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Residential care with nursing - needs description

This information is for service providers and professionals who work with us or would like to work with us.

Service categories - needs description

You can also view the following information as a pdf (on page 2) in a table format.

See also the service category overview for residential care with nursing

1. Health care needs

Health care needs
Service category Needs description:

Nursing
  • may have complex physical health care needs, including long term conditions that require timely and frequent intervention to manage symptoms
     
  • may require health care tasks to be administered by a Registered Nurse in a care home with nursing, including:
  1. Application of orthoses – neck
  2. Assisted intermittent catheterisation – urethral / suprapubic (SP)
  3. Complex wound care – requires packing, compression bandages
  4. Emergency medication – Adrenaline, Nifedipene, Buccal midazolam / rectal diazepam
  5. Laryngectomy Care (stoma and prosthesis cleaning)
  6. Syringe driver
  • unstable diabetic – requires active intervention more than once a day
  • may experience altered states of consciousness due to blood sugar instability, hypoglycaemia, hyperglaecemia, epilepsy, seizures, strokes, vasovagal
  • may require Non-Invasive Ventilation, Long Term continuous oxygen therapy, daily chest physiotherapy exercises to prevent chest infections, suctioning, use of cough assist machine, use of nebulisers
Nursing - advanced dementia and mental health needs
  • may have complex physical health care needs, including long term conditions that require timely and frequent intervention to manage symptoms
     
  • may require health care tasks to be administered by a Registered Nurse in a care home with nursing, including:
  1. Application of orthoses – neck
  2. Assisted intermittent catheterisation – urethral / suprapubic (SP)
  3. Complex wound care – requires packing, compression bandages
  4. Emergency medication – Adrenaline, Nifedipene, Buccal midazolam / rectal diazepam
  5. Laryngectomy Care (stoma and prosthesis cleaning)
  6. Syringe driver
  • unstable diabetic – requires active intervention more than once a day
  • may experience altered states of consciousness due to blood sugar instability, hypoglycaemia, hyperglaecemia, epilepsy, seizures, strokes, vasovagal
  • may require Non-Invasive Ventilation, Long Term continuous oxygen therapy, daily chest physiotherapy exercises to prevent chest infections, suctioning, use of cough assist machine, use of nebulisers
Advanced / complex nursing
  • may have complex physical health care needs, including long term conditions that require timely, frequent, and sustained intervention to manage symptoms
     
  • may require health care tasks to be administered by a Registered Nurse in a care home with nursing, including:
  • Application of orthoses – neck
  • Assisted intermittent catheterisation – urethral / suprapubic (SP)
  • Complex wound care – requires packing, compression bandages
  • Emergency medication – Adrenaline, Nifedipene, Buccal midazolam / rectal diazepam
  • Laryngectomy Care (stoma and prosthesis cleaning)
  • Syringe driver
  • unstable diabetic – requires active intervention more than once a day
  • may experience altered states of consciousness due to blood sugar instability, hypoglycaemia, hyperglaecemia, epilepsy, seizures, strokes, vasovagal
  • may require Non-Invasive Ventilation, Long Term continuous oxygen therapy, daily chest physiotherapy exercises to prevent chest infections, suctioning, use of cough assist machine, use of nebulisers

 

 

2. Medication

The administration of medication is a health care need which can be met at the lower end of need by the local authority but CHC and Joint Funding should be considered where this need is indicative of eligibility by its’ nature, intensity, complexity and unpredictability.

Medication
Service category Needs description:

Nursing
  • may require preparation, administration and monitoring of medication regime by a person with a high level or skill, or specifically trained for the task, due to the route of medication, or because there are risks associated with the potential fluctuation of the medical condition or mental state, or risks regarding the effectiveness of the medication or the potential nature or severity of side-effects
  • may have medications which require precise timing. Covert administration of medication protocol may be required
  • may require clinical judgement as to whether to administer or withhold medication depending on presenting symptoms, this may include titration of such medication for example, insulin
     
  • may require clinical monitoring for example blood glucose levels
Nursing - advanced dementia and mental health needs
  • may require preparation, administration and monitoring of medication regime by a person with a high level or skill, or specifically trained for the task, due to the route of medication, or because there are risks associated with the potential fluctuation of the medical condition or mental state, or risks regarding the effectiveness of the medication or the potential nature or severity of side-effects
  • may have medications which require precise timing. Covert administration of medication protocol may be required
  • may require clinical judgement as to whether to administer or withhold medication depending on presenting symptoms, this may include titration of such medication for example, insulin
     
