Robin Tuffley, Closomat, looks at the options that give provider and client best value- and not just in £
Would you like someone to wipe your bottom? 
In my line of work, I sometimes sound like a stuck record saying that. It’s also one of those things that cuts both ways- equally, would you like to have to wipe someone’s bottom?
It is a British peculiarity that we don’t have serious conversations about using the toilet. Service providers and clients alike are reluctant to raise it, yet it is one of the five Activities of Daily Living (ADLs) that justify provision of social care support.
But which solution justifies best value? It depends on each individual client, and to what extent they need care support. If the main “need” is toileting support, then the maths clearly proves best value for everyone involved is achieved by providing kit (https://www.closomat.co.uk/resources/cost-of-care.html). It also means care staff can be deployed where they are most needed.
Care v kit package:
- care package (1 or 2 carers to assist, equivalent of 2 hours/day, 7 days/week, 365 days/year)
- Provision of a shower/wash and dry toilet aka Closomat Palma Vita
- Provision of a shower toilet and toilet lift aka Closomat Palma Vita and Aerolet toilet lifter
‘Year of care’ costs:
- Care package: £15/hour = £10,950 pa* ongoing cost
- Provision of a shower toilet i.e. Closomat Palma Vita: £2660 one-off cost
- Provision of a shower toilet (Palma Vita) and toilet lift (Aerolet): £5735 one-off cost
So, if the social care provider funds the equipment, four people can be helped for the cost of providing one carer to do the same task. Surely that gives better value?
Potentially, the cost benefit for the social care provider is even greater, equivalent to £0.
Government funding available
Provided certain criteria are met, the client could apply for a Disabled Facilities Grant (DFG) from the local council. The grant is mandatory, if the client has an assessed need at the point of application, and can be up to £30000 to make alterations that are “necessary and appropriate” and reasonable and practical”.
The client can apply personally, or a landlord on their behalf (again assuming certain conditions apply). The council can also instigate a Regulatory Reform Order (RRO), to provide more flexibility in the way the DFG is applied in their area, according to their own local needs. This may include such measures as removing the means test for adaptations up to a certain value, for certain types of adaptation, or to add discretionary top ups to the statutory maximum of £30,000
The RRO also gives the council the flexibility to fund preventative adaptations.
Such orders can also be used to deliver a preventative solution. (https://www.foundations.uk.com/dfg-adaptations/dfg-regulations/the-regulatory-reform-order/)
Foundations, the national body for home improvement agencies (HIAs), says greater take-up of the Grant would free up significant social care resource to assist those where provision of kit is not a stand-alone solution. The RRO provides councils with the powers to maximise flexibility to optimise the DFG fund for the benefit of vulnerable and disabled people.
Cost to health & wellbeing
How do you put a price on independence? On staff health & wellbeing?
Time and again, Closomat users reiterate the psychological advantages of regaining their independence, of not having to rely on someone to help them ‘go’, to wipe them afterwards, nor worry that they have not been able to clean themselves effectively.
Manual handling is the most common cause of injury to care staff. And, as I said earlier, how would you like to wipe someone’s bottom? It is a function we all do as rote, but it is complex in terms of gross and fine motor skills, in terms of balance, load-bearing, and flexibility.
That can also lead to risk of exposing the client to risk of falling.
There is also the issue of the consistency of clean, regardless of who is wiping. Have they managed to clean every skin fold, remove every trace of urinary or faecal contamination? Residue can lead to skin complications. Unless hands are washed thoroughly it can transfer to others.
All of these have health implications, which can impact significantly on NHS costs.
So look beyond the bottom line to achieve best value- you do, after all, have a duty to achieve that, for you and your clients.
