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Social Care Outcomes Care Planning


The Memo Hub clients consisted of two groups, people discharged from hospital and using a reablement service and people where there were concerns over wellbeing and safety due to Covid.


Overall, 40% of care plans were amended in light of the new insight being provided. Care pan size was both increased and decreased and details of the financial impact are described further below. The common theme was adjusting a care plan to better meet the needs of the client and hence increasing the personalisation and the quality.


Examples of changed plans included both avoiding care home admission and one example where a client was significantly more frail than anticipated and care home admission was the best option.


Social Worker Feedback


Grandson delighted to see his Granddad was safe at home and not using the kettle or microwave unless carers were present or leaving the property. The system provided clear evidence and provided reassurances.


Can clearly see when carers are in and these times are matching the care plan. Happy that client is in the kitchen a lot and mobilising. Happy not in bed all day also plenty of movement around the property.


There were several unexpected insights. For example, a 93-year-old living on his own where the family had requested domiciliary care support. The evidence produced from the Memo system showed he was coping well and had a regular daily activity pattern. Both the Social worker and family agreed he would not benefit from additional support. The family continued with the service to both provide reassurance and alerts should things change.


There were also some suggestions that Memo could be used to better evidence reablement progress and hence shorten the service duration, effectively leading to increased capacity.


Financial A detailed analysis was carried out looking at 15 clients spread across two partners.


Of the 6 clients in the reablement service one was admitted to Long Term Care and for one client additional home care costs for personal hygiene were not avoided.


Of the 9 Covid vulnerable people, three have not required more domiciliary care. The fourth has received increased domiciliary care at home and has not required Long term Care Admission.


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