4.2.3 Adult Short Breaks

1. Introduction

See also Caring for someone? What you need to know about arranging a Short Break.

This policy sets out how Lancashire County Council, under Section 2 of the Care Act 2014, will arrange short breaks for an adult being cared for which will also support the informal (unpaid) carer in their caring role.

Caring for someone living in the community can be a full-time commitment, often carried out alongside paid employment and other domestic responsibilities. This policy applies to adults with care and support needs who may be supported by an informal (unpaid) carer who either lives with them, or who lives elsewhere. but who needs regular visits, support and companionship from the unpaid carer.

It can be difficult for carers to prioritise their own needs, but breaks are vital to the carer’s own wellbeing and to prevent, reduce or delay onset of their own health needs. It can give the adult who is being cared for an opportunity to enjoy new experiences, have a change of scene and routine and mix with other people.

In accordance with Social Care Institute for Excellence (SCIE) guidance (Providing breaks – adult carers) Lancashire County Council will:

• Provide clear information – about the range and variety of services and support. For each service, we will provide information about the type of setting and support, the duration and the cost.
• Ensure breaks are easy to arrange – carers will be given information on times, costs, eligibility, availability, skills of staff, how to book and contact details.
• Ensure quality – comply with Care Quality Commission (CQC) fundamental standards, and the family and friends test. We will involve carers and community members in checking services.
• Co-production – involve carers in shaping services. What would people like? Be flexible about how you do this and really listen to what they say. See also Involving People who Use Services / Co-production chapter).
• Offer flexibility and variety – overnight breaks are important, but so are regular breaks during the day. Carers often want to take a break with the person they care for, but not have to do all the caring tasks. Both options should be available.
• Plan for continuity – by having good plans in place to respond to gaps in the care market. Ensure contingency plans are in place for people who are supported by unpaid carers.
• Build on what works – for example, where our services are trusted and understand people well, we will use their skills and expertise.
• ‘Get to know me and the person I care for – get to know our family’ – if a carer is experiencing support for the first time, they will need a period to adjust while they get a feel for what works.
• Skilled staff – carers don’t want to ‘pick up the pieces’ after a break that did not work well for the person they care for.
• Get the basics right around reliability and communication – keep carers in touch and informed.
• Measure impact – so we can know if our services are making a difference.
• Be part of the community – breaks can help people to stay connected to the things they enjoy, reducing loneliness and can help build new links both for the carer and the person they care for.
• Use technology to compliment support– technology can offer peace of mind, but there must be a balance, as carers may not feel like they are having a break if they are in constant contact with the person they care for.
• Make the break enjoyable.

2. Policy Aim

This policy aims to:

• provide short breaks that meet the needs of carers and adults with social care and support needs.
• support adults with care and support needs, who are supported by carers, to develop their independence, learn new skills, make friends and reduce isolation.
• provide short breaks which support carers with their caring responsibilities.
• provide our short breaks offer across three distinct levels:
  1. information, advice and guidance about accessing universal support.
  2. short breaks of up to 6 weeks as part of our duty to prevent, reduce and delay the need for long term care and support.
  3. long-term support which is assessed for both the adult with care and support needs and their carer.
• involve adults with care and support needs and their families with decisions.

We want unpaid carers to be able to say:

• I am supported to provide care and to do so in a way that takes into account my own needs including access to education, employment, health and wellbeing.
• I have a life outside caring, and I am able to remain connected to the people who matter to me.
• I know my needs are equally recognised and my goals and aspirations are respected and fulfilled.
• I have the right information and advice to be able to make informed decisions.
• I have access to appropriate support, that suits my needs including respite care and carers’ breaks.

3. Principles and Definitions

3.1 What is a short break?

Short breaks should maximise independence for the adult with care and support needs and, wherever possible, should be provided close to where they live in a community setting to maintain their usual networks of support.

A short break can include day, evening, overnight or weekend support which can take place in the adult’s home, in the home of an approved carer, in a community setting or in a residential home.

Short breaks will give a carer a break from their caring role. They should not subsidise a service the adult and carer would normally purchase for themselves on a regular basis, or a service commissioned on an ongoing basis to the adult with care and support needs.

Where care and support is needed in an emergency situation, for example due to the usual carer being unavailable because of ill health or because something has happened which has led to carer breakdown, the adult should have contingency arrangements outlines in their care and support plan. Depending on the circumstances, this could be classed as a short or long-term care arrangement based on the adult’s eligible needs.

