Minor Adaptations and Adaptive Equipment

‘Supporting the life that matters to you’

Adaptations, TEC and equipment can make a significant impact on a person’s ability to remain in their own home with dignity and control, enabling them to maximise their independence and support carers in their roles. Reducing or delaying the need for funded care and informal care. Enabling people to continue to be able to do the things that are important to them. These services support a strengths-based approach to supporting individuals in their own homes. Giving people the access to the right help at the right time and maximising independence are key elements of Readings vision for social care.

This procedure applies to those adults who are ordinarily resident in Reading or of no settled residence but physically present in the area. There may be some instances when the authority has placed an individual in an out of area placement and may be required to ensure access to appropriate reviewed on a case-by-case basis. Services for Children are provided by Brighter Futures for Children.

Reading Adult Social services uses the 3 Conversations Model see Local DACHS Procedures Strength Based Approaches (Conversations Count).

Throughout this chapter, “practitioner” will also be described as a “prescriber” in relation to equipment provision.

This procedure should be used by all social care practitioners to order adaptive equipment or arrange a minor adaptation. There is also useful information on major adaptations. 

This procedure applies to:

• Occupational Therapists;
• Social Care Practitioners;
• Occupational Therapy students;
• OT/SW Apprentices;
• Social Workers.

Care Act

Section 1: A general duty to promote the wellbeing of the person with lived experience. Wellbeing is defined to include personal dignity, physical and mental health, emotional wellbeing, control over day-to-day life and the suitability of a person’s living accommodation.

Section 2: Prevention, delay and reduction of need, general duty on local authorities to provide, arrange or otherwise identify services, facilities and resources to prevent, delay or reduce the needs of adults either for care and support, or the needs of informal carers for support. 

Section 9: As part of a Care Act Assessment.

Further guidance can be found in Appendix C.

Occupational Therapy enables people to experience health, wellbeing, and life satisfaction through participation in activities or occupation. When people cannot participate in their daily activities through mental or physical illness, disability, or old age their wellbeing, identity and sense of purpose is affected, and they can become dependent on others. Minor adaptations and adaptive equipment are just some of the ways in which Occupational Therapists can support individuals to remain at home independently and with dignity. 

Social workers and Social Care Coordinators who have received appropriate training and are competent are able to prescribe simple low risk equipment and minor adaptations. 

All Social Care Coordinators must complete the mandatory DLF Assessing for Minor Adaptations Virtual Course, which will enable staff to assess, measure and prescribe minor adaptations and simple equipment:

• Chair and bed raisers;
• Bath boards, seats;
• Stair rails, rails for toileting, raised toilet seats and frames;
• Grab rails;
• Perching stools and small household items.

Joint working with health colleagues is essential in providing an integrated service for the person with lived experience and their families, to avoid unnecessary bureaucracy and ensure people get the help they need quickly. To support this ethos Health Occupational Therapists, have access to 12-week NRS Tec referrals and can refer directly for minor adaptations to enable safe and fast hospital discharges. 

Both the Council Adult Social Care OTs and Health OTs can apply for joint funded for equipment or 100% health funding under an agreed joint process. Referrals for equipment and minor adaptation from other external therapists will also be considered on case-by-case basis.

Health Occupational Therapists can also apply for Health and Wellbeing Grants to support safe discharge or high-cost minor adaptations. 

Training is delivered by Living Made Easy - 3 - Trusted Assessor: Assessing for Minor Adaptations.

In addition to extensive training program offered by NRS IRIS 4 (nrs-uk.co.uk).

Basic understanding of equipment is delivered by the NRS OT Training is available on NRS for all equipment prescribed which can be booked directly with NRS. The training is a mixture of face to face, MS Teams, and Webinars.

Occupational Therapists – for standards and competences please see:

Professional standards for occupational therapy practice, conduct and ethics - RCOT.

Occupational therapists | (hpc-uk.org).

Tri.x DACHS Local links below:

Social Care Practitioners (OT Trusted Assessors) - RBC Social Care Coordinator OT Trusted Assessor Tool kit and Competencies.

Occupational Therapist: Moving and Handling Competencies and Resource Tool - to follow.

All prescribed interventions and recommendations covered in this guidance will be recorded by practitioners on a Conversation 2 or 3 or an OT assessment episode, depending on their role and level of competency. This will be signed off by a supervisor.

Adaptive equipment is equipment that can prevent, reduce, delay, or meet a need and includes equipment to help people move around, or get in and out of a chair, bed, or bath.

Equipment is provided by NRS through a joint Berkshire Equipment Service called BCES vai an online ordering system called IRIS. 

Note: Equipment to move around does not include walking aids which must be assessed by a Physiotherapist or an Occupational Therapist with the right competencies.

If you are not clear about what equipment can or cannot be provided speak to your manager.

