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Carers breaks including respite policy and guidance for practitioners August 2022

Introduction 

This guidance sets out how short breaks can be provided to family and friend carers looking after adults. This guidance also incorporates carers over the age of 65. 

Please note not all carer breaks are going to involve adult social care because carers can have eligible needs under the Care Act without the cared-for person having eligible needs. For example, carers can have a personal budget that is administered by The Caring for Carers service which won't rely on the eligible needs of the cared-for person Care Act 2014).  

This guidance has been produced to help the cared-for person to continue to live at home by supporting their unpaid Carer. 

Access to social care-funded short breaks is based on the carer's assessment and provision must reflect the assessed needs of the individual they care for.

A short break is defined as:

A session or more of care and support that enables disabled or vulnerable individuals to spend time away from the person(s) who provide them with regular and substantial care.  This includes the provision of short periods of day, evening and weekend activities, as well as overnight stays.  Such breaks can be provided in the individual's own home, or in another setting, but no break should exceed one month's continuous care.

Carol Robinson SWALD March 2003: Short Breaks in the South West of England for Disabled Children and Adults with Learning Disabilities 

This guidance is a tool for practitioners to aid decision-making and to help in locating local resources. This guidance includes some criteria for assessing whether a short break is appropriate and, if so, what type of support is most appropriate. Underpinning these criteria is the recognition that individual carers and the person they care for are all different and that provision needs to be appropriate to individual strengths and aspirations which not all may be best met through 'formal' adult social care provision.

It also sets what should not be a 'short break' and provides guidance for the actions required in these circumstances.

What is not a short break?

Some types of care are confused with short breaks but are not. The list below provides examples of these:

  • When the home situation breaks down and an individual is placed in alternative provision whilst alternative placements are found
  • Crisis support for individuals at risk of mental health inpatient admission. Alternative specialist support should be provided within the person's existing placement or in a fixed-term specialist provision and, if appropriate, a new care plan agreed upon and arranged
  • When a personal assistant goes on holiday and temporary cover is required. Individuals should use their direct payment /personal budget to pay for holiday cover
  • When a medically fit person is discharged into a residential care unit because their home is not suitable. This is a temporary arrangement that will be managed through post-discharge planning for the individual
  • Step-down for a person who is not yet medically fit and requires further support in a step-down or rehabilitation bed. This is an NHS provision.

Using short-term residential care for individuals without a carer. For example, when large-scale adaptations are happening to the house, they live in. 

Carer's assessment and carer's needs

In line with the requirements of the Care Act 2014, carers' assessments should establish the carer's needs for support and the sustainability of the caring role itself, which includes identifying what the carer's aspirations are beyond their caring responsibilities and the impact of caring upon those activities.  

This can include things the carer wants to do with the person they care for or activities they need to do without them. This may include times when the Carer will need a break from their caring role (for example time for a hospital appointment) or support to access joint activities with the person they carer for (for example a swimming class).

Sometimes, individuals attend day opportunities or receive additional adult social care support in their employment. 

Short breaks are paid for from their indicative social care budget of the person being looked after and carers of individuals receiving direct payments could be eligible to have a short break but if social care services are used these will need to be paid for from the direct payment.

Carer's break local options

The points below provide an overview of the types of support that should be included in the local carer's break offer. A range of provisions will ensure that support can be deployed at the right level of intensity at the right time. 

Examples of short breaks support

  • Support from a volunteer in the person's home for a fixed period of time - where personal care is not required 
  • Day opportunities, activity groups or clubs during the day and sometimes in the evening so that the carer can have a break while they are away from home. These can be adult social care services, local community and voluntary provision
  • Services at home - such as sitting services where a care worker comes into the home or could be a package of care for a set period/number of weeks, to enable the carer to have a break away from their caring responsibilities
  • Temporary supported living, residential or nursing care - for longer periods that cover both day and night, this provides a complete break from caring. 

Being creative

There are lots of examples of creative approaches to short breaks that both help deliver better outcomes for the Carer and the person they look after. 

