Sheletered Housing

Sheltered or retirement housing is suitable for people who like independence but want assistance on hand in an emergency, but don’t need to move into a care home. There are different types of schemes available to rent and to buy. Some developments have a scheme manager/warden and the majority have a community alarm service. >>More

Extra Care

New forms of sheltered housing and retirement housing have been pioneered in recent years, to cater for older people who are becoming more frail and less able to do everything for themselves. >>More

Close Care

The term ‘close care’ usually covers the type of care associated with that provided in a residential nursing home, whilst the descriptions ‘sheltered housing’ and ‘assisted living’ cover something less than that, but still an ‘extra’. In some cases the ‘extra’ will be quite sufficient to enable many elderly persons, who would otherwise need to be in a residential nursing home, to remain in the own home. >>More

Virtual Care

A team of home carers operate between the hours of 10 pm to 7 am to provide intensive support to vulnerable people otherwise imminent risk of admission to residential or nursing home care or may be especially vulnerable after hospital discharge. >>More

Extra Care for People with Dementia

One of the most challenging areas of providing Extra Care Housing is in providing for people who have dementia.  In recent years ther has been an advancement in the research, design, and technology to support high quality dementia care for people living in Extra Care Housing settings.  Extra Care Housing for people with dementia is now becoming a significant model where techinical support can enable people to remain as independant as possible for longer. >>More

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Extra care housing developments also called very sheltered housing or assisted living apartments are a growing and popular part of the housing with care market. Most ‘extra care’ consumers are older people and they often find it attractive because it offers them independent living in a home of their own with other services on hand if they need or want them.

What is extra care housing?
It is a concept rather than a housing type and while for simplicity’s sake we use the term extra care throughout there are many different kinds of housing and services that come under this label (see later in the factsheet). They are aimed at people with different kinds of incomes and aspirations. Some are for rent only and are aimed at ‘social’ tenants while others are aimed at people who can pay market rents. There are developments that are purely for sale or leasehold and others that are mixed rental and leasehold, often called shared ownership.

Until quite recently most extra care in the UK was developed with public subsidy by housing associations and was only for social rent. This is no longer the case. Many housing associations now provide mixed tenure developments. There is a thriving commercial sector as well. It is likely that this will begin to outstrip the level of social extra care provision over the next few years, in line with tenure patterns in ordinary housing, where around 70% of older people own their own homes.

The most important fact is that extra care housing is housing first. People who live there have their own self-contained homes. They have legal rights to occupy that are underpinned by housing law. This means there is a clear distinction between extra care housing and residential care as recognised by the Care Quality Commission. Further information can be found by going to www.cqc.org.uk

What is it for?

Mainly to provide well-designed housing that enables people to self-care for longer and give them access to care and other services, which help them, retain their independence.
Some properties in a development might also be used for providing intermediate care or rehabilitation services. Facilities might be based in a development to provide day centre activities, ageing well and keep fit for people living in and outside the development. These are usually separated from accommodation units in a development, to ensure privacy for the people who live there. Some developments also have office facilities for communitybased teams of domiciliary care or housing related support and health workers.

What does extra care housing look like?

There isn’t an easy way to describe the buildings because they are so diverse. They can look like a:

• Purpose built retirement village
• Large block of apartments with a restaurant or other linked buildings
• Leisure complex
• Development of bungalows and a mix of apartments and a central resource building that houses community health services or other facilities serving the occupants and local people
  • Sheltered housing scheme
  •  Hotel

You can find photographs and even plans of many developments detailed on the Elderly Accommodation Counsel extra care website www.extracarehousing.org.uk

Buildings may be new and purpose built or they may be older buildings that are re-used. Sometimes buildings are ‘remodelled’ so that each occupant has better facilities such as walk-in showers.
Extra care developments can contain a laundry for residents (or each apartment has a washing machine and dryer), lounges, meeting rooms, hobby rooms, and space for health or care staff. They may, but don’t have to have a specially equipped bathroom for assisted bathing and a restaurant. Extra care developments that have been built with public funds tend to make support and care accessible 24 hours a day. This doesn’t necessarily mean that it is all on site, although this may be subject to conditions of some capital and/or revenue arrangements. The level of support and care required is
something that has to also be addressed by commissioners. For example, if people need waking night cover it is likely that support and care staff will have to be based at, or close to, the development. More information on this subject is given in Essential Short Facts: Extra Care Housing, Factsheet 2 Commissioning Housing Based Models for Care at www.icn.csip.org.uk/housing

Care homes
Care homes (with nursing)
Specialist care
Care villages 
Virtual Care
Close Care

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Close Care schemes are a relatively new concept and consist of independent flats or bungalows built on the same site as a care home. Residents often have some services (such as cleaning) included in their service charge and other services can be purchased from the care home. Close care schemes can either be rented or purchased. Purchasers may receive a guarantee that the management will buy back the property if they enter the care home.

