Residential and nursing care provision

This page is part of Slough’s Joint Strategic Needs Assessment which looks at the health needs of our community.

Residential and nursing care is available for adults who are no longer able to look after themselves.

Residential care homes provide 24 hour care to meet personal, emotional and other care needs, whilst enabling the person to continue to be independent as possible in a safe environment. Nursing care homes provide 24 hour care for people who require the skills of qualified nursing staff and substantial assistance with personal and emotional care. Nursing homes are required by law to have a qualified nurse on duty 24 hours a day.

What do we know?

Many older people will need full-time support in either residential or nursing care settings each year. By virtue of this need for support, residents of care homes are vulnerable and at risk of further ill health and potential admission to hospital. Care homes therefore perform a vital role of providing both a safe and comfortable environment for their residents.

There is expected to be a significant increase in the number of older people in Slough, and indeed in England, requiring help with their health and social care needs over the next decades. This increase in demand is happening at a time in which funding for health and social care is limited. Much work is being undertaken both nationally and locally to ensure that plans and resources are in place to meet these challenges.

Facts, figures, trends

Current demand and estimating future demand

Slough has 26 care homes, which cover all care categories. 8 of these homes serve elderly care, comprising of 5 nursing and elderly mental health (EMH) homes together with 3 residential/EMH homes.

Slough Borough Council’s Local Account identified that 117 people aged 65 and over were placed in nursing care in 2014/15, and that 77 were placed in residential care which is significantly fewer than in 2012/13. In October 2014 there were 44 recorded care home placements outside of the Slough Borough, although 54.5% of these were in neighbouring Local Authorities or counties. Figures 1 and 2 shows trends in residential care and nursing care use in Slough.

Figure 1. Adults in Residential Care in Slough

Figure1

Figure 2. Adults in Nursing Care in Slough

Figure 2

Source: Adult Social Care Combined Activity Return (ASC-CAR).

In 2014 the total population of people aged 65 and over in Slough is 13,600, which equates to around 9% of the total population within the Borough. Whilst the percentage increase in older people in Slough is reducing compared to the overall population, the actual number of people aged 65 and over is estimated to be rise to 21,300 by 2030. (Office for National Statistics).

One indicator of potential future demand for care is the number of older people who live alone. It is predicted that by 2025 (under ten years’ time) there will be approximately 4,000 people over the age of 75 living alone in Slough.

Another indicator of the current and future demand for care is the total population of persons aged 65 and over who are predicted to have a long-term illness. In 2014, 3,782 persons fell into this category,this is predicted to increase to 5,900 by 2030.

If no other provision is developed within the Borough, and assuming the forecasted demand information is accurate, the increase in the older people population and those having a limiting long-term illness would result in an increased cost of 23% on the current residential care budget of between £1.9 and £2.5m.

National and local strategies (current best practices)

National

The national institute for health and care excellence (NICE) guidance “Older people in care homes” advises that to ensure wellbeing of people in care homes we should:

  • Set clear policies and plans for older people in care homes
  • Ensure older people in care homes retain their independence and identity
  • Work with residents to deliver person-centred care
  • Provide equal access to services
  • Ensure residents are safe

Local

The development of our Commissioning Strategy for Older People 2013-2018 showed some common themes, which have been raised by Older People regarding the future delivery of residential provision. These include:

  • social care and health services need to be more coherent and joined up to provide a seamless service to older people in Slough
  • the future care home provision needs to focus around meeting more complex needs which might feasibly result in less distinction between “care homes” and “care homes with nursing”.

As well as promoting the development of extra care accommodation, emphasis needs to be placed on ensuring some homes in the larger developments meet the ‘lifetime homes’ criteria, enabling older people to stay independent for longer and be integrated into new and existing communities.

The Supported Accommodation Strategy 2011‐16 along with the Slough Adult Social Care Reform Programme currently in development are other local drivers to consider.

What is this telling us?

The requirements for residential and nursing home care are changing. We need to consider the continued reducing need for elderly frail placements in residential care with the increased future demands for elderly mental health (EMH) placements. There needs to be a whole system care approach, which could support people within their own homes to meet demands.

What are the unmet needs/service gaps?

  • Greater support to remain at home – utilising the voluntary sector contract and promoting information and advice for self-care
  • Improved flexible service models
  • More specialist services for those with advanced dementia
  • Housing
  • Specialist housing that can accommodate those aged under 55 with long term conditions
  • Improved availability of a range of suitable housing and housing related support services
  • Enhanced nursing care

Recommendations for consideration by other key organisations:

More extra care housing options in all areas of Slough need to be developed together with a range of floating support services for older people.

More flexible care home provision, particularly in Slough, catering for dementia and short term reablement services needs to be developed.

  • Closer monitoring of referrals for residential care
  • Further development of nursing care services for elderly mental health
  • Encourage establishment of Dignity Champions in care homes
  • Ensuring care homes are all aware of Deprivation of Liberty Safeguard