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Understanding beds in Health and Social C are

Understanding beds in Health and Social C are. November 2018. Lee Baxter. Types of beds. NHS delivered beds Acute hospital beds Community Hospital beds (stroke, medical) Private sector Intermediate Care beds Nursing (NHS funded, block or spot)

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Understanding beds in Health and Social C are

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  1. Understanding beds in Health and Social Care November 2018. Lee Baxter

  2. Types of beds • NHS delivered beds • Acute hospital beds • Community Hospital beds (stroke, medical) • Private sector • Intermediate Care beds Nursing (NHS funded, block or spot) • Intermediate Care beds Residential (NHS funded, block or spot) • Short stay Nursing (NHS, DCC or private) • Short stay Residential (NHS, DCC or private) • Long stay Nursing (NHS, DCC or private) • Long stay Residential (NHS, DCC or private)

  3. Residential or Nursing • Main difference – Nursing has a registered Nurse on the premises 24hrs per day • Private Nursing and Residential care homes are supported by NHS services and the NHS supply both with core services to support if required • Most people do not require 24hr Nursing support. • We commission very few Nursing beds based on individual needs.

  4. Case study • 94 year old lady • Has had recent hospital admission due to a fall • Has mild dementia • Wanders at night and poses significant risk to self • Is insulin dependant diabetic requires twice daily insulin • Has leg ulcers that require compression bandaging • Is socially isolated and family live out of area • Family hold LPA over health and wealth • Needs all care provided • Needs medication monitored and given to her • All meals and fluids need monitored balancing to support diabetes and underlying renal failure • Is doubly incontinent and wears pads

  5. So on discharge out of an Acute Hospital… should she… • Go into a Community Hospital • Go into a long term Nursing home • Go into a Long term Residential home • Go into a short term Nursing home • Go into a short term Residential home • Go into an Intermediate Care placement • Go home with Intermediate Care

  6. Well any….. but…. • Go into a Community Hospital - NO • Go into a long term Nursing home - NO • Go into a Long term Residential home - NO • Go into a short term Nursing home - NO • Go into a short term Residential home - NO • Go into an Intermediate Care placement - MAYBE • Go home with Intermediate Care - MAYBE

  7. Delayed Transfers of Care DTOC • The data across the footprint is made up of small numbers • DTOC (Delayed Transfer of Care) includes people who are delayed by either health or social care, choice or market sufficiency – next step of onward journey blocked • Average per day for the whole of South Devon equals approx. 7 people • Dartmouth does not stand out as an area of concern in our DTOC data. • No problem with availability of Statutory funded Domiciliary care in Dartmouth

  8. What the Data currently tells us! • We use on average 2 medical Community Hospital beds per day (average 1 Totnes & 1 Brixham) • We use on average 1-2 Stroke beds on Teign ward per day • We use on average 1 Intermediate Care bed per day. All in Residential placements • We have on average 2 people in receipt of Intermediate Care at home per day.

  9. Dartmouth • A Nursing Home isn't sustainable given the low numbers of people who need 24hr Nursing care. Currently 1 person. • Residential numbers are low – its hard to answer if another care home would be financially viable in Dartmouth (market has two care homes close, and a further market in Totnes, Torbay and Newton Abbot) • Riverview was never able to fill beds and was an importer of people from other areas into Dartmouth to fill beds. • There is a Nursing Home planned in Totnes? Nothing clearly described yet but planning permission granted. • Intermediate Care placements low – now average 1 per day, including any out of area placements made for Dartmouth Medical Practice people. • Hard to identify unmet need (if you base it on Local Authority eligibility)

  10. Market issues • Commissioning patterns 24 residential placements long term, 1 Nursing long term. based on historical data. • Changes to support from community services • Reablement approach Intermediate Care • Short term offers to support Rapid response and Social care reablement • Availability of care packages

  11. Summary • People de-condition if they have extended hospital stays • We don’t want people to prematurely enter long term placements. Why? Because it reduces liberty, independence, mobility, and can have a financial impact on them. • If we can promote recovery and independence then people may be able to remain at home for longer truly in their community. • People tell us that they don’t want to enter long term care unless they have to. • We aim to recover people from periods of illness in the least restrictive way, supporting them to have care as close to home as possible.

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