Adult Care, Housing and Public Health Market Position Statement: Adult Care Market and Demand

Demographic

The population aged 65 and over in Rotherham is estimated at 55,400 in 2023, this is predicted to increase by 3.2% to 57,100 by 2025 and by 11.5% to 61,800 by 2030. The age group of 75+ is showing the greatest rate of increase (POPPI June 2023).

Support needs

In 2023 it was estimated that the number of people aged 65 and over who need help with at least one self-care activity, was 15,788. This number is expected to increase by 3.4% to 16,354 by 2025 and by 13.5% to 17,867 by the year 2030 (POPPI May 2023).

People receiving service

There are approximately 2,126 older people receiving service (June 2023). Based on ONS projections this number is predicted to rise by 9.8% to 2,210 people by the year 2027, and by 14.2% to 2,342 by the year 2032.

Table 1. Older People Service Provision - All Types (June 2023)

Home Care and Support

The Council operates a joint home care and support contract with South Yorkshire ICB (Rotherham Place) within a Flexible Purchasing System (FPS) arrangement. The contract will be in place until 2025 (minimum of five years) and operates using a tiered approach.

• Tier 1: Nine providers work on a geographical footprint and are expected to accept 75% of requests for service.
• Tier 2: Any CQC registered home care provider, rated Good or above, can apply to be a Tier 2 provider. Tier 2 providers work borough wide and are offered packages that the Tier 1 providers cannot undertake.
• The Framework also operates a specialist Lot that enables providers with a specialism such as providing services to people with a learning disability or mental ill-health to apply and provide service to that client group.
• Another Lot provides the opportunity to provide home care and support that benefits unpaid carers.

Capacity and Activity

On average in 22/23, the Council commissioned around 15,795 hours per week for 1,189 people (all ages and cohorts). Around 382 people are supported with multiple carer visits. The service specified offers support to enable people to continue living as independently as possible in their own home. Supporting people to access enabling technology/equipment and community assets, the service supports people to maintain the levels of independence achieved following a period of reablement, which is a service delivered by the Council.

Where people have a need for end of life care this service offers person centred support tailored according to the individuals needs and wishes.

The service is undergoing transformation and providers have a role in the organisation, adjustments, and reviews of care arrangements to the benefit of people accessing the service.

The Council invites suitably qualified and experienced providers to apply for a position on the framework.

Residential and Nursing Care Homes

There are 1,593 independent sector residential, nursing and EMI beds for older people in Rotherham across 32 care homes. The Council owns two additional care homes supporting older people.

There has been a significant shift in the types of ownership relatively recently with large national providers exiting from the market i.e., from a position of 50% market share to 20% market share.

Table 2. Older Peoples Care Homes Market Split as of May 2023

In-house Provision

The Council provides two residential care homes (Lord Hardy Court, Rawmarsh and Davies Court, Dinnington). Together, these offer a total of 120 beds providing support to older people, made up of:

• 30 intermediate care beds.
• 15 surge beds - to support hospital discharges during peak times.
• 59 residential/residential EMI care beds.
• 16 beds currently utilised on a temporary basis to support people living with a learning disability.

Trend

In Rotherham, there is a long-term trend moving away from traditional care home provision that mirrors the national picture. People are being supported at home for as long as possible and are entering 24-hour care for the last 2 to 3 years of their life when the complexity of needs has increased, and they are unable to manage their long-term conditions in their own home.

The number of older people admitted to residential care who are financially supported by the Council has declined over the last previous years from:

• 310 in 2017/18
• 292 in 2018/19
• 297 in 2019/20
• 227 in 2020/21
• 323 in 2021/22
• 341 in 2022/23

The increase in admissions in 2022/23 is recognised as the Council continuing to support people to remain independent in their own homes as far as possible plus continuing to support hospital discharges, to reduce pressure but this in turn has also added pressure to the social care system.

Primary Need

The primary need for people aged 65 and over in residential/nursing care homes are:

• 66.1% Physical support.
• 22.0% Support with memory and cognition.
• 9.5% Mental health support.
• 2.3% Learning disability support.
• 1.0% Sensory support.
• 1.1% Social support.

