1. Transforming Your Care
– Vision to Action
May 2013
Primary Care & Older People’sPrimary Care & Older People’s
Services DirectorateServices Directorate

2. ProposalProposal
The Directorate seeks Trust Board approval to proceed to
consult on the proposed closure of four Residential Care
Homes for Older People in the Western Health and Social
Care Trust area as part of the TYC Vision to Action Report.
The Homes involved are: -
– Greenfield Residential Care Home, Strabane
– Rectory Field Residential Care Home, Derry / Londonderry
– Thackeray Place Residential Care Home, Limavady
– William Street Residential Home, Derry / Londonderry

3. Presentation OverviewPresentation Overview
 This document is a summary of the proposals made by
Trust officers in relation to Residential Care for older
people.
 It gives details of the rationale behind the proposal: -
– Background & Drivers for Change
– Summary of Proposal
– Process
– Priorities
– Next Steps

4. Drivers for ChangeDrivers for Change
 WHSSB’s “Meeting the Needs of Older People Locally”, 2007-2017
 Transforming Your Care – Vision to Action Consultation Document
 Demographic Profile
 Dementia Prevalence
 RQIA Standards

5. Meeting the Needs of Older PeopleMeeting the Needs of Older People
LocallyLocally
 Older people want to remain in their own
homes for as long as possible.
 Recommended reform of residential care.
 Recommended development of alternative
community supports.

6. TYC Vision to ActionTYC Vision to Action
• The Policy of the Government at both national and local level
is that more older people who require care should be looked
after at home or as close to their own homes and communities
as possible.
• The overarching intention of community care is to help people
to live at home with appropriate and timely support.
• Re-shaping services to promote independence means less
people will require institutional care.
• There will be a reduction of at least 50% in the provision of
statutory residential care.

7. Demographic Profile:Demographic Profile:
The age profile of the Western & Social Care Trust
is changing quite significantly, 65+
Cityside
Wards
Waterside
&
Limavady
Fermanagh Omagh &
Strabane
Western
Trust
Crude Population
Census 2011
6,572 10,515 9,844 11,682 38,613
Crude % 17.02% 27.23% 25.49% 30.25% 100%
Age Needs Weighted
Population
5,745 10,378 10,435 12,438 38,996
PoC 4 Age Needs
based Formula
14.73% 26.61% 26.76% 31.90% 100%
Age Needs Weighted
Population adjusted
for Rurality and EoS
5,685 10,280 10,524 12,506 38,996
PoC 4 Age Needs
based Formula
adjusted for Rurality
and EoS
14.58% 26.36% 26.99% 32.07% 100%

8. The Split of the Older Population by Age Band

9. Increasing Needs Associated withIncreasing Needs Associated with
Dementia DiagnosisDementia Diagnosis
 Increasing numbers of residents with
dementia
 RQIA guidance given regarding placement
of people with dementia
 Implications for staffing, environment, safety
and risk management
 Registration status needs to be considered.

10. • The Review of Statutory Residential Care for Older
People highlighted that in line with the RQIA standards
regarding the current structure/layout of the homes,
each home would require a substantial financial
investment to bring them up to the identified “Minimum
Standards”.
• Calculations are highlighted in the following table.
RQIA Standards

11. Home Total upgrade
2008
Total upgrade
2013
Greenfield 740k 858k
Rectory Field 550k 638k
Thackeray Place 520k 602k
William Street 496k 575k
Overall £2.673milion
Table of Upgrade Cost Estimates for
Residential Homes

12. What does this mean for theWhat does this mean for the
Western Area?Western Area?
 Older people’s population is growing
 Older people who require care have a preference
to stay in their own homes
 Alternative care arrangements have been
developed
 The need for general residential care is declining
 Over the last year there has been a further decline
in the admission of permanent residents.

13. What Does this Mean for theWhat Does this Mean for the
Western Area?Western Area?
 Cash Releasing & Reinvestment
 Process
 Alternatives to Statutory Residential Care
 Priorities

14. Reform to DateReform to Date
 Closure of Statutory Residential Care
Homes: -
– Foyleville, Derry / Londonderry
– Drumhaw, Lisnaskea
– Gortmore, Omagh

15. Current Beds Status Information
(as at 29 April 2013)
Home Bed
establish-
ment
No. of
beds
occupied
No. of
vacant
beds
No. of
perm
residents
No. of
temp
residents
No. of
respite
residents
No. of
step
down
residents
How many
admissions
in last week
How many
discharges
in last week
Greenfield 34 24 10 19 5 0 0 0 0
Rectory
Field
35 22 13 14 6 0 2 1 2
Thackeray
Place
32 30 2 26 4 0 0 0 0
William
Street
27 20 7 15 5 0 0 0 0
TOTALS 128 96 32 74 20 0 2 1 2

16. Occupancy Levels (as at last day of month)
From 30th April 2012- 31st March 2013
William Street
(bed estab. 27)
Rectory Field
(bed estab. 35)
Greenfield
(bed estab. 34)
Thackeray Place
(bed estab. 32)
Perm Temp Perm Temp Perm Temp Perm Temp
April 12 24 0 17 10 24 5 29 1
May 12 24 0 17 9 25 5 27 1
June 12 24 0 18 8 23 4 27 1
July 12 22 0 18 9 21 4 28 1
August 12 20 1 17 8 21 4 27 1
September 12 19 0 15 9 19 7 24 1
October 12 19 1 16 8 18 6 23 4
November 12 16 2 16 10 20 4 25 4
December 12 16 1 17 9 19 5 23 4
January 13 16 3 16 5 18 6 22 5
February 13 15 5 13 6 19 7 24 4
March 13 15 5 13 6 18 5 26 3
Occupancy Levels Residential Homes

17. Dependency Scales (as at 31
March 2013)
Independent Low Medium High Max
Dependency
Greenfield 1 11 12 1 0
Rectory Field 0 0 9 8 1
Thackeray Place 2 7 6 8 4
William Street 0 3 4 4 9
TOTALS 3 21 31 21 14

18. Dependency Scales Level ofDependency Scales Level of
People in Residential CarePeople in Residential Care
On review of the current dependency scales
we can see there are increasing numbers of
residents in the high to maximum category.
This would indicate the residents in these
homes are moving towards requiring nursing
home care, which will result in a further
reduction in demand for residential care
homes.

