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Forum to assist all patients to obtain NHS care 'free at the point of need' which has been the statutory right of every resident British citizen since the 1946 National Health Service Act became law.

    Dependency criteria

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    PennyB

    Dependency criteria

    Post by PennyB on Thu 24 Nov 2011 - 12:20

    Please could somebody point me to where i can find the criteria used for assertainig patient dependency scores in a Nursing home.
    Many thanks

    Guest
    Guest

    Re: Dependency criteria

    Post by Guest on Fri 25 Nov 2011 - 4:14

    Any eligibility criteria that is being put forward in any way regarding healthcare is absolute rubbish, and unlawful, and I feel sure that at some point Esquires, when he has time, will flesh this out.

    it is not in the 1946 Health Act which still stands (although this government is trying its best to torpedo this, and may well succeed in their current moves) and this whole eligibility, banding, or whatever you wish to call it was put paid by the Coughlan decision, and others following - Booker etc.

    it may be that they are trying to dress this up differently with new gobbledegook (that is one of the techniques) but the principle remains the same if I have understood that "patient dependency" is the same as eligibility criteria, but it sounds like it.

    Guest
    Guest

    Re: Dependency criteria

    Post by Guest on Fri 25 Nov 2011 - 11:22

    Penny, don't know for sure whether you're looking at staffing levels based on patient-dependency, but this RCN doc may be of use:

    http://www.rcn.org.uk/__data/assets/pdf_file/0008/78551/001934.pdf

    I've tried to do a bit of research for you, but the only time that patient dependency scoring comes up is all to do with nurse staffing levels. I've not so far found any reference to patient dependency within eligibility criteria for CHC or for anything else, come to think of it!! Cool

    It seems that it's a fairly oft-used 'essay question' too. But that may not be what you're looking for, so ignore if irrelevant.

    VM pig

    PennyB

    Re: Dependency criteria

    Post by PennyB on Sat 26 Nov 2011 - 3:46

    Many thanks for both the replies.
    I think i have a two pronged issue.
    The background is that after a six year fight with my father's PCT, i DID get awarded retrospective CC in full, so i do feel that with boxes and boxes of paperwork appeals and reviews, i know the system reasonably well. However....
    I now have been volunteering in a local State Nursing Home which has mainly (95%) Alzheimers and Dementia residents. I visit residents on a one to one level and have attended residents meetings and fought for staffing in the recent cutbacks.
    My first issue is that out of the 80 residents, many of whom not only have Alzheimers/Dementia, but a variety of physical illnessess only 4 receive CC! There are also instances where even terminal admissions are not granted CC. Having fought and knowing the rules i am appalled.
    The second issue, is indeed of staffing levels. They have been severely cut in the latest round of Adult Service cutbacks. I have been assurred the levels are correct and are set dependent on the resident dependency scores. There are certainly residents whom i would most definately have classed as high dependency, but not knowing how that particular scoring system works, that is purely my perspective.
    So, i am trying to get any information that i can.
    I havent looked at the document you suggested as yet, but i will study it.
    Yet again many thanks.
    PennyB

    Guest
    Guest

    Re: Dependency criteria

    Post by Guest on Sat 26 Nov 2011 - 6:22

    PennyB,

    Now that I know more about what you're looking for, I've found a more up-to-date version of the RCN safe nurse staffing levels doc (so ditch the previous one, maybe!). This one has specific sections about care home staffing. Also a number of references (at the end) that you can check out to see if they've got more info for you.

    http://www.rcn.org.uk/__data/assets/pdf_file/0005/353237/003860.pdf

    VM pig



    LL

    Re: Dependency criteria

    Post by LL on Sat 26 Nov 2011 - 7:03

    I would think that legislation dictates minimum staffing levels/ratios - care homes have to register for specific client groups/ages/type of care - there would be care standards associated with each if thse. They form part of inspection i think.

    BigJen

    Re: Dependency criteria

    Post by BigJen on Sat 26 Nov 2011 - 8:21

    This document may be worth a gander:
    http://www.rqia.org.uk/cms_resources/Staffing%20Guidelines%20for%20Residential%20Care%20Homes.pdf

    It mentions the CAPE assessment tool (Clifton Assessment Procedure for the Elderly) - I have done a quick Google search and there are a lot of hits but I can't actually find the assessment tool itself. If anyone has heard of this or has more time to trawl the hits perhaps they could post a link. I wondered if the tool itself may be useful for others?

