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.
Hollacombe Community Resource Centre Open
Hollacombe Community Resource Centre is a day service for young people and adults who have a profound and multiple learning disability who may also have complex health and social needs. Hollacombe has been closed since 17h March 2020. Daily contact has been made with families and care agencies to ensure individuals are maintaining their health and wellbeing as far as possible and staff have been supporting people in a variety of ways. A ‘Red, Amber, Green’ (RAG) system is being introduced to determine which people are most at risk being isolated at home. A set of standard operating procedures are being followed to allow services to re-open to those people, to ensure the risk of infection is mitigated as far as possible.
Of the regular attendees at Hollacombe before lockdown, a small group will return to the centre in bubbles with specific staff, transport and people. A group will continue to be supported by specific staff in the community and their own home and a small number of people will want or need to wait until the service can confidently open further.
Example of flexible funding arrangements
Devon County Council Open
The Council’s review of existing financial support has recognised that due to the wide variety of settings and activities and different levels of COVID-19 vulnerability in people potentially attending, it is essential that each provider undertake a full risk assessment, in liaison with their local community team before making the decision to re-open.
The review has also recognised that whilst these assessments are taking place many providers have utilised their staff teams to support service users in their own homes or in other varied forms of service delivery. Where this is the case, or where it has been deemed safe to resume some form of day opportunity service with reduced capacity, we would want to support you from needing to furlough additional staff. In these circumstances the Council will therefore:
- continue to pay for the number of commissioned places at the level of the next pay run i.e. before you had to take action to close your day service
- continue to pay you at whatever agreed rate pertains at that point.
Terms and conditions
The extension of financial flexibilities described in this update will only apply to day opportunity services that confirm to us that staff are actually working the hours and / or remain available after 10 June 2020 to be redeployed to support other providers or the Council/NHS if not (with all appropriate training and support).
These arrangements will be in operation until 30 September 2020. They will be reviewed at the end of August.
Please be assured we will be doing our utmost to ensure that payments are made to your business in a timely way to ensure you can continue to operate during the next 13 weeks and to think through with us any longer-term implications for your service model. We will however need to ensure that funding which has been provided to you is made for additional cost incurred; so, in due course we may contact you to request additional supporting information, which we reserve the right to access under the existing terms of the contract we have for services with you.
We will also, where carer/care staff sickness payments have been made, require that Statutory Sickness Pay which has been reimbursed by the Government, is repaid to the Council.
If providers are able to claim from central government in respect of SSP reimbursement, or for wages support of up to 80 per cent, then they should do this and claim from government. You should not claim for such additional costs from DCC, UNLESS you require urgent cash flow stabilisation. In this case we would like you to notify us once you have received reimbursement from central government so that we can assess if any of the payments we have made to you need to be returned to us. i.e. so that there is no double counting of government and local government funding.
Ultimately please note that monies can be recouped from schedule payment runs, although we will always seek to agree an amount and timing with you first.
Bradford Triangulated Approach Open
In Bradford a triangulated approach was used between commissioners, operational teams and providers. This has involved discussions strategically and with individuals and families who use services on: what was provided before COVID-19, what was done differently during COVID-19, and what is considered as important in the future offer of day opportunities (recognising that restrictions in the current pandemic and the heightened need to keep safe). See plan below:
Service to assess and prioritise individuals most at risk and in need of a service over the summer.
Communication to be issued providers to understand their set-up and plans, and potential offer (in addition to virtual) for individuals in the short term. Should be clear that the expectation is not yet to re-open a building-based service.
Need to understand the options available to service users for the next three to six months including: - number of sites that will be open - potential sessions available - day respite opportunities - what the offer is for people who require a service and their carers.
Once short-term offer becomes clear - map service availability against locations of people who receive a service and understand transport/ travel implications.
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.
- 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.
- 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.
- 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)
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
- 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]
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.
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.
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.
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.
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.
Add details of any disadvantages or practical challenges you have identified with this plan – either or 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