This guidance is for all providers of adaptations, aids and equipment, to enable people to live safely and independently in their own homes.
Purpose of this guidance
During the current public health emergency, providers of adaptations and equipment in people’s homes should prioritise activity which supports the acceleration of safe transfers of care from hospital to the community.
This guidance is for all providers of adaptations, aids and equipment, to enable people to live safely and independently in their own homes. This includes:
- Care and Repair agencies
- local authorities
- Registered Social Landlords (RSLs), including Large Scale Voluntary Transfer (LSVT) organisations
Links to additional government guidance are highlighted in the text.
The public health emergency created by the spread of COVID-19 means that health and social care services are now subject to unprecedented demand. Reducing delayed transfers of care has always been an objective of adaptations services, but accelerating the discharge of hospital patients as soon as it is clinically safe to do so is now a key priority. This will help free up hospital beds to meet to the current and expected rise in patients who contract COVID-19.
However, transfers of care from hospital to the community can be hampered by homes which lack necessary aids and adaptations to allow patients to return to safe and accessible environments. The urgent provision of these services by care and repair agencies, local authorities and RSLs can help accelerate transfers of care during this period.
Care and repair agencies
Care and repair agencies operate in all local authority areas of Wales. They are funded by the Welsh Government as Home Improvement Agencies, through the Hospital to a Healthier Home (H2HH) pilot operating in a number of key hospitals and through the Rapid Response Adaptations Programme (RRAP).
In order for care and repair agencies to escalate this work and facilitate an increase in their capacity to enable the safe discharge of vulnerable individuals from hospital to home, or to prevent hospital admissions in the first place, agencies will be expected to:
- prioritise the H2HH scheme, utilising available capital funds for this programme to maximise hospital discharges and reduce delayed transfers of care
- utilise the RRAP capital funding as necessary to facilitate and further extend the discharge of individuals from hospital or step down facilities to a safe home environment or to prevent a hospital admission
The Welsh Government has provided additional grant flexibilities for local agencies to draw down capital funding in order to respond to local need.
As Home Improvement Agencies, we expect care and repair agencies to work with partners and stakeholders, including local authorities, the NHS and third sector organisations to maximise and share resources in relation to local resilience plans and to further support vulnerable and older people as far as possible, within their respective communities.
Regional Partnership Boards (RPB) have been advised by the Welsh Government of increased flexibilities in relation to the Integrated Care Fund (ICF) capital programme, including investment in COVID-19 related step up/step down facilities, purchase of equipment and the provision of aids and adaptations. RPBs decide how this flexibility is to be exercised in their region. Care and repair agencies are advised to liaise with RPBs to maximise the potential of this funding to accelerate safe hospital discharges.
Local authorities provide aids and adaptations through the Welsh Government ENABLE grant programme, through statutory Disabled Facilities Grants (DFG) from their own resources, as well as discretionary grants and loans.
The ENABLE grant programme is currently used by local authorities to provide housing adaptations in their area in partnership with their key partners. This funding has been used to provide additional resources to help people live independently where provision had not existed. In determining priorities, local authorities are encouraged to undertake discussions with local partners including Local Health Boards, RSLs and Care and Repair agencies, as required by the existing grant terms and conditions.
Our priority is to ensure that unless required to be in hospital, patients must not remain in an NHS bed. For the duration of the public health emergency we encourage local authorities to ensure funding is directed towards activities that alleviate pressures on the health service, including discharge from acute care and step down facilities. Therefore, we expect to see an urgent and increased focus on housing adaptations that support hospital discharge, and which support individuals who are vulnerable to the Coronavirus to continue to live independently and safely at home. Both ENABLE and DFG funding may be used for this purpose.
Registered social landlords (RSLs), including LSVTs
RSLs provide adaptations through the Welsh Government’s Physical Adaptations Grant (PAG) scheme. LSVTs provide adaptations through their own resources, including dowry funding provided by the Welsh Government, and through other means.
As is the case with local authorities and Care and Repair agencies, our priority is to ensure that unless required to be in hospital, patients must not remain in an NHS bed. For the duration of the public health emergency we encourage RSLs and LSVTs to ensure funding is directed towards activities that alleviate pressures on the health service. Therefore, we expect to see an urgent and increased focus on housing adaptations that support hospital discharge, and which support individuals who are vulnerable to the Coronavirus to continue to live independently and safely at home.
In addition to the priorities noted above, there will be demands on all organisations to respond to emergencies which threaten the ability of people to remain in their own homes, e.g. a boiler breaking down, or a water leak. As such emergencies may adversely affect the health of residents, providers should continue to respond to these situations as quickly and safely as possible.
The Welsh Government recognises the difficulties that adaptations providers face in the current circumstances. These include reduced staff capacity, access to specialist equipment and building supplies, and the hazards associated with undertaking assessments and works safely in the homes of people who are shielding or self-isolating.
Access to residents’ premises should be restricted by limiting the number of staff attending each project/scheme, and strict adherence to cleaning and infection control guidance, in order to reduce the possibility of exposure. Personal Protective Equipment (PPE) should be used in line with guidance from the Welsh Government and Public Health England jointly with Public Health Wales. We are aware that access to adequate PPE at this time can be problematic, especially for third sector organisations. We are working with partners to resolve these issues and we will issue specific guidance on PPE shortly.
This guidance will be kept under review. We will provide further guidance if the evolving situation requires additional measures. We will also work to ensure that where best practice is identified, this is disseminated across Wales.
Advice on COVID-19 is updated regularly and available on the following websites:
Any queries should be sent to: IndependentLiving@gov.wales