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The FACE Adults RAS Details & Configuration Guide V7RAS Version 7 – Master Formula Version 1.7

London Borough of Hammersmith and Fulham, Royal Borough of Kensington and Chelsea, City of Westminster Council

Mark Rogers - FACE Implementation & Support Consultant

Document Owner - Malcolm Rose, City of Westminster Council

Contents

Version History............................................................................................................................1Introduction.................................................................................................................................2Background Information..............................................................................................................2Local Rates and Configuration Decisions.....................................................................................41 Input and Output Decisions...................................................................................................4

1.1 RAS Forms.....................................................................................................................41.2 RAS Outputs...................................................................................................................4

2 RAS Formula Summary (including specific rates and configuration decisions)......................62.1 Personal care – morning.................................................................................................62.2 Personal care – evening.................................................................................................62.3 Personal care – adjustment for mobility/positioning difficulties......................................62.4 Personal care – adjustment for memory/acceptance of support difficulties...................62.5 Personal care – during day.............................................................................................62.6 Personal care – support from family/friends/volunteers.................................................72.7 Preparing meals/snacks/drinks and Medication support.................................................72.8 Learning disability personal care/meals/medication adjustment....................................82.9 Conversion to monetary allocation................................................................................82.10 Ensuring safety – service users who cannot be left alone (waking hours)......................82.11 Combined allocation for personal care, medication, meals/snacks/drinks and safety. .102.12 Personal care – support of two.....................................................................................102.13 Household tasks...........................................................................................................112.14 Social, leisure, cultural and spiritual activities.............................................................122.15 Work, training, education and volunteering.................................................................132.16 Total of daytime needs allocations...............................................................................132.17 Care home adjustment................................................................................................132.18 Night support allocation...............................................................................................142.19 Living situation cap and addition.................................................................................152.20 Sustainability allocation (i.e. respite breaks)................................................................162.21 Overall high-end cap and minimum budget adjustment..............................................172.22 Adjustments relating to National Eligibility Framework................................................17

©2015 FACE Recording & Measurement Systems Ltd. All rights reserved.This document is for licensed FACE customers only. No part of this documentation may be reproduced or

transmitted in any form, by any means, without the prior permission of FACE Recording & Measurement Systems Ltd.

Version History

Date Name Detail of changes

02/03/16 Mark Rogers Combined 3-Borough document created05/04/16 Mark Rogers Updated following configuration meeting20/04/16 Malcolm Rose Updated with LA rates. 21/04/16 Malcolm Rose Updated LA rates

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IntroductionThis document describes the workings of the FACE RAS and has been produced to reflect FACE’s commitment to transparency – the importance of which is emphasised in the Care Act 2014’s ‘Statutory Guidance for Implementation’ – which states:

‘11.4. It is vital that the process used to establish the personal budget is transparent so that people are clear how their budget was calculated, and the method used is robust so that people have confidence that the personal budget allocation is correct and therefore sufficient to meet their care and support needs. The allocation of a clear upfront indicative (or ‘ballpark’) allocation at the start of the planning process will help people to develop the plan and make appropriate choices over how their needs are met.’

The document also acts as a record for a Local Authority of the decisions they have made regarding the rates and configuration within their local RAS – showing where each decision or set of decisions is used within the RAS.

Background InformationThe FACE RAS has been developed over a period of seven years and the development has involved over 40 councils to date. At the forefront of the development has always been the core aim of enabling personalisation to be realised in the context of accurate needs and outcomes-based targeting of resources, whilst ensuring financial sustainability.

The FACE RAS allocations are based on a national baseline model with adjustments applied to account for local costs and allocation practices. Effectively, the method of arriving at any single indicative budget figure can be described as ‘in line with what it costs to meet the needs of other comparable individuals locally, based upon a nationally-validated overall model’. The national model was developed and tested in conjunction with independent researchers at University College London.

It is sometimes incorrectly stated that the FACE RAS replicates existing costs and practice. In fact, the FACE RAS is based on standard costs rather than actual costs and is carefully configured during setup to ensure any undesired existing allocation practices are not perpetuated. What a council chooses to use as standard costs is up to them, but it can be, for example:

Actual costs (not recommended as these vary according to provider, e.g. in-house and external)

Average actual costs External standard costs PSSEX return costs Anticipated or desired standard costs based upon service reconfiguration

The above leaves considerable room for flexibility. For example, if a council wished to use or move towards a single cost model for all, actual cost data for younger adults and adults with learning disabilities could be collected and then re-standardised based on standard older people costs, with the RAS then being recalibrated accordingly.

