Practice examples of delivering safe adult day care

These practice examples are all from before 19 July 2021, but remain relevant given the ongoing COVID-19 context.

• Example from a county council as to how it identified individuals with a high need to resume services using a Red, Amber, Green system Open

  Please note: These types of risk assessment should be undertaken by staff trained to do so and ideally include social work oversight

  Red – There is immediate risk for the person or carer. Indicators include:

  • A safeguarding concern has been raised.
  • There is an imminent breakdown of either paid or unpaid care arrangements due to care support no longer being able to manage.
  • Person has high levels of anxiety which is being expressed through distressed behaviours towards self, others and objects.
  • Person has been prescribed antipsychotic drugs to reduce distressed behaviors during lockdown.
  • Person’s mental health is declining and they are becoming withdrawn and less willing to engage.
  • Carer’s mental health is declining, or they are experiencing high levels of anxiety
  • Person is experiencing deterioration of their physical health.
  • Person is unable to be supported at home or in the community due to their anxiety, their understanding of the situation and lack of community facilities that are open.
  • Person is unable to be supported at home due to the vulnerability of other family members.

  Amber – The person or carer is experiencing difficulties but are not in immediate risk. Indicators include:

  • The existing care arrangements are at risk.
  • Family carers are choosing to self-isolate due to the health vulnerability of the person they care for however there is an increase in risk to their own health and concern regarding how much longer it is sustainable.
  • There are some signs of deterioration in mental and physical health that are of concern but they’re being managed.
  • The person’s deterioration above or the ongoing caring requirement is likely to have an increasing impact on the unpaid carer.
  • The situation is affecting the carer’s outcomes under the Care Act such as ability to work.

  Green – There are minimal concerns regarding person’s or carer’s wellbeing. Indicators include:

  • Carer isn’t expressing any concerns.
  • There were no welfare concerns prior to the person going into isolation.

  Following a person being identified as being Red, a Mental Capacity Assessment must be completed to firstly determine if the person has capacity to make an informed decision and if not, decide if the person should resume day services.

  The assessment must take into consideration the indicators but also the following:

  • People making decisions on behalf of the person to understand fully the risk of person contracting COVID-19 and that risk to be weighed up against quality of life.
  • If the person has any health conditions that makes them at risk of COVID-19.
  • If the carer has had a Carers Assessment in the past, it will be worth them requesting a review. If they have not, it is worth requesting one via Adult Social Care

• New Directions Subgroup (Ireland) example of a tool for prioritising risk Open

  Priority 1 (P1)

  Service users

  Red Risk on Matrix

  Having considered the individual’s overall package of care and the presenting needs of the individual and their family, the profile of a P1 person will be:

  • day attendee
  • person not receiving any or very limited ancillary/social care supports e.g. respite, home support/PA
  • person with noted increase in behaviours of concern
  • person who has a noted decline in presentation i.e. mental
  • health, physical health etc due to absence of a regular day service
  • safeguarding
  • familial vulnerabilities/circumstances i.e. single parent, elderly parents, residing with persons who are immune compromised, limited external supports, parents returning to work.

  Priority 2 (P2)

  Orange risk on Matrix

  Having considered the individuals overall package of care and the presenting needs of the individual and their family, the profile of a P2 person will be:

  • person receiving limited ancillary services/social care supports
  • presenting with an emerging need that could escalate to P1 should services not respond.
  • person is managing reasonably well at home and/or are lonely, seeking contact with peers.

  Priority 3 (P3)

  Orange/Green on Matrix

  Having considered the individuals overall package of care and the presenting needs of the individual and their family, the profile of a P3 person will be:

  • person is contented at home and the services provide support to reassure and enable them to have a structured day.

  In offering remote services consider infrastructure, interest and capacity of individuals.

  Priority 4 (P4)

  Orange/Green on Matrix

  Having considered the individuals overall package of care and the presenting needs of the individual and their family, the profile of a P4 person will be:

  • persons may opt in or out of this offered support. Not anxious to avail of support during this COVID-19 pandemic.

  In offering remote services consider infrastructure, interest and capacity of individuals.

• Example from ‘Helping adult day centres to unlock lockdown’
  (King’s College London) Open

  Helping adult day centres to unlock lockdown (King's College London)

  Scenario 1 / Service user group

  [Add detail of this scenario / service user group]

  Location

  Add detail of which parts of the day centre this scenario applies to, if relevant.

  Number of daily service users

  Add detail of numbers of staffing and volunteers required for this scenario, including detail of numbers of staff and volunteers to be deployed in other parts of the day centre, if applicable.

  Equipment

  Add detail of any new or increased equipment that needs to be installed or made available – or considered at a future point: e.g. plastic screens, yellow marker tape, cupboards for storing out-of-use equipment, small tables for use as hand sanitising stations, specific chairs or chair coverings, automatic doors, automatic taps, additional sinks, etc.

  Attendance

  Add details of number of days this applies to and any conditions attached: e.g. limits to number of days each service user may attend to enable the whole service user group to attend at least once weekly.

  Criteria for inclusion in this scenario or group

  Add detail of criteria to be met to be included in this group e.g. service user characteristics (personal care needs, low/high level of cognitive impairment), any paperwork required.

  Support level

  Add detail of what type of support this group of people need, including staffing levels for providing this and any other conditions relevant to staffing: e.g. personal care assistance, support with symptoms of cognitive impairment, socialising.

  Exit criteria (service users)

  Add detail specifying criteria or the circumstances in which a service user might not be able to attend the centre or may need to be moved to a different service user group (based on their needs).

  Assessment and care plan

  Add detail concerning planned reviews of care plans if relevant.

  Pros

  Add detail of any advantages you have identified with this plan, either for the organisation, for the service user, for family carers, for the bigger picture: e.g. the importance of risk empowerment, personalising information and communications.

  Cons

  Add details of any disadvantages or practical challenges you have identified with this plan - either for the organisation, for the service user, for family carers, for the bigger picture - and how these could be addressed: e.g. challenges associated with meeting staffing and volunteer requirements