Associated Service are:

Extra Care Housing
Care homes
Care homes (with nursing)
Specialist care
Care villages 
Virtual Care

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This is a development / pilot scheme to test whether the provision of a very personalised and flexible service, involving telecare systems where possible, can maintain people for longer in their own homes, or enable them to return to their homes from hospital at the earliest opportunity.  It may, if successful (as all other similar schemes have been), provide a major step forward in developing personalised services and greater choice for vulnerable older people.

Associated Service are:

Extra Care Housing
Care homes
Care homes (with nursing)
Specialist care
Care villages 

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All Social Services departments in England have a duty to undertake an assessment if it appears to them that you may need the services that they provide.

To request an assessment call in Warwickshire boroughts call 01926 410410, you will intially speak to Customer Services Advisor who will advise you of your eligibility and needs for services

or visit http://www.warwickshire.gov.uk/adultsocialcare.

Please note that if you are a self funder it is still advisable to have an assessment of need; in the event that your funds fall below the threshold of £23,000. Social Services may not support your funding in the establishment of your choice.

Being reassessed

Most people’s health needs change over time. Your care plan should be reviewed regularly. As a minimum, reviews are carried out three months after services are first provided or significantly changed, and then once every year. Reviews should be carried out more frequently if necessary. If you would like to be reassessed because your needs have changed, contact your local social services or community health team within your local council.

However if you are clear as to your care need you can go directly to:

• Care Home & Domiciliary Care Search (Click here)
• ‘For other types of Care Information’ (Click here)

Further local guidance on Adult Social Care is available from the Warwickshire County Council Adult Social Care Services Site or from WPIC Care Information Centre

For national guidance please refer to the DirectGov – Health and social care assessments

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The GSF is a framework to enable a gold standard of care for all people nearing the end of their lives. It is concerned with helping people to live well until the end of life and includes care in the final year of life for people with any end stage illness.

GSF in care homes programme.

This is a three tier programme whose aims are:-

• To improve the quality of life for people nearing the end of life in care homes.
• To improve collaboration between care homes , GP’s/Primary Care teams and specialist palliative care teams and
• To reduce the number of admissions to hospital in the last stages of life and enable more to die peacefully in the care home.

Evaluation of the programme to date has shown improved quality of care, improved staff confidence, a 12% decrease in hospital admissions and an 8% decrease in hospital deaths.

The Gold Standard Framework award has been achieved by a number of Warwickshire homes and is applicable to both nursing and residential homes. Those holding award are  indicated in the care homes search.

“One of the ways we can measure ourselves as a society and as a healthcare system is in the way we care for our weakest, including our dying patients. We must regard care of the dying therefore, as a measure of our success and not our failure, within the NHS.Despite many examples of excellence, good care for the dying in this country is still very much a matter of luck. Using the Gold Standard Framework to improve care in the community is one of the building blocks on which we can develop a comprehensive and reliable national end of life care strategy, and so reduce the element of luck, and enable all to receive the best quality care at the end of their lives.”

Dr Keri Thomas – NHS National Clinical Lead for Palliative Care

More details available at: http://www.goldstandardsframework.nhs.uk/

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What Care Quality Commission (CQC) do

CQC regulate health and adult social care services, whether provided by the NHS, local authorities, private companies or voluntary organisations. And, we protect the rights of people detained under the Mental Health Act.

CQC regulate health and adult social care services in England, whether they’re provided by the NHS, local authorities, private companies or voluntary organisations. And, we protect the rights of people detained under the Mental Health Act.

CQC make sure that essential common quality standards are being met where care is provided and we work towards the improvement of care services. We promote the rights and interests of people who use services and we have a wide range of enforcement powers to take action on their behalf if services are unacceptably poor.

