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9.2.1 Provision of Community Equipment in Care Homes

This chapter was introduced to the manual in June 2012.


Contents

  1. Introduction 
  2. Purpose of Document
  3. Definition of Terms
  4. Overarching Duties of Care Homes for Community Equipment Provision
  5. Assessment for Community Equipment
  6. Common Assessment Scenarios
  7. General Principles for Provision of Equipment through ICES
  8. Additional principles for provision of community equipment through ICES to care homes
  9. Equipment that Care Homes are Expected to Provide - 'Standard' Equipment
  10. Equipment that Care Homes are not Expected to provide 'Non-standard' Equipment
  11. Exceptions to Standard Equipment Guidance
  12. Seating
  13. Pressure Prevention/Relieving Equipment
  14. Wheelchairs
  15. Operational Guidance on the Issue and use of Community Equipment in Care Homes
  16. General Legal Responsibilities of the Care Home re Community Equipment Provision
  17. References and Guidance

    Appendix A: Care Standards Regulations and Equipment

    Appendix B: Continuing Care

    Appendix C: Equipment Table


1. Introduction

1.1 This policy clarifies the relative responsibilities for the provision of community equipment between Councils/Directorates with Social Services responsibilities, the National Health Service (NHS) and all care homes (both residential and care homes with nursing) in the city of Brighton and Hove.
1.2

The policy applies to:

  • Adults who are registered with a GP practice within the NHS Brighton and Hove boundary; and/or
  • Publically and privately funded adults who are in a long stay placement within the Brighton and Hove Local Authority boundary:
    • Where an adult has been placed in Brighton and Hove by another local authority, funding of services remains the responsibility of the placing authority;
    • Where adults move into permanent residential accommodation under private arrangements and are funding their own care, responsibility for provision of services usually transfers to the area in which they are now resident (LAC(98)19).
1.3 The outcome of the policy is for residents in care homes to have their needs appropriately assessed and the necessary equipment provided that will enable them to participate in personal care, leisure and social activities, access environments of their choice and maintain their health and independence.


2. Purpose of Document

2.1

The purpose of this document is to:

  • Clarify the relationship between community equipment services and care homes;
  • Provide a basis for local protocols and contracts;
  • Enable lead commissioners of integrated community equipment services (ICES) to identify their obligations in relation to all care homes;
  • Enable care home owners to identify their obligations around community equipment provision;
  • Identify relevant Department of Health guidance and references;
  • Clarify the assessment process.
2.2 This policy should be read in conjunction with 'Getting Started' Community Equipment and Care Homes (last updated October 2004). The document states that 'organisations responsible for commissioning community equipment.....must ensure that clear policies and auditable procedures are in place. These are particularly necessary so that disputes do not arise when a service users condition or situation changes." p5
2.3 This policy also draws on best practice from a range of local guidance produced by other Councils.


3. Definition of Terms

3.1 Care Home: In this document the term 'care home' is used generically for all care homes. 'Residential home' is used for a residential/rest home and 'nursing home' for a care home with nursing.
3.2 Integrated Community Equipment Service: In Brighton and Hove this service is jointly commissioned by the CCG and the council to provide equipment to service users who have an assessed eligible need.
3.3 A reviewer of equipment needs must also be an authorised prescriber of community equipment. A list of authorised prescribers is available from ICES.


4. Overarching Duties of Care Homes for Community Equipment Provision

4.1 The starting point in determining who is responsible for provision of equipment is that to meet the National Minimum Care Standards, care homes should be 'fit for purpose'. To be 'fit for purpose' the home must be able to demonstrate that it is successful in meeting its stated aims (Section 23 (1) of the Care Standards Act 2000.
4.2

Under Standard 1, each care home must produce a Statement of Purpose to ensure that it is meeting the needs of its residents.

For example, if a home states that it caters for the needs of people with physical disabilities in order to be 'fit for purpose' it must have good wheelchair access and a range of equipment which is likely to be needed by people with physical disabilities.
4.3 In order to meet these needs, the expectation is that the care home should have an adequate supply of equipment/medical devices to fulfil their obligations to residents and to their workforce for health and safety. Account must be taken of variations in size i.e. height, width and weight of residents.
4.4 Residents in Council, independent, voluntary or charity owned care homes have the same rights to services, including the provision of equipment, as people living in their own homes.
4.5 Care homes should not care for residents whose assessed needs they cannot meet.


