Short-notice care home closures

Assessment and choice

Assessing people's individual needs, preferences and aspirations and enabling them to make informed choices about their place of residence are just as important as in situations of planned change.

Enabling people to have choices is important, even when the closure of the home is inevitable. We have to make sure we honour this and don't rush people into decisions just because it's neat and tidy for us when we're working under pressure

Commissioner

• Underlying principlesOpen

  • Local authorities have a duty to assess the needs of all residents irrespective of the arrangements for paying for their care.
  • If a person is facing a major decision about where to live and lacks the mental capacity to make that decision for him/herself and has no family or friends willing and able to be consulted as part of making that decision, then it is mandatory that the local authority or NHS body commissioning the care must instruct an IMCA (independent mental capacity advocate) to be part of the decision-making process. The IMCA does not become the decision maker, but the identified decision-maker (generally a care management professional from the local authority) must take account of the views of the IMCA
  • The Directions on choice still apply.
  • The Mental Capacity Act clearly applies.
  • Relevant agencies should work together in the best interests of the residents.
    
    

  See examples and tips and checklists for more information.

• Organisational arrangements Open

  • Where the number of people requesting a particular home exceeds the number of places, there will need to be a robust and defensible allocation process in place to manage competing priorities.
  • Where a person's first choice is not immediately available, interim placements can be offered - though choice elsewhere may be constrained by availability and the willingness of a new provider to accept the placing authority's terms and conditions (see Directions on choice).
  • The needs of groups with protected characteristics must be addressed - i.e. age, ethnicity, religion, disability, mental capacity, sexuality.
  • After a transfer to a new home has occurred, residents must be routinely reviewed to ensure that their new homes are meeting their needs and that their wellbeing is maintained.
  • Resources will need to be found in order to deliver the required assessment and case reviews.
  • Formal and recorded meetings need to be held with the home owner/manager and other senior officers on managing the transfer.
  • Formal and recorded meetings need to be held with nominated care managers and assessing staff on detailing information on each resident.
    
    

  See examples and tips and checklists for more information.

• Care and transfer planning Open

  • Ensure that every resident has access to a professional key worker who is qualified to undertake their assessment and care planning.
  • Agree and develop a care plan for every resident, in conjunction with them.
  • Establish the extent of involvement with the resident of their family, friends and/or carers and work with them to effect the best outcome for the resident.
  • Agree with the resident the degree that family, friends or carers are involved in identifying an alternative home and associated arrangements.
  • Stress the importance of protecting friendship groups in the decision making.
  • Ensure that self-funding service users are offered the support of a care manager and all of the above considerations - though they are free to decline support.
  • Obtain the resident's consent to transfer of information and records.
  • Review care plans as their quality will vary considerably, particularly where closure has been enforced because of poor care practices.
    
    

  See examples and tips and checklists for more information.

• Transport Open

  • Consider transport arrangements, which may involve liaison with local ambulance services.
  • Consider how people's luggage and personal furnishings and equipment are going to be moved with them.
    
    

  See examples and tips and checklists for more information.

• Capacity Open

  • The assessment should consider issues of mental capacity and any risk factors and relevant information associated with the actual move from the home.
  • For residents who lack mental capacity or who are not in contact with family or friends, consider an independent mental capacity advocate (IMCA)
    
    

  See examples and tips and checklists for more information.

• Nursing and medical assessment Open

  • Local authorities will need to be proactive in their dialogue with NHS partners.
  • Some residents may require a higher level of care such as residential care with nursing or NHS continuing health care.
  • Where nursing care is involved, medical assessment and management must be part of the planning.
  • Check the accuracy of medication records and prescriptions rigorously.
  • Make arrangements for appropriate quantities of the right drugs to accompany the resident to their new setting.
    
    

  See examples and tips and checklists for more information.

• Contractual issues Open

  • Cancel existing contracts - this may seem obvious but as each resident is moved, the formality of cancelling existing contracts remains necessary, even if the move is forced by circumstances not of the resident's or commissioner's making.
    
    

  See examples and tips and checklists for more information.

Examples and tips

Examples of what others are doing plus materials they have developed and useful tips.

Assessment and choice - examples and tips sections

Tools and checklists

Assessment and choice - Tools and checklists section

Key points from policy and research

• Research by Glasby et al (2011) stresses the importance of keeping the assessment team separate from staff who have been involved in any consultation or discussions about closure. The availability of a dedicated member of staff to discuss concerns with residents and family members was seen to significantly reduce anxiety for all concerned. Of course, resource implications should be considered.
  
  
• In emergency closures, research indicates that providing appropriate support to residents may be adversely affected by lack of complete or good quality information (Glasby et al, 2011).
  
  
• One concern about moving residents from their familiar environment is the threat of premature death. The evidence is mixed, though such evidence as there is suggests that adverse effects can be minimised if continuity of care is maintained and there is good consultation and planning. One study reported on practitioner research comparing mortality rates of a small sample of older people from private residential homes who were relocated involuntarily with a sample of older people who had recently moved to a private residential home. Overall, the findings suggested that there was no difference in the mortality of the two groups (Gascoigne, M and Mashhoudy, H: Practice, 23(2), April 2011, pp.83-94).
  
  
• Relationships with staff, in particular key worker relationships, are important in minimising the impact of the move on the health of residents. Residents’ relationships with staff, where good, should be maintained as far as possible throughout the closure period (Le Mesurier and Littlechild, 2011).

What the regulator says

In the event of threatened or imminent emergency closure, commissioners should make contact with the Care Quality Commission (CQC) at the earliest opportunity. CQC will provide information under its information-sharing protocols indicating any action which it is taking.