Examples include:

  • The Carer could go on holiday without the person they care for, and a personal assistant or home care provider could support the person at home - using social care funding.
  • The individuals could go to a short-term Shared Lives arrangement, or individuals in Shared Lives could go to another Shared Lives carer while their carer has a break.
  • Direct payments and the use of personal assistance extends choice, as it does in other areas, on the arrangements for providing care during Carer's short breaks.

Matching support to a carer's needs

Short breaks should always provide a break from caring for the Carer and ensure that the person they care for retains their independence. Having a plan for what sort of short breaks they need, how frequently and for how long will help prevent crises or late planning for breaks. Carers can become frustrated when planned breaks do not happen because there is no availability and the person cared for can become distressed by the lack of certainty about these plans.

The list below provides details of what a planned approach to Carers' breaks could look like. This approach recognises that some carers will need additional help to find the right short break and should be complementary to the services provided to Carers by Improving Lives Plymouth.

Practitioner tools

When formulating the support plan after an assessment practitioners really need to capture the detail for the carer about what is really needed for the person with a series of critical questions including:

What type of break is needed?

  • Length - a couple of hours, an afternoon or longer?
  • Type of Care Needed? Care in their home, day opportunities, support to access community leisure or community activities or an overnight stay?
  • Location needed - close to their home, or activity further from their home?
  • How often - will it be required i.e., regularly or just to cover a one-off event?
  • In answering this question, the Carer's Assessment should be considered alongside a conversation with the Carer.

Types of care

  • Could a local group or organisation provide the break without additional support?
  • Could an ASC-funded day opportunity service provide the break?
  • Could a befriender visit and support the individual?
  • Could a paid carer provide care in the family home? Low hours to overnight?
  • Would a short stay in supported living provide the right support?
  • Are needs more complex and will need overnight support in residential or nursing care homes?

In answering these questions above, the person being cared for Care Plan and Assessment should be considered alongside the views of the Carer.

Getting it right through co-production

  • Whilst many carers may ask for overnight provision away from the family home - many just want a break.  
  • Working with the carer to discuss ideas for a break that is not about overnight care outside of the family home can generate other solutions.
  • Engaging carers in discussions about the availability of services and waiting lists also helps them to balance their expectations with what is available.
  • The person cared for also needs to be involved in deciding on the right type of break. For example, if they can do many tasks for themselves, they may have views on going into a more restrictive setting. Knowing these things will help produce a plan that works for both carer and the person being cared for.

Short breaks - a carer-centred plan

  • Everyone knows how often and where
  • Plans reflect the capacity, aspirations, and strengths of families.
  • Community activities, volunteers, care at home and day opportunities are used, alongside more intensive care where needed, to meet the identified needs of the Carer.
  • Carers understand that some services are at capacity on some days - so expectations are managed.
  • The person cared for is comfortable with the plans and the risks of distress or confusion are minimised.

Appendix A provides an overview of community resources and contacts that could be used to help carers have a break without overnight.

Access to supported living, nursing and residential short-breaks

The following section below sets out a system to help with planning the use of the overnight provision, outside of the family home, for those carers looking after someone with very high levels of support needs. This means individuals that require their carer or a paid carer to undertake personal care tasks.

The system sets out some broad bands for allocating a maximum number of nights to families, including weekend nights, to reflect the different needs of Carers and the people they care for. This system should help practitioners to work with Carers to plan their breaks whilst recognising that demand for weekend nights often exceeds supply and there needs to be a way to ensure more equitable access to these.

Once a short breaks plan has been agreed upon, as part of the assessed needs of the Carer. Carers will be advised of their allocation which will enable them to plan and negotiate with the appropriate service provider for specific dates and patterns of usage.

Banding criteria 

Please see below the agreed banding criteria to be applied now to the allocation of short breaks for carers:

Band one

This band is for Carers where the intended outcome of the short break is one or more of these:

  • Carer(s) will be able to take a holiday or participate in a family event that would mean an overnight stay away from home. 
  • Carers will be able to have quality time with other siblings/family members.
  • Carers will be supported to maintain their working lives for example when they would need to attend an overnight training event.

