4.2.4 Planned Respite Policy for Adults with Care and Support Needs

1. Introduction

The purpose of this policy is to introduce an equitable needs-based system for the allocation of planned respite to ensure fairness and consistency across Adult Health and Social Care (aged 18 years +).

Prior to this policy, there was no clear and consistent process for the allocation of planned respite. This resulted in an inequitable offer of respite provision.

The principles underpinning this policy are:

• To ensure a fair and equitable service for all adults who need access to respite and their carers.
• To be transparent with how planned respite is allocated.
• To be outcome focused and in line with the Care Act 2014.
• To assess the needs of the cared for person and their carer.
• To ensure the service which is received that prevents care needs from becoming more serious or delays the impact of need.

For the purpose of this policy, planned respite (also known as short breaks) is defined as:

a planned arrangement of temporary care to support customers to have a short break from their current care arrangement. This can benefit the adult’s wellbeing by providing new opportunities and experiences, stimulation and a change of routine. It is also a replacement or alternative care arrangement to support carers to have a break from their caring responsibilities when they most need it, knowing that the person they look after is safe and receiving good care.

The ADASS report  Commissioning or Providing Day Services gathered information from local authorities and found increased use of home-based respite support, community support schemes and day service schemes across England. The shift away from day centre respite is due to the long-standing desire to provide a more diverse and sustainable community-based offer.

2. Legal Framework

The Care Act 2014 provides a legislative framework for carrying out assessments and determining eligibility for Adult Social Care.

An adult has eligible needs if:

• Their needs arise from or are related to a physical or mental impairment or illness:

• As a result of these needs, the adult is unable to achieve two or more specified outcomes.

• As a consequence of being unable to achieve these specified outcomes, there is likely to be a significant impact on the adult’s wellbeing.

For more information see the Eligibility chapter.

2.1 Assessment outcomes for respite

The specified assessment outcomes which will be considered when determining the allocation of planned respite are:

• Managing and maintaining nutrition.
• Maintaining personal hygiene.
• Managing toilet needs.
• Being appropriately clothed.
• Being able to make use of the home safely.
• Maintaining a habitable home environment.
• Developing and maintaining family or personal relationships.
• Accessing and engaging in work, training, education, or volunteering.
• Making use of necessary facilities or services in the local community including public transport and recreational facilities or services.
• Carrying out any caring responsibilities the adult has for a child.

2.2 Assessing a carer’s needs

The Care Act extends local authorities duties beyond people who need help and support to also include their carers. The Act introduced eligibility criteria for carers. In considering whether a carer has eligible needs, the local authority must consider whether:

• Their needs arise as a consequence of providing necessary care for an adult.
• The effect of the carer’s needs is that any of the circumstances specified apply to the carer.
• As a consequence there is, or there is likely to be, a significant impact on the carer’s wellbeing.

The specified outcomes for carers are:

• Carrying out any caring responsibilities the carer has for a child.
• Providing care to other persons for whom the carer provides care.
• Maintaining a habitable home environment.
• Managing and maintaining nutrition.
• Developing and maintaining family or other personal relationships.
• Engaging in work, training, education, or volunteering.
• Making use of necessary facilities or services in the local community including public transport and recreational facilities or services.
• Engaging in recreational activities.

Where a referral is required for a Care Act Assessment or a Carer’s Assessment, Adult Care Connect and Direct Service need to be contacted.

3. Definition of Planned Respite

Respite care traditionally supports carers to fulfil their caring responsibilities and enables them to have breaks from their caring role throughout the year.

This policy relates to planned respite, whereby following an assessment it is determined that an adult requires a planned temporary arrangement of care to support them to have a short break from their current care arrangement. A carer’s assessment might also determine that they require a break from their caring responsibilities when they most need it, therefore a temporary replacement or alternative care arrangement will be sourced for the cared for adult to ensure they are safe and receiving good care.

Planned respite can be delivered in a number of ways including:

• Family/ friends take over caring responsibilities;
• Social prescribing;
• Day Services;
• Shared Lives (daytime sessions and/or overnight);
• Breaks using self-directed support e.g., Direct Payments;
• Sitting Service;
• Holiday breaks;
• Supported breaks for the person with care needs and their carer together;
• Befriending schemes where volunteers provide short breaks;
• Overnight respite in a residential setting.

Planned respite depends on the needs of the carer and the person they care for based on the Care Act 2014. They may need a few hours to themselves each week, a day here and there, a week or two for a holiday, or a mixture. This will be determined by an assessment of care needs and a carer’s assessment.