5. Assessment for Community Equipment

5.1 Many disputes about equipment provision can be avoided by good practice in assessment (Community Equipment and Care Homes 2004 p5)
5.2 Under the Community Care Act 1990, all residents have the right to an assessment of their needs by the local authority regardless of how the provision of services (including equipment) is to be funded. Standard 3 National Minimum Standards similarly requires that all residents have a full assessment regardless of the way in which their care is funded.
5.3 The assessment should lead to a support plan for short and longer term outcomes including arrangements for monitoring and review if needs change.
5.4 When a person is being considered for a place, assessment of their needs should include consideration of the equipment that is required to support their 24 hour care. The responsibility for provision of this equipment should be explicitly documented in an individual's support plan. If no equipment is needed this must also be documented.
5.5 When a care home accepts a resident, they should make their own assessment and compile a resident's plan of care, based on the care management support plan provided by NHS/Council. This care plan should include more detailed information on the practical considerations around the use of equipment such as training, maintenance and storage arrangements etc.
5.6 If, as part of the assessment (and using the agreed local risk assessment tool), the resident is identified as at risk of developing pressure injuries, the support plan must include the provision of equipment to prevent and/or treat these injuries and it must be reviewed regularly. This is likely to include amongst other things, equipment such as pressure reducing and relieving overlays and replacement mattresses/seat cushions to maintain tissue viability (static and dynamic systems)


6. Common Assessment Scenarios

6.1

There are three common scenarios where assessment or review of needs in relation to equipment may occur:

Scenario 1: Equipment is identified as required to support long term admission to a care home:

A review of the person's needs and their equipment requirements for use in the care home must be undertaken prior to admission.

This review should be undertaken by an authorised prescriber of community equipment. The following procedure should then be followed:

  • Reviewer to liaise with the care home to establish whether the home has the appropriate equipment available as identified in the support plan;
  • If the care home has the appropriate equipment available, the reviewer should ensure that ICES are requested to pick up any surplus equipment from the person's home;
  • If the care home does not have the appropriate equipment the reviewer should ensure its provision by establishing whose responsibility it is to provide the equipment using Appendix C: Equipment Table of this document;
  • If the responsibility for equipment provision is with the care home, equipment should not be taken into a care home from a person's private home unless the prescriber obtains a formal agreement from ICES.

Scenario 2: Equipment is identified as required for a resident already living in a care home

A review of the person's needs and their equipment requirements for use in the care home must be organised by the care home and undertaken by an authorised prescriber of community equipment. The support plan/plan of care should be amended accordingly. The following procedure should then be followed:

  • Reviewer to liaise with the care home to establish whether the home has the appropriate equipment available as identified in the amended support plan/plan of care;
  • If the home does not have the appropriate equipment the reviewer to ensure provision by checking whose responsibility it is to provide the equipment using Appendix C: Equipment Table of this document.

Scenario 3: Equipment is required for transfer from one type of care home to another:

Following a review if the decision is for a resident to be transferred from one type of care home to another, it should be classed as critical. If a care home cannot manage a resident's care needs there are issues of safety. It is contrary to good practice and regulatory standards and at worst, may cause safeguarding issues. The following procedure should be followed:

  • Reviewer to liaise with the future care home to establish whether the home has the appropriate equipment available as identified in the support plan;
  • If the home does not have the appropriate equipment the reviewer to ensure provision by checking whose responsibility it is to provide the equipment using Appendix C: Equipment Table of this document.


7. General Principles for Provision of Equipment through ICES

  • Residents should meet local Fair Access to Care Services 2010 (FACS) or Health criteria for equipment provision;
  • The equipment provided must be issued as part of a risk management process and staff competently trained;
  • Loaned equipment should be properly maintained and returned promptly;
  • Where equipment is for a designated user as part of a care plan, it must not be used by others;
  • Residents must not be asked to fund equipment even if they are privately funding their care package. The requirement to provide equipment free of charge regardless of residence is set out in the Community Care (Delayed Discharges etc) Act 2003. This is further spelt out in LAC(2003)14 which states:" Any item of community equipment which a person (or their carer) is assessed as needing as a community care service and for which the individual (or their carer) is eligible, is required to be provided free of charge".


8. Additional principles for provision of community equipment through ICES to care homes

The principles outlined in this section are those which have been used to produce the Equipment Table at Appendix C: Equipment Table.