The age of older people being admitted into care homes is also slowly increasing from an average of 83 years in 2015/16 to 85 years in 2018/19. In 2022/23 the average age for admission into a care home has decreased slightly to 84 years.

Length of Stay

In 2022/23 the average length of long term stays in older peoples care homes was 30 months, a similar rate as 2021/22.

Care Type Demand

There are low level numbers of vacant nursing and nursing EMI beds and an over-supply of residential and residential EMI beds. The low occupancy in residential EMI beds may be due to the dementia diagnosis prevalence decreasing due to the impact of Covid-19, although this is predicted to increase in the coming years.

The current vacancy level across all older people’s residential and nursing care homes is around 16% and has slowly recovered from its highest vacancy rate of 26% in July 2020 (Covid-19 Pandemic). Prior to the pandemic the vacancy rate was around 14%.

The Council supports 58 older people to live in out of Borough long term residential and nursing care homes.

There are 17 people under the age of 65  living in care homes which are designed to care for older people, and 16 people under the age of 65 in older people’s short-term accommodation.

The Council expects a downward demand for residential care due to increasing supply of alternate provision in response to the Home First and Reablement ethos, provision of equipment, assistive technology and adaptations, an increase in older people's accommodation and changing customer attitudes.

A reprovision of residential beds to nursing and nursing EMI beds should be considered for some providers through transparent dialogue with the Council.

The Council is keen for care home provision to be modernised through additions of technology enabled care.

Extra Care Housing Schemes

Extra Care Housing in Rotherham is based across three sites providing 108 units of accommodation at Potteries Court, Swinton (35 units), Oaktrees, (Stag) (20 units), and Bakersfield Court, Herringthorpe (53 units). Each site provides accommodation aimed at enabling people to remain independent within their home for longer. There is a dedicated team of staff who work across the Extra Care Housing sites. The Council works in conjunction with the landlord Together Housing. Personal care is delivered by the independent sector at all 3 sites through the Council’s contracted Home Care and Support Service.

Extra care housing combines a safe secure environment in a community setting and is seen as a way forward to provide older people with their own high-quality accommodation, with access to housing related support and a personal care when required.

The Council is keen to expand supported housing options for older people and encourages providers and developers to enter into dialogue with the Council.

Figure 2. Estimated percentage change in care demand by MSOA 2030 and the current accommodation provision across Rotherham (Source: ONS mid-year population forecasts 2019)

Dementia

Dementia prevalence rates in Rotherham are increasing despite a decline in formal dementia diagnosis during COVID-19 due to the circumstances in primary care, in line with the national picture.

In March 2023, there are 2,260 older people (aged 65 years and over) registered with GP practices in Rotherham who have received a dementia diagnosis.  The expected number based on national modelling is 2,951, giving Rotherham a diagnosis rate of 76.6%.  This is higher than the national rate of 63% (Source: NHS Digital).

As of 2023, 3,859 people aged 65 and over are predicted to have some levels of dementia. By 2040, the prevalence is expected to increase to a predicted 5,327 people aged over 65 with dementia. The prevalence increases with age, and diagnosis rates are higher in women (Source:  POPPI, May 2023).

Support with Memory and Cognition

The Council currently supports 411 older people who have a primary need of memory/cognition and who may be diagnosed with dementia (Source: Insight). According to ONS data this number is expected to increase by 23% over the next 10 years to 480 older people..

Of the 411 older people currently receiving service the majority (315 or 77%) are living in a care home indicating more needs to be done to support people to remain in the community.

Please go to our Unpaid Carers Section to learn about services to support carers who care for someone with dementia.

