Equipment in care homes should be based on need, not resources

RCOT launches guiding principles for assessment and provision of equipment in care homes

Published on 5th July 2019

The provision of equipment in a care home should be the result of residents' needs and not funding restrictions, a report has warned.

The 'Care Homes and Equipment Guiding principles for assessment and provision report,' published by the Royal College of Occupational Therapists states that the guiding principles first and foremost, place the person at the heart of the planning, decision-making and equipment provision.

"The intention of this guidance is to identify a number of principles which need to underpin local decision making when planning the provision of, or providing, equipment for care home residents," said the report. "Current legislation and guidance do not always provide clear-cut answers to certain questions concerning the provision of equipment in care homes.

"Using case scenarios, this document will highlight a number of responsibilities and standards of practice to help prioritise the importance of the person’s wellbeing in the decision-making process for the provision of equipment," the report added.

There are four overarching principles in the report which, the RCOT "would urge all partners to hold to...when planning and providing equipment to care home residents".

1) Residents of care homes have the same access to a needs assessment, with the provision of equipment and other services, as any other resident in their local area.

2) The focus of the planning and provision of equipment to care homes starts with the residents and their needs, with their chosen goals or outcomes. Equipment is a tool to enhance wellbeing, enabling a person to actively and safely participate in occupations (everyday activities).

3) No single organisation can step back from their responsibility to be part of a comprehensive service to care home residents.

4) The totality of equipment provision services in an area are primarily shaped by the needs of residents, not by funding structures. Provider partners plan and work together to prevent delays in equipment provision.

Residents have the right to safety and security; respect, privacy and dignity; freedom of thought, faith and self-expression; autonomy and choice; participation, inclusion and society. Equipment can assist in meeting and maintaining these rights and support people’s health and wellbeing, said the report.

Equipment enables occupational engagement and optimises independence, choice and participation. Occupations are fundamental to human health and wellbeing because they provide meaning, identity and structure to people’s lives and reflect society’s values and culture. To deny suitable equipment to achieve these would potentially limit a person’s autonomy and access to the lifestyle of their choice.

Appropriate provision and use of equipment can maintain and increase physical health and contributes to safety, independence, quality of life and personal dignity.

The guide says that the following principles apply to the assessment of equipment and should guide practice:

- Using the same criteria as people living in their own home, residents admitted to hospital should be considered for an occupational therapy assessment.

- Following assessment, temporary loans of equipment should be offered, in line with local agreements between health and local authorities, to enable discharge and to prevent the exacerbation of health issues.

- Equipment provision should be based upon the assessed needs of the resident/s. These are met with the most appropriate equipment. There is no ‘standard’ resident or ‘one size fits all’ response.

- Very particular or specialised needs, outwith the care home’s stated purpose, should be assessed and met with specific apposite equipment from the most appropriate provider.

- The person assessing the need for, recommending, providing, or using the equipment, must be demonstrably trained and experienced to do so.

- Assessors and providers should consider the most cost-effective way of meeting the individual’s needs, as well as the health, safety and welfare of both the resident and any formal or informal carers.

- Alongside an assessment of need, a full assessment of risk should be made.

The contract for local authority-funded placements should identify and include any individual requirements of the resident. When a resident’s needs change and equipment is required that is not standard provision, then the contract should be referred to when agreeing funding for further provision, the report adds.

Clear and comprehensive local agreements, considering every potential situation, are essential to ensure the totality of users’ needs are met as seamlessly and effortlessly as possible. It is the local agreement which should define for all partners who is responsible for what element of service provision.

A care home should provide a range of standard equipment to meet the needs of its residents and its aims, as defined by its statement of purpose, and to fulfil its health and safety obligations to its own staff. To be ‘fit for purpose’ the home should demonstrate that it is successful in meeting its stated aims.

The Care Act 2014 or equivalent UK legislation, places a general duty on the local authority to provide, arrange or otherwise identify services, facilities and resources to prevent, delay or reduce the needs of adults for care and support in the local area. The local authority can offer a personal budget/direct payment to residents for equipment to meet a clinically assessed need as part of a community care assessment, which can be used to purchase equipment.

Care home staff should ensure that a piece of equipment is safe, clean, comfortable and suitable for use by residents. It is recognised that the use of inappropriate or inadequate equipment, or the lack of provision, may be seen as a safeguarding concern. Further, lifting equipment should be inspected and thoroughly examined by a ‘competent person’ every six months. Care homes should also have a range of standard attendantpropelled wheelchairs, including enough to cater for any extremes of size and weight.

RCOT Lead Professional Adviser Karin Orman said: “This is a really important guide. Current legislation does not provide clear-cut answers concerning the provision and funding of specialist equipment in care homes and this guide will give direction to everyone involved in the process.

“The right piece of equipment can make a life changing impact to a person’s life in a care home and this guide will help everyone involved with providing and maintaining equipment as easily as possible. Occupational therapy is all about person centred care and these principles place the person at the heart of the planning, decision-making and provision of equipment," she concluded.

Care homes and equipment
Guiding principles for assessment and provision


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