  • may require clinical monitoring for example, blood glucose levels
Advanced / complex nursing
  • may require preparation, administration and monitoring of medication regime by a person with a high level or skill, or specifically trained for the task, due to the route of medication, or because there are risks associated with the potential fluctuation of the medical condition or mental state, or risks regarding the effectiveness of the medication or the potential nature or severity of side-effects
  • may have medications which require precise timing. Covert administration of medication protocol may be required
  • may require clinical judgement as to whether to administer or withhold medication depending on presenting symptoms, this may include titration of such medication for example, insulin
     
  • may require timely, frequent or sustained clinical monitoring for example, blood glucose levels

 

 

 

 

3. Mobility, transfers, falls

Mobility, transfers, falls
Service category Needs description:

Nursing
  • may be completely immobile and/or have a clinical condition, e.g. Motor Neurone Disease, such that, in either case, on movement or transfer there is a high risk of serious physical harm and where the positioning is critical
  • may require the use of equipment to position, reposition or transfer safely
  • may be at risk of falls, may have a history of falls, may require observation or equipment to monitor falls e.g., sensor mat, sensor beam
     
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a minor risk to self, others or property however the behaviour(s) can be managed within a range of planned interventions
Nursing - advanced dementia and mental health needs
  • may be completely immobile and/or have a clinical condition, e.g. Motor Neurone Disease, such that, in either case, on movement or transfer there is a high risk of serious physical harm and where the positioning is critical
  • may require the use of equipment to position, reposition or transfer safely
  • may be at risk of falls, may have a history of falls, may require observation or equipment to monitor falls e.g., sensor mat, sensor beam
     
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a moderate risk to self, others or property, that may not be manageable solely within planned interventions
Advanced / complex nursing
  • may be completely immobile and/or have a clinical condition, e.g. Motor Neurone Disease, such that, in either case, on movement or transfer there is a high risk of serious physical harm and where the positioning is critical
  • may require the use of equipment to position, reposition or transfer safely
  • may be at risk of falls, may have a history of falls, may require observation or equipment to monitor falls e.g., sensor mat, sensor beam
     
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a moderate risk to self, others or property, that may not be manageable solely within planned interventions

4. Continence needs

Continence needs
Service category Needs description:

Nursing
  • may require continence care that is beyond routine and may be timely and require skilled intervention, for example frequent bladder wash outs/irrigation, manual evacuations, frequent re-catheterisation, frequent urinary tract infections and chronic diarrhoea
  • may require the assistance of more than one person
     
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a minor risk to self, others or property however the behaviour(s) can be managed within a range of planned interventions
Nursing - advanced dementia and mental health needs
  • may require continence care that is beyond routine and may be timely and require skilled intervention, for example frequent bladder wash outs/irrigation, manual evacuations, frequent re-catheterisation, frequent urinary tract infections and chronic diarrhoea
  • may require the assistance of more than one person
     
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a moderate risk to self, others or property, that may not be manageable solely within planned interventions
Advanced / complex nursing
  • may require continence care that is beyond routine and may be timely and require skilled intervention, for example frequent bladder wash outs/irrigation, manual evacuations, frequent re-catheterisation, frequent urinary tract infections and chronic diarrhoea
  • may require the assistance of more than one person
     
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a moderate risk to self, others or property, that may not be manageable solely within planned interventions

5. Pressure and skin care management

Pressure and skin care management
Service category Needs description:

Nursing
  • may have skin damage, skin breakdown, pressure areas and open wounds
  • may require preventative treatment such as repositioning, application of creams and use of equipment
  • may have high/severe pressure area risk
  • may have graded pressure sores, for example open wounds which are or are not responding to treatment
  • skin may require frequent monitoring for example, multiple times throughout a 24-hour period
     
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a minor risk to self, others or property however the behaviour(s) can be managed within a range of planned interventions
Nursing - advanced dementia and mental health needs
  • may have skin damage, skin breakdown, pressure areas and open wounds
  • may require preventative treatment such as repositioning, application of creams and use of equipment
  • may have high/severe pressure area risk
  • may have graded pressure sores, for example open wounds which are or are not responding to treatment
  • skin may require frequent monitoring for example, multiple times throughout a 24-hour period
     
