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This policy is designed to:
- Ensure residents of care homes have their needs appropriately assessed and the necessary equipment provided to enable them to participate in personal care, rehabilitation, leisure and social activities, access environments of their choice and maintain their health and independence
- Clarify the responsibilities for the provision of equipment between Blackpool Council, Blackpool CCG and care homes including those offering nursing care
- Provide guidance on when/which equipment may, or may not be provided to adult residents in nursing and residential care homes
- Promote understanding between managers of care homes, equipment services, providers and other parties involved in the provision of equipment to residents of care homes
This policy describes local arrangements for the issue of community equipment to residential care and nursing homes by assessors (registered practitioners or other approved assessors across acute and community services) who are authorised to prescribe any of the assistive equipment referred to in the equipment list attached to this policy. Equipment will only be provided where the person is unable to achieve the activity or goal in any other way.
In the context of this policy a care home is defined as a local authority, NHS or private residential care or nursing home which is registered with the Care Quality Commission to provide accommodation and care to adults. It excludes housing complexes where there may be a warden or housekeeper because such schemes are treated as a person’s private dwelling.
The policy excludes equipment for children and 18 or 19 years old in full time education (who come under the children and families services).
Adult – is any person over 18 years old who is living as a resident in a care or nursing home on either a short or long term basis and is receiving a 24 hour care service.
Assessor – is any competent Registered Practitioner/Prescriber or another approved person who is authorised and has the required training and knowledge to prescribe assistive equipment referred to in this policy.
The Care Quality Commission “Essential Standards of Quality and Safety” require all registered health and social care providers to deliver care in an environment suitable for purpose and with access to suitable and safe equipment. The care home must be able to demonstrate that it is successful in meeting its stated aims (Section 23(1) of the Care Standards Act 2000). Under standard 1, each care home must produce a statement of purpose to ensure that it is meeting the needs of the residents.
In line with Department of Health guidance: Equipment … should be provided by the care home if it is the type of equipment often required by its users as part of its statement of purpose. (Department of Health Integrating Community Equipment Services 2004, p.iv).
For example, if a home states that it caters for needs of people with physical disabilities, in order to be fit for purpose it must have wheelchair access and a range of equipment which is likely to be needed by people with physical disabilities.
When a person is being considered for admission/readmission an assessment of their needs should include consideration of the equipment required to support their care. care homes should not admit people whose assessed needs they are unable to meet.
It is expected that care homes will provide the range of standard assistive equipment which their service users could reasonably be expected to require for both long and short term care. The standard equipment which a care home may be expected to have would equate to that which is widely available to end users in their own homes.
Standard equipment may be of the type that will:
- Be used by more than one person
- Be frequently/regularly used by the end user
- Support care given by informal or funded carers
- Support general personal or nursing care
- Assist activities of daily living and enable independence
- Be issued without the requirement for an advanced assessment
- Be for short-term or long-term need
- Support a safe environment for users.
(The Royal College of Occupational Therapists)
In order to meet residents’ needs, a care home is expected to have an adequate supply of equipment/medical devices to fulfil their obligations to residents and their requirements for health and safety. Variations in resident's size, height, weight etc. should be taken into account when supplying equipment. Examples may include such items as commodes, high seat chairs, shower chairs and attendant pushed wheelchairs
The Health and Safety at Work Act (1974) requires employers to provide suitably maintained equipment, staff training, and supervision in a safe working environment. It is the employee's responsibility to follow instructions and to ensure their own safety and that of others at all times. The Management of Health and Safety at Work Act (1992) requires employers to ensure risk assessments are carried out and that risks are minimised as far as possible.
The Care Standards Act (2000) requires that the health, safety and welfare of Residents and staff are promoted and protected. It is the responsibility of the registered manager to ensure that all working practices are safe.
On occasions when assistive equipment is provided via the equipment service to a resident the care home must:
- Provide nominated staff member/s to receive instruction from the provider/supplier and cascade to other staff members
- Ensure that all members of staff who use the equipment are competent to do so, and have a process for maintaining competence
- Ensure that the equipment is only used by the person for whom it was provided
- Notify the prescribing service of any changes in the person’s condition that may affect their safe use of the equipment provided.
