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EHJ August 2004, pages 252-254
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A novel pilot project illustrates how new methods of working
between local authorities and occupational therapists can
help disabled people receive grant aid to adapt homes to their
needs. Clare Lovell and Penny Stephens report
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An Englishman's home is his castle the old saying goes. But for
the UK's disabled population, the individual freedoms that most
people enjoy are not always so easily accessible. Simply getting
through the front door can prove a mission for a person who is wheelchair-bound.
Things most people take for granted, such as controlling their
light, power and heating or using the toilet, bath and shower can
turn into mammoth tasks for disabled people unless a property can
be adapted to meet their individual needs. Disabled facilities grants
(DFG), administered through local authorities, are an important
source of financial aid to get necessary adaptations made, and to
enable disabled people to live as independently as possible. Before
any adaptations can be made however, a disabled person's needs have
to be assessed and this is normally done by an occupational therapist.
Adaptations have to be reasonable and practicable in relation
to the property, so an occupational therapist has to visit the home
to carry out an assessment. A common problem is the length of time
that many disabled people have to wait for an assessment to be done.
It's not unusual for some people to sit on a waiting list for years.
A novel partnership project between Ipswich DC, Mid Suffolk DC
and Suffolk CC social care services (SCS) has looked at new methods
of working in a bid to resolve a growing waiting list problem and
to improve services to those needing assistance. The results have
been startling. Waiting lists have been cut through increasing referrals
to Ipswich DC and Mid Suffolk DC's private sector housing departments
and grant aid for Ipswich DC has increased to enable a speed up
in adaptations.
The idea behind the project emerged when both of the local authorities
grew increasingly concerned by the low number of DFG referrals from
Suffolk CC SCS. A bottleneck had built up with some people waiting
as long as 29 months for an assessment. During this same period,
neither Ipswich DC or Mid Sussex DC's private sector housing departments
operated a waiting list and the low number of referrals had resulted
in a consistent under spend of their DFG budgets.
Most of those who had been waiting the longest were elderly and
needed help with bathing and/or assistance getting in and out of
the property and getting to and from the first floor. At their initial
contact with Suffolk CC SCS, the clients had been given a low priority
rating.
The partnership realised that the only way to tackle the waiting
list was to review the current arrangements for referring clients
for a DFG. As a result, the two local authorities and Suffolk CC
SCS decided to fund a one-year project with specific aims to: review
and revise procedures, deal with the backlog of assessments and
review adaptations in the public sector.
In the project, a SCS-employed occupational therapist was assigned
to Ipswich DC's private sector housing department.
The Ipswich DC-based therapist took the longest waiting list clients
while other occupational therapists working in the Ipswich area
continued to take their usual cases, mostly high-priority ones.
Before the project launch, Suffolk CC SCS was unable to accurately
report the number of cases on the waiting list. It was able however,
to report that the longest waiting case had been for two and a half
years.
The partnership originally planned to assess client needs for
small grants, which could be processed quickly, enabling items such
as over-bath showers or stair-lifts to be installed. This wasn't
possible however, because most of the grants required larger scale
adaptations. One explanation was that clients had to wait a long
time for an assessment and consequently their needs had become greater.
Another was that clients either understated their needs or didn't
provide enough information to Suffolk CC SCS at the initial enquiry.
The project results were assessed over a 10-month period to allow
sufficient time for an evaluation to be carried out.
As the table (see below) shows, 56 of the 89 cases taken from
the SCS's waiting list required an occupational therapist to undertake
a full assessment. From these assessments, 43 were referred to Ipswich
DC for a DFG. During the same period, the other occupational therapists
working outside the project referred 30 clients for a DFG visit.
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While working for Ipswich DC, the occupational therapist
spent a fifth of her time with the council's public sector
housing department. During this time, the therapist dealt
with 108 cases, carrying out assessments and/or giving professional
advice. Through this work, Ipswich DC was able to fill its
council-owned properties much faster. It also helped the council
to move clients away from temporary accommodation into suitable
housing that either immediately met their needs or could be
adapted easily. The improved service took a significant proportion
of clients away from Suffolk CC SCS's waiting list.