In all councils where the FACE RAS is in full routine use, it has been thoroughly tested through specific testing exercises or via pilot use before proceeding to this stage. This testing involves comparing indicative budgets produced by the RAS with the cost of support for sets of cases that were not used to calibrate the RAS initially – providing an independent test of accuracy.


Careful analysis is carried out on any cases where there is not a close relationship to ensure that the RAS is as accurate as possible for all types of cases. These financial audits have consistently found high levels of accuracy.

For RAS Version 7, additional core requirements have been:

To ensure compliance with the Care Act 2014 – with the FACE V7 Overview Assessment having been specifically developed to meet these requirements, and the key principles of the new national eligibility framework having been incorporated into the RAS algorithm itself.

To increase transparency of the method of calculation – for which this document has been produced. The remainder of the document shows a summary of each of the steps in the FACE Version 7 RAS formula. In order to explain the approach fully, it is important to highlight that the overall RAS formula has two components:

1. The council’s individual ‘configuration decisions’ – to be considered in two distinct parts:

o The standard rates that have been agreed locally for applying to ‘units’ determined by the core algorithm. For example, the cost per hour for meeting personal care needs; the cost per ‘session’ for meeting social participation needs; the cost per night for providing ‘sleep-in’ support; the cost of residential and nursing care home placements locally.

o A number of local decisions regarding how the RAS should operate that are linked to the paid and unpaid services available within the local marketplace, including consideration of any ‘in house’ services run by the local authority. For example: Should different rates be used for people with a learning disability or people with a mental health problem, compared to older people?; How should the RAS allocate budgets for people living in ‘Extracare’ housing (where cost models tend to be bespoke and therefore not comparable to the cost of meeting the same needs elsewhere)?

2. The ‘core’ algorithm which calculates the indicative budget in a number of steps, using the local configuration rates/decisions above.


Local Rates and Configuration DecisionsDuring the implementation of the FACE RAS, information and intelligence must be collected on both the costs of different types of services locally and the local requirements for the configuration of the RAS model(s). This document is designed to capture all of the information required and therefore needs to be populated during the course of the implementation in order for FACE to set up the RAS model(s) in line with the requirements of the Local Authority being worked with.

Following ‘go live’ of the RAS, this document will act as a reference point for the decisions made during the implementation phase. It will need to be updated prior to each RAS update or recalibration to form the basis of configuration of the revised model(s) – reflecting any changes in local rates or policy since the last update.

1 Input and Output Decisions 1.1 RAS FormsOverview Assessment, Carer’s Assessment and ‘Joint Carer’s Supplement’For the latest toolset version (V7) there is a single core social care tool in the FACE Toolset which links to the Adult’s RAS for calculation – the FACE Overview Assessment V7. In addition, the FACE Carer’s RAS can be optionally purchased – for which there are two tools that can be used – the standalone Carer’s Assessment and the ‘Joint Carer’s Supplement’ (for use alongside the Overview where a carer’s needs are to be assessed at the same time as the cared-for person).

Decision: Not using FACE Carer’s RAS Use FACE Carer’s RAS via standalone Carer’s Assessment only Use FACE Carer’s RAS via standalone Carer’s Assessment and Joint Carer’s Supplement

Details:

1.2 RAS OutputsIn addition to the output of the Indicative Budget itself, there are a number of other optional outputs that can be generated by the RAS from an Overview Assessment.

1. Allocation Summary – a breakdown of the IB into high-level domains/units: Key information regarding the IB calculation (text statement; may be blank). Carrying out essential daily living tasks:

o The overall allocation for personal care, meals/snacks/drinks preparation and medication (waking hours). Note: The amount here will reflect any reduction made due to visits not needed where the safety allocation is sufficient to cover this (where constant presence/supervision is needed).

Carrying out essential daily living tasks – number of hours per week. Carrying out household tasks.

o The overall allocation for keeping home sufficiently clean/safe, shopping for food/essentials and managing paperwork/finances.

Carrying out household tasks – number of hours per week. Supplement for support of two carers.

o This covers any additional allocation for personal care tasks requiring the support of two carers.

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Supplement for night support.o The allocation for support during the night.

Supplement for night support – type of support & number of nights per week. Staying safe & social activities/relationships.

o The sum of any allocations given for safety during waking hours (for service users requiring constant presence/supervision) and social activities and relationships. These areas are combined here due to the clear overlap between the two.

Staying safe & social activities/relationships – number of days/sessions per week and number of 1:1 presence/supervision hours per week.

Engaging in work, training, education or volunteering.o This is the allocation for work/training/education/volunteering (where there

is an amount remaining after calculating any ‘offset’ with the above domain).

Engaging in work, training, education or volunteering – number of days/sessions per week.

Sustaining carer’s role (carer breaks allocation).o The allocation for ‘sustainability’ of the carer(s)’ role.

