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  6. Residential care without nursing - needs description

Residential care without 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 within this pdf (on page 2) in a table format.

See also the service category overview for residential care without nursing.

1. Health care needs

Health care needs
Service category and number Needs description:

Residential -
low level needs
0
  • will be generally stable or where unstable, the person is able to communicate any issues
Residential - medium level needs 
1
  • may have health care needs which may or may not be unstable. Where unstable the person is able to communicate any issues
Residential - 
high level needs
2
  • may require some health care tasks to be undertaken by a trained, clinically supervised person
  • due to cognitive impairment, the person may be unable to communicate pain or a change in their physical condition
Residential -
advanced dementia and mental health needs (without nursing)
2a
  • may require some health care tasks to be undertaken by a trained, clinically supervised person
  • due to cognitive impairment, the person may be unable to communicate pain or a change in their physical condition

 

 

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 and number Needs description:

Residential -
low level needs
0
  • may require supervision or prompting with medication

Residential -
medium level needs 
1
  • may from time to time, be non-compliant with medication but risks relating to the person’s behaviour are generally predictable and responsive to planned interventions
Residential - 
high level needs
2
  • may require administration and monitoring of medication regime by a person specifically trained for the task 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. However, with such monitoring, the condition will usually be non-problematic to manage 
Residential -
advanced dementia and mental health needs (without nursing)
2a
  • may require administration and monitoring of medication regime by a person specifically trained for the task 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. However, with such monitoring, the condition will usually be non-problematic to manage

 

 

3. Mobility, transfers, falls

Mobility transfers and falls
Service category and number Needs description:

Residential -
low level needs
0
  • will be able to safely mobilise around the home but may require guidance and/or equipment to do so. Low risk of falls
     
  • no risks around behaviours and non-compliance with care

Residential -
medium level needs 
1
  • may require supervision and/or assistance up to 2 carers to mobilise and for transfers. Moderate to high risk of falls
     
  • risks around behaviours and non-compliance with care can be managed within planned interventions, and pose a minor risk to self, others or property
Residential - 
high level needs
2
  • may require supervision and/or assistance of up to 2 carers to mobilise and for transfers
  • may be at moderate to high risk of falls
  • may be at risk of contractures and require support to prevent further restrictions and/or deterioration
  • may be completely immobile or have a clinical condition such as Motor Neurone Disease, where there is a high risk of serious physical harm associated with movement or transfer
     
  • may lack understanding of their mobility limitations which could put the person or others at risk
     
  • risks around behaviours and non-compliance with care may not be manageable solely within planned interventions, and pose a moderate risk to self, others or property
Residential -
advanced dementia and mental health needs (without nursing)
2a
  • may require supervision and/or assistance of up to 2 carers to mobilise and for transfers
  • may be at moderate to high risk of falls
  • may be at risk of contractures and require support to prevent further restrictions and/or deterioration
  • may be completely immobile or have a clinical condition such as Motor Neurone Disease, where there is a high risk of serious physical harm associated with movement or transfer
     
  • may lack understanding of their mobility limitations which could put the person or others at risk
     
  • risks around behaviours and non-compliance with care unlikely be manageable solely within planned interventions, require a prompt and skilled response that may be outside the range of planned interventions, and pose a moderate or high risk to self, others or property

 

4. Continence needs

Continence needs
Service category and number Needs description:

Residential -
low level needs
0
  • may be incontinent of urine and faeces but where applicable this is managed via medication, regular toileting and/or equipment
     
  • no risks around behaviours and non-compliance with care

Residential -
medium level needs 
1
  • may have daily episodes of incontinence.
  • continence care is routine but requires monitoring to minimise risks
     
  • risks around behaviours and non-compliance with care can be managed within planned interventions, and pose a minor risk to self, others or property
Residential - 
high level needs
2
  • may have 4 or more episodes of incontinence daily
  • continence care may be problematic and require the assistance of 2 or more people
  • may require catheter/stoma care and support from a health professional and general maintenance from care staff
     
  • risks around behaviours and non-compliance with care may not be manageable solely within planned interventions, and pose a moderate risk to self, others or property
Residential -
advanced dementia and mental health needs (without nursing)
2a
  • may have 4 or more episodes of incontinence daily
  • continence care may be problematic and require the assistance of 2 or more people
  • may require catheter/stoma care and support from a health professional and general maintenance from care staff
     
  • risks around behaviours and non-compliance with care unlikely be manageable solely within planned interventions, require a prompt and skilled response that may be outside the range of planned interventions, and pose a moderate or high risk to self, others or property

5. Pressure and skin care management

Pressure and skin care management
Service category and number Needs description:

Residential -
low level needs
0
  • will have pressure areas intact with no to minimal risk to pressure areas

Residential -
medium level needs 
1
  • may require daily checks for skin integrity
  • mild to moderate risk of pressure area breakdown
Residential - 
high level needs
2
  • may have poor tissue viability and/or lack awareness of when skin damage occurs. High/severe risk of pressure area breakdown
  • may require regular turning
  • may have graded pressure sores, which require care by a trained, clinically supervised person
Residential -
advanced dementia and mental health needs (without nursing)
2a
  • may have poor tissue viability and/or lack awareness of when skin damage occurs. High/severe risk of pressure area breakdown
  • may require regular turning
  • may have graded pressure sores, which require care by a trained, clinically supervised person

