Services for Older Adults

Number of people 65+ with dementia and dementia prevalence as a percentage of the total 65+ population (2020)

Source: NHS Digital, Recorded Dementia Diagnoses publications.

Dudley Council and health partners have a common goal to promote independence, reduce dependency and support more people to remain living in their own homes for as long as possible with appropriate support.

It is recognised that there is a need for high quality care when people’s needs are such that they are unable to continue living in their own home, though there are a few extra care facilities these tend to operate at maximum capacity, most of the need is therefore currently fulfilled by registered care homes in Dudley.

Key priorities identified in the 2023-2025 plan include:

• Transform palliative care services to ensure a true integrated team across health and social care
• Provide a collaborative approach to delivering the Discharge to Assess model
• Integration of Own Bed Instead (OBI) with Pathway 1
• Review medical cover for reablement services and align rehabilitation investments to look at opportunities for transformation
• Handyman investment: To support quick and efficient discharge for those people with housing issues where a simple intervention can reduce delays
• Health inequalities: Providing Health inequality assessments is an aspiration, and some areas will be prioritised
• Admission avoidance via the Clinical Hub

People who may require support on discharge from hospital will do so through a discharge to assess model to minimise risk and impact of a delayed stay in hospital for the person. Undertaking an assessment of needs in hospital is often not the appropriate environment where the following pathways will support in enabling a timely discharge from hospital and necessary assessment and support afterwards.

Supported Hospital Discharge Team

This is a new service in development that provides an integrated approach to supporting hospital discharge. Supports people to be assessed in their own home following discharge from hospital to determine the appropriate level of support to meet the needs, including appropriate equipment and assistive technology.

Urgent Care Service

This is a local authority service that delivers a hospital admission avoidance and crisis intervention. The crisis intervention is to avoid people going into hospital and or long-term care. This may include a package of care, equipment, short term care in their own home or in a crisis / emergency bed as a place of safety and as a last resort.

Tiled House

Tiled house is registered care home run by the local authority providing intermediate care funded by the ICB. The service provides care where the person is unable to return home, offering short-term bed-based provision identified for a period of recovery, recuperation, rehabilitation that enables people to return home.

• The council intends to identify people’s long term needs within timely period following hospital discharge
• We want to ensure we support as many people to return home as possible
• We want to ensure we provide the person with choice and control through enabling the person to have their needs assessed in the appropriate setting outside of the hospital through a strengths-based approach
• We need to ensure we have the correct provision of short-term intervention services available and used efficiently to ensure we maximise supporting people at home
• We want to ensure timely transitions and choice when people are transitioned from short term care to the long-term care market whilst still fostering a promoting independence approach
• We want to ensure that people receive the right amount of support at the right time and where their independence is regained that support is reviewed to avoid over-prescription of care

The current Homecare / Domiciliary Care framework commenced in 2016 and was extended due to the Covid Pandemic. It is due for renewal by April 2024 and the procurement for the new framework will commence in summer 2023.

There are currently 34 domiciliary care providers supporting 1557 people via the domiciliary care framework. The services deliver short calls to people aged 18+ though most of the activity is for people aged 65+ and delivers approximately 17,275 hours per week.

Domiciliary care average hours per person in Dudley for new care packages is 14.8 per week for the commissioned market, this is increasing as the complexity of need increases for people requiring domiciliary care. Pre pandemic the average hours of domiciliary care per person was just over 11. Dudley Domiciliary care market has grown on average 2.6% each year over the last 7 years and demand continues to increase.

Quality Ratings for all Domiciliary Care providers based in Dudley

As part of winter pressures activity discharge to assess blocks were established in late 2022 and have proven successful in having providers attached to specific postcodes. Over recent years through many engagement sessions with the domiciliary care market suggestions for improvements to how the care is commissioned included more geographically focused contracts to reduce travel time, support workforce issues and improve efficiency.

Single handed care and promoting independence initiatives will be embedded in the new framework from 2024 onwards.

Alongside the development of the new Domiciliary Care Framework, will be the introduction of a new portal within the Adult Social Care portals that will facilitate Brokerage. The development of the brokerage function will be undertaken throughout 2023 with the intention of this commencing alongside the new framework.

