7 Costs/Benefits of Re-ablement
Introduction
7.1 An important element of the overall evaluation of the new re-ablement service is to assess the costs of the new service in comparison to the non-re-ablement/traditional home care service. In order to do this, our evaluation compared the costs of a group of 90 clients who had undertaken the re-ablement to an equivalent 90 control group clients in the non-re-ablement/traditional home care service.
7.2 The costs include:
- Weekly Care Costs (Social Care Worker/Home Help/Independent Sector)
- Management/ supervisory and Administration costs
- Weekly OT Costs
- Training Costs (where applicable)
Costs of Re-ablement
Social Care Workers, OTs and management and administration costs
7.3 Costs have been calculated for the 90 re-ablement clients who started and completed re-ablement. Based on the Weekly Domiciliary Care Monitoring summary over a 4 month period, on average 33.75 social care workers have been employed in re-ablement in the South East. As stated previously, from the re-ablement dataset, there were 115 re-ablement clients who made up the evaluation cohort. Our group of 90 re-ablement clients account for 78.3% of these 115 clients. We have therefore apportioned 78.3% of the 33.75 social care workers to the costs of the 90 clients. The weekly costs of the 33.75 social care workers are £14,573. (This is based on a weekly cost per social care worker of £431.79 which is based on the mid-point on the salary scale for a social care worker including all employer costs. This approach to weekly salaries has been applied to all posts). 11 Based on the allocation of 78.3% of social care workers to the 90 clients, the weekly costs associated with these clients is £11,411. Over the six week period, this amounts to £68,463
7.4 Total average weekly cost for OTs (2.6 FTEs) is £1,703. As above, we have apportioned 78.3% of OT costs to the 90 clients. Therefore the weekly OT costs for the 90 clients are £1,334. Over the six week period, this amounts to £8,002.
7.5 The following are the annual costs attributed to the management structure of re-ablement .
- Home Care Service Manager £45,777 @ 0.5
- Home Care Co-ordinator £30,716 @ 3.5
- Home Care Organiser £23,868 @1.5
- Admin Worker £19,790 @1.7
7.6 Using these figures the costs for all the administration, management and supervisory staff for the re-ablement service calculated on an annual basis is £199,840. On a weekly basis, this amounts to £3,843. As above, we have apportioned 78.3% of management and administration costs to the 90 clients. The weekly management and administration costs associated with the 90 clients are £3,009. Over the six week period, this amounts to £18,055.
Training costs for Re-ablement
7.7 In terms of training costs, there are several elements that need to be taken into account:
- Time costs for the social care workers who attend the course
- Admin Set up costs
- Cost of Trainer
- Cost of OT input to training
7.8 The costs associated with the above are listed in the table 7.1 below. Costs have been calculated per social care worker and are one-off costs based on an average attendance of 20 social care workers per course. The social care worker costs are based upon 13 hours attendance over the 2 days of training. The Admin set up costs are based upon 1 hour of support. OT input is based upon 3 hours of support per course.
Table 7.1 Training Costs for social care workers
Training costs per social care worker | Costs |
|---|
Time costs per social care worker | £151.71 |
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Admin set up costs | £0.54 |
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OT Training Input | £2.43 |
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Trainer costs | £36.56 |
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TOTAL | £191.24 |
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Total costs for Re-ablement
7.9 In total, the costs for the 90 re-ablement clients over the six week period which include social care worker costs (£68,463), OT costs (£8,002) and management and admin costs (£18,055) are £94,520. This computes to an average cost per client over the 6 week period of £1,050. One off training costs of £191 per social care worker should also be noted.
Costs of Control Group
Costs of social care workers and home help hours
7.10 Costs have been calculated for the 90 control group clients over a six week period. On average 51.75 social care workers and 129.75 home helps have been employed in the South West area. These workers care for an average of 450 clients per week based on figures from Weekly Domiciliary Care Monitoring summaries over a 4 month period. The costs for the control group are more complicated than those for the re-ablement group, who receive all their care from in-house social care workers. Control group clients, can receive support from either home helps or social care workers provided in-house, support from the independent sector or a mix of both. As such, it is important for costs to reflect this mix accordingly.