4. How to Access Short Breaks

4.1 The short breaks offer

Lancashire County Council will support adults with care and support needs and their carers to access to short breaks in three ways.

1. We will provide information, advice and guidance about accessing universal support in their local communities, which could include activities in leisure centres, community group, faith groups etc.
2. Where there is an opportunity to regain skills, confidence and prevent, reduce or delay the need for long-term support or for carer breakdown we will offer support up to 6 weeks.
3. For access to long-term short breaks, Care Act eligibility will be assessed.

4.2 Advocacy

Care and support should always be person-centred and include the views and wishes of the person/ people involved. Under the Care Act, Lancashire County Council can arrange for an independent advocate to facilitate the involvement of the adult with care and support needs in their assessment, if two conditions are met:

• The adult has substantial difficulty in being involved in these processes;
• There is not an appropriate individual willing to support them.

For more information please see Independent Care Act Advocacy Policy.

5. Eligibility for Short Breaks

Eligibility for long-term short breaks will be considered as part of the adult’s social care assessment.

The level of a short break offered, with overnight short breaks offered at the more complex end of care needs, will reflect the impact of the caring responsibility on the carer and the wellbeing of the adult with care and support needs. A range of factors will be taken into account including:

• If care provided is physically demanding.
• The level of support the adult requires when they are awake.
• If the carer is required to wake at night to provide care during the night.
• Extent of sleep disruption and ability or otherwise to manage this.
• Level of complexity and behaviours e.g. if the adult cannot be left alone.
• Whether the carer has sole responsibility and receives little support from others.
• The potential impact on the wider family.
• What other support the family may receive.

Accessing long-term short breaks, can look different. Examples of how these may be provided include:

• day care – where the adult attends a service or participates in activities away from home, enabling the carer to have a break (this excludes the use of direct payments to access Lancashire County Council services).
• day-sitting service – which enables the carer to go shopping, meet friends or have time to do other things they want to do.
• night-sitting service – to care for the adult during the night, to enable the carer to rest and sleep throughout the night.
• residential or nursing homes
• Shared Lives
• holidays – help and support for the carer and / or adult whilst on holiday either together or separately.

It is the responsibility of the NHS to organise short breaks for those who are continuing healthcare (CHC) funded, so that the NHS are assured that the care being given is of an appropriate standard.  Lancashire County Council still has a duty to assist carers by assessing and supporting them when they are having a break.

To establish eligibility for long-term short breaks, Lancashire County Council will conduct assessments with both the adult and the carer, to ensure they are Care Act eligible (see Assessment of Needs policy).

During this process, Lancashire County Council will:

• carry out an assessment of anyone who appears to have needs for care and support, regardless of whether those needs are likely to be eligible.
• focus the assessment on the adult’s needs and how they impact on their wellbeing, and the outcomes they want to achieve.
• involve the adult in the assessment and, where appropriate, their carer and/or someone else they nominate.
• provide access to an independent advocate to support the adult’s involvement in the assessment, if required.
• consider other things besides care services that can contribute to the desired outcomes (e.g. preventive services, community support).

A carer’s assessment should consider the impact of the caring role on their wellbeing across the following areas:

• how caring affects their work and personal life.
• physical, mental and emotional health.
• how they feel about their caring role, including their choice about being a carer.
• work, study, training and leisure commitments and goals.
• personal relationships.
• housing situation.
• contingency planning / planning for emergencies.

See Carer’s Assessments policy for more information.

6. Annual Review of Short Breaks

In accordance with the Care Act 2014, adults with long-term care and support needs who receive short breaks will be reviewed every 12 months from the date of their assessment or review to ensure the support is still meeting eligible needs. See Review of Care and Support Plans.

7. Charging for Short Breaks

Lancashire County Council has two charging policies; the Non-Residential Care Charging Policy which covers support offered in the community e.g. day care, and the Residential Charging Policy which is used when the adult’s care and support needs require 24/7 or overnight support.

Care and support which is provided directly to the adult on a regular and ongoing basis to complement the role of the informal (unpaid carer) is chargeable.

A financial assessment will be carried out to understand whether the adult will need to pay a contribution towards their short breaks and other care and support.

Lancashire County Council is required to offer short breaks that meet Care Act eligible needs in a way that also delivers affordability and value for money. If the adult chooses a different and more expensive option, an additional ‘top up fee’ will be charged.

The ‘top-up’ fee is calculated by subtracting the cost of the option identified by Lancashire County Council, minus the care contribution identified in the adult’s financial assessment, from the cost of the preferred placement.