The social care practitioner must be skilled, knowledgeable, competent, and appropriately trained to assess for equipment and minor adaptations.

To be eligible for adapted equipment of minor adaptations the person must either:

1. Meet the Care Act eligibility for care and support needs;
   1. Arising from, or related to, a physical or mental impairment or illness;
   2. Inability to achieve at least two outcomes;
   3. There must be a significant difficulty or risk, or take a long time or at the cost of significant pain, distress, or anxiety.
2. As part of a reablement approach to promote independence;
3. To prevent further needs as part of 3 Conversations model, to halt the Care Act assessment and provide preventative adjustment to avoid the need for further care.

Consideration should be given to preventing or delaying care needs from becoming more serious or delay the impact of their needs. 

Consideration should be given on impact on carers and long-term outcomes for both carer and people with lived experience. 

When adaptive equipment or adaptations are identified as a solution following an assessment of need, the practitioner must record the following:

On Mosaic: Assessment on Conversion 2 or 3 or OT assessment

Include options appraisal, risks and evidence of other equipment considered.

Record the following:

• Evidence of impact on wellbeing;
• Eligibility criteria;
• Client / carer outcomes;
• Impact on funded care either a direct reduction or cost avoidance;
• Clinical reasoning.

The practitioner must consider health funding and check recycled specials availability. 

Management oversite: Supervisors sign off clinical decision making on Mosaic, for further information on managerial oversite see Occupational Therapy Assessment Tool “Strengths-Based Practice A Practice Guide to completing an Occupational Therapy Assessment” Tri.x Local Procedures.

Once the equipment is in place the prescriber is responsible for ensuring the equipment is correct, fitted safely and meeting the individual's outcomes. The prescriber is responsible for ensuring that the individual, carer, family, or care providers know who to use the equipment safely.

Due to new guidance must be assessed for by an Occupational Therapist or practitioner with appropriate training.

Additional information can be found in Occupational Therapy folder on Tri.x Local Procedures Local DACHS Procedures (trixonline.co.uk) and SharePoint Bedrails and Bed Grab Handles.

Adaptive equipment is on loan to the person with lived experience and therefor there is no charge for the loan of the equipment.

Minor adaptations under £1000 are provided with no charge.

Adaptations over £1000 can be supported either though DFG application see section of DFGs or via a Health and Wellbeing Grant – see Section 24, Health and Wellbeing Grant.

Adaptive equipment can be provided in any setting, including in a care home, so long as the responsibility to provide the equipment does not fall with the service provider.

To read more about providing equipment in a care home see below:

West Berkshire Equipment in Care Home: Reading Borough Council Equipment in Care Home Guidance.

RCOT Guidance: RCOT Care homes and equipment - Guiding principles for assessment and provision.

Local guidance seating in Care Homes: Seating Information.

NRS Healthcare has been contracted to provide a Community Equipment Loan Service. This service provides management, procurement, storage, delivery, installation, collection, refurbishment, disposal, tracking and maintenance of:

• Aids for daily living (ADL) and medical equipment;
• Supply/manufacture/modification of non-contract (specials) equipment;
• Other equipment and/or services as defined within the contract.

To use the service prescribers must be in possession of a Personal Identification Number (PIN). All Adult Social Care staff are issued with a pin and are required to complete induction and Tec Training and additional training dependent on the role and level of experience.  The IRIS pin with a unique prescribers login and password and is organised by Business Support as part of the Induction Programme.

Prescribers should only ever use their own PIN and not allow it to be used by anyone else. PINs will only be issued to staff who have received relevant training. Additional authorisation may be required in certain instances depending on the type of product, value and services requested. Prescribers should ensure that their line manager is informed when a PIN needs to be deactivated.

Users of this online system, IRIS, should be aware of their obligations under the Data Protection Act (DPA) 2018 and Computer Misuse Act (1990). Prescribers will be asked to acknowledge this when logging in and encouraged to change their password regularly. 

All ASC Social Care Practitioners are expected to access IRIS, attend training for equipment and TEC provision as part of the Induction process and probation. Add link to Induction Programme.

Click here for NRS training video NRS Induction & Introduction Video.

Access to all IRIS forms and guidance can be found here or under documents on the IRIS system.

Equipment is to be ordered on three-to-five-day delivery slots unless the practitioner identifies that the individual is at risk in which case same day delivery can be requested.

NRS delivery team will fit the equipment upon delivery. The prescriber will need to specify this as a requirement when ordering along with any specific details such as location items are to be placed in or height settings.

To access equipment on IRIS each prescriber will receive an authorisation level to ensure practitioners are working with in their competencies and to manage risks.

Pin authorisation levels will not impact on staff ability to order equipment.

In the event of Team Manager or seniors leave staff can choose from pick list other seniors/TM to authorise requests.

If individuals have significant joint health and social care needs which require equipment it may be appropriate for a 50/50 or 100 % health funding request.