9. Equipment that Care Homes are Expected to Provide - 'Standard' Equipment

9.1 For the purposes of this guidance, 'standard equipment' refers to equipment which is suitable in design for a range for residents.
9.2 The equipment is adaptable and flexible and could be used to meet a person's general care needs. Full details of responsibility for standard items of equipment are contained in Appendix C: Equipment Table of this document.
9.3 Getting Started Community Equipment and Care Homes 2004 outlines the type of equipment which should be provided by care homes in order to be fit for purpose. The document refers to 'standard equipment' as that which is widely available to people living in their private homes.
9.4 There is additional guidance for nursing homes provided by The National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care - July 2009 - "It is expected that care homes providing nursing care will be fit for purpose, which, in the main, means they will have in place basic handling, mobility, and lifting equipment and adaptations". Equipment for the preventative care and relief of pressure ulcers should also be provided for the resident concerned.


10. Equipment that Care Homes are not Expected to provide 'Non-standard' Equipment

10.1 For the purposes of this guidance, non standard equipment refers to equipment which is bespoke i.e. designed or adapted or bio-engineered and manufactured for a specific individual.
10.2 By definition it can not be used to meet another resident's care needs. Full details of responsibility for non standard items of equipment are contained in Appendix C: Equipment Table of this document. It is important to note that this is not the same as the category 'special' equipment currently used by Brighton and Hove ICES to cover a broader range of items.
10.3 HSC 2203/006 LAC 2003 (7) states that 'it would be unreasonable to expect care homes to provide items of equipment that, by the nature of their design, size and weight requirements need to be specifically tailored to meet the individuals needs and are not capable of being utilised by other care residents'. The expectation is that this type of equipment would not be provided by the care home and would be loaned from the ICES store. Getting Started (p2) terms this equipment 'non standard' and advises that council agreements should determine the exact nature of the items which fall in the category of non standard equipment.
10.4 Non standard or bespoke equipment will be provided if it is not an item which the care home has undertaken to supply under the terms of its Statement of Purpose or in its service user plan of care.
10.5 In order for ICES to supply, there must be an assessment by an equipment prescriber who is authorised to prescribe specialist equipment i.e. not an enhanced assessor.
10.6 The equipment will be provided by ICES for the resident's assessed needs and will not be used for any other residents. It will be returned to ICES when it is no longer needed. There is no time limit on how long this non standard equipment can be used by the resident to meet their needs
10.7 For both standard and non standard items, the care home is responsible for ensuring that the equipment continues to meet the needs of the residents. If there are any concerns, the care home manager should contact the Access point on 01273 295555 or accesspoint@brighton-hove.gov.uk to, organise a review of care and invite an authorised equipment prescriber.


11. Exceptions to Standard Equipment Guidance

11.1

Exceptions to standard equipment guidance

In exceptional circumstances i.e. where the provision of equipment would facilitate a discharge from hospital, or the resident to stay in the care home, then standard equipment loans may be considered under the following criteria:

  • The equipment may be loaned for a period of no more than 6 weeks. In exceptional circumstances it may be possible to extend the temporary loan beyond 6 weeks but only if approved by a senior ICES manager and on a week-by-week basis. All such extensions will be in writing and detail the reason for the extension;
  • The prescriber of the equipment must authorise the loan and put in place a review of the resident's needs. If the responsibility for the resident moves from one team to another, then a transfer of the review process must be established by the prescriber;
  • Within 5 working days of the end of the 6 week loan period, ICES will collect the equipment. If the home is not in a position to return the equipment, they may risk being invoiced for any charges ensuing for continued use.
11.2

Exceptions to non standard equipment guidance:

The exception to the above terms of provision are non standard or bespoke items of daily living equipment required by residents who are in receipt of Continuing Health Care funding. This is subject to local funding procedures and protocols which are currently under development.
11.3

Exceptions for temporary care needs arrangements:

Provided the care home can meet a persons needs, it is against the ethos of care to move a person from their current care home if they have a new condition that requires equipment for a temporary period. In these cases ICES will be expected to provide equipment on loan. It is likely that charges for this service will be introduced.

ICES are therefore expected to provide equipment on loan for some short term care services. This includes:

  • End of life care (not inc. pressure area care for nursing homes);
  • Short term care including intermediate care, reablement, transitional, interim etc in any care home;
  • Treatment for pressure ulcers following discharge from hospital for a new or current resident in a residential care home.
Regular and rolling respite - arrangements should be made to allow equipment to accompany the person into the care home from their home environment. This equipment must only be used by the person for whom it is prescribed.


