12.3 Preventing, Reducing or Delaying Needs for Care and Support

1. Introduction

One of the key aims of the Care Act 2014 is that the care and support system works to actively promote wellbeing and independence, and does not just wait until people reach a crisis point before responding. Services need to intervene early to provide care and support to adults and carers, help them retain or regain their skills and independence, and prevent the development of needs and / or delay deterioration in their health and wellbeing wherever possible.

The Care and Support Statutory Guidance sets out how local authorities should go about fulfilling their responsibilities to promote wellbeing and independence. These responsibilities apply to all adults, including:

• those who do not have any current care and support needs;
• those with needs for care and support, whether their needs are eligible and / or met by the local authority or not; and
• carers.

The term ‘prevention’ covers many different types of support, services, facilities and  other resources; it can range from widescale, whole population measures aimed at promoting health, to more targeted, individual interventions aimed at improving skills or functioning for one adult or a particular group of adults or carers or reducing the impact of caring on a carer’s health and wellbeing.

2. Prevent, Reduce, Delay

‘Prevention’ is often broken down into three general approaches – primary, secondary and tertiary prevention.

2.1 Prevent: primary prevention/ promoting wellbeing

These are services, facilities or resources for adults who have no current health or care and support needs, and aim to help them avoid developing care and support needs or to help carers avoid developing support needs. They are generally universal services (meaning they are available to everyone), and can include:

• providing good quality information;
• supporting safer neighbourhoods;
• promoting healthy and active lifestyles;
• reducing loneliness or isolation or;
• encouraging early discussions in families or groups about planning for the future, for example conversations about care arrangements or suitable accommodation should a family member become ill or disabled.

2.2 Reduce: secondary prevention/ early intervention

These are more targeted interventions aimed at adults who have an increased risk of developing needs, where the provision of services, resources or facilities may help slow down or reduce any further deterioration or prevent other needs from developing. Often early support can help stop an adult’s life tipping into crisis, for example helping someone with a learning disability manage their money or providing support to help a family carer so they do not become overwhelmed.

Early intervention also covers falls prevention services, adaptations to housing to improve accessibility or provide greater assistance, handyperson services, short term provision of wheelchairs and telecare services. To identify those adults most likely to benefit from these targeted services, local authorities may undertake screening or case finding, to identify those at risk of developing specific health conditions or experiencing certain events (such as strokes, or falls), or those that have needs for care and support which are not currently met by the local authority. Targeted interventions will also identify carers, including those who are taking on new caring responsibilities

2.3 Delay: tertiary prevention

These are interventions aimed at minimising the effect of disability or deterioration for people with established or complex health conditions, (including progressive conditions, such as dementia), supporting people to regain skills and manage or reduce need where possible. Tertiary prevention includes, for example the rehabilitation of people who are severely sight impaired. Local authorities must provide or arrange services, resources or facilities that maximise independence for people who already have these needs, for example, interventions such as the provision of formal care to meet a person’s needs in their own home and rehabilitation / reablement services, for example community equipment services.

Tertiary prevention services also include helping improve the lives of carers by enabling them to continue to have a life of their own alongside caring, for example through short breaks / respite care, peer support groups or emotional support or stress management classes which can provide essential opportunities to share learning and coping tips with others.

Prevention is not a one-off activity. For example, a change in the circumstances of an adult and / or carer may result in a change to the type of prevention activity that would be of benefit to them. Prevention can sometimes be seen as something that happens mainly at the time of (or very soon after) a diagnosis or assessment or when there has been a change in the person’s condition. Prevention services are, however, something that should always be considered. For example, at the end of life in relation to carers, prevention services could include the provision of pre-bereavement support.

3. Intermediate Care and Reablement

‘Intermediate care’ is a time limited, structured programme of care to help a person to maintain or regain their ability to live independently at home.

‘Reablement’ is a type of intermediate care, which aims to help the person regain their capabilities and live independently in their own home.

There are four models of intermediate care (see Intermediate Care Guide, SCIE):

1. Bed-based services are provided in an acute hospital, community hospital, residential care home, nursing home, standalone intermediate care facility, independent sector facility, local authority facility or other bed-based settings.
2. Community-based services provide assessment and interventions to people in their own home or a care home.
3. Crisis response services are based in the community and are provided to people in their own home or a care home with the aim of avoiding hospital admissions.
4. Reablement services are based in the community and provide assessment and interventions to people in their own home or a care home. These services aim to help people recover skills and confidence to live at home and maximise their independence.