• We want to ensure we support as many people to return home as possible after a hospital stay
• We want to ensure we provide the person with choice and control through enabling the person to have their needs assessed in the appropriate setting outside of the hospital through a strengths-based approach
• We want to ensure that people are supported to maintain their independence and reduce unnecessary reliance on paid services
• We want all services to deliver high quality care
• We want efficient, effective and responsive services delivered by an experienced and skilled workforce that can adapt as people’s needs change
• We want to maximise the use of digital technology to support improved outcomes for people accessing services as well as drive up quality and efficiency in provider services

We currently have four purpose built Extra Care Housing schemes in Dudley which are designed to enable people aged over 55 to live independently in their own self-contained homes whilst living in a wider safe and supportive environment containing a range of on-site facilities and services. The existing model is based on a mixed tenure of rented and privately purchased apartments.

There are two providers of extra care housing in Dudley providing four schemes between them with a total of 395 properties of which 315 are for social rent, and 74 are shared equity properties. There are 165 properties with on-site care and the Council has nomination rights for these properties.

All the Extra Care schemes have some form of 24-hour support and/or care response.

The percentage of people living in Extra Care housing in Dudley as a percentage of people receiving care is 42% of these 3% are over 60 years old, 24% are over 80s years old, 9% are over 90 and only 6% are under 60. Of those living in extra care with care needs around 30% have more than 15 hours of care per week, and 20% of those requiring care need two carers.

Dudley Council is currently progressing plans for a new extra care facility that will provide 100 units of self-contained accommodation with care. The proposed development will be solely for older adults who have Care Act 2014 eligible needs. The new scheme will be located in Brierley Hill and will provide an alternative to traditional residential care. The proposed development will offer care for people with complex care needs and will support the council in meeting the future increased demand for more personalised care. It is anticipated that this will enable people to live in their own purpose-built home that will accommodate a range of care needs and complexity and deliver improved outcomes.

• Dudley Council is exploring the potential for an increased extra care offer for people with eligible care needs including those with complex needs with the development of a new facility in Brierley Hill
• Further extra care developments may be considered after 2027
• Further Housing with Care models and housing for older people with care needs will be considered
• Future engagement with housing and care providers to explore opportunities and interest in new innovations
• We want to ensure there is high quality care delivering outcomes that support people to maintain their independence and wellbeing

Dudley has 91 CQC registered care homes within the borough of these 54 are focused on care delivery for people aged 65+. Currently the council commissions long term care via spot purchase agreements with care homes. There is currently no block bed arrangement for long term care. According ONS data (May 2022) Self Funders make up around 27% of the market.

Dudley Integrated Health Care Trust also commission a number of P2 & P3 beds across the borough.

The market is made up of 100% for-profit organisations and categorised by size as below.

*One dual registered

Dudley commissions care for 785 people over the age of 65 in residential care homes and 327 people over the age of 65 in Nursing homes.

Care Homes people 65+ by Spend %

CQC Quality Ratings

At the start of 2024 the current minimum contract rates for bed-based care are as follows:

During 2023 the council engaged with care home providers of both residential care and nursing care about the cost of care and current market pressures

Whilst the council had previously indicated standard contract rates, often care homes have negotiated a slightly increased rate at the start of the persons placement and or negotiated a rate. It is quite common practice now for care homes to charge a 3rd Party Top up.

The average rate paid to care homes for placements frequently exceeds what was previously a stated contract rate as additional cost pressures resulting from the pandemic, Brexit impact, national minimum wage and the cost of living has meant that additional fees have been charged either to the client’s representatives, health commissioner or the council. The council now identifies the minimum rate paid rather than stating a standard rate due to fluctuations in rates paid and variation in complexity of need for people requiring care home placements.

The council is aware of the market sustainability issues and pressures as experienced nationally and specifically within Dudley. The council and partners are committed to working with the market to establish a formal framework for care homes that is sustainable and delivers quality care to meet Dudley citizens needs and outcomes. A Pilot for the care home framework for older people started in January 2024 and will inform future market shaping.

Currently fees paid for care home placements prior to January 2024 did not indicate a level of complexity or acuity of need. The council intends to ensure that there is clarity on fees paid and the correlation of complexity of need. This will be delivered through assessment to clearly stated needs that we are able to monitor and measure and assist us in demand and future service development.

A new framework for care homes will be introduced within the next 12 months , this will be formally established using a new specification and agreement and expressions of interest. The council will provide support to the care home market to enable participation with this process.

• The council intends to develop a formal care home framework within the next 2 years
• The strategic development and increase of nursing care provision is key to meeting future demand for Dudley’s aging population where people have complex health needs
• The correlation between fees paid, outcomes delivered, and complexity of need will form the basis of the new formal framework
• Quality support for care homes will continue to be a priority
• Regular engagement with care homes to develop provision and new innovations will be held through virtual and face to face forums
• Care homes are expected to ensure they maximise the use of digital technology for improved outcomes for residents and increased efficiency in care delivery

Page updated April 2024

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