12. Seating

12.1 It is the care home's responsibility to provide a range of seating options suitable for the service user group normally admitted. The range of seating to be supplied by care homes would include high chairs, ejector chairs, riser recliner chairs. As a resident's needs change, so should seating provision be updated. It is important to note that there are more stringent rules for fire retardant materials in a care home setting compared to a domestic setting. Manufacturers will be able to give advice.
12.2 This means that chairs normally provided for domestic use are likely not to be suitable for care homes. On occasions there may be the need to provide individual posturally moulded seating; an assessment will be required by one of the following as appropriate: occupational therapy/wheelchair/ nursing service and/or physiotherapy.


13. Pressure Prevention/Relieving Equipment

13.1 Nursing homes are responsible for the provision of all equipment such as pressure reducing mattresses, cushions and overlays and/or pressure relieving overlays, cushions and replacement mattresses to maintain tissue viability (static and dynamic systems) for those residents assessed to be at risk of developing pressure related damage or have existing pressure damage. Residential homes may request the loan of this equipment from ICES via an assessment of the residents needs by the District Nurses.
13.2 It is the responsibility of the care home to ensure that all beds, mattresses and cushions are fit for purpose and in good condition. Equipment should be inspected regularly and cleaned according to the manufacturers instructions, to avoid any cross infection. Dynamic mattresses and cushions should have an annual maintenance check
13.3 In order to assist in determining which service users may be vulnerable to developing pressure related damage, an informal risk assessment should be carried out to help identify the intrinsic risk factors and an formal risk assessment using the appropriate agreed risk assessment tool. This must be undertaken by a professional who has had the appropriate training. Once risk has been identified action must follow to reduce risk wherever possible. These actions must be fully documented in the resident's records.
13.4 If the resident is identified as at risk of developing pressure injuries or has existing areas of pressure damage, the support/care plan must include the provision of equipment to prevent and/or treat these injuries and it must be reviewed regularly. As residents needs change the provision of equipment also needs to be updated.
13.5 All staff involved with residents who are vulnerable to pressure damage should access relevant training or education in pressure ulcer risk assessment, prevention and treatment.


14. Wheelchairs

14.1 It is the responsibility of the care home to provide standard transit (attendant propelled) wheelchairs and pressure relieving cushions for their residents. Subject to assessment, the NHS wheelchair service will loan self propelling and powered wheelchairs to residents to support independent mobility. For pressure ulcer prevention, safety and comfort, residents who are not independent wheelchair users should not be left sitting in a transit wheelchair. Residents should be supported to transfer into a supportive armchair with an appropriate pressure relieving cushion.
14.2 Residents who have a need for a transit wheelchair, but due to complex physical disability, could not safely sit in a standard transit chair are eligible for assessment by the NHS wheelchair service. Consideration will then be given to NHS provision of a wheelchair with specialist postural supports to meet the complex postural needs of the resident. An example of this is where a resident leans heavily to one side in sitting and is unable to independently correct their position.


15. Operational Guidance on the Issue and use of Community Equipment in Care Homes

15.1 It is important to consider the weight of a resident in relation to the upper weight limits on equipment. Manufacturers' specifications vary and safe working loads should be checked against manufacturers' specifications.
15.2 Where the equipment has been provided through the ICES store it is the responsibility of the prescriber to demonstrate or arrange for the demonstration of the equipment to the user and a nominated person within the care home and advice re maintenance required. Thereafter it is the responsibility of the nominated care home staff to provide instruction and training to any other people who require it. A record should be maintained of appropriate instruction together with any method statement and any visual prompts.
15.3 When the care home has privately purchased an item, it is their responsibility to arrange the appropriate training according to the relevant legislation/guidance. This should be available through the equipment supplier or the Daily Living Centre can be contacted for information on 01273 296132. Community equipment services may be willing, subject to capacity, to help care homes with advice on sourcing and replacing privately purchased equipment
15.4 When a resident purchases equipment privately, they must assume full responsibility for arranging training, maintenance and insurance.
15.5 Day to day operational cleaning and decontamination of loan equipment is the responsibility of the care home and must follow the manufacturer's instructions and instructions provided by the community equipment service.
15.6 The care home or resident will need to meet the cost of all repairs arising from negligence, damage or inappropriate use of loan equipment or the cost of replacement if it is lost or beyond repair.
15.7

All repair and maintenance of ICES loan equipment should be coordinated and carried out by the ICES staff or authorised service provider. Appropriate records need to be maintained for tracking and traceability of the loan items by ICES. The care home manager must notify ICES on 01273 294629 to arrange collection in the following circumstances involving loaned equipment:

  • Resident no longer requires a loaned item of equipment;
  • Resident has died or moved to another location;
  • Resident needs have changed and the loaned item may need to be replaced;
  • Equipment breakdown or repair required.
15.8 Equipment risks need to be managed in the context of advice from the Medical Health products Regulatory Agency (MHRA)
15.9 The loan of equipment is non-discriminatory, in line with legislation, policies and guidance. Ethnic and cultural aspects must be considered. It may be necessary to seek appropriate advice.