Sustaining carer’s role – number of nights per year.

2. Automatic Quality Assurance – an auto-generated list of potential scoring errors from the completed assessment which checks scores in different areas against each other for common mistakes (e.g. ‘Undressing scored higher than Dressing’).

3. CHC Checklist Mapping – a set of predictions in relation to potential eligibility for Continuing Healthcare funding, using a mapping to the national CHC Checklist.

4. Global Need Band – an overall level of need for the assessed person using bands from 0 to 6 via the FACE Global Need Scale. The need band is generated regardless of any support.

5. Prediction of Potentially Eligible Domains – an algorithm within the RAS uses the needs scores to identify each national domain as ‘potentially eligible’ or ‘no indication of eligibility’ – splitting the ten domains into two lists based on this.

Decision: ‘Allocation Summary’ required:

Key information regarding the IB calculation Carrying out essential daily living tasks Essential daily living tasks (hours/week) Carrying out household tasks Household tasks (hours/week) Supplement for support of two carers Support of two carers (hours/week) Supplement for night support Night support (type and hours/week) Staying safe and social activities Safety/social (days/activities and 1:1hours / week) Work/training/education/volunteering Work/training/education/volunteering (activities/week) Sustaining carer’s role (carer breaks) Sustaining carer’s role (nights/year)

‘Automatic QA’ required ‘CHC Checklist Mapping’ required ‘Global Need Band’ required ‘Prediction of Potentially Eligible Domains’ required

Details: Allr required with exception of Global Needs Bands which carries the risk of being confusing to assessors/customers


2 RAS Formula Summary (including specific rates and configuration decisions)

The sections that follow explain how each element of the allocation works in the context of the two core components (standard rates; local configuration decisions) – with space to record local rates and configuration decisions in each relevant section.

2.1 Personal care – morningThe independence scores for personal care morning tasks (‘Dressing’, ‘Washing whole body’, and ‘Using the toilet’) are used to determine whether a base allocation of 30 minutes daily for support with morning personal care routines is required.

1. If the only identified morning need here is for Washing whole body and the ‘How often’ score is less than daily (e.g. 3 times a week), the 30 minutes per day allocation is only given for the number of days per week needed.

2.2 Personal care – eveningThe independence score for ‘Undressing’ and the independence/how often scores for ‘Using the toilet’ and ‘Washing whole body’ are used to determine whether a base allocation of 30 minutes daily for support with evening personal care routines is required.

2.3 Personal care – adjustment for mobility/positioning difficulties

Here, the total hours per week for personal care support allocated for morning and evening are totalled. An adjustment is then made to the combined hours where:

Support is needed with mobility transfers; or support is needed with staying comfortable/repositioning; or there is a risk to self/others during transfers; or the person’s weight means mobilising takes longer.

2.4 Personal care – adjustment for memory/acceptance of support difficulties

Here, an adjustment is made to the total hours so far where:

There are often, usually or always difficulties with the person’s acceptance of support; or

There are moderate, severe or very severe difficulties with the person’s memory/orientation.

2.5 Personal care – during dayThe independence/how often scores for ‘Using the toilet’ are used to determine whether additional allocations need to be added for support with using the toilet/managing continence through the daytime – for example, if the ‘How often’ score is ‘Four times a day’ an allocation to cover the additional two visits needed per day will be added here.

Note – the base visit length for personal care support within the RAS is set to a default of 30 minutes, in line with Department of Health recommendations against using ‘shorter’ care visits. This default can be overridden if the local decision is that shorter visits are appropriate (for example, 15 minute daytime visits where the only need is for toileting support).


2.6 Personal care – support from family/friends/volunteersThe ‘Ongoing support’ scores for personal care (no. of mornings/daytimes/evenings per week) are then used to reduce the personal care allocation where family/friends/ volunteers are providing support. The overall percentage reduction made varies depending on the expected number of visits required each day.

2.7 Preparing meals/snacks/drinks and Medication supportDue to the clear overlap between support to meet personal care needs, support with preparing meals and eating/drinking, and support with medication, the algorithm does not make a separate allocation for the latter two areas.

Instead, the algorithm calculates:

Whether the duration apportioned for support times already allocated needs to be increased due to the need to prepare a meal or provide support with eating and drinking at these times (in addition to personal care) – extending the duration for these visits depending on the additional tasks needed.

Whether additional visits will be needed based on the ‘How often’ scores for ‘Preparing meals/snacks/drinks’ and ‘Taking/applying medication’ – adding an allocation to cover additional visits required for these tasks – e.g. where personal care is required in the morning only, but support with meals is needed twice/day.

