Adult Social Care - Data
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Adult Social Care relates to the assessment of care and support needs and provision of support across all adult and older people client groups. It comprises of the following field work staff: 29.7 Social Workers (includes Mental Health Officers), 9.8 Occupational Therapists, 9.2 Community Care Assistants and 8 team leaders (numbers are whole time equivalent). A restructure of Adult Social Care is underway (2018/19) with the proposal to focus on specialist teams, categorised by client group, and with an emphasis on closer joint working with health colleagues. This restructure includes a proposal to create an enhanced Community Care Assistant role.
2000 adults are in receipt of a care package funded through the Adults and Social Care Team.
There are almost double the number of referrals for those aged 65+ compared to those under the age of 65.
76% people who are in receipt of support said it helps them live independently 82% staff agree with this. 80% people and staff believe the support provided helps people feel safe. 65% people who receive support at home and 43% of Health and Social Care staff believe that support is provided at the right time.
In 2018 the average wait time between referral and assignment to a worker was 22 days. Referrals are screened on the basis of urgency. Those requiring an Adult Support and Protection response must be assigned to a Council Officer within 24 hours and other urgent referrals are assigned within a short timescale, therefore the difference between the shortest and longest wait is large (longest wait can be several months).
The reducing numbers of referrals and average wait time for Adults and Social Care correlates with the promotion of realistic care, realistic expectations.
Day Opportunities
There is one learning centre for adults with complex learning disabilities based in Bonnyrigg which is open Monday – Friday. 50 people use this centre every week. CAT, the Community Access Team, supports adults with Learning Disabilities through programmes of activities in 5 community hubs (2 in Mayfield, 1 in Penicuik, 1 in Dalkeith, 1 in Lasswade). These hubs support 162 people.
There are 4 day centres for older people, one of which is dementia specific. They support 95 people per week.
Many day opportunities are run or supported through the third sector such as Local Area Co-ordination and Befriending. People also use self-directed support to build personalised and creative day opportunities.
Residential care
Over 65 The private sector is the largest provider of care homes for older people. The voluntary sector provides proportionally more care home places in Midlothian than in Scotland as a whole. There is a move to support more people at home with complex needs, this means people living in care homes tend to have more complex needs.
The number of care homes owned by the partnership reduced from 3 in 2015 to 1 in 2017. One care home was closed in 2015 (Pentland House) and another (Highbank) has become a transitionary hub providing rehab, respite and interim care linked to hospital discharge. A small number of permanent residents remain at Highbank, hence its inclusion in the table below. The remaining partnership care home (Newbyres) now provides both residential and nursing care. It previously provided residential care.
The number of care homes relates to the number of homes in which Midlothian has responsibility for funding clients, whether in whole or in part, not the total number of homes (with the exception of Midlothian Council homes). While most people moving to a care home continue to reside in Midlothian some people move out of area, mainly into neighbouring Lothian Authorities. Midlothian retains responsibility for the funding of these placements.
There was a large increase in the number of Midlothian funded care home residents in 2017 and 2018 in comparison to previous years and also in the number of care homes residents are funded in. This goes against the trend of general decline between 2011 and 2016, which can be traced back to 2003. The change is believed to be linked to capacity issues with Care at Home services (see Care at Home Section below).
The average care home stay was 22 months in 2017/18 compared to 23.5 months in 2011/12 and the average resident age in 2017/18 was 85. The balance between residential and nursing placements has shifted with more nursing beds in Midlothian.
Under 65
There are 2 residential care homes registered in Midlothian to support adults with a learning disability, there are plans for one of these to deregister. The other provides care to older adults with a learning disability. The majority of this support is now provided under more flexible models of support such as housing support.
There is 1 registered care home in Midlothian to support adults with a physical disability and 1 care home in the Southside of neighbouring Edinburgh which supports a number of Midlothian residents.
Respite
- Learning Disability - 1 dedicated facility with 3 bedrooms, alongside a small team (currently 7) of shared lives carers
- Adults over 65 - 12 dedicated respite beds across two Local Authority owned care homes.
- Adults with a physical disability - no dedicated facilities
- Adults with a long term condition – no dedicated facilities. Previous use of hospital beds at the Astley Ainslie Hospital for respite admissions have ceased. This has been identified as an area of difficulty.
Self-directed support has resulted in an increase in respite being provided in alternative ways to traditional residential care. Almost 20% of funded respite requests in 2018 used options 1,2 or 4 of Self Directed Support138. This is not suitable or desirable for all.
Care at Home
The main focus of care at home services is personal care. Most people in receipt of care at home are 65 and over. Personal care is non chargeable for people over the age of 65 with an assessed need. From April 2019 it will also be non-chargeable for those under 65.
Around 700 people each week are able to live in their own homes because of Care at Home services. This means the scheduling of 12,000 visits each week, 1,700 per day or 115 visits every hour or more or less 1 visit every 30 seconds. The minimum scheduled visit time is 15 minutes. Inhouse care workers drive around 37,000 miles each month providing care. The equivalent data for walked routes is not currently available.
Over 200 care workers across 3 care at home teams provide 2,500 hours of care per week to 310 individuals. The independent sector is the main provider of care at home for older people providing 3,100 hours of care per week to 370 individuals. For other client groups the voluntary sector tends to be the main provider.
The intensity of demand for Care at Home services requires incredibly skilled coordination as home care must flex around the daily changing lives of people, hospital & GP appointments, family, unpaid carers, day care, holidays, sickness etc. There are particular known challenges with capacity, recruitment and retention in care at home specific to older people. These challenges are more pronounced in the independent sector where terms and conditions of employment differ. Assessed requests for Care at Home support are screened on the basis of urgency and need. This include hospital discharge referrals. Some people wait a long time for a consistent care provider or package of care – up to a year. SDS enables people to exercise choice and control over their care but with this comes the additional challenge of balancing this with the ability to meet the needs of as many people as possible.