Commissioning for Falls Prevention
in Care Home Services
Matthew Areskog – Commissioning Manager
Key Areas
1. The Bristol Context
2. Commissioning for better outcomes
3. Service Specification 2012
Population of Bristol
65+ population fell in the last 10
years (-5%), BUT…..
Predicted to increase over the next
10 years by almost 10%
2010 Estimates of Bristol population
All ages = 441,300,
65 and over = 55,200 (13%)
85 and over = 8,600 (2%)
Bristol vs England:
% change of projected population 2010 - 2020
30%
Percentage change
25%
20%
15%
Bristol
10%
England
5%
0%
-5%
0 to 14
15 to 24
25 to 44
45 to 64
65 to 74
-10%
Age categories
75 +
All ages
Health & Wellbeing
- More older people living alone (+5% to 2020)
- 22% older people in income-deprived
households
Older People (over 65)
Avonmouth
2010
Henbury
Southmead
Kingsweston
Horfield
Westbury-onTrym
Henleaze
- People living longer, with complex
health and social care needs
Lockleaze
Bishopston
Eastville
Stoke Bishop
Estimated population
over 65
Redland
Cotham
Clifton
East
Hillfields
Ashley
619 to 1096.9
1097 to 1575.8
Southville
Brislington East
1575.9 to 2086.4
Windmill Hill
Knowle
2086.5 to 2597
Bishopsworth
- Increasing pressure on informal carers
St George
East
Lawrence
Hill
Clifton
Bedminster
- Link between areas with high rates of
obesity and diabetes
Easton
St George
West
Cabot
- Inequalities across city
Frome Vale
Brislington
West
Filwood
Hartcliffe
Hengrove
Source: ONS Experimental
Statistics © Crown Copyright
Whitchurch
Park
Stockwood
Dementia in Bristol
Estimated Dementia Prevalence
(60+) 2011
Differences in Dementia
prevalence across city
Avonmouth
2011
Henbury
Southmead
Kingsweston
Horfield
Westbury-onTrym
Lockleaze
Henleaze
Frome Vale
Bishopston
Projected 7% increase
(2012-2020) for People
Living with Dementia
2012 = 4,425
2020 = 4,750
Eastville
Stoke Bishop
Estimated numbers
with Dementia (60+)
47 to 84
85 to 123
Redland
Cotham
Clifton
East
Hillfields
Ashley
St George
West
Cabot
St George
East
Lawrence
Hill
Clifton
Southville
Brislington East
124 to 190
Windmill Hill
Bedminster
Knowle
191 to 257
Brislington
West
Filwood
Bishopsworth
Source: Pop: ONS Census
2011; Prevalence rates:
Dementia UK - Full report
2007
Easton
Hartcliffe
Hengrove
Whitchurch
Park
Stockwood
Increasing Demand
The demand for residential and nursing care services will grow
significantly
10 Year picture
- 13% Growth in Older
Service Users
- 6% Growth in Younger
Service Users
- Average 11% growth on
people requiring
Residential/Nursing care
Current Placements by BCC
Currently, Bristol City Council supports 1,100 older people in residential and
nursing care home settings. Of those, 38% are for people with Dementia
Care Type
Dementia Elderly Frail
Nursing Care
183
381
Residential Care*
236
309
Total
419
690
Total
564
545
1109
Of the above 1,100 service users, BCC commissions care home placements in
neighbouring Local Authorities areas, particularly homes close to the border of
Bristol UA:
South Glos – 73 service users
Bath & North East Somerset - 33
North Somerset – 78
Out of Area - 62
Of those, 40% are for people with Dementia – reliant on out of area more
Service Specification 2012
DRIVERS FOR CHANGE
•National Legislation
•Demographic change in Bristol
•Changing Care environment (Higher dependency levels in Care Homes)
•JOINT specification between Bristol City Council and Bristol Clinical
Commissioning Group
•Aligned to CQC Regulations where possible
•Applicable to all care home settings and all service user groups
•Core Aims
–High quality care provision
–Improved accessibility
–Offering choice and control
–Delivering care with dignity
–Person Centred Care
–Promoting Quality of Life for all
Key Outcomes
Reduction in the Risk of Falls
People are treated with Dignity and Respect
7.4
- Whole system approach to
reducing the risk of falls
Person Centred Reviews
7.5
Management of Health and Wellbeing Needs
7.9
Best Use of Assistive Technology and Equipment
7.10
Management and Leadership of the Care Home
7.13
High Quality Care Home Staffing
7.14
Proactive Quality Assurance
7.15
The Environment of the Care Home
7.18
- No single outcome is effective by
itself
- Holistic approach, centred around
the individual
Prevention is better than cure!
Some examples of key outcomes and standards for care home providers to
meet that contribute to preventing the risk of falls:
- Safe, dignified moving and handling practice from qualified staff
- Service users are enabled to build and maintain independent living skills
- Care plan reviews following changes in service user health / care needs
-Use of equipment and assistive technology to support service users independence and
manage risk
- Strong Management - Service users receive a consistent, safe and high quality service
that maximises their independence. The service develops their management staff that
take responsibility for delivery of a high quality service and retains high quality staff
Prevention is better than cure!
7.9 – Management of Health and Wellbeing Needs
-The care home is a physical and mental health promoting environment enabling service
users to optimise their health, enabling activities, exercise and a healthy lifestyle
-Hydration and Nutrition, Foot Care, Proactive medication reviews with GP and other
health professionals
- The provider ensures that service users are assessed for risk of falls within 24 hours of
admission (where possible) and recorded in care and support plan
-Service users who are vulnerable to falls are actively supported by their key worker or
equivalent members of the staff team to reduce / prevent the risk of a fall occurring
-Emergency admissions due to falls are minimised through proactive falls risk
management
-The provider maintains a falls register recording information such as causes, location etc
and uses this to reduce the risk of falls occurring within the care home
Prevention is better than cure!
7.14 – Care Home Staffing
-Staffing numbers, skills, qualifications, induction standards
-Staff receive regular training on core areas around health and safety, risk assessment,
moving and handling etc
-Registered Nursing Staff regularly liaise with GPs and other allied health professionals to
ensure health needs are met
7.15 – Quality Assurance
- Current and future risks are identified, accountability, risks routinely monitored and
managed
-Sharing best practice between providers (CH Provider Forum etc)
Prevention is better than cure!
7.18 – The Environment of the Care Home
-Health & Safety – Service Users should be able to move around the home safely
regardless of any physical, sensory or cognitive impairment
-Provider ensures home is run in a way that protects
service users from avoidable risk or harm
-Environment of the home promotes
greater independence and has access
to outdoor, social and therapeutic space
Thank you for your time today
Matthew Areskog
Commissioning Manager
Health & Social Care
matthew.areskog@bristol.gov.uk