For individuals who require meal/snack/drink preparation support but not personal care alongside this, a decision is needed as to the minimum duration for each instance of support. Decision:Minimum meal/snack/drink preparation support duration: No allocation 15m 30m

Details (including rationale if no allocation):

The policy around funding of the need for ‘medication pop-in’ visits varies significantly between different Local Authorities. In some cases, there is a local agreement between Social Care and Health that one or the other will provide for and fund the service to meet this need. If the LA’s policy is that they would not provide funding for situations where visits are required for medication support only, then a discussion will be required regarding whether the item ‘Taking/applying medication’ within the assessment should be weighted at zero. Analysis of sample cases will help to establish whether the LA does routinely fund this need.

Decision: Include medication only visits? Yes NoIf yes: Minimum medication support duration 15m 30mDetails (including rationale if no allocation):

Support from family/friends/volunteers with these tasks is factored in within this step.


2.8 Learning disability personal care/meals/medication adjustment

Within the RAS, there is the option for allocations to be adjusted where a service user’s predominant need arises from a learning disability. If there is a local decision in favour of this, the existing allocation for personal care, medication and meals/snacks/drinks is adjusted here using a weighting set during the calibration process based on the local data sample analysed.

Decision: Universal allocation weightings for all service users Separate allocation weightings where primary support reason is a Learning Disability

Details (including rationale if separate weightings chosen): Initially, this will be set at default and reviewed following testing.

2.9 Conversion to monetary allocationThe total hours-allocation for personal care, medication and meals/snacks/drinks is converted to a monetary figure at this stage, using the appropriate hourly home care rate that has been locally decided. This is either the default rate, the LD rate/MH rate/Extracare Housing rate if different, or an ‘Enhanced health needs rate’ (where the needs-based criteria related to high needs in the areas of breathing and consciousness has been met) – this is normally only used in the context of a personal health budgets RAS for Continuing Healthcare.

Please record the Local Authority’s hourly rate(s) for domiciliary care in the table below. The rate(s) are used in the personal care allocation steps described above.

Domiciliary Care Unit Default LD rate MH rate Extracare rate

Day time Per hour £ 15.47 £ 15.47 £ 15.47 £ 13.89

Details:

Note: The RAS is designed to ensure that money allocated for ensuring safety (as set out in the next section) is ‘offset’ against money allocated for essential daily living tasks where a service user requires constant presence/supervision during waking hours – preventing ‘double-counting. This is reflected in the ‘Allocation Summary’ details accompanying the Indicative Budget, where the amount for essential daily living tasks will be reduced accordingly in the situation where the safety allocation is covering some or all of what is needed for essential daily living tasks (e.g. removal of the value of two personal care lunch visits weekly where two safety day sessions have been allocated).

2.10 Ensuring safety – service users who cannot be left alone (waking hours)

The algorithm now calculates an amount of money to meet the safety needs of service users who cannot be left alone. This method of calculation is different for service users living in 24 hour supported living environments than otherwise.

For service users not living within 24 hour staffed supported living accommodation, the allocation is worked out based on 105 hours/week, as follows:


For weekday daytimes, 5 x relevant daily rate for safety support within local configuration (e.g. 5 x £50 per day for ‘background support’, or e.g. 5 x £100 per day for ‘1:1 support’). This is reduced based on how much unpaid support is available for safety daytimes.

Please record the Local Authority’s per-weekday rate(s) for day safety support in the table below. The rate(s) are used in the safety allocation step described above.

Day Support for Safety Unit Default Working-age

rate LD rate MH rate

Standard Per weekday (e.g. 9-5)

£ 56 £ 56 £ 56 £

High (1:1) £ 620 £ 620 £ 620 £

For the other 65 hours/week, an hours-based allocation is made, using the relevant hourly rate from the configuration reduced by the ratio between this and the local Personal Assistant rate (e.g. 20% removed if the PA rate is 20% less than the standard hourly rate). If a PA rate is not relevant, no adjustment would be made. This is reduced based on how much unpaid support is available for safety mornings/daytimes/evenings.

Decision: Allocate safety 1:1 hours at standard domiciliary care rate Allocate safety 1:1 hours at reduced (PA) rate as follows: £ 15.47 / hour

Details: .

For service users in 24h supported living, the allocation is based on the locally-determined weekly amount for ‘background safety’ – though often this is the same as for non-supported living cases. By default, the allocation is then proportionately reduced if the accommodation is shared with other tenants – although again, this is a local configuration decision to reflect local commissioning arrangements. The exception is where the safety daytime score is 1:1 (meaning the support cannot be shared so is not reduced), or 2:1 (meaning the allocation is doubled).