CQC work brings together independent regulation of health, mental health and adult social care. Before 1 April 2009, this work was carried out by the Healthcare Commission, the Mental Health Act Commission and the Commission for Social Care Inspection. These organisations no longer exist.

CQC main activities are:

• Registration of health and social care providers to ensure they are meeting essential common quality standards
• Monitoring and inspection of all health and adult social care
• Using our enforcement powers, such as fines and public warnings or closures, if standards are not being met
• Improving health and social care services by undertaking regular reviews of how well those who arrange and provide services locally are performing and special reviews on particular care services, pathways of care or themes where there are particular concerns about quality
• Reporting the outcomes of our work so that people who use services have information about the quality of their local health and adult social care services. It helps those who arrange and provide services to see where improvement is needed and learn from each other about what works best

Rating Rules

CQC work out the quality rating for a care service by looking at how well the service meets the desired outcomes set out in the national minimum standards. We call these judgements.

CQC use a set of guidelines, called the Key lines of regulatory assessment, to judge how well services are meeting outcomes.

Generally speaking, the more outcomes that are graded as excellent the more likely a service is to achieve 3 stars. The more outcomes that are graded as poor the more likely a service is to be rated as 1 or zero stars. However, in awarding a quality rating we take particular account of how safe and how well managed a care service is.

As they are especially important to quality we have stricter rules for those outcomes relating to safety and management. Services can only be as good as their ‘poorest’ rating in these areas.

Quality rating judgement tool

This is the tool inspectors use to calculate the quality rating for a service following a key inspection. Service managers can also use the tool to confirm they have been rated correctly.

Rules for each quality rating

3 star service (Excellent)

It must be possible for a service to be ‘3 star’. In other words, the expectation is not for perfect services but for particularly good services, well managed, and with a sustained track record of high performance.

• Services cannot be 3 star if any outcome group is scored as being poor, and;
• outcomes relating to safety and management must be at least good and;
• at least one outcome relating to safety and management must be excellent and;
• at least 50% of outcome groups must be judged as either good or excellent (for example, if there were 7 outcome groups for your type of service, 4 of the outcome groups would need to be good or excellent) and;
• a brand new service cannot be excellent at the first key inspection following registration, as it would lack a track record of performance over time. By brand new we mean that the service, as it is registered, did not operate before registration. Those services can only achieve a 2 star, good, rating. But;
• there are times when a service is already registered with us but has to make application for registration due to changes in the way it is to be run. It will be possible for those services to achieve an ‘excellent’, 3 star, rating at their first key inspection as long as the first four bullet points (listed above) are met. To achieve an excellent rating the service will need to have demonstrated excellent and good practice consistent with the Key Lines of Regulatory Assessment (KLORA). Excellent services will have a sustained track record of delivering good performance and managing improvement. Read more about this rule.

2 star service (Good)

A ‘2 star’ service may have some excellent outcomes.

• Services cannot be good if any outcome group is scored as poor, and;
• outcomes relating to safety and management must be at least good, and;
• at least 50% of outcome groups must be judged as at least good

1 star service (Adequate)

A ‘1 star’ service may have some outcomes that are good, even excellent.

• Outcomes involving safety and management must be at least adequate and;
• at least 50% of outcome groups must be at least adequate

0 star service (Poor)

A ‘0 star’ service may have some strengths. It may have some good or even excellent outcomes, or it may be a generally low performing service. The key issue is that it does not perform as a safe service.

• One or more outcome groups that focus on safety and management are judged poor or
• It does not meet the rules for a 1 star, 2 star or 3 star service

More details are available from Care Quality Commission (CQC)

NB: the above information was provided with the permission of Care Quality Commission (CQC) - http://www.cqc.org.uk/

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Registered Nursing Care Contribution

Under the terms of “free nursing care” the Government states that the NHS will pay for “any services provided by a registered nurse involving the provision of care, or the planning, supervision or delegation of the provision of care, other than services which do not need to be provided by a registered nurse.”

In England:

If you were living in a care home on 1st October 2007 , your nursing needs will have been in the low, medium or high band, the rates for these bands being £40 – £139 per week. However, after 1st October 2007, a new flat rate was introduced as below:

New residents and residents who were on the Low or Medium bands , now receive the flat rate of £106.30 per week regardless of the level of nursing care required. The nursing needs will be identified as part of your comprehensive needs assessment and included in your care plan. 
Respite care will also attract this rate so long as the stay is not for less than 6 weeks.

