Equipment Provision by Local Authority Occupational Therapy Teams Using the Fair Access to Care Services Eligibility Framework: A Vignette and Interview Study

Abstract

The provision of adaptive equipment to older people living at home maintains and improves independence and reduces health and social care costs (Logan et al 1997, Mann et al 1999). Physical disability is the best predictor of adaptive equipment use (Tomita et al 2004). Despite legislation that attributes the statutory responsibility for such services to local authorities (National Health Service and Community Care Act 1990), the Audit Commission (2000) has found that provision is inadequate and geographically variable. Questionnaire and interview studies have shown that provision is influenced adversely by inconsistencies in referral mechanisms, eligibility criteria and funding (Cowan and Turner-Smith 1999, Carpenter et al 2002). This led to the first national eligibility framework for adult services and, in April 2003, Fair Access to Care Services (FACS) (Department of Health 2002) was implemented. The assessment criteria focused on the person's autonomy, health and /or safety, management of daily routines and /or the person's ability to maintain meaningful participation in family or community life, all considered vital aspects of independence. The eligibility framework is graded into four bands, which describe the seriousness of the risk to independence for the individual or other consequences if needs are not addressed. The four bands are summarised as follows

An Evaluation of the Use of Self-Assessment for the Provision of Community Equipment and Adaptations in English Local Authorities

“…That differences between people receiving self and traditional assessments were mostly modest suggests that selfassessment may be appropriate for many of the relatively independent service user group who access community equipment and adaptations. Moreover, self-assessment would appear to have the potential to engage a new, less vulnerable group of people not traditionally served by social services, so contributing to the preventative agenda, something many therapists will welcome (Sackley et al 2009). This does not mean that self-assessment will be appropriate for everyone, however, and people with more complex needs may, in particular, continue to be better served by a professional assessment.…”

The Effectiveness of Local Authority Social Services' Occupational Therapy for Older People in Great Britain: A Critical Literature Review

“…However, several authors have recommended what needs to be done in terms of evaluation in future. In relation to policy implementation, Ridout and Mayers (2006) called for more active auditing in order to evidence the client-centeredness of occupational therapy practice in the light of the single assessment process (SAP); Sackley et al (2009) pointed to a lack of audit of the use of eligibility criteria. In order to evidence effectiveness across services, Skelton (2006) suggested that a comprehensive database of occupational Gail Boniface, Margot Mason, Jacqueline Macintyre, Christine Synan, and Jill Riley therapy services and staff in local authorities was needed.…”

“…Fair Access to Care Services (FACS) inEngland (Lett et al 2006, Sackley et al 2009, services remained variable and localized(Lett et al 2006). In addition, the high referral rates, which contributed to lengthy waiting lists for occupational therapy services in many authorities impacted on staff morale(Hunt and Cook 2001, Wilson 2010), which, in turn, affected professional autonomy and, consequently, the perceived effectiveness of occupational therapy intervention and service delivery.…”

Waiting list management practices for home-care occupational therapy in the province of Quebec, Canada

“…Delayed access to occupational therapy also hinders the possibility of providing prevention and health promotion interventions before accidents happen (Sackley et al . ), and may lead to increased utilisation of other services during the waiting period (Canadian Association of Occupational Therapists ).…”