When costing the support packages of service users sharing accommodation within a Supported Living scheme providing 24-hour support, the standard approach taken in the RAS is to firstly determine the cost of the service user’s individual needs (as with any other case) and then determine the cost of the shared elements of support – ‘background’ support for daytime hours plus the shared element of either sleeping or waking night support – and add this on.

Separating out costs in this way allows the RAS to factor in the number of tenants within the accommodation when calculating the indicative budget. Some Local Authorities prefer not to factor ‘Number sharing support’ into the calculation as this requires determination of the living situation prior to calculating an indicative budget (i.e. pre-judging the nature of the support during the assessment).

By default, the RAS allocates the ‘baseline’ day time safety amount for a service user requiring support constantly nearby/with them at all times in the same way as for non supported living cases (described above) – but this can be overridden with a specific amount if required:

Decisions: Use default baseline allocation for day safety (see above)


Use specified weekly amount as follows: Standard: £ LD-specific: £

By default, the RAS reduces the baseline day safety allocation using standard ratios reflecting the number of tenants sharing support within the accommodation. The Local Authority is able to choose to use the defaults or define specific ratios reflecting desired local allocation practices.

Decisions:Reduction for two tenants: Use default of 50% Use specified reduction of: Reduction for three tenants: Use default of 67% Use specified reduction of: Reduction for four tenants: Use default of 75% Use specified reduction of: Reduction for five tenants: Use default of 80% Use specified reduction of: Reduction for six+ tenants: Use default of 83% Use specified reduction of: Details:

2.11 Combined allocation for personal care, medication, meals/snacks/drinks and safety

The algorithm now adds the safety allocation to the previous allocations for personal care, medication and meals/snacks/drinks using the following adjustments:

For 24h supported living cases, the full allocations are added together, as it is assumed that the safety allocation will not cover care tasks due to the shared nature of ‘background support’ in these environments.

For other service users, the full allocations are added together and an appropriate ‘offset amount’ is removed. This is calculated by removing money for care task visits where that time is already covered by the safety allocation (e.g. removing meals/personal care for 3 lunchtimes per week where an allocation for 3 safety daytimes has been made).

2.12 Personal care – support of twoAn additional allocation for personal care now takes place where the support of two people is needed for personal care task(s) – as the previous steps only account for the support of one.

Hours for a second carer in the morning/daytime/evening are allocated using the same scored areas as for the first carer, but checking which areas are scored as needing the support of two. The support-of-two allocation is subject to the same mobility and memory/orientation/acceptance of support adjustments as for the first carer.

The ‘Ongoing support’ scores for personal care are then used again to reduce the allocation where family/friends/volunteers are providing unpaid support. If the option of ‘Relative/friend is 2nd carer’ is used, this will prevent an allocation in this area.


2.13 Household tasksThe allocations for each of ‘Maintaining your home in a sufficiently clean and safe condition’ and ‘Shopping for food/essentials’ are calculated using the independence scores for each along with the local configuration decisions regarding ‘hours per week’ to give an allocation for each.

The ‘Ongoing support’ response for each area is used to remove/reduce allocations where unpaid support is being provided by family, friends or volunteers.

If support is required with either/both of ‘Managing day-to-day paperwork’ and ‘Managing finances’, the local configuration decisions regarding ‘hours per week’ for paperwork/finances support is used to give a monetary allocation for these areas. The ‘Ongoing support’ response for paperwork/finances is used to remove/reduce

allocations where unpaid support is being provided by family, friends or volunteers.

Allocation within the RAS for support with household tasks is a variable area and often dependent upon local availability of ‘Universal Services’ (such as Voluntary shopping services). This means that an analysis on what is available locally, and at what cost, is required in order to establish whether these areas within the RAS might need to have weightings set at zero on the assumption that a Universal Service will meet the need. The Care Act 2014 does not set out managing paperwork/finances amongst its eligible outcomes, though many LAs do fund support for these areas. The RAS therefore offers the option of including or excluding from the allocation, making this a local decision.Decisions:Allocate for ‘Maintaining home in a sufficiently clean/safe condition’? Yes No Allocate for ‘Shopping for food/essentials’? Yes No Allocate for ‘Managing paperwork/finances’? Yes No Details (including rationale if no allocation): Possible bespoke element required: no allocation for maintaining home for service users who are to receive 10.5 hours or more domiciliary care per week (Hammersmith & Fulham suggested). Look at allocations/time planned for laundry during testing.

Within the RAS, there is the option for the allocations relating to household tasks to be adjusted where a service user’s predominant need arises from either a learning disability or a mental health problem. If there is a local decision in favour of this, the existing allocations for Maintaining home/Shopping for food/essentials, and for Managing paperwork/finances are adjusted here using weightings set during the calibration process based on the local data sample analysed.