    This is the best I found so far:
    http://www.radcliffe-oxford.com/books/samplechapter/2668/Gupta_Section%2002A-45a70500rdz.pdf
    which is an excerpt from a book about assessment I think

    mergymraeg100

    Re: Dependency criteria

    Post by mergymraeg100 on Sat 26 Nov 2011 - 10:27

    BigJen....the Glasgow Coma scale http://www.radcliffe-oxford.com/books/samplechapter/2668/Gupta_Section%2002A-45a70500rdz.pdf

    The GCS is a tool used to measure the level of conciousness in a patient suffering a head injury whether from accident or stroke...usually carried out for a minimum of 24 hours of entering a hospital where unconsciousness has occurred prior to admission. This scale when used to measure neurological reflexes will indicate the damage caused to the brain...and will also monitor recovery...or suggest surgical intervention.......GCS would be used in a nursing home should a patient suffer a fall and as a result became unconsciousness for a short period of time...observations carried out under the supervision of the GP....in practice however the home would probably call an ambulance and have the patient admitted for observation in a hospital setting..... One would need to be a qualified RGN to carry out this level of observation....I hope I have been of some help...will now investigate CAPE.... Smile

    BigJen

    Re: Dependency criteria

    Post by BigJen on Sat 26 Nov 2011 - 11:58

    The document I provided the link for is quite a long one, detailing many assessment tools, the first of which certainly is the GCS. Page 39 details the CAPE.

    mergymraeg100

    Re: Dependency criteria

    Post by mergymraeg100 on Sat 26 Nov 2011 - 12:00

    Thank you Very Happy

    Guest
    Guest

    Re: Dependency criteria

    Post by Guest on Sat 26 Nov 2011 - 13:12

    BigJen wrote:The document I provided the link for is quite a long one, detailing many assessment tools, the first of which certainly is the GCS. Page 39 details the CAPE.

    The first link http://www.rqia.org.uk/cms_resources/Staffing%20Guidelines%20for%20Residential%20Care%20Homes.pdf only applies to N Ireland, and the second link refers to GCS, AMT,MMSE cognitive assessments, rather than nursing dependency assessments.

    There is no legislated-for defined staffing level/ratio of staff to residents in care homes with or without nursing in England. So it depends where the care home is situated as to which regulations apply.

    The CQC requirement is that:

    22. In order to safeguard the health, safety and welfare of service users, the registered person must take appropriate steps to ensure that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced persons employed for the purposes of carrying on the regulated activity. Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

    That reflects more or less what PennyB has been told by her care home management. (But I don't know where PennyB is working/living so I may be wrong in thinking that PennyB's in England.) The staff:resident ratio varies according to the needs of the residents - so whenever residents arrive with more 'challenging' needs, the staffing levels should change. Note the word 'should'!!! Note also the words "suitably qualified, skilled and experienced person" ----- ---- IF ONLY!!

    VM pig




    mergymraeg100

    Re: Dependency criteria

    Post by mergymraeg100 on Sat 26 Nov 2011 - 13:16

    VW pig SPOT ON Smile

    BigJen

    Re: Dependency criteria

    Post by BigJen on Sat 26 Nov 2011 - 15:02

    I quoted the NI document as it suggests this:

    2.9.1 Assessment of Need
    Although there are a wide range of instruments available for assessing need in the various categories of care. For the purpose of determining staffing levels in homes for elderly persons, it is recommended that the 'Clifton Assessment Procedure for the Elderly' (CAPE) is used.

    Then I searched for info on the CAPE and found the link.

    Sorry if you found it useless - I was only trying to help. I'll stop now

    mergymraeg100

    Re: Dependency criteria

    Post by mergymraeg100 on Sat 26 Nov 2011 - 15:43

    BigJen.....having investigated CAPE...Quote: "Thus the CAPE provides practical information that is useful when planning service provision."
    Quote: "The advantage of the instrument is that it provides a common metric across different settings based on a person's degree of impairment and dependency."

    VM pig The staff:resident ratio varies according to the needs of the residents - so whenever residents arrive with more 'challenging' needs, the staffing levels should change. Note the word 'should'!!! Note also the words "suitably qualified, skilled and experienced person" ----- ---- IF ONLY!!

    Having spent thousands of hours observing the standard of care provided in care homes, VM's concerns are SPOT ON.

    Thank you BigJen for broadening our knowledge with regard to CAPE.....when I am in possession of mother's medical notes I will look for evidence of this assessment occurring before her discharge from hospital.... Smile It is the gold standard of tests and is widely used in the UK....I wonder if that includes Wales????? affraid

    mergymraeg100

    Re: Dependency criteria

    Post by mergymraeg100 on Sat 26 Nov 2011 - 15:53

    Sorry but on second thoughts...staff would not carry out this assessment on discharge of a patient from hospital into a care home...it might result in proving a Health Need.... Question

    Guest
    Guest

    Re: Dependency criteria

    Post by Guest on Sun 27 Nov 2011 - 9:52

    This may be of interest to someone :

    http://www.rcpsych.ac.uk/pdf/semOAP_ch1.pdf

    VM pig

    mergymraeg100

    Re: Dependency criteria

    Post by mergymraeg100 on Sun 27 Nov 2011 - 11:41

    Thank you VM pig Your diligence in assisting to educate us all on matters of concern is very much appreciated and unrivalled. sunny