Planned respite will be allocated annually and can be taken throughout the year. Planned respite should be booked as far in advance as possible within the allocated year and all respite will need to be booked with a minimum of 1 months’ notice. Anything requested outside of this minimum notice period will be assessed on a case by case basis.

3.1 Services which are outside the scope of this policy

• Short Term Care: a further period of assessment following discharge from an acute hospital setting that allows an in-depth assessment to take place in a more appropriate surrounding and allows time for an adult’s potential to be fully assessed.

A period of assessment to support an individual living in the community if they are experiencing increased levels of difficulty in maintaining their independence which in turn may jeopardise their ability to remain in their own home. This should be no longer than 3 weeks.

• Emergency Respite – Emergency respite is provided at a time of crisis, where due to unforeseen circumstances, an adult with care and support needs is no longer able to manage safely in the community. This may be due to a variety of reasons including, the decline of the adult with care and support needs, whereby their needs now exceed the level of care being delivered, a decline in the carer’s health which may include an admission to hospital, or due to a bereavement which takes the carer away from their existing caring role. A respite stay provided at a time of crisis does not count towards an adult’s annually assessed allocated number of nights.

If an adult requires emergency respite care that exceeds 14 days, then it is the responsibility of the allocated practitioner or Duty Officer to review the emergency placement on a weekly basis. If it is known and agreed how long the emergency respite is needed for e.g., a carer being required to stay in hospital for 6 weeks due to an operation or treatment, the allocated practitioner or duty officer will review up to 2 weeks before the end of the agreed respite arrangement. This is to ensure that all reasonable and practicable measures are being progressed regarding alternative arrangements, and that adults do not remain in emergency respite care for any longer than is required. The allocated practitioner or Duty Officer needs to determine the most appropriate method of conducting each review, which will be dependent on the circumstances (whether that is a face to face or telephone review).

3.2 Transport

Transport requirements to and from respite service will be considered as part of the assessment and support planning process (see Transport Policy, in the Appendices). As part of a Care Act assessment, reassessment or review, the local authority will consider all transport options. If these are felt to be unsuitable, the provision of transport will be considered using the following guidance:

• For specific health and safety reasons specialised transport arrangements may be necessary.
• The adult is unable to access services without supervision or support.
• The adult has no access to transport and cannot mobilise, use assisted mobility (wheelchair/aids), or use public transport, either independently or with support, in line with the transport policy.
• The adult cannot access a service within the borough as there is no placement available, or the services available cannot meet their needs and all other options have been explored and exhausted.

4. Eligibility Criteria for Respite

Eligibility for planned respite will be assessed in line with the Care Act 2014 (see Eligibility chapter). The Council has a duty of care to assess an adult’s care needs as well as assessing carer’s for their needs in fulfilling their caring role. Once these are known and the assessment has been completed those who are eligible for respite will be provided with an annual allocation.

Exceptional circumstances should be explored during the carer’s assessment or review and at the cared for person’s care and support plan assessment or review. Exceptional circumstances might occur throughout the year before the next review, these will be considered by the assigned social work team and new/ additional respite allocated if it is felt to be necessary and agreed by senior management within Adult Social Care. Senior management would include senior members of the assigned social work team such as senior practitioners or team managers.

5. Allocation of Respite

The allocation of planned respite will be determined following an assessment of the adult’s needs. The assessment outcome will identify the number of nights respite per year that is needed to sustain the carer in their role.

Nights can be defined as a day and/or night of support. This could include support for a few hours during the day, a day out or an overnight stay.

5.1 Principles for allocation

1. The number of nights offered should correspond with the needs of the adult and/or their carer.

2. The level of disability, illness or frailty of the adult is not necessarily an indicator of the number of nights required. Other factors may have more significance, e.g., health of carer, or be less noticeable, e.g., sleeping patterns.

3. The allocation of nights must be equitable, i.e., people with similar needs should receive a similar level of service.

4. The maximum amount of respite that can be allocated is 28 nights (4 weeks).

This is in line with government care and support statutory guidance on allocation of respite under a direct payment. Planned respite will be allocated equitably regardless of the funding mechanism.

The amount of respite allocated will be based on an assessment completed by a social worker/ duty practitioner. The Guide to Respite Allocation (in the Appendices) can be used when completing the assessment if required.

Allocations of respite provision will be reality checked against the adult and carer’s specific circumstances to ensure that what is proposed is likely to meet the assessed need and agreed desired outcomes. A case study (in the Appendices) provides an example of an adult and their carer who requires respite as part of their care package.