Decision: Universal allocation weightings for household tasks for all service users Separate allocation weightings where primary support reason is LD/MH

Details (including rationale if separate weightings chosen): Initially set to default and reviewed following testing.


2.14 Social, leisure, cultural and spiritual activitiesThe scores from the ‘Social relationships and activities’ section (‘Support needed’ and ‘How often’) are used to give a monetary allocation to fund support with social, leisure, cultural and spiritual activities. The first score is used to determine the level of support needed (local configuration determines rates for ‘background’, ‘1:1’ and ‘transport only’). The second score is used to determine the number of activities needed (the default being 0, 1, 2 or 5 activities per week, with the option to override these within the local configuration).

For service users requiring provision aimed at meeting needs regarding social activities and relationships (such as one or more days at day care or a number of hours of Direct Payment monies), an allocation decision must be made for each of the need levels on the Social activities need item (attaching a weekly number of activities to each of the levels – with the monetary allocation then being calculated using the Social rates defined in the table below). The levels and defaults are shown below:

Occasional support needed (less than weekly) – Default allocation = zero Weekly support needed with an activity – Default allocation = cost of one activity per week Regular support needed (e.g. 2-3 activities/week) – Default allocation = cost of two

activities per week Daily support needed (e.g. 5 activities/week) – Default allocation = cost of five activities

per week

Decision: Use defaults Use bespoke configuration

Social activities(e.g. day care or 3h with a

PA)

Unit Default Working-age rate LD rate MH rate

Transport Per activity (Transport for return journey)

£ 0 £ 0 £ 25 £ 0

Shared £ 45 £ 45 £ 55 £

1:1 £ 45 £ 45 £ 55 £ Details (including rationale if no allocation):

The ‘Ongoing support’ score for ‘Social, leisure, cultural and spiritual activities’ is then used to reduce the number of activities given where unpaid support is being provided by family, friends or volunteers (effectively only allocating for the difference between the total activities required and the activities supported by family/friends/volunteers).

An adjustment is then made (where relevant) with regard to any previous allocation for ensuring safety, to prevent ‘double counting’ (i.e. where the allocation for ensuring safety has been sufficient to cover some or all of the identified social activities needed).


2.15 Work, training, education and volunteeringFor this area, the allocation is identical to the above method for allocating ‘Social, leisure, cultural and spiritual activities’, but using the two corresponding scored items from the ‘Work, training, education and volunteering’ section.

For service users requiring support with work, education, training or volunteering activities, a decision is needed as to whether to include this within the indicative budget, and if so, whether the allocation should ‘overlap’ with any allocation generated for social activities and relationships, to prevent ‘double-funding’ of needs. If funding is to be within the RAS, the monetary allocation will be calculated using the work/training/education rates defined in the table below.

Decision: No work, education, training and volunteering allocation Work, education, training and volunteering allocation – overlap with Social allocation Work, education, training and volunteering allocation – no overlap with Social allocation

Work, training & education Unit Default Working-age


Transport Per activity

(Transport for

return journey)

£ 0 £ 0 £ 25 £

Shared £ 45 £ 45 £ 55 £

1:1 £ 45 £ 45 £ 55 £

Details (including rationale if no allocation):

As per the previous section, an adjustment is made (where relevant) with regard to the allocation for ensuring safety, to prevent ‘double counting’.

Additionally, if the decision above is to ‘overlap’ the work/training/education/ volunteering allocation with the social allocation, an allocation for work/training/ education/volunteering will only be made where the number of activities where support is needed exceeds the number of social activities where support is needed (e.g. if five work/training/education/volunteering activities are needed and one social activity is needed, an allocation for four activities would be made in this section).

2.16 Total of daytime needs allocationsThe allocations for ‘Personal care’, ‘Meals/snacks/drinks’, ‘Medication’, ‘Safety’, ‘Support of two’, ‘Household tasks’, ‘Social, leisure, cultural and spiritual activities’ and ‘Work, training, education and volunteering’ are then totalled – giving an overall allocation for waking hours.

2.17 Care home adjustmentAn adjustment may be made at this point for service users living in a care home to account for the nature of the environment (controlled by a weighting set during the calibration process).


2.18 Night support allocationIf the score for ‘The support you need to stay safe at home during the night’ indicates support is needed, an allocation is made based on the level chosen (the amount to be allocated for each level of need is a local configuration decision). The allocation is also based on the living situation in the assessment (i.e. whether the support setting is independent living, supported living or a care home – which can all have different rates). Separate rates can also be chosen for LD and MH cases – used here where relevant.

