Care Home Framework

The Services are split between two types of care: - residential care and - care home with nursing care, each of which are further delineated into sub-categories set out below The Services therefore can fall into any of the following 5 categories (each a "Category"): 1. Care Home Placements (Residential) 2.

Care Home Placements (Nursing) 3. Care Home Placements (Dementia Residential) 4.

Care Home Placements (Dementia Nursing) 5. Care Home Placements (Discharge to Assess)

Residents in residential care homes will be mobile with little assistance required to get up or mobilise themselves, although some assistance may be required by 1 carer. Providers will be expected to support residents with their personal care, providing physical assistance and/or encouragement and/or training and/or advice to perform the below tasks (with the assistance of 1 carer), in accordance with the individual care needs of the residents and helping residents to be as independent as possible.

Nursing care residents have increased needs in addition to the general standard of care provided within residential care settings. In Nursing Care, a resident may require 2 carers at times to assist with some/all of their care needs, and a nurse to oversee or manage health needs that require frequent or complex intervention that can not be managed within a residential setting by Community Health teams.

A Registered Nurse creates and monitors care plans, and provides some treatments and medical interventions. This could include administering injections or intravenous medication, as well as treating wounds such as pressure sores or managing recovery after an operation.

Residential care residents have increased needs related to their dementia in addition to the general standard of care provided within residential care settings. Although care is still expected to be provided by 1 carer the majority of the time, understandably this may take some more time to complete, and an increased level of expertise will be needed to understand the difficulties faced by residents living with dementia and in particular, their communication needs.

Residents living with dementia are likely to need more engagement and attention to try to address things such as walking with purpose around the home, looking for things that they feel they are expected to be doing. Bexley Council expect a level of activities in dementia services to reflect this, and that reflect the past and present interest of the resident groups, and be based on their pattern of the day, and not the homes' availability of staff.

In a residential service specialising in dementia care, there is an expectation that residents who may behave in ways that can cause challenges in providing their care, will need to have a multidisciplinary response to support them. Bexley Council expect to work in lock-step with providers in such circumstances, to ensure that residents are given every opportunity to have their needs fully met.

Dementia Nursing care involves specialist support for those living with complex healthcare needs as a result of their advanced dementia and other conditions they are living with. Residents in Dementia Nursing Care will more often require 2 members of staff to meet their needs and staff in these homes receive additional and more specialist training in dementia and its associated impacts on residents to reflect the more complex needs of the residents they care for.

Nurses will also be on site to help manage general health conditions, and some homes will have Registered Mental Health Nurses to manage complex mental health issues and medications. The Discharge to Assess (D2A) scheme is used for those who require a period of therapy led recovery and assessment of need following an acute hospital admission.

This is needed to support seamless transition from the acute environment and ensure high quality patient care, timely assessment of a person's ability to return home or transfer to a long term appropriate care setting. It is also required to respond to the increased acuity that is currently being seen by vulnerable individuals following discharge from hospital.

Given the need to meet a wide variety of needs on the units and increased focus on recovery, services offering D2A are expected to have an increased specialism in this. The service could be expected to meet any needs a resident has across all categories of care, including both Nursing input and a specialism in Dementia.