    PennyB

    Re: Dependency criteria

    Post by PennyB on Mon 28 Nov 2011 - 4:58

    Many thanks for all your input and hard work in helping me. I did reply last night to you all, but sods law, my laptop gave up the ghost and i lost the whole reply!!
    Anyway, i will look at all the info and see what i can learn from it. I totally agree that "The staff:resident ratio varies according to the needs of the residents - so whenever residents arrive with more 'challenging' needs, the staffing levels should change. Note the word 'should'!!! Note also the words "suitably qualified, skilled and experienced person" ----- ---- IF ONLY!!". Which is why i want to find the actual assessment criteria.
    My volunteering is in a Social Service NHome within the UK. The recent cutbacks have meant a whole new restructuring of Nursing and Care staff and from a personal perspective, i do not believe they are adequately staffed. I dont just mean what we would all like to have, but i do mean enough to cover the needs of the residents.
    Also, again, personally, i feel that a resident with Alzheimers/Dementia and unable to make themselves understood, bed bound, hoisted unable to feed themselves and doubly incontinent with other physical problems would be classed as highly dependent, whereas thet class this as Medium dependency?? Which i why i would like to see the criteria, before i go "blundering in" with my viewpoints. I also feel that residents needs change, mostly requiring more and not less care with age and that frequent assessments are paramount. I am after all doing the voluntary work for the benefit of the residents and hope to make their quality of life better. So that was the reason i wanted to see the criteria.
    As i said, on the other hand i have been making waves in the CC funding as i do feel that more should be done in this area.
    Thanks again for all your help.
    PennyB


    mergymraeg100

    Re: Dependency criteria

    Post by mergymraeg100 on Mon 28 Nov 2011 - 5:50

    PennyB may I ask you if you have any formal training in the medical field...i.e. nursing etc? I ask only so that we may be better able to help you in your quest for answers....CC funding...do you mean CHC or do you mean the Registered Nurse payment....or maybe both?
    I agree with you that the patient you describe could hardly be classified as medium dependency in a nursing home environment....it could be in a hospital environment when compared with critical care patients however...so it really depends where the patient resides and to whom you are referring... "They class it as medium dependency". I am new to this forum, so I like you are a learner...sorry to asking so many questions. Would like to know what the "restructuring of Nursing and Care staff" means and what effect has it had on the staff and patients concerned? Looking forward to your response. Smile

    Bernard

    Re: Dependency criteria

    Post by Bernard on Mon 28 Nov 2011 - 6:36

    Hello Penny B

    It seems you are an original member and a 'winner' of this and a previous forumfreenursingcare.findtalk.biz/t641-i-won-last-year-through-sheer-hard-work

    Re this subject, our experience through 2010 / 2011 is that dependency is used wholly within social assessments firstly via the FAC and then via the BARTHEL scale as a 'social' means of determining activities of daily living abilities, closely linked to 'rehabilitation' worthiness and used within the 'registered nursing' contribution set up too.

    It seems your experience as a long term survivor within the system will be invaluable.

    Please post more about your current experiences if possible.

    Bernard

    Guest
    Guest

    Re: Dependency criteria

    Post by Guest on Mon 28 Nov 2011 - 7:00

    PennyB,

    From 2004 but haven't found a revised version - yet!

    "Primarily intended for use by registered nurses who are undertaking an assessment of an older person currently in a care home, it may also be used by nurses working in the community and in hospitals to assess an older person’s need for nursing care." There's a section on workforce planning too.

    It would fox most of the care homes that I've had to deal with, but may be of use to you in your research.

    http://www.rcn.org.uk/__data/assets/pdf_file/0010/78616/002310.pdf

    VM pig

    Esquires
    Moderator

    Re: Dependency criteria

    Post by Esquires on Mon 28 Nov 2011 - 10:35

    It would be interesting to see what the Care Quality Commission have to say! Steve.

    Guest
    Guest

    Re: Dependency criteria

    Post by Guest on Mon 28 Nov 2011 - 11:10

    Esquires wrote:It would be interesting to see what the Care Quality Commission have to say! Steve.

    I can guess what the CQC would say about staffing levels : it is a requirement (as per the one I quoted from Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010) that any care home (with or without nursing) has to ensure that sufficient staff are on duty to meet the needs of the residents. If the residents needs change, the staff : resident ratio should change. Be it daily via the bank, weekly via the other bank, or even 'shift by shift' if suddenly and unexpectedly a whole bunch of residents demonstrate needs that need to be cared for, or if a couple of new admissions present with challenging needs. (I mean challenging to abilities of the care provider and management and bank balances and things like the bottom line of care. affraid )

    As for the means of determining dependency - that's all down to the Manager and his/her Management training (if they're lucky enough to have had any training).