CHC funding is available for people with complex health needs. If an individual requires 100% health funded equipment or a number of 50/50 equipment items use the CHC checklist to see if the individual is eligible for CHC funding.

Click here for additional guidance: RBC Guidance on Health and Social Care Joint Funded Equipment.

These can be used to support those people with straight forward needs and in predicable situations with simple solutions.

e.g., assessments for rails, bathing, equipment for transfers, kitchen work, personal care, toileting etc please consider using NRS trusted assessors.

Complete NRS request on Iris instruction on page 6 below and send the Trusted Assessor Referral form securely to enquiries@berkshire.nrs-uk.net.

• Not be used if there are any risks to workers identified or the person is unlikely to engage in an assessment;
• The service user must consent to the assessment and be prepared to engage with the process and assessment;
• Not suitable for end of life or rapidly deteriorating conditions or complex neurological conditions e.g., MND;
• Not suitable for major adaptations e.g., stairlifts / shower;
• Not suitable for specialist seating or manual handling or risk of pressure damage.

NRS OTA assessments are for simple situations where outcomes and solutions are predicable. Some examples: where the person is still mobile without walking aids and needs bathing assessment, something to sit on when washing and dressing, simple rails, difficulty getting on of bed, chair, toilet.

If in doubt about anything speak to an OT or call NRS for advice. enquiries@berkshire.nrs-uk.net or 0344 893 6960.

NRS stores recycled specials, which can be ordered by prescribers, these items are not serviced or repaired in the warehouse until a prescriber has confirmed they want to order the item. The prescriber will need to request a quote for this repair or service before an order is placed.

However once confirmed the costs of any necessary repairs, parts, or servicing agreed with NRS, NRS should facilitate this for you. Likewise, they should liaise with the supplier on the prescriber's behalf if any further information about the item is needed.

This is the responsibility of NRS to ensure all NRS issued equipment meets the health and safety legislation and is fit for use. NRS are required to service and maintain any powered equipment yearly and for equipment used to lift people e.g., hoists this is 6 monthly. Practitioners when carrying out home visits are expected to routinely check that equipment has been serviced (NRS sticker with date can be found on the hoists with date of last service) If this is not in place practitioner must contact NRS and request urgent service and escalate to Principal OT.

NRS must be alerted to any broken or unsafe equipment immediately and the equipment not used and moved to a safe space.

Legislation and Health and Safety Executive’s guidelines:

• Lifting Operations and Lifting Equipment Regulations 1998 LOLER Safe use of lifting equipment. Lifting Operations and Lifting Equipment Regulations 1998 - L113 (hse.gov.uk);
• Manual Handling Operations Regulations, 1992 (as amended);
• Management of Health and Safety at Work Regulations (Amendment), 2006’;
• Health and Safety at Work etc. Act, 1974;
• Reporting of Injuries, Diseases and Dangerous Occurrences Regulations, 2013;
• Provision and Use of Work Equipment Regulations 1998 (Puwer 1998) Provision and Use of Work Equipment Regulations 1998 (PUWER) (hse.gov.uk).

A summary of these documents is available from the Health and Safety Executive website.

The procedure applies in conjunction with the following Local Policies and procedures:

• Health and Safety Policy (link on Intranet);
• Adult Social care Infection Control Policy (link on Intranet);
• Cop 21 - Manual Handling (link on Intranet);
• CoP 27 – Risk Assessment (link on Intranet);
• Cop 16 – Lifting Operations and equipment (link on Intranet);
• CoP 1 Accident Reporting (link on Intranet);
• Adult Social Care People Moving and Handling Procedure.

Department of Health guidance states that people “should” be able to take with them, equipment provided by one local authority, when they move in order to live in the area of a second local authority. In deciding whether the equipment should move with the person, the local authorities should discuss this with the individual and consider whether they still want it and whether it is suitable for their new home. Consideration will also have to be given to the contract for maintenance of the equipment and whether the equipment is due to be replaced.

The Council will consider each case, on a case-by-case basis, considering the need to comply with guidance but also cost effectiveness of any decisions. For example, standard equipment requiring ongoing maintenance and servicing e.g., hoists, profiling beds, riser recliner chairs should be arranged with the new local authority. Bespoke or specialist equipment may need to transfer with the person to avoid unnecessary delays and risks. 

Practitioners should ensure that decisions on equipment are clearly agreed and communicated with the new local authority and individual. Transporting the equipment may be challenging so must be part of the transfer plan.