By default, the RAS includes night support allocation for service users needing this and living in the community. Some LAs operate a local policy which states that they would not fund night support for community-based service users, other than in exceptional circumstances, but it may still be desirable for the RAS model(s) to include night support in order for a comparison to then be done against the cost of supported accommodation – or the LA may wish the night support element for community cases to be removed, on the basis that it would not routinely be provided within a PB.

Decisions:Include pop-ins? Yes No Include sleep-ins? Yes No Include wake & watch? Yes No Details (including rationale if no allocation): Policy with London boroughs that no pop-in visits past 10pm.Please record the Local Authority’s rate(s) for night support within independent living settings in the table below. The rate(s) are used in the night allocation step described above.

Domiciliary Care (Independent Living) Unit Default LD rate MH rate

Night Per visit £ 0 £ 0 £ 0

Sleep-inPer night

£ 50 £ 50 £

Waking £ 140 £ 140 £

Please record the Local Authority’s rate(s) for night support within 24-hour staffed supported living in the table below. These are the ‘baseline’ rates for those requiring sleep-in/waking night support. Decisions:

By default, the RAS will reduce the baseline day safety allocation using standard ratios reflecting the number of tenants sharing support within the accommodation. The Local Authority is able to choose to use the defaults or define specific ratios reflecting desired local allocation practices.

Decisions:Reduction for two tenants Use default of 50% Use specified reduction of: Reduction for three tenants Use default of 67% Use specified reduction of: Reduction for four tenants Use default of 75% Use specified reduction of: Reduction for five tenants Use default of 80% Use specified reduction of: Reduction for six+ tenants Use default of 83% Use specified reduction of: Details: Awaiting rates

The ‘Ongoing support’ score for ‘Supporting you during the night’ is then used to calculate a percentage reduction (if relevant) for needs met through unpaid support.


Rate per week

Sleep-ins Waking nights

£ 40 £ 140

2.19 Living situation cap and additionDepending upon local decisions, the allocation may be ‘capped’ at this point if the living situation is a care home, a Shared Lives setting, or involves a live-in care worker, as it is common for standardised rates to be supplied and configured for each of these (including client group specific variants where relevant).

Whether to include service users moving into/already residing in Registered Homes is a key decision for a RAS implementation. As of June 2015, legislation does not allow for a Direct Payment to be given in lieu of commissioning a placement, but there are pilots underway to explore this as an option. Nevertheless, an LA may still wish to use the RAS to generate Indicative Budgets for service users in this category in order for the figure generated to act as the basis for negotiation on cost.

The item ‘Anticipated living situation’ captures the nature of the accommodation in which the service user will be living when they receive their support – including residential/nursing options.

Default rates for residential and nursing homes can be chosen together with separate dementia rates, which would be applied instead of the non-dementia rates where the assessment indicates the presence of dementia together with sufficiently high scores in the ‘Your mental health and well-being’ section. These rates then act as a ‘cap’ in the RAS (to bring down the allocation to the appropriate standard rate for a Registered Home). Please record the Local Authority’s standard rate(s) for care homes in the table below. The rate(s) are used as caps in the way described above.

Care Homes Unit Default Working-age rate LD rate MH rate

Residential Per week £ 645 £ 900 £ 1400 £

Residential Dementia Per week £ 695 £ 695 £ 1400 £

Nursing Per week £ 795 £ 795 £ 1400 £

Nursing Dementia Per week £ 805 £ 805 £ 1400 £

Details: Residential £615 - £670 per week

Res. Dementia £675 - £715 per week

Nursing£770 - £815 per week

Nursing Dementia £795 - £815 per week

Working age rate is for physical disability residential.

For Shared Lives cases, the standard rate may only include support for safety during the day/night, it may also include support for personal care/meals/snacks/drinks/medication/household tasks, or it may include all support (including for social/leisure/cultural/spiritual activities and work/training/education/volunteering activities). This choice should be indicated below in order for the RAS to be set up correctly in terms of whether allocation on top of the standard rate is made.

Shared Lives Support Default LD rate

Basic weekly rate for provision of background support and on call support at night if required. £ n/a £

Decision: Shared Lives standard rate includes safety day/night support only Shared Lives standard rate includes safety day/night support and support for ADLs also, but not

support for social/leisure/cultural/spiritual activities and work/training/education/volunteering activities


Shared Lives standard rate includes all support (i.e. standard rate is a definitive cap)Details: Awaiting rates

For live-in care worker cases, the standard rate automatically includes all elements of support with the exception of where the support of two carers is required for personal care/mobility tasks (in which case the allocation for this is added to the standard rate, as this would not be covered by a single live-in care worker).

Please record the Local Authority’s standard rate(s) for live-in care in the table below. The rate(s) are used as caps in the way described above.