Band one provision: up to a maximum of 21 nights of short breaks a year which can include up to 7 weekend nights: Friday, Saturday, and Sunday.

Band two

Band two criteria in addition to meeting the criteria for band one, also meets at least one of the following criteria: 

  • The Carer has no family or friends to provide support in their caring role.
  • The Carer has a disability that meets the definition of disability under the Equality Act 2010.
  • The Carer is receiving treatment for physical or mental health conditions.
  • The Carer is required to provide mobility support or transfers. 
  • The Carer is supporting someone who displays some unpredictable behaviour, medical condition or challenging behaviour that requires them to provide guidance and monitoring throughout the day and night. 
  • The Carer is under stress due to individual or family circumstances

Band 2 provision:  up to a maximum of 42 nights of short breaks per year which can include up to 18 weekend nights: Friday, Saturday, and Sunday.

Band three:

Additional nights are available if the service user or carer, in addition to meeting the criteria for band two, also meets more than one of the following criteria: 

  • Carers can find it difficult to provide care, on occasions, because of their own frailty due to age, health condition or a deterioration in health.
  • The Carer is supporting someone who requires frequent active assistance and close monitoring because of complex, challenging and /or disruptive behaviour including self-harm. 
  • The Carer is supporting someone who requires active assistance because of complex health care needs example enteral feeding, colostomy care, and tracheostomy care. 
  • The Carer regularly has disrupted sleep patterns because the person they care for has disrupted sleep or needs interventions during the night.
  • Band 3 would tie into CHC (Continuing Health Care - where care is arranged and funded by the NHS) assessment levels

Band 3 provision: up to a maximum of 56 nights of short breaks per year which can include up to 24 weekend nights: Friday, Saturday, and Sunday.

Monitoring and review:

  • Short break arrangements are to be monitored by the appropriate Care Manager.
  • The booking in of short breaks should be managed and supported by the care provider to ensure that the family carer understands that this has to be equally spread across the year, according to the agreed/assessed criteria for the family. 
  • Reviews must be undertaken at least annually, to ensure the service continues to the meet assessed needs of the Carer. 
  • Carers must be advised of their right to have access to the Council's Complaints and Representations Procedure. 

Emergency provision

Services to support families in emergency situations will be provided in addition to the above allocation and in accordance with the family's emergency support plan. 

Exceptional circumstances

 The maximum number of nights can only be increased between reviews upon agreement by the Service Manager, in cases where there are exceptional circumstances.

Frequently asked questions 

  • This policy does not include the provision of transport.
  • This policy and allocation relate to overnight short breaks.

Carers support plan

It is expected that the care provider does not exceed the respite detailed in the support plan for the cared-for person.  Should there be exceptional circumstances, for example, the family carer is in hospital (and is expected to resume their caring role) the provider must call into duty for an urgent response and authorisation. 

Please note that anything above a week has to be processed under a formal authorisation. 

Implementation and review date

This policy will become operational for staff from Livewell Southwest to use from the 1st of August 2022. It will be reviewed every year. 

APPENDIX A

Signposting to carers organisations and short-breaks alternatives to overnight stays

Dedicated carers support service 

Improving Lives Plymouth - Main adult carers service that delivers a range of services including carers' assessments, plans and administration of direct payments

Carer free breaks

Care in the home

Assistive technology in the home

Social activities for the carer 

Evening clubs or activities for the carer

Volunteer for the carer

Befriending for the carer

Linking to community or wellbeing hubs

Time banking - linking to other people in the local community registered with a scheme to donate and receive support

Barnardo's, Hamoaze, PCC youth services - Time 4 U project supporting young carers

Please note can also use a personal budget to facilitate a short break which can include payment to wider family members.

Somewhere for the cared-for person to go

Daycare provision

Plymouth SEND local offer - Short Break Activities

Overnight stays with in-house or private respite - Supported living enabling

Shared Lives Southwest - range of short breaks and overnight stays

Domiciliary care enabling/ Direct payment for a personal assistant

Evening clubs or activities

Please also refer to this best practice information - https://www.scie.org.uk/carers/breaks/adults

 

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