Jess is funded by Continuing Health Care, she has 2 carers 24/7 – the package of care is from both trained nurses.

Jess is hoisted for all transfers by x2 nurses and has ceiling track hoists in situ. Jess is not able to assist at all. Bariatric size bed had recently been provided requested by family without OT assessment.

Following Specialist OT assessment, it was identified that the bed was too wide and caused increased risk to carers during moving and handling and also reduced the available space in the environment. Jess was only of small proportions and the wider bed exacerbated moving and handling risks to care staff. The OT recommended standard size profile bed and organised a trial of a specialist bed turning system.

A bed turning system allows carers to alter Jess’s position single handed, allows improved positioning in bed when being rolled for suctioning / dressing, plus reduce moving and handling risk to carers. Family expressed pressure marking on skin from care staff holding Jess when being repositioned. The bed turning system also reduced the need for multiple ‘hands on’ and reduced risk to skin from pressure marks.

• Trial of bed turning system was successful in achieving single handed care approach in altering positioning, it reduced the need for 2 nurses 24:7.  Double handed care was merely required for full personal care each am and pm. Through a robust specialist assessment by the OT skilled in CHC complex needs, justification was given where single handed care was able to be completed whilst also managing the risk.   This reduced the cost of the package of care and optimised care needs.
• Cost of the bariatric bed was an unnecessary expense to CCG at a cost of £8500, family had identified the wider bed they ‘wanted’. This had not been assessed by the specialist OT. If the OT had been involved in the initial assessment of the person’s function, manual handling and environment, double handed care would not have been required for hoisting or repositioning and the initial cost for the bariatric bed would also have been avoided.
• It was also identified the 2^nd person for double handed care, am and pm could be a skilled carer for an hour each visit instead of a Nurse.

Yearly saving to the CCG – £730,184 per annum

Please contact CHCOT Network for a full breakdown of cost savings.

Case referred due to high POC and management of needs still not improving after 18 months, now increased to 3:1 from 2:1 following discharge from hospital.

Client had autism and a learning disability, cognitive impairment and behaviours that challenged others, he was residing in a small shared supported living with another client.

Specialist LD assessment identified that the individual had sensory needs which required further Sensory assessment and intervention, the environment was also assessed revealing this was a big contributory factor impacting the client’s behaviour that challenged.

Recommendations were for re-settlement with adaptations to the new environment with a robust sensory diet and care plan.

The client after many months was re-settled with the CHC OT finding the right environment and undertaking specialist sensory assessment with accurate outcomes. The right Personal assistants were sought to meet the client’s needs as a Personal Health Budget was felt the preferred option.

Once re-settled the client reduced from 3:1 to 1:1; with the right level of support, optimum environment and robust sensory diet, care plan and positive risk taking the clients behaviours were no longer apparent. The previous environment, lack of sensory intervention and 3 staff were compounding the client’s behaviours. This also proved a lesser restrictive option.

Following CHC OT assessment and intervention package of care was £2,856 per week – £148,512 per year.

Case management also undertaken by the CHC OT enabled monthly reviews to evidence improvements in need and more importantly enhanced quality of life.

Saving to the CCG of £297,024 per annum

Please contact CHCOT Network for a full breakdown of cost savings.

Potential for the client to return to the local authority as evidence of more social care needs now behaviours reduced, with evidence from the case manager CHC OT recommended review of CHC eligibility.

Phil is fully funded by CHC due to his spinal injuries sustained from an RTA. He is at risk of autonomic dysreflexia and experiences pain on all movement during moving and handling.

He has a live-in carer 24:7 with additional x4 double up calls for an hour each time to support hoisting with a mobile hoist and moving and handling when on bed rest.

Specialist CHC OT assessment initially requested for slings provision, OT identified additional problems during moving and handling with issued equipment and environmental constraints.

Issues identified 

Mobile hoist not raising high enough for clearance into wheelchair, flooring unsuitable and impacting upon risk to carers, sling cutting into patient’s legs as leg sections too short and too small, shoulders too reclined. Pain on all movement exacerbated when being hoisted. Increased risk to carers over-reaching, manoeuvring mobile hoist, thus increased pain, spasms and skin integrity risks for Phil.