Residents who were on the High Band will recieve £146.30 unless on reassessment:

• you are found to be eligible for NHS continuing healthcare (the full cost of your care will then be the PCT’s responsibility);
• your nursing needs have diminished to the extent that if the old guidance relating to nursing bands were applied, you would only be eligible for either the low or medium bands (the PCT will then pay the single rate from 14 days following notification of the outcome of the reassessment);
• you no longer have nursing care needs.

For many, the concern is that the level of funding provided through this system may not directly meet an individual’s nursing costs and that consequently a shortfall may arise. Claims should be made to the NHS co-ordinator via the care home and payments awarded will be made directly from the National Health Service to the care provider.

If you disagree with the decision made following reassessment you can ask the Primary Care Trust for a review of the decision and if necessary, an independent review.

Any complaints regarding the nursing care paid for or provided by the NHS can be made using the NHS complaints procedure via the care home, the Primary Care Trust or Health Authority.

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• Guarantee Credit
• Savings Credit

Both of the elements are assessed independently and have differing age limits. It is therefore important to recognise that individuals may have an entitlement to either or both components.

The Guarantee Credit is available for people aged 60 and over. It is broadly a replacement for the current Income Support system with benefits paid at generally the same rates. The Guarantee Credit will ensure that individuals receive a minimum amount of weekly income which reflects their circumstances and needs. This is known as the appropriate or applicable amount. The basis of Guarantee Credit is the Standard Amount as detailed below:

This will be increased by a series of premiums or extra amounts if you have a disability, or are a carer or have relevant housing costs. The most relevant of these premiums for individuals in care is the Severe Disability Premium. This is applicable if you receive Attendance Allowance or the middle or higher rate of the care component of Disability Living Allowance (DLA). The additional premium is £52.85 and eligibility will be subject to no one receiving the Carers Allowance for looking after you.

If your income is less than your applicable amount, the difference will be made up by Guarantee Credit.

Your income will be calculated as being the amount you receive, excluding any disregarded amounts such as Attendance Allowance. In addition, an amount will be included in respect of the “notional” income generated from your savings. This is taken to be £1 per week for every £500 of capital. The first £6,000 of savings are excluded if you live at home and this figure rises to £10,000 if you are permanently resident in a care home.

The Savings Credit component of Pension Credit is available to individuals aged 65 and over who have income from their savings or have a personal or occupational pension.

If your qualifying income is higher than the savings credit threshold, but below a given maximum, then you will be entitled to receive Savings Credit.

• Savings Credit Threshold

The amount of entitlement is calculated as 60% of your “qualifying income” above the savings credit threshold, subject to a maximum of £20.40 a single person and £27.03 for a couple.

The amount of Savings Credit payable may however be subject to a reduction at the rate of 40% of the amount of qualifying income above the applicable amount.

People aged 60 and over who live permanently in residential or nursing homes will be entitled to Pension Credit instead of Income Support and in such circumstances, the higher level of capital will be disregarded, i.e £10,000.

Under the terms of Pension Credit, it is possible for care residents to qualify for some support, even with capital assets of up to £79,300.

The Pension Credit Helpline can be contacted at http://www.direct.gov.uk/en/MoneyTaxAndBenefits/BenefitsTaxCreditsAndOtherSupport/On_a_low_income/DG_10018692

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To qualify for Attendance Allowance, you must meet the following conditions:

Attendance Allowance is payable at two levels:

The Lower Rate is £47.10 and the Higher Rate is £70.35 both of these amounts are payable weekly and entitlement will depend on which of the two conditions, as detailed below, are met.

The Lower Rate will be payable if you are so disabled that you require frequent help throughout the day with your normal bodily functions or if you require prolonged or repeated help with bodily functions during the night. The Higher Rate is payable for individuals whose condition dictates that they require help during the day and night. It will also be payable if another person needs to be awake for a prolonged period or at frequent intervals throughout the night to avoid putting yourself or others in substantial danger.

Leaflet DS702 (Attendance Allowance) provides additional information on this benefit and a claim pack can be obtained by using the tear off slip on that leaflet. Alternatively, the application form is available from your local Deapartment of Works & Pesions/Benefits Agency office, or by contacting the Attendance Allowance Unit

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