5.1 Planned respite

Planned respite (short break) is defined as a planned arrangement of temporary care to support customers to have a short break from their current care arrangement. It is also an alternative care arrangement to support carers to have a break from their caring responsibilities when they most need it knowing that the person they look after is safe and receiving good care. Planned respite can be delivered in a number of ways depending on circumstances in which the care is typically delivered.

Best practice for allocating the type of respite provision uses the following stages:

While this is not appropriate for every adult, all options should be considered before selecting overnight residential respite and/ or where the overnight respite will be provided.

6. Re-assessment and Review

All respite arrangements will be reviewed as part of the Care Act assessment review process. Where an adult has already received an assessment for their respite allocation this will continue until their next review, at which point any changes will be implemented to align with this policy. Where it is felt that an adult may benefit from a different type of respite or alternative care provision than they have received historically, this will be explored and the adult and/or their carer will be supported to access this.

7. Charging Adult Social Care Customers for Respite

The Council has a policy for charging service users who receive care and support services, including respite (see Charging and Financial Assessment Policy in the Appendices).

Adults who are assessed as requiring a respite service will be financially assessed to determine their contribution towards the cost of the service. The assessor will provide the adult with the relevant forms for completion as part of the  financial assessment. The forms will then be sent to the Personalisation and Support Team who will process the information and determine the contribution to be paid.

Planned respite may be provided by commissioned services or through individual arrangements paid for by direct payments.

The cost of respite will vary dependant on the type of service received, as each service has a different charge. Anything over and above the agreed commissioned rate will need to be funded separately. The agreed rates for 2022/23 are detailed below:

These rates are likely to change dependant on the fee setting process which is undertaken annually. The standard rates for 2022/23 were set in March 22 to come into effect on 1^st April 2022.

Each case for funding above the commissioned rate will be considered on an individual basis and formal approval will be sought if it is deemed essential. Funding approval above the commissioned rate will be considered by a panel of professionals who consider respite allocations on a monthly basis. The panel will include individuals from Community Commissioning, Finance, Health and Social Care and Providers.

Should there not be an appropriate respite provision in borough and an individual must go out of borough for their support The One Commissioning Organisation will review and negotiate against the other local authority’s commissioned rate. Anything above this rate will be considered on an individual basis and formal approval will be sought if it is deemed essential.

If appropriate respite is available in borough yet a customer, their family or advocate chooses to attend respite provision out of borough then they will be obliged to fund any costs over and above the agreed locally commissioned rate. An arrangement will be made between The One Commissioning Organisation and the customer as to how the difference will be met however if The One Commissioning Organisation is not satisfied that the difference can/ will be met it will not agree to arrange care and support in the preferred accommodation.

8. Implementation

To implement this policy, a phased approach is proposed to mitigate any potential impacts to adults and/or their carers.

Phase 1; Implement the policy for new social care customers with effect from 1^st October 2022.

Phase 2; For existing customers receiving respite as part of their care package, this policy will be implemented at the time of their next care package annual review starting from 1^st April 2023.

The timeline for all existing packages to be reviewed is within two years of the start date. The aim is for all reviews to be completed by 31^st March 2025.

From Protocol (care management system), the number of people with Respite services on their support plans (at w/c 29/11/21) is 201.

Broken down by primary support reason the figures are:

9. Appeals and Complaints

Any adult who is not satisfied with the One Commissioning Organisations decision in relation to respite or the service provided, should in the first instance liaise with their social worker.

Should the customer remain dissatisfied, the customer may instigate either the Council’s Complaints Procedure or NHS GM ICS complaints procedure (see Appendices) dependant on which organisation their care is arranged by. Investigating the complaint, the appropriate manager will look at the operation of the relevant policy and procedure and will also be able to consider any special circumstances that may apply to any customer and submit a request through governance process for approval.

10. Further Reading

10.1 Related chapters

Carers’ Breaks – Overview

Complaints

10.2 Relevant information

Commissioning or Providing Day Services (ADASS)

Supporting Carers Hub (ADASS)

Appendices

Transport Policy (Draft) (opens as PDF)

Guide to Respite Allocation (opens in Word)

Case Study (opens as PDF)

Charging and Financial Assessment Policy (opens as PDF)

Bury Council Complaints Procedure

NHS GM ICS (Bury) Enquiries and Complaints (opens as PDF)

Process for Booking and Recording Respite Allocation: