North Yorkshire County Council Social Services

1
North Yorkshire County Council Social Services

• Hilary Richards General Manager
• Extra Care Assisted Living as a Replacement for
  Institutional Care

2
Background

• An ageing population
• Recognition that older people do not want to live
  in institutional care
• Large proportion of the sheltered housing stock
  does not meet the aspirations of potential
  tenants
• Increasing expenditure by NHS on older people

3
North Yorkshires Our Future Lives Policy

• Policy adopted in 1999 by North Yorkshire County
  Council within the context of a multi-agency
  Older Peoples Strategy
• Sets out our policy for the care of Older People
• The overall aim is to promote and maintain
  greater independence
• Replacing Residential Care with Extra Care

4
Across North Yorkshire currently we have

• 2 Replacements for Sheltered Scarborough/
  Northallerton.
• 1½ Replacements for Elderly Persons Home plus
  community resources and dedicated flats for
  people with dementia Knaresborough/Stokesley
• Bainbridge replacing both
• Easingwold EPH replacement plus community
  resources and dedicated flats for people with
  dementia
• Hollins Hall private scheme 2 interim flats
  Harrogate
• Esk Moor small rural scheme with resource
  centre
• Plaxton Court (Scarborough) larger mixed tenure
  scheme
• Enhanced Warden schemes (sheltered housing)
  Richmondshire
• Extra Care is evolving all the time.

5
Associated Developments

• Specialist teams of home care staff to provide
  reablement service at home
• Overnight home care team in operation
• Enhanced Warden Scheme

6
What Older People want

• Their own home
• Privacy/own lifestyle
• Choice control
• Maintain Health ability
• To control their own income
• Social environment

• An appropriate environment
• Safety security
• Care services as required
• Help in emergencies
• To be valued
• To stay together as a couple

7
What is the size of the Market in the UK

• Over 60s - 75 will be homeowners by 2011
• That is over 6m people
• There are 185,000 Private Residential Care Homes
• Those over 65 years control 80 of the nations
  wealth

8
Features of Extra Care

• Replacement for residential care
• Partnership between Care Housing providers
• Tenants/Owner Occupier
• 24 Hour care and support available and tailored
  to individual need
• Range of facilities e.g. cafeteria, shop,internet
  access, central laundry, assisted bathrooms,
  hobby/therapy rooms and hairdressing salon
• Localised Day Services

9
Extra Care vs Residential Care

• Own flat/front door
• Independence
• Tenant
• Home Care
• House Move
• Manage your income
• AT HOME

• Own room
• Dependence
• Licensee
• Group Care
• Move into Care
• Pocket Money
• IN A HOME

10
So what about the money?

• Capital Development
• Revenue costs (staff and running costs)
• Income
• Potential transitional costs of reproviding
• What is the Break-Even level of service?

11
Capital

• On the back of the Our Future Lives policy, North
  Yorkshire County Council agreed to make 1m
  available in its capital programme for each extra
  care development that replaced an EPH.
• The revenue budgets had to include the amounts
  necessary to service this debt.
• Due to success in obtaining funding from other
  sources, it has not been necessary to utilise the
  capital in all cases.

12
Running Costs

• Separation of housing from care means that the
  Care Provider (the Council) only has the care
  costs to deal with.
• The housing costs are covered by rent, and in
  most cases, housing benefit.
• Housing Related Support is covered by Supporting
  People (this is less so now as the SP pot is
  exhausted)

13
Income (Charging)

• Two situations
• Tenants who were previously in residential care
• Tenants who moved from their own home
• For those who moved from residential care, they
  moved from one benefits regime to another, and
  from being charged under the national CRAG
  charging policy to the local Fairer Charging
  policy.
• For self-funders moving from residential, with
  high levels of care, there have been instances of
  them being worse off financially

14
Transitional Costs

• Number of options
• Decant people temporarily while re-build on same
  site
• Build elsewhere, no double running costs
• Build elsewhere, but phase implementation,
  therefore double running costs

15
Break Even

• Based on a number of assumptions.(see handout)
• In a 40 unit Extra Care Scheme
• An average of 13 hours personal care per tenant
  agreed as break even.
• More hours was less cost effective than
  residential model
• Fewer average hours was more cost effective than
  break even

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Does Extra Care provide the answer?

• Independence
• Choice of tenure
• Dignity
• Social contact
• Care and support
• Healthier living
• Aspires to be a Home for life
• Can be a more cost effective model

17
The Governments View

• Many older people want to stay in their own
  home, while others will want specialist forms of
  housing that offer complete security and an
  environment where care and support can be
  delivered effectively. Our challenge is to
  develop policies and services that allow older
  people to choose the housing that is right for
  them
• Dr Stephen Ladyman, Dept of Health