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Residential care

Mental frailty & high dependency - level 3 (2009/10 £381)

Is for people who, in addition to the needs described in the 2 levels above, need:

• Help with exceptional⁵ bowel and / or bladder incontinence
• Supervision by day or night to prevent risk of harm to self or others
• High⁴ levels of emotional support by day or night
• High⁴ levels of assistance with mobility and transfers - up to two carers and equipment for daytime needs
• High⁴ risk to pressure areas
• Regular² assistance during the night - more than twice a night
• Assistance and encouragement to communicate needs
• One-to-one prompting and active assistance with eating and drinking
• An environment where occasional¹ challenging behaviour is understood and managed

Very high dependency - level 4 (2009/10 £415)

In addition to its use for a new placement, this band may be appropriate on review for people whose needs have increased whilst in a residential care home. For example, it could be appropriate for a person with advancing dementia where a change of environment is desirable and it is judged that the residential environment is more appropriate. Such a judgement may be appropriate where there is nursing need which the community nursing or community psychiatric nursing service is willing to support.

This band is for people:

• Who are in the advanced stages of a deteriorating condition or have a substantial organic or functional mental infirmity,
  
  or
  
  
• Who have such multiple and extensive needs at level 3 above that they need constant³ assistance of a skilled nature;
  
  or
  
  
• Who need exceptionally high⁴ levels of staff time, for example one-to-one attachments for substantial periods, or two or more assistants with mobility and transfers including at night;
  
  or
  
  
• Who need an environment where regular² verbal or physical aggression is understood and managed.

Nursing home care (2 bands)

Standard (2009/10 £522)

For people who have been assessed as requiring Nursing home care according to current eligibility criteria.

Nursing home care is available for people who meet the criteria for residential care and where a nursing needs assessment carried out by a Level One Nurse has resulted in a nursing care plan which demonstrates to Devon Social Services’ satisfaction that the person meets the following eligibility criteria:

• They need professional nursing observation and assessment or re-assessment at frequent unpredictable intervals within a 24 hour period;
  
  or
  
  
• They are at risk of deterioration without constant³ professional nursing overnight, for example, someone with an unstable condition who is unable to express themselves;
  
  or
  
  
• They are very immobile, at risk, or needing treatment for, serious pressure sores;
  
  or
  
  
• They are in need of frequent daily attention to their personal care needs of a kind only a professional nurse can supply, for example, certain feeding techniques;
  
  or
  
  
• They are undergoing treatment, which may only be administered or monitored by a professional nurse in constant³ attendance.

In all cases it must be established that nursing home care is necessary to assure the success of the placement/

People falling into this 'Standard nursing care” band would not have needs described in the 'High dependency & mental frailty' band below.

High dependency & mental frailty (2009/10 £533)

This band is appropriate for those people who, in addition to general eligibility for 'Standard nursing home care' (see above) have:

• A highly complex and comprehensive care plan including high⁴ levels of nursing needs, some of which may be the purchasing responsibility of the National Health Service.
• Need nursing care in respect of mental frailty of an organic or functional nature.

Notes:

1. By occasional we mean something that happens from time to time, i.e. infrequently or irregularly.
2. By regular we mean something that happens uniformly and frequently.
3. By constant we mean something that happens steadily and more or less continually.
4. By high we mean something that is much greater than usual.
5. By exceptional we mean something that is very much greater than usual.

See also:

• Social Services' payments to residential and nursing homes