Agenda item

Care Home Update

The Director of Health and Care provided the Care Home update report as requested at a meeting on 31 January 2022.

He updated Committee on changes since the last meeting including:

·       The Discretionary Fee Review

·       Care home Covid controls relaxed - restrictions on visiting activity and admissions were required in event of Covid outbreak.

The Director advised Government guidance had also been updated and that in relation to paragraph 3c(i) relating to Covid tests,  the following now applied: (i) there was no longer a requirement for staff contacts to take a PCR test, this had been replaced by (ii) a requirement for staff for to take Lateral Flow Tests (LFT) in the event they were contacts. Also, (iii) in case of an outbreak at a care home all staff and residents would need to take LTF and PCR tests.

The Committee noted the following comments and responses to questions:

·       The Council’s increase in fees for residential and nursing home placements for 2022/23 was 6.24% and this had been offered to providers with the application of a 3% quality premium for some placements and a 3% productivity saving for others. This would reduce the variation in care home fees, and was consistent with Government’s adult social care reforms with the requirement to determine and move towards a Fair Cost of Care for each local authority area, with additional funding provided through the “Market Sustainability and Fair cost of Care Fund: purpose and conditions 2022 to 2023”.

·       Quality premium. Committee was assured that the Council would continue to work with all care homes to maintain and improve quality with a combination of support and challenge. There would be a particular focus on care homes rated as requires improvement by the Care Quality Commission.

·       Fair cost of care. It was clarified that this would tend to equalise payments between local authority and privately funded individuals. Committee understood that this would typically cost local authorities more and privately funded individuals less, albeit with a varying impact on local authorities and people self-funding their care. 

·       It was too early to estimate the cost to the Council. Estimates were difficult to calculate for a range of reasons but there were national tools being developed to help calculate  the Fair Cost of Care that would be used.

·       There was increasing concern nationally that Government funding for all adult social care funding reforms was substantially short of their actual cost and Government was being lobbied by Local Government to ensure reforms were properly funded and that there were not un-costed liabilities falling on local authorities.

·       It was clarified that with the introduction of cap on care costs and capital thresholds, people self-funding their care could come to the Council for a Care Act assessment and financial assessment. It was expected that the increase in assessments would require considerable resources for the extra staff, and that the extra requirement would have to be estimated based on number of self-funders currently in the County with sensitivity analyses based on the proportion that may come forward.

·       In terms of Covid booster jabs it was confirmed that 55% of care home staff had received a second booster, a figure for care home residents would be circulated to members.

·       The Director was confident that the £32 million additional government funding during the pandemic did meet most of the additional costs of activity in most of the care homes. The risk highlighted was that the funding was non-recurrent, and as the pandemic was not yet over there may be unfunded liabilities in the future.

·       Occupancy rates. The current occupancy rate was 80%, care homes typically based business plans on around 85% occupancy rate. If occupancy rates remained lower than this then there were two potential risks: either that care homes raised the average price of a placement to increase the revenue per bed whilst having fewer beds occupied; or that  and care homes financial sustainability might be compromised. 

·       There is not a target care home occupancy figure, the aspiration would be to have people looked after in their own home. The Council’s intention is to offer the market insight into what future demand and capacity requirements, to help care homes plan for the next 10-20 years.

·       A member expressed concern that Oxyvision was being used in care homes and had a preference for personal care of residents. It was clarified that Oxyvision was being piloted at the moment as an alternative to close supervision residents who required intensive monitoring. The Council was keen to encourage innovation in the care market and had to trial technologies to see if they could work and were beneficial. Committee was advised that benefits of Oxyvision were that it was less intrusive for individuals and that it freed up staff time. It was not envisaged to replace personal care but had potential to complement it.

·       Listing of care home’s Care Quality Commission ratings in Staffordshire was available both on the Council and CQC websites.

·       Pressures on the NHS and adult social care remained high in the face of high demand and elevated staff sickness absence levels. Hospital discharges were difficult with discharges to home care more problematic than to care homes. 50 care homes were affected by Covid outbreaks and although Government guidance was more permissive and allowed care homes to admit residents, many were still anxious about doing so. The Council was working with them to encourage an appropriate balance between infection prevention and control and timely admission both for new and returning residents, in order to help flow through the urgent care system.

·       Joint procurement. The Council worked closely with NHS on quality improvement and joint planning, but there was little joint procurement. There were separate procurement systems in place and an opportunity to consider joining these up, especially in light of the Government policy on Fair Cost of Care. The Council would discuss this with the new Integrated Care Board (ICB).

·       In terms of the residents’ voice, it was clarified that good care homes consider feedback from their residents and the Council reviewed people annually and considered their safety and quality of life. It was acknowledged that information could be better collated and that this could be explored further. The Chairman welcomed this suggestion which he felt would provide additional assurance and visibility.

·       Number of care homes in Staffordshire. It was clarified that pre-pandemic the Council had concluded that there may be insufficiency capacity particularly in nursing homes, which had led the Council to consider building new nursing homes to the South and middle of the county. However in light of lower bed occupancy post-pandemic it would now be necessary to review capacity requirements to ascertain if there was a need for the Council to intervene in the market.

The Chairman thanked the Director for Health and Care for the report and thanked care homes for the work they continue to do in difficult circumstances. The report had highlighted several strategic issues that the committee may want to consider for inclusion in the work programme 2022-23, as follows:

• Quality of care homes based on CQC rating
• Sustainability of care homes
• Fee payment
• Cost saving measures
• Staff recruitment and retention

Resolved:

1. That the Care Home Update report be noted.