19. Cash Releasing & ReinvestmentCash Releasing & Reinvestment
 Potential savings of £1.313m
 We are planning to cash release £313,000 for
TYC.
 The remainder, circa £1m, of the combined
finances from the proposed closure of these
homes will contribute to the re-provision costs in
providing alternatives for the existing residents
within the homes.

20. ProcessProcess
 EQIA 13 week full consultation
 Relatives’ and Residents’ meetings
 Staff / Trade Union meetings
 Inviting written and oral submissions
 Public Representatives

21. Alternatives to StatutoryAlternatives to Statutory
Residential CareResidential Care
 Reablement
 Flexicare
 Supporting People Schemes
 Independent Sector Provision
 Domiciliary Care
 Day Care
 Integrated Service Delivery Teams including: District Nurses, Social
Workers & AHPs
 Rapid Response Nursing
 Active Living Schemes
 Community Challenging Behaviour Service

22. ReablementReablement
This service provides the opportunity to allow people to
learn or re-learn the skills necessary for daily living, which
have been lost through deterioration in health and well-
being and/or increased support needs. A focus on
regaining physical ability is central as is active re-
assessment, reducing ongoing support needs through
sustaining independent living.

23. FlexicareFlexicare
 A service made up of a partnership approach with a range
of local community and voluntary groups to enable people
to live within their own homes for as long as possible.
 Flexicare provide services such as: -
– Befriending
– Assisted Shopping
– Handy Help for odd jobs around the house
– Chaperones to help people attend appointments
– Additional services relate to affordable cleaning / gardening
services.

24. Supported LivingSupported Living
A service that enables vulnerable people to
access and maintain accommodation suitable
to their needs and help them to live as
independently as possible, through working in
partnerships with local Government, service
users and supportive agencies to allow
services to visit their home in the forms of
personal care and clinical care.

25. Independent Sector ProvidersIndependent Sector Providers
A number of local independent sector
providers have approached the Trust
indicating plans for provision of a number of
residential / nursing bed within the Western
Trust area in the next 12 – 15 months: -
160 beds in Cityside / Waterside
50 beds in Limavady

26. Alternative Care ProvidersAlternative Care Providers
Strabane Area
Through the Western Area Supporting People
Partnership, the Directorate is exploring the potential
for the provision of a Residential and Housing with
Care Supported Accommodation Facility for Older
People with Dementia in the Strabane area.
The Trust will engage with the independent sector
with a view to encouraging the development of
additional accommodation in the Strabane area.

27. Strabane area continued
There currently 23 individuals placed in a private
facility within the Strabane area. These individuals are
from the Derry / Londonderry and Limavady areas. It
is anticipated that when alternative options become
available in these individuals’ own areas the Trust will
engage with those residents to facilitate transfers back
into their own areas if they wish. This will then create
capacity within the private sector within the Strabane
area.
Currently in Greenfield there are some residents with a
diagnosis of dementia whose needs would be better
met in a dementia specific facility.

28. Derry / Londonderry
The Trust has been approached by an independent
sector provider who will open a 46 bedded care home
on the Culmore Road area of the City in December
2013. There is also a plan within the following 12
months to increase capacity by an additional 34 beds
(making 80 in total).

29. Derry / Londonderry continued
The Trust has been approached by an independent
sector provider indicating plans to open an 82 bedded
facility in the Trench Road area with a mixed provision
of dementia care, residential, intermediate and nursing
care.
There are currently some residents within the Rectory
Field and William Street with a dementia diagnosis
whose needs would be better met in a dementia
specific facility.

30. Limavady area
An independent sector provider has advised the Trust
it will be increasing its current bed capacity by 50.
A further proposal for Limavady will be the subject of a
SOC (Strategic Outline Case) and will be submitted via
the WASPP (Western Area Supporting People
Partnership) for consideration.
There are currently some residents in Thackeray Place
with a dementia diagnosis whose needs would be
better met in a dementia specific facility.

31. PrioritiesPriorities
– Supporting Residents and Families through this difficult
period including Independent Advocacy.
– Supporting Staff through the change process and
securing suitable alternative employment
– Securing Supporting People funding to develop some
alternative accommodation.
– Keeping the public and service users aware of direction
and developments.
NB: No closure would happen unless a
suitable alternative is in place.

32. Summary of ProposalSummary of Proposal
 In summary the Directorate currently provides statutory residential care for
Older People in 5 homes with a total bed complement of 153.
 The Directorate proposes to complete a full EQIA Consultation over a 13 week
period.
 Homes subject to consultation are: Greenfield, Rectory Field, Thackeray Place
& William Street Residential Care Homes involving 128 beds.
 The exception is Seymour Gardens Residential Care Home which is a
Dementia Care specific home
 The consultation would commence on 1st
June 2013.
 Proposal if agreed – homes would close 12 months following decision being
made, subject to suitable alternatives being in place.
 Subject to Trust Board approval
 Subject to Ministerial approval

33. Next StepsNext Steps
 The Directorate submits this proposal to Trust Board for
approval to proceed to consult on the proposed closure of
four Residential Care Homes for Older People in the
WHSCT area as part of the TYC Vision to Action Report.