Options considered and recommended by specialist OT

• Ceiling track hoist or gantry hoist for smoother transfers – due to private rental of property gantry was final option as via Disability Facilities Grant (DFG) ceiling track hoist would have had a recharge due to rental property. Gantry hoist allows for smoother hoisting, assists with reducing pain, reduces moving and handling risk to carers and is less cumbersome that mobile hoist.
• Air flow slings provision allows skin to breathe, fully supporting trunk and limbs, preventing risk of leg sections cutting in legs. Sling provided with extensor loops around shoulders allowing for improved movement in the event of extensor spasms reducing pain as the sling allows movement during spasm rather than restricting movement. (Pain medication may now not be required).
• Single handed care is optimised with use of gantry hoist as allowed one carer to transfer from bed into powered wheelchair.
• Care undertaken on bed can also be completed single handed with provision of a 4-way glide bed management system which allows single carer to move Phil on bed without any risk to moving and handling and reduced physical handling for Phil. 

Overall annual saving to CCG for single handed care and no double up – £26,572 per annum.

Please contact CHCOT Network for a full breakdown of cost savings.

Had specialist CHCOT been asked to assess prior to discharge from hospital the gantry hoist could have been ordered and CCG would not have needed to have paid the double handed care costs from onset. Also optimised care for the patient who did not wish for his schedule to be dictated by waiting for a 2^nd carer for moving and handling.

Jeannie is 74 years of age, she lives alone in her own home since the death of her husband 2 years prior and has been diagnosed with middle stage dementia, she experiences short term memory loss. She remains mobile and physically agile, she was assessed as having eligible care needs requiring support and was in receipt of a domiciliary care package, funded and organised by the Local Authority.

Support needs include personal activities of daily living each morning, which includes prompting and initiating with personal care tasks such as washing/ showering and reminding to change clothes. 

A tea-time call included support with Jeannie making a sandwich or hot evening meal, sometimes a walk to the local shop to purchase daily supplies which offered some community access for both socialisation and exercise.

The regular carer Sally had been supporting Jeannie for almost a year however due to Jeannie’s memory declining she was sometimes suspicious of Sally’s visits and mistrusting of Sally in her home. Jeannie started to misplace her handbag, each time the carer arrived to support her she was agitated that she could not find it. This was causing Jeannie to become increasingly anxious when not locating her handbag which contained her purse and some other personal valuable’s. 

We discovered Jeannie was actually ‘hiding’ her handbag herself due to her feelings of mistrust of others in her home, however owing to her short-term memory loss once she had done so she herself could not remember where she had put it.

Carer’s were spending their support time reassuring Jeannie and desperately trying to find where she might have placed her handbag which also had her purse and keys within it. On occasions carers had little time left to support Jeannie to undertake personal care tasks or to make her sandwiches. 

With little time left after finding her handbag carers frequently had to quickly make sandwiches for Jeannie and could not offer her enough time for adequately being supported to shower. Tasks were being ‘done to’ Jeannie instead of ‘done with’ and was therefore reducing her own skill base, visits to the local shop could not be undertaken as there was not enough time left to do so most of the time.

On another occasion when Sally could not locate Jeannie’s handbag, there was an allegation made of possible theft and needed a prompt investigation.

The care agency had already requested an increase in care hours being undertaken due to staff not having adequate time to support Jeannie following the handbag hunting. With this recent investigation in mind were now looking for 2 carers to visit due to the allegation made in order to protect the staff supporting Jeannie.

The case was referred to the Occupational Therapist who was supporting with the care package review, she felt the wireless key finder could resolve some of the issues in the first instance.

The wireless key finder is battery operated, has a main transmitter and comes with 6 receivers, the individual receivers can be placed into up to 6 locations. Receivers can be stuck or a ring is used to attach to items.

The OT decided that initially:

• One receiver should be placed in Jeannie’s handbag
• One receiver should be placed in Jeannie’s purse
• One receiver should be attached to Jeannie’s house keys

This way Jeannie’s handbag, purse and keys could be located even if they were not all placed together.

The transmitter was agreed to be placed in a safe place for carer use only in Jeannie’s best interest.

At each visit when the handbag, purse or keys could not be found the supporting carer quickly and easily located the items for Jeannie using the transmitter. This resolved Jeannie’s anxiety promptly, enabled support needs to be met as identified in the support plan and increased carer rapport. More time was spent with Jeannie directly which overall improved her well-being.

On one occasion when first using the device, the carer operated the transmitter and could hear a very feint signal. She located where the noise was coming from to discover Jeannie had actually placed her handbag and contents inside the loft. She had done so herself using some old step ladders that had not been used or noticed by visitors in a long time. Whilst the handbag was retrieved preventative measures were taken in removing the step ladders to avoid them being used again by Jeannie and placing herself at risk.