7.11 In terms of the control group, 60 of the 90 clients receive an in-house service. This reflects the Edinburgh wide ratio of in-house hours provided to Care at Home hours (66.1% to 33.9%, based on the Weekly Domiciliary Care Monitoring summary).
7.12 The calculations of domiciliary costs for the control group are presented below.
- The weekly costs of the total 129.75 home helps are £39,105. Our group of 60 in-house clients from the control group account for 13.3% of the average number of clients cared for per week in the South West (450). Therefore we have apportioned 13.3% of the costs of 129.75 home helps to these 60 clients. The weekly costs associated with the 60 in-house clients from the control group are £5,201. Over the six week period, this amounts to £31,206.
- The weekly costs of the 51.75 social care workers are £22,345. Once more we have apportioned 13.3% of costs of the 51.75 social care workers. The weekly costs associated with the 60 clients are £2,972. Over the six week period, this amounts to £17,831.
- The same approach could not be used to calculate the costs associated with Care at Home clients. This was because figures for Care at Home are Edinburgh wide and not broken down at area level in the Weekly summaries. Similarly, salary costs for the independent sector are not provided in the summaries, instead an hourly rate that includes staff costs and overheads is available (£12.98). As noted above, we have applied the Edinburgh wide ratio of Care at Home hours (33.9%) to the 745.5 hours of the control group. Therefore, the calculations below assume that 253 of the 745.5 hours are provided by the independent sector.
- Costs of Independent sector care hours are £3,284 per week (for 253 hours based on hourly cost of £12.98 which is total cost to council for purchasing hours of care). Over the six week period, this amounts to £19,704.
- In total, the care costs for the control group over the six week period include in-house home help costs (£31,206); in-house social care worker costs (£17,831) and costs for the independent sector (£19,704) are £68,741.
OT Costs for Control Group
7.13 There are no OT posts directly based in the South West home care team. Therefore no costs have been attributed for the control group. However, some of the control group clients will have had support from mainstream OTs in Sector Practice Teams - these costs have not been estimated.
Management and administration costs for Control Group
7.14 The following are the annual costs attributed to the management structure of the South West home care team. (including employer costs).
- Home Care Service Manager £45,777
- Home Care Co-ordinator £30,716 @ 4
- Home Care Organiser £23,868 @3
- Admin Worker £19,790 @ 1.5
7.15 As such for all the administration, management and supervisory costs for the South West home care team on an annual basis is £269,930. On a weekly basis, this amounts to £5,191. As above, we have apportioned 13.3% allocation of staff to 60 in-house control group clients. This equates to £690.40 per week (for the 60 in-house control group clients). Over the six week period, this amounts to £4,142.
Total costs of Control Group
7.16 In total, the costs for the 90 control group clients which include care costs (£68,741) and management and admin costs (£4,142) are £72,884. This computes to an average cost per client over 6 weeks of £809.82.
Costs of Re-ablement and Control group
7.17 Table 7.2 shows the cost of providing the six week re-ablement service compared to six weeks of traditional/non-re-ablement service.
Table 7.2 Comparison of Re-ablement service and Control Group costs
| Re-ablement Service 6 week costs (90 clients) £ | Control Group 6 Week costs (90 clients) £ |
|---|
Frontline Care Costs | 68,463 | 68,741 |
|---|
OT Costs | 8,002 | N/A |
|---|
Management and administration costs | 18,055 | 4,142 |
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TOTAL for 6 week period | 94,520 | 72,884 |
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Average cost per client for 6 weeks care | 1,050 | 810 |
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7.18 The front line care costs for the 2 groups are very similar. This may be surprising given that the control group clients are cared for by a mix of home helps and social care workers, whereas the re-ablement group are cared for solely by social care workers (who have a higher hourly rate than home helps). However, it should be noted that the management and overhead costs associated with the service provided by the independent sector, which accounts for a third of the control group, are included in the front line care costs for the control group. This is because the hourly rate paid to the independent sector includes these costs along with the care costs.