Commissioning Intentions Summary

• The Council will continue to support people to live independently at home through provision of equipment, adaptations to property and digital innovation.
• The Council welcomes the opportunity for discussions with housing providers and developers to explore housing options for older people.
• The Home First model (a model where the emphasis across the health and social care system is to care for people at home whenever we can, or if they are admitted to hospital, get them back home again as soon as possible) will continue to be adopted. This will increase the amount of home care and support needed, and the Council invites new applicants to the Home Care and Support Framework.
• Care homes will continue to support older people with the most complex needs and an increase in nursing and nursing EMI care home capacity is required. A reduction of residential and residential EMI beds is expected as alternative provision develops.
• The Council will continue to ensure people approaching the end of their life receive high quality care, wherever that care is delivered.
• The Council is keen for care home provision to be modernised through additions of technology enabled care.
• The Council will continue to support the emerging priorities from the Framework for Enhanced Health in Care Homes, (england.nhs.uk) to ensure joined up primary, community and social care to promote the   good health of residents in care homes. The framework is centred on the needs of individual residents, their families and care home staff. Such care can only be achieved through a whole-system, collaborative approach.
• The Council is working with the CCG to provide a joint service specification for care homes during the financial year 2023/24.

Supporting People to Remain Independent

As well as a home care and support service the Council and the NHS Rotherham South Yorkshire ICB (Rotherham Place) jointly commission a range of services together to improve the lives of the most vulnerable people. These services are funded from the Better Care Fund (BCF) and include the Community Occupational Therapy Service, Intermediate Care Service, Reablement Service and Urgent Response services. These services all have a strong focus on delivering early intervention and prevention.

Other jointly commissioned services procured from the independent sector include:

1. Integrated Community Equipment and Wheelchair Service provides a wide range of equipment, aids and wheelchairs to children, young people and adults with physical and sensory disabilities, and to older people, so that they can continue to remain in their own homes. Equipment Service is currently operating on 7 days a week basis to support discharge processes to ensure timely discharge from hospital. The contract term runs until 2024 with an option to extend for a further two 12 month periods.
   This is a jointly funded service between the NHS and the Council. The lead provider provides the community equipment element of the contract, and the wheelchair element is subcontracted; both are nationally recognised independent sector providers.
   The Integrated Community Equipment Service is currently operating on 7 days a week basis to support discharge processes to ensure timely discharge from hospital.
   The contract term runs until 2024 with an option to extend for a further two 12 month periods.
    
2. The Intermediate Care Service is an integrated service which includes provision in a person’s own home and within short stay intermediate care beds. The service is working with nurses, social care, GPs, occupational therapy, physiotherapists and reablement teams to promote recovery from illness, prevent acute hospital admissions and premature admission to long term residential care, support timely discharge from hospital and maximise independent living. This service operates 7 days a week.

Assistive Technology

Adult Social Care has an ambition to fully utilise the benefits and opportunities provided by assistive technology to enable individuals to live healthy, fulfilled, and independent lives within their homes.

This ambition links to the Council's Corporate Digital Strategy

The Council intends to:

• Increase awareness of assistive technology and its benefits.
• Explore new ways to support people to prevent, reduce and delay the need for formal care Expand the provision of assistive technology across formal and informal care sectors.
• Develop a Strategy for Technology Enabled Care, to give a clear vision for provision of assistive technology in Rotherham.

The current offer includes:

1. RotherCare Community Alarm - this is an installed alarm in the person’s home. Should the person have an emergency they can raise the alert, or it may be done automatically depending on the individual’s assessed needs and help and advice is available 24 hours a day, 365 days a year.
2. Assistive Technology Service - this service supplies and installs a wide range of Technology Enabled Care equipment such as falls alert pendants, bed sensors, and memory support devices. Some of these link with the RotherCare system and others can be used independently. Assessment for these items can be accessed through the Council’s Adult Social Care contact centre.
3. Rotherham AccessAble (formally known as Disabled-Go) – AccessAble provides detailed guides to people with physical, sensory, learning difficulties and/or autism of the accessibility of facilities they may wish or need to visit within Rotherham. The provider visits the facilities to independently review the physical environment, as well as identifying if other needs are considered and catered for. The guides are reviewed and updated on a regular basis. The provider has been awarded a 3-year contract in 2022/23, with an option to extend for a further 3 years.

The Council is keen to expand the current assistive technology offer to fulfil the ambition of assistive technology being widely utilised to promote independence in home environments.