- Ensure manufacturer’s instructions for use are kept available for staff to refer to
- Promptly inform the provider if the resident moves to another address
- Arrange prompt return of any loaned/hired equipment to the provider when no longer required
- Arrange prompt return of the equipment at the end of an agreed period of short term loan
- Inform equipment provider promptly in the event of equipment breakdown of loaned/hired equipment
- Make loaned/hired equipment available for repair in the event of breakdown and for routine servicing
- Inform the provider of any incidents or near misses when using the loaned/hired equipment according to instructions and for the purpose for which it has been provided
- Meet the cost of all repairs arising from negligence, damage or inappropriate use and the cost of a replacement if it is lost
- Safely dispose of any non-returnable equipment when it is no longer required
When assistive equipment is provided via the equipment service to a resident of a care home the provider must:
- Provide an assessment of needs and recommendation of provision
- Provide a demonstration to nominated care staff. Thereafter it is the responsibility of the care home to cascade these instructions to other staff
- Ensure manufacturer’s instructions for use are provided with the equipment
- Provide contact details for breakdown or return of loaned/hired equipment
- Make arrangements for the servicing, maintenance and repair of any loaned/hired equipment according to relevant legislation and manufacturers recommendations
- Ensure that the care home is informed if the equipment is non-returnable or provided on a short term, long term or hire/loan agreement and the length of time the equipment is to be provided for
Each person is entitled to an assessment of need and advice. However provision of any recommended equipment is at the discretion of the Blackpool Council/CCG. Local commissioning agreements will determine the conditions under which equipment is provided e.g. non-returnable or under a short term loan, long term loan or hire agreement.
An assessment of need, recommendations or decision to loan equipment must be carried out by an appropriately trained and competent assessor with reference to these guidelines. There are four common scenarios where an assessment or review of needs in relation to equipment may occur.
- New admission to a care home
- Existing resident in care home
- Transfer between care homes
- Urgent admission/readmission to facilitate hospital discharge or to prevent an avoidable admission to hospital
- As part of a new or ongoing rehabilitation plan/goals
In the majority of instances a decision on provision of equipment to a care home will follow the guidance for standard equipment.
However under certain circumstances, according to local commissioning and funding agreements, provision may be considered on an individual case basis where a person is found to have specialist needs, which can only be met by bespoke items.
Provided a care home can meet a person's assessed needs, it is against the ethos of care to move a person from their current care home if they have a new condition that requires equipment for a temporary period. In such instances provision may be agreed following a specialist assessment. Examples of temporary care needs could include:
- Temporary short term care including; early supported discharge from hospital, intermediate or rehabilitative care in a care home
- Treatment for pressure care following discharge from hospital for a new or current resident in a residential care home (this does not include nursing homes).
- An episode of acute illness or end of life care where lack of provision of non-specialist equipment for an individual in a care home could result in admission to hospital or transfer to nursing care.
Any decision to provide/loan equipment to a care home must be approved by an authorised person before a loan/hire arrangement is made.
In the circumstances described above and following an assessment, short term provision of equipment may be considered on an individual case basis. In such cases the assessor with the approval of their authorising manager/s may decide to provide equipment on a temporary hire/loan for up to 6 weeks. It may be expected that the care home fund equipment in certain circumstances.
In some exceptional circumstances, it may be possible to extend a temporary hire/loan of equipment beyond 6 weeks, but only if approved by the assessor’s authorising manager in consultation with the commissioners of the service. All such extensions will be in writing and describe the rationale for the extension.
The assessor must complete a temporary equipment loan agreement obtaining both the agreement to the terms and conditions of the loan and the signature of the care home manager.
It will be made clear to the care home at the time of recommendation whether the provision of equipment is on a short term, non-return or loan/hire basis.
Where a loan has been agreed, the care home will need to make final arrangements for the replacement and return of loaned equipment towards the end of the loan agreement.
The care home must arrange for collection of loaned equipment via the community equipment service at the end of the loan period.
If the equipment is not returned at the end of the agreed loan period, or when the client no longer has a need for the equipment, a charge will be made to the care home for that piece of equipment at the full replacement value.
If a resident’s need/s change, it is the responsibility of the care home to request an assessment/review from the most appropriate health or social care service. Where equipment is for a designated resident as part of a care plan, it must not be used by others.
Where individuals in a care home require equipment to meet their nursing care needs, there are several routes by which it may be provided:
a) The care home may be required to provide certain equipment as part of regulatory standards or as part of its contract with the CCG. For example; The NHS contract states: ‘Services provided will be inclusive of the following elements:
- 1.9.5 Medical devices/equipment – range of equipment required to support the delivery of care for the care categories for which the provider is registered.
- 1.9.6 Continence – provision of disposable continence products in accordance with the commissioner’s local protocol on continence management.’
Further details of the regulatory standards.
b) Individuals who are entitled to NHS-funded nursing care have an entitlement – on the same basis as other people – to joint equipment services. CCGs and local authorities should ensure that the availability to those in receipt of NHS-funded nursing care is taken into account in the planning, commissioning and funding arrangements for these services.
c) Some individuals will require bespoke equipment (or non-bespoke equipment that is not available through routes (a) and (b) above) to meet specific assessed needs identified in their care plan. CCGs and (where relevant) local authorities should make appropriate arrangements to meet these needs.