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a moderate risk to self, others or property, that may not be manageable solely within planned interventions
Advanced / complex nursing
  • may have skin damage, skin breakdown, pressure areas and open wounds
  • may require preventative treatment such as repositioning, application of creams and use of equipment
  • may have high/severe pressure area risk
  • may have graded pressure sores, for example open wounds which are or are not responding to treatment
  • skin may require frequent monitoring for example, multiple times throughout a 24-hour period
     
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a moderate risk to self, others or property, that may not be manageable solely within planned interventions

6. Mental health, cognition and behaviour

Mental health, cognition and behaviour
Service category Needs description:

Nursing
  • may have a cognitive impairment and may exhibit behaviours including frequent disorientation, disinhibition, restlessness. The person maybe totally dependent on others to assess risks and capable of making only very simple decisions
     
  • may have a risk assessment that indicates that the person’s behaviour poses a minor risk to self, others or property however the behaviour(s) can be managed within a range of planned interventions (*)
Nursing - advanced dementia and mental health needs
  • may have a cognitive impairment and may exhibit behaviours including frequent disorientation, disinhibition, restlessness. The person maybe totally dependent on others to assess risks and capable of making only very simple decisions
     
  • may exhibit behaviours including aggression, persistent attempts to leave the care setting, and/or socially inappropriate behaviour, that require the development and maintenance of a Positive Behaviour Support Plan. This may include individuals who are actively mobile and whose behaviour impacts on other residents because of this (*)
  • may have a risk assessment that indicates that the person’s behaviour poses a moderate risk to self, others or property and/or identifies that the behaviour(s) require(s) a prompt and skilled response that might be outside the range of planned interventions (*)
Advanced / complex nursing
  • may have a cognitive impairment and may exhibit behaviours including frequent disorientation, disinhibition, restlessness. The person maybe totally dependent on others to assess risks and capable of making only very simple decisions

7. Psychological and emotional needs

Psychological and emotional needs may be indicative of eligibility for CHC and Joint Funding across all Service Categories. CHC and Joint Funding should be considered where this need is indicative of eligibility by its’ nature, intensity, complexity and unpredictability.

Psychological and emotional needs
Service category Needs description:

Nursing
  • may require additional support/reassurance to manage at times of actual or potential anxiety/low mood/distress/hallucinations but likely to respond positively when this is provided (*)
Nursing - advanced dementia and mental health needs
  • may require additional support/reassurance to manage at times of actual or potential anxiety/low mood/distress/hallucinations but likely to respond positively when this is provided (*)
Advanced / complex nursing
  • may require additional support/reassurance to manage at times of actual or potential anxiety/low mood/distress/hallucinations but likely to respond positively when this is provided (*)

8. Communication needs

Communication needs
Service category Needs description:

Nursing
  • may be unable to effectively or reliably communicate, including communication of pain or a change in their physical condition, requiring all needs to be anticipated by familiar carers
  • may have Visual and/or Hearing impairment requiring additional support to communicate
  • may become frustrated due to inability to communicate effectively or if communication misinterpreted by carers
Nursing - advanced dementia and mental health needs
  • may be unable to effectively or reliably communicate, including communication of pain or a change in their physical condition, requiring all needs to be anticipated by familiar carers
  • may have Visual and/or Hearing impairment requiring additional support to communicate
  • may become frustrated due to inability to communicate effectively or if communication misinterpreted by carers
Advanced / complex nursing
  • may be unable to effectively or reliably communicate, including communication of pain or a change in their physical condition, requiring all needs to be anticipated by familiar carers
  • may have Visual and/or Hearing impairment requiring additional support to communicate
  • may become frustrated due to inability to communicate effectively or if communication misinterpreted by carers

9. Acceptance of care

A person’s acceptance of care may be indicative of eligibility for CHC and Joint Funding across all Service Categories. CHC and Joint Funding should be considered where this need is indicative of eligibility by its’ nature, intensity, complexity and unpredictability.