The wireless key finder device solved the posed issues and concerns for Jeannie and her carer and avoided an increase in the package of care, proving cost efficient to the Local authority. More importantly Jeannie’s ongoing care and support proved more beneficial and productive enabling carers time to be spent ‘doing tasks with’ Jeannie which retained her skill base while doing meaningful and purposeful tasks. Jeannie particularly enjoyed resuming her visit to the local shop most days with Sally. One carer offers the least restrictive level of support for Jeannie and also enhances rapport.

Additional key benefits of the wireless key finder equipment

• Safeguarding avoided re: further allegations of financial abuse avoided
• Reduced the need for 2 carers to support re: allegation risk
• Prevention of falls and risk of harm to Jeannie as step ladders removed in best interest
• Time spent with Jeannie was more effective and productive which enhanced Jeannie’s overall well-being.
• Reduced the agitation Jeannie was experiencing through carers being able to source ‘lost’ items speedily, thus offering immediate reassurance.
• Reduced and minimal periods of mistrust of supporting carer
• Least restrictive option with x1 carer as opposed to 2 carers supporting
• 1 carer offers an increased likelihood of direct communication and rapport building with Jeannie
• Reduced the risk of de-skilling Jeannie as she could continue to ‘do with’ carers
• Less frustration for carers searching repeatedly for misplaced items.
• Avoidance of a full re-assessment as per Care Act

The equipment is in-expensive and can be purchased independently through client’s own funds with PIP/ DLA or Attendance allowance. If this is not an option a one-off Direct payment can be requested and approved by the local authority for the equipment. 

Yearly cost avoided £13,195 by using the wireless key finder

Please contact CHCOT Network for a full breakdown of cost savings.

Andy was referred to us for specialist assessment; he was CHC funded in a Nursing placement with an additional 1:1 24:7.

Client was 42 years of age with a subarachnoid brain haemorrhage, he was immobile and PEG fed with cognitive impairment and behaviours that challenged.

Outcome of specialist assessment identified:

• Postural management with specialist seating and specialist harness to maintain posture and position; also requiring written best interest for provision and waterlow, requiring full assessment, trial and evaluation for suitability.
• Specialist assessment also completed for bed with bed rails to keep client safely positioned and risk assessment completed.

Equipment provided was from re-cycled stock sourced form CCG owned equipment with minor alternative specifications organised by the Assessing CHC OT

With immediate effect the client no longer required 1:1 in the nursing provision as his needs were being managed safer and in a less restrictive manner. He was also able to socialise most of the day with others in the placement instead of being 1:1 managed in his bedroom. It was also identified the client’s behaviour was not challenging but due to being monitored on a 1:1 it was causing the agitation.

It was also recommended the nursing placement purchase some ceiling track hoists or gantry hoists for their moving and handling management of the client as per service level agreement. This was not to promote single handed care for the given client but to encourage efficiency and effectiveness during moving and handling tasks. It was additionally identified that staff undertaking moving and handling lacked competence and confidence which was impacting clients perceived challenging behaviour. Techniques in moving and handling were given to care staff regarding how to improve moving and handling for the client and care planned for his specific needs.

Total saving to CCG per annum – £131,040

Please contact CHCOT Network for a full breakdown of cost savings.

It was also recommended that Andy’s CHC eligibility was reviewed as a primarily social care need as his needs had now been reduced due to them being successfully managed. 

Carly is 26 years of age, she lives in a supported living home she shares with another tenant since she re-settled after leaving her parent’s home. Her parents wanted to ensure she was settled in a nice place while they were still able to be involved.

Carly has profound and multiple learning disabilities with co-morbid epilepsy and she is immobile, during the re-settlement process she was assessed as having eligible care needs requiring support with a care package, funded and organised by the Local Authority.

Support needs include personal activities of daily living each morning, which includes assistance with all personal care tasks such as washing/ showering and toileting needs throughout the day. Carly also requires all assistance with domestic activities of daily living.

Carly is in receipt of shared support at all times with the individual she shares her home with and receives some 1:1 support for accessing the community in her wheelchair. Carly and her house-mate enjoy each other’s company and have many similar interests and were identified as being compatible long before the actual re-settlement.

Carly and her house mate had regular support staff who were familiar and knowledgeable with their support needs and offered a good routine, Carly had a good sleep pattern and had always slept well at night.

At night there had previously been one sleep in member of staff however a recent tonic clonic seizure occurred and was un-detected with the previous epilepsy alarm.  An incident was raised and a recommendation was made for Carly to receive 1:1 at night to manage this risk. There had also been frequent disturbances for Carly and staff with the previous epilepsy alarm giving false alerts to a call centre.