The pilot has produced some startling results. The initial
target to reduce the waiting list by 25 per cent has been
exceeded with an overall reduction of 36 per cent. The results
are particularly impressive considering that the reductions
were made during a 10-month period when a total of 355 new
clients joined the waiting list. The project has also reduced
the waiting list time from 29 months to 14 months.
There have been other benefits as well. Referrals to Ipswich
DC's private sector housing have increased by more than 100
per cent, although this will not be apparent for some time
because of the lag time before applications are submitted.
Another benefit from the pilot is an increase in Ipswich DC's
grant spend. The council has agreed to an increased bid of
29.5 per cent over previous years.
One of the other tasks for the project was to review current
procedures. The partnership used the SCS's DFG protocol, which
had been in operation for local and registered social landlord-owned
properties, as a starting point for the review. A number of
proposals and changes in methods of working have since been
recommended:
- Under the current system, occupational therapists visit
a client, send a referral to Ipswich DC and then make a
second visit with a grant officer, after which they send
a recommendation to the council. The project trialled a
combined form for the referral and recommendation and in
some cases grant officers visited without the occupational
therapist. This saved valuable time, for example, reducing
the time for schedules to be issued. Also, queries can be
discussed immediately and an agreement reached.
- A letter is now sent to potential applicants when they
join the waiting list suggesting they contact Ipswich DC
for a preliminary means test. The reason for doing this
is so that people with large means tested contributions
do not sit on the waiting list when it is unlikely that
they would receive any grant aid. It also enables these
applicants to progress any works themselves. Since the introduction
of this letter, the council is averaging five calls a month
that require full means tests, not including those in receipt
of a passport benefit.
- A booklet is currently in production, which combines
all the assessment and grant processes to allow applicants
to understand the process more fully.
- To help provide consistency across the county, standard
specification paragraphs for basic items are in the process
of being developed for the occupational therapists to use.
Currently, there is a large variation in requirements for
items such as flush floor showers and ramps.
- As a result of research undertaken by the project, a
trial is currently being undertaken in two areas - the training
of wardens/scheme managers in sheltered housing complexes
to recommend minor equipment and adaptations such as grab
rails, infill ramps and threshold removal. To date, the
results have been positive, although a formal evaluation
has yet to be undertaken.
- Suffolk's CC SCS should train community care practitioners
to carry out assessments for minor adaptations, which would
include fixed ramps and over-bath showers. The proposal
requires it to take action to bring this about.
- A DFG progress chaser should be employed to work alongside
occupational therapists to increase efficiency and accelerate
the DFG progress. Suffolk CC SCS has received this proposal
favourably and it looks likely that the post will be set
up, based in the local home improvement agency.
The project's success has resulted in it being extended
for another year with an agreement that an occupational therapist
should be based permanently in private sector housing as long
as funding is available. The project's remit may change in
the future, however. Suffolk CC SCS needs to tackle bed blocking
and hospital discharges and at present is trying to integrate
its SCS and health occupational therapists so that one assessment
can be carried out. The therapist based in Ipswich DC will
play a major role in the process, enabling any new structure
to be effectively linked with the council, thereby improving
communication and working relationships between SCS, Ipswich
DC and Ipswich primary care trust.
Two main factors have ensured the project's success. One
is the occupational therapist's focused remit, which has been
reinforced by being based in private sector housing. One result
of this has been that the local performance indicator to help
over-sixties remain living in their own homes has been exceeded
by 100 per cent in the private sector.
The other factor is the flexibility of occupational therapists
and local authority officers to trial new methods of working.
Ipswich DC and Suffolk CC SCS have both identified and realised
the benefits of the project and closer partnership working
and are fully committed to identifying permanent funding for
the post.
All the partners have worked hard to ensure the project's
aims and objectives have been met. The long lag time with
the larger adaptations has meant that the increased DFG spend
has not been apparent in 2003/04 but the budget is already
fully allocated for 2004/05. Overall, the project has shown
how effective partnerships can be in reducing waiting lists
and improving services.
The authors' comments reflect those of Ipswich DC and Suffolk
CC social care services. They do however, acknowledge the
work of Mid Suffolk DC and the other occupational therapists
who were involved and contributed to the project's success.
Clare Lovell is senior EHO in private sector housing
at Ipswich DC. Penny Stephens is an occupational therapist
in Suffolk CC social care services
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