Acceptance of care
Service category Needs description:

Nursing
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a minor risk to self, others or property however the behaviour(s) can be managed within a range of planned interventions
Nursing - advanced dementia and mental health needs
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a moderate risk to self, others or property, that may not be manageable solely within planned interventions
Advanced / complex nursing
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a moderate risk to self, others or property, that may not be manageable solely within planned interventions

10. Eating and drinking

Eating and drinking
Service category Needs description:

Nursing
  • may need prompting/supervision/full assistance of staff to maintain adequate dietary and fluid intake, which may include physical assistance to eat and drink because of cognitive or physical restrictions and the risk of choking. This could include people who are nutritionally at risk or who have an eating disorder
  • may no longer be able to request food or drinks and all needs are anticipated by carers
  • may require Safe Swallow Plan/postural care/mouthcare
  • may have Specialised feeding plan from Dietician
  • may have difficulties with swallowing and with gastric reflux, vomiting and aspiration. May have dysphagia requiring skilled intervention to ensure adequate nutrition/hydration and minimise the risk of choking and aspiration to maintain airway (*)
  • may be unable to take any food and drink by mouth, but all nutritional requirements are being adequately maintained by artificial means, for example via a PEG
     
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a minor risk to self, others or property however the behaviour(s) can be managed within a range of planned interventions
     
  • may require specified moving and handling and the physical assistance of 2 or more people for washing and bathing or care on bed
Nursing - advanced dementia and mental health needs
  • may need prompting/supervision/full assistance of staff to maintain adequate dietary and fluid intake, which may include physical assistance to eat and drink because of cognitive or physical restrictions and the risk of choking. This could include people who are nutritionally at risk or who have an eating disorder
  • may no longer be able to request food or drinks and all needs are anticipated by carers
  • may require Safe Swallow Plan/postural care/mouthcare
  • may have Specialised feeding plan from Dietician
  • may have difficulties with swallowing and with gastric reflux, vomiting and aspiration. May have dysphagia requiring skilled intervention to ensure adequate nutrition/hydration and minimise the risk of choking and aspiration to maintain airway (*)
  • may be unable to take any food and drink by mouth, but all nutritional requirements are being adequately maintained by artificial means, for example via a PEG
     
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a moderate risk to self, others or property, that may not be manageable solely within planned interventions
     
  • may require specified moving and handling and the physical assistance of 2 or more people for washing and bathing or care on bed
Advanced / complex nursing
  • may need prompting/supervision/full assistance of staff to maintain adequate dietary and fluid intake, which may include physical assistance to eat and drink because of cognitive or physical restrictions and the risk of choking. This could include people who are nutritionally at risk or who have an eating disorder
  • may no longer be able to request food or drinks and all needs are anticipated by carers
  • may require Safe Swallow Plan/postural care/mouthcare
  • may have Specialised feeding plan from Dietician
  • may have difficulties with swallowing and with gastric reflux, vomiting and aspiration. May have dysphagia requiring skilled intervention to ensure adequate nutrition/hydration and minimise the risk of choking and aspiration to maintain airway (*)
  • may be unable to take any food and drink by mouth, but all nutritional requirements are being adequately maintained by artificial means, for example via a PEG
     
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a moderate risk to self, others or property, that may not be manageable solely within planned interventions
     
  • may require specified moving and handling and the physical assistance of 2 or more people for washing and bathing or care on bed

11. Washing and bathing

Washing and bathing
Service category Needs description:

Nursing
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a minor risk to self, others or property however the behaviour(s) can be managed within a range of planned interventions
Nursing - advanced dementia and mental health needs
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a moderate risk to self, others or property, that may not be manageable solely within planned intervention
Advanced / complex nursing
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a moderate risk to self, others or property, that may not be manageable solely within planned intervention

12. Dressing

Dressing
Service category Needs description:

Nursing
  • may require specified moving and handling and the physical assistance of 2 or more people for dressing, or care on bed
     
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a minor risk to self, others or property however the behaviour(s) can be managed within a range of planned interventions
Nursing - advanced dementia and mental health needs
  • may require specified moving and handling and the physical assistance of 2 or more people for dressing, or care on bed
     
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a moderate risk to self, others or property, that may not be manageable solely within planned interventions.
Advanced / complex nursing
  • may require specified moving and handling and the physical assistance of 2 or more people for dressing, or care on bed
     
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a moderate risk to self, others or property, that may not be manageable solely within planned interventions