    Why don't you send an email to the CQC, Steve? It will be very interesting to read their reply to you.

    VM pig



    PennyB

    Re: Dependency criteria

    Post by PennyB on Tue 29 Nov 2011 - 2:03

    Hiya all & thanks again.
    There has been a recent CQC review on the home and there were areas of non compliance which are being addressed. So, i do know that it is in hand and i should say that the care given by the staff in post is excellent, so i could not criticise them in any way.
    However, i return to my initial request for information on how the dependency criteria is scored. Because from a personal perspective, i feel that the scoring of residents is low i.e. i feel that some of those whom i would classify as highly dependent are being scored as medium. This then obviously as a knock on effect to the staffing ratios, which was and is my reason for trying to follow this through.
    I am not medically trained in any way, just common sense prevails and when you see caring overworked staff trying to cope with demands of very needy residents, then even one more member of staff could make all the difference.
    I do feel that the home is well run, but that the recent cutbacks dictated from above have stretched them so very much. So i was trying to find the criteria. However, i might well just ask the manager what they score against.
    My second bugbear is that so few, 4 out of 80, are Continuing Healthcare funded. The home does apply on their behalf, but requests are normally turned down - even terminal admissions.
    So i have been trying to find (from the home and relatives) more information on this aswell.
    PennyB

    Guest
    Guest

    Re: Dependency criteria

    Post by Guest on Tue 29 Nov 2011 - 3:44

    PennyB wrote:Hiya all & thanks again.
    There has been a recent CQC review on the home and there were areas of non compliance which are being addressed. So, i do know that it is in hand and i should say that the care given by the staff in post is excellent, so i could not criticise them in any way.
    However, i return to my initial request for information on how the dependency criteria is scored. Because from a personal perspective, i feel that the scoring of residents is low i.e. i feel that some of those whom i would classify as highly dependent are being scored as medium. This then obviously as a knock on effect to the staffing ratios, which was and is my reason for trying to follow this through.
    I am not medically trained in any way, just common sense prevails and when you see caring overworked staff trying to cope with demands of very needy residents, then even one more member of staff could make all the difference.
    I do feel that the home is well run, but that the recent cutbacks dictated from above have stretched them so very much. So i was trying to find the criteria. However, i might well just ask the manager what they score against.
    My second bugbear is that so few, 4 out of 80, are Continuing Healthcare funded. The home does apply on their behalf, but requests are normally turned down - even terminal admissions.
    So i have been trying to find (from the home and relatives) more information on this aswell.
    PennyB


    All the things you have said here, and experienced are spot on. Just about everyone on this forum has had the same kind of scoring given to them one way or another, so welcome to the club, but I do not say that with any degree of flippancy - it is a sad gesture from me, and I wish you didn't have to come here at all.

    Call it criteria, eligibility, banding or whatever, it is exactly the same thing.

    NOW you realise what you are up against, and what lies are told to you. You are fortunate in one respect, as too many will never come here, and realise just how much they are being conned - and conned is absolutely the right word.

    At this point, all you are going to get from authority is the big NO. The home will also be told this, but at least they appear to be trying, unlike too many others.

    So what do you do? I do not know what documents you have signed or not signed, and have you or a relative,got Power of Attorney ? There is a lot here you can do if you have.

    DO take up time to read the STICKIES, where Esquires - who pioneered this forum and its forerunner, and has been one of those at the forefront of the fight against all you have had to face - gives excellent advice. And only take notice of what he says for the present, until you know better about the forum. He is in the process of launching a class action which covers much of the ground that you have experienced, so DO NOT consult ANY lawyers at present. We really are - or most of us - in this together, at every level.

    Keep us informed.

    Esquires
    Moderator

    Re: Dependency criteria

    Post by Esquires on Tue 29 Nov 2011 - 4:30

    PennyB - please read my post No. 23 under my 'Vital Advice' sticky for a quick guide to the 'Great NHS continuing care scam!' Steve.

    PennyB

    Re: Dependency criteria

    Post by PennyB on Tue 29 Nov 2011 - 5:14

    Thanks to all.

    This has to be quick as am off out.

    Please dont feel bad for me - i am not emotionally involved in all of this. I won retrospectve fully funded CHC & an apology in writing from the SHA Chief exec, for my late Dad after 6 years of battling them, appeals & reviews. I shed loads of tears then and it almost brought me to my knees, but hey i'm still here!

    Now i am a volunteer in a SS Nursing Home which has 90% Alzheimers/Dementia residents who mostly have other physical disabilities and nursing needs.

    Knowing what i do, i am hoping to help others there, which is why i started this request for extra info, and thanks to you all i have much to work with.

    PennyB

      Current date/time is Mon 24 Nov 2014 - 17:11