16. General Legal Responsibilities of the Care Home re Community Equipment Provision

All equipment must meet requirements of:

  • Health & Safety at Work Act (1974);
  • The Lifting Operations and Lifting Equipment Regulations (1998) - LOLER;
  • The Provision and Use of Work Equipment Regulations (1998) - PUWER;
  • The Manual Handling Operations Regulations (1992);
  • Care Standards Act (2000).


17. References and Guidance

  1. The Care Standards Act 2000;
  2. Care Homes for Older People: National Minimum Standards 3rd edition;
  3. Department of Health. Guidance on Free Nursing Care in Nursing Homes. HSC 2001/17: LAC (2001)26. Department of Health. London. 2001;
  4. The national framework for NHS continuing healthcare and NHS-funded nursing care - July 2009 (revised) (Department of Health website);
  5. Health and Safety at Work Act 1974;
  6. Community Care (delayed discharges etc) Act (Qualifying services)(England) regulations 2003 (legislation website);
  7. 'Getting Started' Community Equipment and Care Homes last updated 12 October 2004;
  8. The Management of Health and Safety at Works Regulations 1992 (legislation website);
  9. The Lifting Operations and Lifting Equipment Regulations 1998 - LOLER (legislation website);
  10. The Provision and Use of Work Equipment Regulations 1998 - PUWER (legislation website);
  11. The Manual Handling Operations Regulations 1992 (legislation website).


Appendix A: Care Standards Regulations and Equipment

The relevant regulations are:

  • Regulation 12/13 - health and welfare of service users;
  • Regulation 14 - assessment of service users;
  • Regulation 15 - service user plan;
  • Regulation 16 - facilities and services including equipment;
  • Regulation 17 - records;
  • Regulation 18 - staffing eg qualified, competent, experienced includes training;
  • Regulation 19 - fitness of workers.

Minimum standards expected of individual care homes

Some relevant minimum standards for younger adults include:

  • Standard 6 - service users plan;
  • Standard 17 - personal and healthcare support;
  • Standard 29 - adaptations and equipment.

Some relevant minimum standards for older people include

  • Standard 6 - intermediate care;
  • Standard 7 - service user plan of care;
  • Standard 8 - service users health care needs are fully met eg tissue viability;
  • Standards 22 - specialist equipment to maximise independence;
  • Standard 38 - safe working practices.
Note this list is not exhaustive


Appendix B: Continuing Care

Continuing Care:

'The care which people need over an extended period of time as the result of disability, accident or illness to address both physical and mental health needs. It may require services from the NHS and/or social care. It can be provided in a range of settings, from an NHS hospital to a nursing home or residential home and peoples own home'

From: HSC 2001/015: LAC (2001)18.

Fitness for purpose:

The regulatory powers provided by the CSA are designed to ensure that care home managers, staff and premises are 'fit for their purpose'. In applying the standards, regulators will look for evidence that a home - whether providing a long-term placement, short-term rehabilitation, nursing care or specialist service - is successful in achieving its stated aims and objectives.

Meeting assessed needs

In applying the standards, inspectors will look for evidence that care homes meet assessed needs of residents and that individuals' changing needs continue to be met. The assessment and service user plan carried out in the care home should be based on the care management individual care plan and determination of registered nursing input (where relevant) produced by local social services and NHS staff where they are purchasing the service. The needs of privately funded service users should be assessed by the care home prior to offering a place.

From: National Minimum Standards document page ix


Appendix C: Equipment Table

The table below is provided to assist community equipment services determine the arrangements for funding, provision and maintenance in the case of examples of equipment for care homes. Not all of the items listed are provided by community equipment services nor is the list exhaustive. Some health items may be provided directly by Clinical Commissioning Groups. Care homes will need to meet the minimum standards for provision of equipment for users as well as health and safety for users and staff etc

Equipment provided by care home must be able to accommodate a range of heights, weights and widths

Use the following abbreviations: CH = Care Home ICES = Integrated Community Equipment Service CHC= Continuing Health Care.

Short-term provision of equipment: When a person's condition or situation changes, it is against the ethos of care to move people from their present settings if their new condition is short term. In these cases, ICES may be expected to provide equipment on loan. Examples of such changes of condition are outlined in the Guidance - section 8.

Click here to view the Equipment Table

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