Most of us would like to stay in our own homes for as long as possible. We feel safest when we’re surrounded by familiar things and it’s accepted that it can be traumatic, especially for older to people, to have to ‘up sticks’.
It may be the case however, that our domestic environment doesn’t quite suit our needs any more. Fortunately, there are plenty of ways in which, with adaptations, homes can continue to be the centre of our world.
The nature of adaptations will dictate the level to which we chose to adapt a property. Whilst some adaptations mean wholesale change, especially in the bathroom or kitchen, small tweaks coupled with new habits can mean the difference between disabled people having to move into residential care or living independently, at home.
As we all know, adaptations can be expensive; fortunately, help is available.
Daily living equipment
If you feel that you or someone you care for requires specialist equipment in order to manage more safely and easily around the home, you can request a needs assessment by contacting the social services department of your local council. They will be able to identify any help that is available to you and point out equipment suppliers (and discuss any financial assistance that you may be eligible for).
Daily living equipment is usually defined as small items ranging from simple ‘assistive technology’ through to adaptations like grab rails. Common solutions include products that help people to use the bath or toilet such as bath boards, raised toilet seats and lever taps and elsewhere in the home, such as adapted kitchen utensils and lever taps, through to larger pieces of equipment like bed raisers and rising armchairs – to help people into a standing position.
The Assessment Process
Assessments usually take place in the home since this is the most convenient place and because it allows the OT or social worker undertaking the assessment to ascertain exactly what is required to makes things easier. Because you have a legal right to be assessed your local social services department is duty bound to investigate your needs, though a letter from your GP or your nurse outlining some of the challenges you’re facing might help to speed up the process.
Sometimes equipment may be provided via healthcare professionals such as physiotherapists and nurses whilst in other cases equipment to meet health-related needs such as a commode or a walking aid, will meet both health and domestic daily living needs and your GP may be able to arrange for you to receive these items (or they may still suggest that you approach social services for a broader assessment of your needs).
If your assessed needs meet the eligibility criteria, you will have a right to services that help to meet those needs. This may include disability equipment, which should be free of charge. An example of this would be where an individual needs to be hoisted from a bed to a chair in their home as part of a care package. The hoisting equipment, its use by properly trained staff and its ongoing maintenance are an essential and integral element of the local authority’s legal duty to meet the assessed eligible needs in this case. Local authorities are not allowed to deny the service to you once it is satisfied that a service is required under eligible criteria.
‘Eligible’ equipment must be provided free of charge by social services. If your assessment confirms that an item of (eligible) equipment is necessary as part of your community care service, and for which the individual is eligible, it must be provided free of charge. This will usually be on permanent loan or until your needs change and you no longer need it.
All ‘minor’ adaptations costing £1,000 or less (including the cost of buying and fitting) are also required to be provided free of charge. Councils retain the discretion to make a charge in relation to minor adaptations that cost more than £1,000 to provide.
Larger, more expensive items may be classed as ‘major’ adaptations. They will then be the responsibility of the housing department through Disabled Facilities Grants but the initial assessment is generally carried out by an OT, again through social services but the two departments are likely to be linked together.
The recently launched Care Act 2015 outlines a greater emphasis on personalising health and social care services. This will give end users more choice and a greater say regarding what their care package looks like and how it operates. Under the new act, local authorities and the NHS are obliged to consider individual circumstances far more carefully, rather than applying a template approach, with the aim being to increase efficacy and provide better levels of personal dignity and the like.
The ‘Retail Model’
As part of the move towards personalisation, the Government introduced the ‘retail model’ which operates exactly as you might expect. Instead of giving somebody a piece of equipment selected for them, the retail model effectively allows greater choice of disability equipment through disabled people being able to ‘shop’ for the items they require. As a result this provides disabled people with greater choice and control over how they manage their circumstances through equipment solutions.
Local authorities or the NHS simply issue service users with a ‘prescription’ that can be exchanged for free equipment at an accredited retailer. This means that the service user will own the equipment. Home delivery and fitting are also funded if they are part of the identified need whilst complex equipment requiring regular servicing and maintenance, such as hoists and electric beds, are still delivered and fitted in the traditional manner, on loan.
Bespoke, one-off equipment is also kept within the existing loan arrangements. It covers equipment provided as part of the hospital discharge process and local authority community services. Hospital discharge may require the loan of equipment from a local stock with replenishment from an accredited retailer.
Most commonly, people are likely to use the retail model to get hold of aids that support them in maintaining their daily independence in mobility, toileting, bathing, cooking, dressing, reaching and eating. Many of these items cost less than £30 and include items such as: kettle tippers, shower stools, reachers, adapted cutlery and raised toilet seats.
In a sense, the Government is extending its thinking on the social model of disability and encouraging disabled people (and their carers) to make independent decisions for themselves. Personalisation and prevention appear to be developing themes that will encourage people to develop a sense of self management regarding the way they live.
The Government is developing ‘prevention’ and ‘personalisation’ agendas across a range of social care and health services. It sees the ‘retail model’ as empowering service users and encouraging increased innovation in equipment provision to both state-provided service users and self-funders.