Bathing equipment
Details of bathing equipment provision
| Equipment | Nursing care home | Residential care home | Notes |
|---|
| Bath seats and bath boards |
No |
No |
|
| Bath lifts electric/manual |
No |
No |
|
| Shower chairs |
No |
No |
|
| Shower chairs- Bespoke. e.g. tilt in space |
Yes |
Yes |
Postural management - unable to safely be supported in a standard shower chair |
Beds
Details of bed provision
| Equipment | Nursing care home | Residential care home | Notes |
|---|
| All types including standard, heavy duty height adjustable, electric profiling and low etc. |
No |
No* |
*In residential care may consider short term loan for end of life |
Bed attachments
Details of bed attachment provision
| Equipment | Nursing care home | Residential care home | Notes |
|---|
| Back rests |
No |
No |
|
| Bed levers |
No |
No |
|
| Bed raisers |
No |
No |
|
| Mattress variations and pillow lifters |
No |
No |
|
| Over bed trolley table |
No |
No |
|
| Lifting pole |
No |
No |
|
| Bed rails and bumpers |
No |
No |
Unless integral to bed |
| Crash mats |
No |
No |
|
Cushions
Details of cushion provision
| Equipment | Nursing care home | Residential care home |
|---|
| At risk cushions of all risk levels |
No |
No |
Environmental controls
Details of environmental controls provision
| Equipment | Nursing care home | Residential care home |
|---|
| Sensors for beds and chairs etc. |
No |
No |
Mattresses
Details of mattress provision
| Equipment | Nursing care home | Residential care home | Notes |
|---|
| All types of pressure relieving mattress static or air flow |
No |
Yes |
Following assessment and while there is a nursing need or long term pressure care risk |
Mobility equipment
Mobility aid provision
| Equipment | Nursing care home | Residential care home | Notes |
|---|
| All walking aids including sticks, crutches and walking frames |
Yes |
Yes |
Following assessment from competent assessor |
Patient repositioning
Patient repositioning
| Equipment | Nursing care home | Residential care home |
|---|
| Standard mobile hoists, slings, transfer boards, glide sheets |
No |
No |
| Bespoke specialist slings – specifically manufactured to meet an individual’s complex needs |
Yes |
Yes |
| Ceiling track and gantry hoists |
No |
No |
| Standing transfer aids - Only as part of an active rehabilitation programme prescribed by registered professional and will be removed when rehab programme ends. If standing transfer aids are needed for long term use the care home will be expected to provide these |
No |
Yes |
Respiratory equipment
Details of respiratory aid provision
| Equipment | Nursing care home | residential care home | Notes |
|---|
| Suction units– for a specific individual |
No |
Yes |
On loan |
| Nebulisers |
No |
Yes |
On short term loan |
Resuscitation equipment
Details of resuscitation equipment provision
| Equipment | Nursing care home | Residential care home |
|---|
| Ambu bags and masks |
No |
No |
Sensory equipment
Details of sensory equipment provision
| Equipment | Nursing care home | Residential care home |
|---|
| Visual or hearing e.g. loop systems, magnifiers, talking clocks |
No |
No |
Seating
Details of seating equipment provision
| Equipment | Nursing care home | Residential care home |
|---|
| All standard seating including heavy duty, high seat chairs, recliners and riser chairs |
No |
No |
| Chair raisers |
No |
No |
| Footrests and leg raisers |
No |
No |
| Specialist posture management chairs |
Yes |
Yes |
Toileting equipment
Details of toilet equipment provision
| Equipment | Nursing care home | Residential care home |
|---|
| Bed pans, urinals |
No |
No |
| Commodes incl. glide about and heavy duty commodes |
No |
No |
| Toilet seats 2”, 4”, 6” , toilet fame with seat and toilet frames |
No |
No |
Some care home residents will require an assessment of need for bespoke equipment or other non-bespoke equipment that is not available routinely but is essential to be able to complete basic activities of daily living
For example:
- Complex seating required for postural support and pressure management
- Bespoke moving and handling equipment e.g. non-standard sling manufactured to order
- Bespoke shower chairs – for example, tilt in space
If this equipment request is made by the patient, carer or care home and does not justify an essential need then an assessment and recommendation will be given by the occupational therapist or other NHS clinician but the CCG will not fund this equipment.
For equipment that is essential for completion of activities of daily living then this request will be sent through to the CCG IPA panel who will make recommendations dependent upon clinical reasoning and funding options.
Funding options for individual pieces of equipment over £1000 could include the part funding of such recommended bespoke equipment with the care or nursing home that is the patient’s normal place of residence.
N.B. Blackpool equipment service should be informed when an adult becomes a new resident of a care home or permanently leaves a care home so that:
- Arrangements can be made by carers or others to return loaned equipment from a resident’s former home to Blackpool equipment services
- Equipment suppliers can amend their records and arrange/review on-going maintenance of loaned/hired equipment
N.B. This does not apply to certain low cost items such as dressing aids as these belong to the individual.
Enquiries