Due to staff requiring a break on night shift this was being reviewed with a view to 2 wake-in night staff to enable staff to have breaks and also to be able to provide support to the other tenant in the event she woke.

Carly had been deemed to lack capacity in relation to her care and accommodation and had a community DoLS in place authorising this aspect.

Upon reviewing the package of care, the local authority felt with the increased level of support now being implemented to manage risk a re-assessment would be necessary. There was a view to an alternative placement that routinely provided staff on duty at night. 

This alternative would have offered cost efficiency for the local authority and also managed the identified risks posed for Carly in relation to her epilepsy at night. This would also have proved a less restrictive solution.

Carly’s parents did not particularly want her to move to another placement and advocated for an alternative solution as they felt she was used to her support staff, her housemate, her routine and her current home. They did not feel Carly herself would be happy to move accommodation or care provider.

Support staff felt ‘watching over’ Carly all night proved difficult as the persistent monitoring was impacting Carly’s sleep as well as the other housemate’s who could also hear staff going about their duties.

The local authority also felt this was overly restrictive for Carly having 1:1 at all times and felt a re-application to the Court of protection would be necessary to approve such increased restrictions.

The case was referred to the Learning Disabilities Occupational Therapist who was supporting with the care package review, she felt the MP5-UT epilepsy sensor monitor could resolve the of the issues while optimising risk management and keeping Carly safe.

The Medpage MP5-UT epilepsy seizure movement detection alarm offers ultra-Sensitivity, it uses a patented sensor specifically engineered to detect when a person is having a Tonic Clonic seizure while in bed.

Key features for using with Carly also included: 

• Detects movements resulting from epileptic nocturnal Tonic/Clonic seizures including minute prolonged movements
• Large area patented monitoring sensor technology for improved movement detection
• Digital sensitivity control to suit the body weight of the user
• Digital alarm delay control to virtually eliminate false alarms by ignoring natural sleeping movements, such as turning over
• Includes an inbuilt sound sensor frequency tuned to continuously monitor for human sounds to detects vocalisations preceding or during a seizure. Can detect aural sounds such as choking, screams or grunting
• Detected seizures are notified to carer via MPPL radio pager (two supplied)

A mental capacity assessment concluded Carly could not consent to the monitor therefore a best interest meeting was undertaken, the OT, LD Nurse, Social worker and Carly’s parents were involved and the OT and LD Nurse concluded the device should be used in her best interest.

The equipment was discussed by the OT with all involved, who was knowledgeable and familiar with the equipment and was able to explain the benefits of the equipment and answer any questions regarding the device. This offered informed decision making by the wider MDT while enabling Carly’s parents to contribute and support staff at the placement who would be using the equipment.

The Medpage MP5-UT epilepsy seizure movement detection alarm successfully solved the posed issues and concerns for Carly and her support staff.  It optimised epilepsy monitoring and avoided an increase in the package of care, proving cost efficient to the Local authority. 

More importantly Carly’s ongoing care and support resumed and the overall household routine got back to ‘business as usual’.

One sleep-in support staff offered the least restrictive level of support for Carly while also offering her an optimised approach to managing and monitoring her epilepsy.

Additional key benefits of the medpage mp5-ut epilepsy seizure movement detection alarm:

• Epilepsy monitored at an optimum
• Reduced the need for 2 carers to support at night
• Reduced the anxiety Carly was experiencing during the night
• Least restrictive option with sleep in staff status resuming
• Care package maintained
• Cost efficiency for the Local authority 
• Less frustration for carers who felt they were disturbing Carly watching over her at night.
• No false alarms 
• Further safeguarding’s avoided re: epilepsy management incidents
• Avoidance of a full re-assessment as per Care Act
• No re-application to the court of protection for amendments
• Sleep pattern resumed for Carly’s house-mate
• Carly’s parents were offered increased re-assurance, which reduced their individual personal anxieties
• Staff felt increasingly re-assured and confident
• Staff alerted immediately during seizure activity as linked to staff pager
• Carly did not have to be re-settled to alternative accommodation

The equipment can be purchased by the Clinical Commissioning group through a one-off personal health budget or the local authority through a one-off direct payment. If neither is an option a non-stock requisition can be completed by an approved prescriber and submitted for approval to equipment services. A Prescriber should be knowledgeable and familiar with the equipment to enable prescribing and explaining the use to staff and others involved.

Yearly cost avoided £98,280 by using the Medpage MP5-UT epilepsy seizure movement detection alarm

Please contact CHCOT Network for a full breakdown of cost savings.