6. Mental health, cognition and behaviour

Mental health, cognition and behaviour
Service category and number Needs description:

Residential -
low level needs
0
  • may experience some confusion or be in the early stages of dementia, but there are no behaviours that are likely to challenge others

Residential -
medium level needs 
1
  • may have a cognitive impairment and/or be in the early to middle stages of dementia and may exhibit unusual behaviours such as disinhibition along with disorientation that requires some staff intervention to promote their dignity and/or prevent disturbance to other residents
Residential - 
high level needs
2
  • may have a cognitive impairment and/or be in the middle or later stages of dementia 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 an increased level of skilled, staff response. This may include individuals who are actively mobile and whose behaviour impacts on other residents because of this
Residential -
advanced dementia and mental health needs (without nursing)
2a
  • may have a cognitive impairment and/or be in the middle or later stages of dementia 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 previously have been assessed by or require further or ongoing input from a Mental Health Professional, eg. CPN
     
  • may exhibit behaviours including aggression, persistent attempts to leave the care setting, and/or socially inappropriate behaviour, that require a more specialist, skilled staff response. This may include individuals who are actively mobile and whose behaviour impacts on other residents because of this

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 and number Needs description:

Residential -
low level needs
0
  • will require minimal reassurance at times of potential anxiety

Residential -
medium level needs 
1
  • may require reassurance at times of actual or potential anxiety but responds positively when this is provided
Residential -
high level needs 
2
  • may experience frequent and sustained episodes of anxiety, low mood and/or periods of distress including possibly hallucinations which impacts heavily on their ability to function and require an increased level of staff response
Residential -
advanced dementia and mental health needs (without nursing)
2a
  • may experience frequent and sustained episodes of anxiety, low mood and/or periods of distress including possibly hallucinations which impacts heavily on their ability to function and require a more specialist, skilled staff response

8. Communication needs

Communication needs
Service category and number Needs description:

Residential -
low level needs
0
  • will be able to communicate their needs verbally

Residential -
medium level needs 
1
  • may require assistance to communicate their needs, with additional effort needed to ensure correct interpretation, or communicate visually, through touch or with hearing
Residential - 
high level needs
2
  • may be unable to reliably communicate their needs and be difficult to understand
Residential -
advanced dementia and mental health needs (without nursing)
2a
  • may be unable to reliably communicate their needs and be difficult to understand

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 and number Needs description:

Residential -
low level needs
0
  • will be compliant with care

Residential -
medium level needs 
1
  • may from time to time, be non-compliant with care but risks relating to the person’s behaviour are generally predictable and responsive to planned interventions
Residential - 
high level needs
2
  • 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
Residential -
advanced dementia and mental health needs (without nursing)
2a
  • may be non-compliant with care and a risk assessment indicates that the person’s behaviour poses a moderate or high risk to self, others or property, and may require care to be delivered in their best interests

10. Eating and drinking

Eating and drinking
Service category and number Needs description:

Residential -
low level needs
0
  • will be able to maintain adequate dietary and fluid intake

Residential -
medium level needs 
1
  • may need support of staff to maintain adequate dietary and fluid intake (Where a person requires support from staff to maintain adequate dietary and fluid intake for more than 30 minutes per day, this 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)
  • may need encouragement and monitoring of diet to ensure sufficient intake and/or minimise risks, e.g. monitoring food intake type for a diabetic who lacks insight
Residential - 
high level needs
2
  • may need full support 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 risk of choking. This could include people who are nutritionally at risk or who have an eating disorder
  • may need staff to follow a SALT plan, liaise with SALT professionals and for the care home to provide a range of modified diets
  • may have dysphagia requiring skilled intervention to ensure adequate nutrition/hydration and minimise the risk of choking and aspiration to maintain airway
Residential -
advanced dementia and mental health needs (without nursing)
2a
  • may need full support 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 risk of choking. This could include people who are nutritionally at risk or who have an eating disorder
  • may need staff to follow a SALT plan, liaise with SALT professionals and for the care home to provide a range of modified diets
  • may have dysphagia requiring skilled intervention to ensure adequate nutrition/hydration and minimise the risk of choking and aspiration to maintain airway

11. Washing and bathing

Washing and bathing
Service category and number Needs description:

Residential -
low level needs
0
  • will need the physical assistance of up to 1 person for washing, bathing and dressing

Residential -
medium level needs 
1
  • may need the physical assistance of 1 or 2 people for washing and bathing
Residential - 
high level needs
2
  • may require specified moving and handling, the physical assistance of 2 or more people for washing, bathing or care on bed
Residential -
advanced dementia and mental health needs (without nursing)
2a
  • may require specified moving and handling, the physical assistance of 2 or more people for washing, bathing or care on bed

12. Dressing

Dressing
Service category and number Needs description:

Residential -
low level needs
0
  • will need the physical assistance of up to 1 person for washing, bathing and dressing

Residential -
medium level needs 
1
  • may need the physical assistance of 1 or 2 people for dressing
Residential - 
high level needs
2
  • may require specified moving and handling, the physical assistance of 2 or more people for dressing or care on bed
Residential -
advanced dementia and mental health needs (without nursing)
2a
  • may require specified moving and handling, the physical assistance of 2 or more people for dressing or care on bed