7.19 Table 7.2 highlights that the management and administration costs are significantly higher for the re-ablement service in comparison to the control group. Again, it should be remembered that a third of the control group clients who have a service provided by the independent sector have no management overheads attributed under this category for reasons stated above. However, even allowing for this, the management costs for re-ablement are still considerably higher. This can be largely explained by the higher ratios of management to staff and staff to client ratios in the re-ablement service. It should be noted, however, that the mainstream Home Care service has very low supervision ratios of 1 co-ordinator to 40-50 home helps and social care workers. This is being addressed by CEC within their wider Home Care Modernisation Programme.
Benefits of the Re-ablement service
7.20 Clearly, the concentration of additional resources to the new service, through these more generous ratios, has allowed staff to work with clients more intensively. This has contributed to clients becoming more independent over a relatively short space of time and reduced the number of care hours they require. Similarly, the more generous staff to management ratios have allowed for an extensive review process to be built in the service as well as improved communication and co-ordination between staff groups.
7.21 Clients of the new service have clearly benefited from the service. The interviews with clients have shown that they have managed to become more independent during the period of re-ablement. Often these clients were recovering after a period in hospital.
7.22 The re-ablement service has also been beneficial to staff, especially social care workers, who emphasised the importance of such a client-focussed service. Social care workers favourably compared the re-ablement service to the traditional non-re-ablement service. They felt that the re-ablement service gave them more time to devote to clients, and they felt more involved in the case management of clients. Similarly the local management were very positive about the re-ablement service having more time for assessments and reviews with clients and more time to engage with social care workers and OTs.
7.23 One of the most notable benefits of the new service was the 41% reduction in care hours required by the 90 re-ablement clients by the end of their re-ablement period. This compared extremely favourably to the control group clients, who actually increased the hours of care they required over a similar period. Furthermore, whilst some 60% of the re-ablement clients reduced their care hours as a result of re-ablement, only 27.8% of clients in the control group managed this.
7.24 Clearly then, although the average cost of care for a client receiving re-ablement care calculated over a six week period is approximately £240 more expensive than a client receiving the traditional service over a similar period, re-ablement clients require less hours of care overall. Therefore, at the end of the six week re-ablement period, the service has the capacity to utilise the 41% of freed-up care hours for new and other clients. This is not the case in the control group, where existing clients require slightly more support by the end of the six week period, with no spare capacity available.
7.25 This additional capacity generated by the new re-ablement service is a good example of a time- releasing efficiency 12. Local authorities in recent years have been encouraged to seek efficiency savings where possible. The main driver for this was the publication by Scottish Ministers of the Efficient Government Plan: 'Building a Better Scotland: Efficient Government - Securing Efficiency, Effectiveness and Productivity'. This plan was central to delivering the Scottish Government's vision for improved quality public services through matching investment with reform, increasing public sector productivity and designing services around the needs of individuals.
7.26 If this additional capacity is sustained over the longer term, CEC will be able to demonstrate significant time-releasing savings as a result of the new service. Chapter 8 highlights that in the initial three month period following re-ablement, this capacity was not only sustained, but expanded marginally.
7.27CEC operates a mixed economy of care, providing some care in-house, at the same time as purchasing some of their care requirements from independent providers. The extra capacity freed up by re-ablement could also be a cash-releasing efficiency if the freed up staff hours as a result of re-ablement were used instead of purchasing hours from the independent providers.
Summary
7.28 This chapter has shown that the overall cost of providing the re-ablement service is greater than those attributed to the service received by the traditional non-re-ablement clients in the control group over a similar period. Of particular note is the management costs attributed to the new re-ablement service. These were markedly higher than those of the control group, mostly due to the lower management to staff ratios in the new service, compared to the mainstream Home Care service where supervision ratios were typically 1:40 or 1:50. The research showed that these ratios are an important part of the success of the new service.
7.29 However, in the longer term, as clients receiving the re-ablement service require fewer hours of care, savings in terms of time or cash releasing efficiencies can be made.