HFH Healthcare Update: 1st Edition 21.05.20
HFH Healthcare Update: 1st Edition 21.05.20
Welcome to our first HFH Healthcare Update in which we share case studies with the MDT to demonstrate how we work in partnership with commissioners to support our clients with complex clinical health care needs.
Today we would like to share with you:
How during the Coronavirus pandemic HFH have been working in partnership with the London CHC Teams/CCGs and hospitals to ensure safe and timely discharges from hospital, creating additional bed capacity and providing a safe and financially viable alternative to nursing home placement.
Who we are:
HFH Healthcare is a specialist pan-London provider for CHC adults and children with complex medical conditions in their own home. Our objective is to provide our clients risk managed, personalised support, empowering them to live the life they choose beyond their clinical care needs.
Our value proposition to CHC Commissioners is high quality, patient centred care with significant savings when safely stepping down nurse delivered packages to HFH Core Carer Teams. The client cohorts we support includes, but is not limited to:
Alongside our personalisation and risk management approach, we have adapted our assessment and onboarding process to accommodate COVID-19 precautionary measures. Over the next few weeks we will be sharing some of our client and safe care case studies with you.
We hope they will give you an increased insight into how we work with you to support our clients. If you have any questions or wish to discuss any potential referral assessments, please do not hesitate our experienced Lead Nurses via our referral contacts:
Refer or Review:firstname.lastname@example.org t: 0208 605 97 14
Client Case Study 1:
Successful Complex Clinical Care Hospital Discharge to Home, During C-19 Pandemic
The following case study demonstrates a successful safe discharge home from hospital within 4 days by adapting our normally assessment and onboarding processes by working innovatively and in partnership with our commissioner and healthcare colleagues.
Towards the end of February 2020 there was a significant drive to discharge patients from hospital in preparation to manage the COVID-19 crisis. HFH were contacted about a gentleman with a degenerative disease and a tracheostomy who had been admitted from a Nursing Home to Guys and St Thomas Hospital two months previously. It was not possible to discharge him back to the Nursing Home. Normally complex discharges home take in excess of 2 weeks to organise across home care provider, family, hospital, CHC, commissioner and community based services. Would it be possible for HFH for enable him to be discharged to his home and partner in 3 days?
To add to the complications, there were concerns about COVID-19 infection within the hospital, so would it be possible for us to achieve a safe discharge without carrying out our normally face-to-face clinical assessment within the hospital?
We knew we had a group of carers available from which we could build and train the team to support this client. So our immediate answer was, “let’s work together to see what we can achieve”.
Our Care Co-ordinators started to contact potential care team members. Within 48 hours our Clinical Team had detailed discussions with the CHC Nurse and the ward team and the clients designated Nurse Case Manager met with him via the telephone to discuss his needs and wants. The Nurse Case Manager also spoke with the clients’ partner to understand what she needed and understand what was needed in their home.
Having obtained all this important information our Nurse Case Manager developed an initial Care Plan for the client and a training programme for the Carers. This was discussed with our Care Co-ordinators, who then contacted available carers who it was felt would best fit with the client.
Four days after first being contacted about this client, his HFH Nurse Case Manager and day and night carers were present with our clients’ partner to welcome him home from hospital.
As a team around the client, they worked to settle him and make sure all the additional support he needed was in place. This included training and orientation for the carers to understand and meet the clients’ needs and how to fit in with the client and his partner in their household. The night carer left to go home to sleep and the rest of the team worked with the household, CHC Team and Ward staff to make sure everything was in place and including arrangements for replacement stock and supplies essential for his wellbeing. They worked with a member of the ward team who dropped in some additional equipment and medication on their way home.
Our Nurse Case Manager contacted or visited the family and carers every day for the first few days to check on progress and amend care plan and needs. Together they identified our client was a “night owl”, so his Carers developed a “quiet” morning handover of shift and his daily routine was amended so that personal care was later, at about 11am. The best way to ensure safe private time for our client and his partner, with the carer in the flat and available if needed for clinical support, was also organised. Any initial difficulties were discussed with their Nurse Case Manager and resolved, and our client and his partner rapidly developed trust in their care team.
The Nurse Case Manager visits and calls reduced to 3 a week, with the client able to contact if concerned. It is now more than 6 weeks since has now been home and is progressing well. Their Nurse Case Manager is in contact with both the family and the CHC / Commissioner every week.
Safe Care Case Study 1:
In late February 2020 the HFH team realized that the COVID -19 had the potential to be a prolonged period of challenge to provision in care. Our contingency planning should there be a significant reduction in availability of Carers needed to be more robust. We felt the standard Red Amber Green assessment criteria was not sensitive enough to define priorities. We therefore developed and implemented a bespoke risk ranking system – Client Exceptional Care Arrangements (ECA):
Stage 1: Client ECA Assessment
- E - It is essential that a careris with the client at all times due to condition or geography: e.g.Trache/vent, client home is isolated with no carers living nearby, cannot be managed through contingency plans in approaches C & A
- C - Arrangements are in place for carer cover be provided through family / Next of Kin in exceptional circumstances: plans agreed with the client need to include named individuals and their contact details, and for how long a time period can this be safely achieved
- A - The client can be safely supported with some gaps in carer support in exceptional circumstances: plans agreed with the client need to define the duration & timing of the potential gaps enabling HFH carers to potentially support two nearby clients with the same carer.
e.g. Alternating 12 hour time periods would allow HFH carers and family to co-ordinate cover, with HFH providing full 24 hour support 1 day in 7 so that the family have rest periods and between us we maintain safe support
Stage 2: Carer team ECA-CT Assessment
Alongside the client risk assessment, we reviewed the core carer team to identify which carers live within a 45 minute walk of their client or are able to use their own personal transport. We assumed these will be able to work providing they are fit and well. This enabled us to identify what gaps in cover are likely and how they might be managed from within the team – ECA-CT:
ECA-CT definitions for clients supported by carers working shifts:
- ECA – CT - In the event of no public transport carer is able to travel to and support this client.”
- ECA – CT - In the event of no public transport carer is NOT able to travel to and support this client BUT is able to support a different client within 45 minutes walk of their home
ECA-CT definitions for clients supported by Live-In carers:
By client – review the core carer team to identify
- The town and country in which they live when not working for HFH
- Their usual mode of transport to and from Live-in placement (plane, train, car, etc)
Stage 3: Client Carer support Contingency planning:
The resulting information is pulled into one view on our information management system HFH Interactive (HFHi), giving a clear overview of client support need and robustness of care team and the ability to target contingency planning actions to be taken by the Nurse case Manager and Care Co-ordinator for each client and their carer team.
This view has also been used to reassure Commissioners on contingency actions.
This approach was launched on 4th March 2020 with a full and clear understanding of risk and emerging contingency plans by 23rd March 2020.
Between 23rd March and 10th May 2020, across the 130 clients supported by HFH there have been 10 shifts out of +/- 12,000hrs of contracted care, where the scheduled Carer has had to cancel at short notice and the client Exceptional Care Arrangements have been implemented. In 9 of the 10 cases the family chose to support the client in preference to a skilled HFH Carer who was available but not already known to them providing the support.
The ECA process is now a key aspect of contingency planning for the HFH Business Continuity Plan. It is being incorporated into new client assessment, onboarding and monthly Virtual Care Round reviews for all clients and their core carer teams.
We hope you have found this information helpful.