Live-in Carer Support Default LD rate

Standard weekly rate for employed live-in carer to include on call support at night if required. £ 850 £ 850

2.20 Sustainability allocation (i.e. respite breaks)If a ‘Yes’ response is given to the item ‘Are full breaks (through the year) required to sustain the ongoing caring situation?’ and the ‘Ongoing impact on main supporting family member/friend’ item is scored at level two or above (‘significant restriction on activities’), this indicates that the support provided by the main carer is not sustainable without an additional allocation to pay for breaks.

The calculation for this is based on a financial measure of how much input the main (unpaid) carer is providing weekly (i.e. how much their input ‘saves’ the Local Authority), combined with the impact on their independence. A number of local configuration decisions are reflected here (including the agreed maximum annual allocation and standard per-week rate(s) for default/high need service users, which may be different depending on the primary reason for needing support and age band, if the local authority has determined this to be appropriate).

FACE has developed a standard methodology for allocating this money which takes into account how much support the main carer provides, the impact on their independence and the Local Authority’s decisions on standard weekly rates and maximum annual allocations (see table below). Using this method, the amount to be added weekly is calculated as:

((‘IB disregarding main carer’s input’ - ‘IB’) X impact score X local weighting) ÷ 52.14The ‘local weighting’ here is calculated by FACE based on the standard rates and maximum allocations supplied by the local authority (and, where possible, through analysis of sample cases with existing short break provision) – as part of the RAS calibration process.

Decision: No short breaks allocation Use carer input value methodDetails (including rationale if no allocation): LD rate is same as spot purchase average. Respite resource is not funded by budgets directly but is block grant. most users use this and will not require a budget.

Carer breaks (respite) Unit Default Working-age


Standard Per week £ 645 £ 645 £ 1400 £ tbc

High need Per week £ 805 £ 805 £ 1400 £ tbc

Annual maximum Weeks per 6 weeks 6 weeks 7 weeks 6 weeks


year


2.21 Overall high-end cap and minimum budget adjustmentThe final step in the calculation process is (where locally decided) to ‘cap’ the overall allocation to the locally-determined maximum weekly amounts representing how much the organisation is prepared to allocate through the RAS (which may be different depending on the primary reason for needing support and age band, if the local authority has determined this to be appropriate). Additionally, if a minimum budget figure has been chosen (e.g. the cost of one hour per week), the final budget figure will be ‘topped’ up to the minimum at this stage.

The application of ‘caps’ within a RAS is a long-debated and contentious topic, and significant differences in practical applications exist between different Local Authorities. It is possible for the RAS model to be configured with cap(s) to prevent allocation above what the LA is prepared to fund within the RAS.

One common example is capping to the cost of a Registered Home – many LAs now are taking the decision that they will not fund needs above this level – and if the service user wishes to remain within the community, an offer of the equivalent amount as a Direct Payment is made – with the implication being that any top-up required must be sourced from other funding streams. The difficulty in enforcing this rule is that this hasn’t been the case in the past, meaning that there are always existing service users with care packages costing more than the amount of the cap (e.g. people with their own live-in carer).

Regardless of policy, it should be noted that applying a cap can actually deplete the usefulness of a RAS, as it means that it is not possible to see ‘what the budget would have been’ – useful information (e.g. knowing the discrepancy is £10/week rather than £300/week may heavily inform decision-making on final allocation).

Allocation Cap

Unit Default Working-age rate LD rate MH rate

Per weekUse highest care home rate

OR £

Use highest care home rate

OR £


OR £


OR £

Details (including rationale for any caps chosen): No caps to be applied. Decision reviewed following testing.

2.22 Adjustments relating to National Eligibility FrameworkFollowing the calculation of the indicative budget, the RAS algorithm will then use the responses given within the ‘Eligibility Summary’ section of the Overview Assessment (where these have been supplied) to ensure that the allocation reflects the Local Authority’s determination of eligibility. This is done in two parts: For each of the 10 national eligibility domains, if the response in the summary

section is ‘Yes’ to the question ‘Can you do this alone and without significant pain, distress, anxiety, or risk to yourself or others?’, any allocation relating to that domain will be removed, as there is not an eligible need for that area.

If the response is ‘No’ or ‘Not applicable’ to the question ‘Is there, or is there likely to be, a significant impact on your wellbeing?’, the overall indicative budget is automatically set to £0, as overall eligibility has been determined as ineligible.


Documents

€¦ · Web viewFACE Recording & Measurement SystemsIssue Date: DATESecurity: RestrictedIssue No: 1Reference ID: IDPage: 0. Reference ID: IDIssue Date: MM/DD/YYYY. Issue No