The term ‘rehabilitation’ is sometimes used to describe a particular type of service designed to help a person regain or re-learn some capabilities where these have been lost due to illness or disease. Rehabilitation services can include provisions that help people gain independence and remain or return to their home and participate in their community, for example independent living skills and mobility training for people with visual impairment.

‘Intermediate care’ services are provided to people, usually older people, after they have left hospital or when they are at risk of being sent to hospital. Intermediate care is a programme of care provided for a limited period to assist a person to maintain or regain the ability to live independently – as such they provide a link between places such as hospitals and people’s homes, and between different areas of the health and care and support system – community services, hospitals, GPs and care and support.

4. Carers and Prevention

Carers play a key role in preventing the needs for care and support for the people they care for, which is why it is important that local authorities consider how they can prevent carers from developing needs for care and support themselves. Examples of services, facilities or resources that can help to prevent, delay and reduce the needs of carers include those which help carers to:

• care effectively and safely – both for themselves and the person they are supporting, for example interventions or advice on moving and handling safely or avoiding falls in the home, or training for carers to feel confident performing basic health care tasks;
• look after their own physical and mental health and wellbeing, including developing coping mechanisms;
• make use of IT and assistive technology;
• make choices about their own lives, for example managing their caring role and paid employment;
• find support and services available in their area;
• access the advice, information and support they need including information and advice on welfare benefits, other financial information and entitlement to carers’ assessments carried out by the local authority under the Care Act 2014.

5. The Focus of Prevention

5.1 Promoting wellbeing

Local authorities must promote wellbeing (see Promoting Wellbeing chapter) and view an adult’s life holistically. This means considering the adult’s care and support needs in the context of their strengths, skills, ambitions and priorities. This should include consideration of the role a person’s family or friends can play in helping the person to meet their goals.

5.2 Developing resilience and promoting individual strength

Adults should be supported to design care and support which helps them achieve their goals. A good starting point for a discussion that helps develop resilience and promotes independence is to ask ‘what does a good life look like for you and your family and how can we work together to achieve it?’

Giving adults choice and control over the support they may need and access to the right information enables them to stay as well as possible, maintain independence and caring roles for longer.

5.3 Working in partnership to focus on prevention

When developing and delivering local approaches to prevention, the local authority will integrate its approach with that of other local partners. Preventing needs is most effective when action is undertaken at a local level, with different organisations working together to understand how the actions of each may impact on the other.

Within the local authority, prevention of care and support needs is closely aligned to other local authority responsibilities in relation to public health, children’s services, and housing, for example. Across the local area, the role of other bodies including the local NHS (for example GPs, dentists, pharmacists, ophthalmologists etc.), welfare and benefits advisers (for example at Jobcentre Plus), the police, fire service, prisons in respect of those persons detained or released with care and support needs, service providers and others will also be important in developing a comprehensive approach

Local authorities should work with different partners to identify unmet needs for different groups and coordinate shared approaches to preventing or reducing such needs, for example working with the NHS to identify carers, and working with independent providers including housing providers and the voluntary sector, who can provide local insight into changing or emerging needs beyond eligibility for publicly funded care.

5.4 Identifying those who may benefit from preventative support

Local authorities should identify and target adults who may benefit from particular types of preventative support.

There are a number of interactions and access points that could bring an adult or carer into contact with the local authority or a partner organisation and these should act as a trigger point for considering whether the provision of a preventative service or some other step is appropriate. These include:

• initial contact through a customer services centre, whether by the adult concerned or someone acting on their behalf;
• contact with a GP, community nurses, housing officers or other professionals which leads to a referral to the local authority;
• a Care Act assessment of care and support needs or a carer’s assessment for support needs, which identifies the adult or carer may benefit from a preventative service or other type of local support.

Many people with low level care and support needs will approach the voluntary sector for advice in the first instance.

There are key points in an adult’s life or in the care and support process however, where a preventative intervention may be particularly appropriate or of benefit, for example:

• following a bereavement;
• at hospital admission and or discharge;
• when a person is admitted to or released from prison;
• when a person applied for benefits such as Attendance Allowance, or Carer’s Allowance;
• through contact with/use of local support groups;
• through contact with/use of private care and support;
• when there is a change in housing.