during the sample week.
The denominator: The total number of weeks all adult client groups and older people were supported in residential and nursing care during the year (including both permanent and temporary residents) divided by 52 plus the number of households in the numerator.
As can be seen from the above definitions, the government's concept of intensive home care is extremely limited, excluding:
· Care in the home (or any other care) purchased with the use of Direct Payments. This is excluded despite it being government policy is to promote the use of Direct Payments for all client groups, especially older people.
· Care at Day Centres. Frequently older people, isolated in their community through illness/frailty, enjoy the social contact at Day Centres. It has been considered good practice to include sessions in Day Centres in the care packages for many such people, where they also receive personal care such as a bath.
· Meals on Wheels. Frequently people with high care needs are unable to cater for themselves and access the Meals on Wheels service. If a Home Carer pops in to microwave a meal and check it is eaten, this is counted; however a meal delivered to the user is not.
· Luncheon Clubs and other locality based activities. These are not counted as part of an intensive care package as the activities take place outside the home.
· Any other care taking place outside the home; such as Laundry Services, Neighbourhood shopping services etc
This matter has been raised with the SSI, but as yet no indicators have been re-defined. The current opinion appears to be that all councils are affected equally by the definition, so there is no reason to change. This is not true for Hampshire, which is amongst the best nationwide for the provision of Direct Payments, and thus considerably affected by their exclusion. It is also believed that the rurality of an area increases the social isolation felt by many clients, impacting on the take up rates at Day Centres etc.
Work was done assessing the specific impact on this indicator of the strict definition, compared to a more 'reasonable' one, last year. The results indicated were:
The DoH indicator should be supplemented with activity based on the following assumptions:
1 day in day care represents 4 hours care and 2 visits
2 hours direct payments represent 2 hours care and 1 visit
Other care is ignored
DoH indicator base 1212 households and a population of 192,791 so C28 PAF is 6.3
Add in Direct Payments and Day Care based on above assumptions
Revised indicator base 2916 households and a population of 192,791 so C28 PAF is 15.1
(Recent work has identified the impact of Direct Payments alone to be 0.7 on the C28 indicator i.e. raising current performance levels from 6.5 to 7.2 per thousand)
The measure including Day Care and Direct Payments is still short of Hampshire's PSA target of 18 households per thousand, but it does indicate how a movement of resources between service types might impact on performance indicators, although not necessarily improve service quality.
Looking at the Intensive Care indicators together:
Inclusion of Direct Payments and Day Care would raise performance against C28 Intensive Care from 6.3 to 15.1; from 2 blobs to 4 blobs
and
Inclusion of Direct Payments and Day Care would raise performance against B11 Intensive Care as % of all Intensive and Residential Care from 17% to 34%; from 2 blobs to 5 blobs
As can be seen from the above, the current mix of care provision does not help improve scores from the PAF indicators. However it must remain a policy decision whether Hampshire continues to offer the existing care mix or decides to shift resources towards those impacting favourably on PAF indicators.