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Neuro rehab insights

Avoiding the trauma of a failed placement

Rachel Calladine at Exemplar Health Care discusses how its person-centred approach is helping to better support clients with complex needs

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For people living with complex care needs, the impact of having one or more failed placements in a care home can be highly detrimental.

Not just to the individual and their family at the time, when they have to face the upheaval and trauma of finding another place to call home, but it can also affect the rehabilitation of the person in the longer-term. 

Unfortunately, this is a situation faced all too often, where a person with complex needs is placed in an environment that doesn’t meet their needs – and the impact can be deep and long-lasting. 

“It’s very sad, heartbreaking in some cases, when a placement fails,” says Rachel Calladine, business development director at Exemplar Health Care. 

“One of the main reasons can be due to a poor assessment, where a holistic assessment of an individual’s needs is not done and the complexity of their needs is not wholly appreciated. 

“In every situation, a thorough assessment of individual needs and risks is key, carried out by a trained professional who has  the skills and expertise to understand how best people’s needs can be supported to achieve the best possible outcomes for them. 

“Part of this approach is working together to identify what type of placement is the right one for each individual – but that does not always happen, as we see all too often.”

Around 60 per cent of current service users at Exemplar Health Care have moved into one of its 35 homes following a failed placement – and its pipeline of potential residents comprises a similar level of failed placements. 

And the impact of the pandemic has likely exacerbated this problem further, says Rachel, with the unprecedented demand for specialist care beds being compounded by the fact many people have remained in an unsuitable home for the past 18 months and may have significantly regressed. 

“When a placement fails, it’s a very distressing time for everyone concerned,” says Rachel. 

“During the pandemic, we have been told that some lower acuity providers attempted to look after people whose needs were far more complex than they would usually have supported, which may be why we are seeing a significant number of people with recent failed placements being referred to Exemplar Health Care. 

“A Commissioner once said to me that a failed placement will follow a service user throughout their care journey – often for service users with behaviours that challenge, they can end up with many readmissions to secure hospitals at a huge cost to the NHS funder and moreover, a significant impact on their recovery journey. 

“At Exemplar Health Care, we believe that everyone deserves the right placement, the first time.” 

And therein lies the crux of the matter – getting to the true heart of a person’s individual complex care needs and having the specialist resource to assess and meet all elements of every person’s needs. 

“It’s vital to do a thorough assessment. We meet with the person and ensure we involve other professionals and family members, as much as is possible, in the process,” says Rachel.  

“We need to build a full picture about every person and think carefully about how we would support them in all areas of their life, and whether we have the right place at the right time, for that individual.

“Do we have the right expertise? Would that person fit into our community? This is probably even more important if someone has had a number of failed placements, it needs to be very clearly established how their needs can be met moving forward. 

“We will never recommend a placement to someone who we don’t think will benefit from being with us, or may not gel well with the people already in the service.”

Cost is, of course and quite rightly, an issue for Commissioners – but a lower cost placement will likely be accompanied by a lower staffing level and a far less specialist provision that is not equipped to manage the holistic and complex needs of the people that Exemplar Health Care supports. 

“We have regularly assessed individuals who have initially been placed elsewhere due to cost,” says Rachel.

“Down the line, these people are re-referred to us following a placement breakdown. We often find that their needs have deteriorated and they require a far enhanced level of support than was seen at the first assessment, as a result of having been in a placement that was just not right for them.

“Without the right level of support, staffing and specialist resource, things can spiral very quickly. 

“This can create the ‘revolving door’ where people are readmitted into a secure unit because their placement isn’t right for them. But for Commissioners, the cost of this is very high, far outweighing the costs of Exemplar Health Care or a similar high acuity care provider. It can be a real false economy.”

But while many service users at Exemplar Health Care have experienced failed placements previously, happily, their experience in their new home are much more positive. Where does Rachel believe Exemplar Health Care succeed where others fail?

“We’re a very well embedded provider with over 20 years’ experience, we’ve grown organically and have learned lessons along the way and will continue to do this as we develop new services,” says Rachel. 

“Our homes are nurse-led with teams of highly trained health care assistants and a range of clinical specialists including our behavioural support team, mental health specialists, clinical nurse specialists, physiotherapists and occupational therapists- we are very fortunate to have such expertise at hand which can support the development of a care plan which can support the best outcomes for that person. 

“We have also developed our own Exemplar Positive Behaviour Support (EBPS) model and training, accredited by the British Institute of Learning Disability. This enables us to deliver bespoke and really personalised care to our people.

And Exemplar Health Care, soon to open its 36th home with more planned as it continues to expand to meet demand, is ensuring its commitment to ensuring the right placement at the right time continues. 

“The demand for services like ours is increasing every day, and that ranges from people with, for example, very complex dementia, complex mental health problems and neurological conditions,” says Rachel. 

“We are seeing a significant increase in demand for services for people with complex behaviours that challenge  – unless providers have the specialist resource and training to manage this type of need, we will continue to see failed placements again and again,” says Rachel. 

“We are expanding and will be able to help more people, hopefully going some way to end the cycle of failed placements and the ‘revolving door’ back into acute hospital settings. 

“Our mission to make every day better for all of our service users and staff will continue. We’re constantly striving to deliver the best service we can for our people, we are so fortunate to have such a highly skilled team in place to help achieve that.”

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