Local authorities sometimes are asked to assess for and provide equipment in relation to 25 Department of Health Care and Support Statutory Guidance: issued under the Care Act 2014, para 17.42 26. This can lead to uncertainty about where the student is “ordinarily resident”. But it is ordinary residence that determines whether a duty arises to meet a person’s eligible need. See guidance from London ADASS “The answer is not always immediately obvious, but Department of Health states that the following approach should be taken. Either, sometimes, becoming ordinarily resident in the area of the university (emphasis added): where a young person is intending to move areas to go to university, the starting point would be that they are ordinarily resident in the same place as they were ordinarily resident under the [Children Act] 1989 Act. Again, this may not always be the case. If the young person moves to the area in which the university is located for settled purposes and has no intention to return to his authority of ordinary residence under the 1989 Act, then the facts of his case may lead to the conclusion that he or she has acquired an ordinary residence in the area of the University. Or, sometimes, remaining ordinarily resident in the original local authority.

Alternatively, if the young person has a base with his or her parents (or those with parental responsibility for him or her) in the local authority where he or she was ordinarily resident under the 1989 Act, and he or she intends to return to this base during the university holidays (including the long summer holiday) then the facts of his case may lead to the conclusion that he or she remains ordinarily resident in the “base” local authority. (…) this local authority would be responsible for meeting eligible needs under the 2014 Act, both during term time at university and during holidays.”

Minor adaptations are those that are easily installed, they include things like grab rails, stair rails and bath rails up to £1000. Minor adaptations are easily installed and do not require structural changes to the home. Minor adaptations under £1000 are provided with no charge. These adaptations are funded by Adult Social Care.

Additional resource: link to RBC updated Adaption Policy to be added once completed. 

Minor adaptations are delivered via the RBC Minor Adaptations Team. 

Referral form

Private Landlords permission letter

In some instances, minor adaptations maybe over £1000.  If the practitioner anticipates that the cost is likely to be in the region of or above £1000, they will complete the Minor Adaptations Form but request a quote before any further work takes place. Once they received the quote from the Minor Adaptations Team and the cost is above £1000 this will be discussed with the Principal OT or OT Team Manager for possible Health and Well-Being Grant or DFG or self-funded if not eligible for further support.

Health and Well-Being Grant referral form can be found here.

Health & Wellbeing at Home Grant

Practitioners to e-mail housing adaptations team manager and Principal OT on case-by-case basis to discuss eligibility for a discretionary Health and Well-Being Grant.

This is a Discretionary Grants: Discretionary grants are issued under local policies and are not a statutory obligation. Discretionary grants will only be considered having regard to the number of financial resources available. Funding for Discretionary grants may be withdrawn without prior notice in order to fulfil statutory obligations under the Act.

The Government has stated its ambition to give more people the choice to live independently and healthily in their own homes for longer, with fewer people staying in hospital unnecessarily or moving to residential care prematurely when that is not where they want to live. 

Adaptations can reduce the amount of formal care and support an individual may require, as well as often making the difference between being able to continue living in their current home or not.

The purpose of an adaptation is to:

• Modify the home environment to restore or enable independent living, privacy, confidence and dignity for individuals and their families;
• To enable people to manage their own health and wellbeing and live independently in their communities for as long as possible;
• To identify and implement individualised solutions that address disabling home environments.

Reading Borough Council applies an integrated approach between services to help determine grant eligible works. The Housing Adaptations & Grants Team and Housing Projects Team deliver adaptations to non-council and council tenants respectively. Both Teams have a duty to consult with the nominated Occupational Therapist on the question of which works are “necessary and appropriate”. This consultation is carried out by way of a recommendation or referral from the OT for adaptations works. It is the responsibility of the Housing Adaptations & Grants Team and Housing Projects Team to decide whether the works are ‘reasonable and practicable’ and ultimately make the final decision on what can be funded.

The local housing authority has a statutory duty under the 1996 Act to provide adaptations for those who qualify for a mandatory DFG.

While the administration of DFGs is the responsibility of the local housing authority, it is important that other bodies and especially social services authorities and health commissioners, play a full and active part in strategic planning of home adaptations and related services.

All Disabled Facilities Grants are managed through the Adaptation and Grants Team, there are 2 Occupational Therapists based in the Adaptation and Grants Team who assess and propose works for consideration under the DFG eligibility criteria.

Referrals are sent on Mosaic to the team to complete the assessment, including a financial assessment and administering of the grant. There are a number of additional discretionary grants available which can be found in the Private Sector Renewal & Disabled Adaptations Policy.

Major adaptations for Council Housing stock such as stairlifts, level access showers, extensions, through floor lifts and ramps are provided through Reading Borough Council Housing Project Team. These adaptations follow the principal of a Disabled Facilities Grants. Referral are managed through Adult Social Care and are assessed by Adult Social Care Occupational Therapists who propose works for consideration and seek landlord permission. The work is administered by Reading Borough Council Property Services and Housing Projects Team.

For Process and guidance see: Reading Borough Council Housing Stock Major Adaptations: Occupational Therapy Process (Including Affinity Housing).

Useful questions to consider when referring for equipment or adaptions

• Do you live alone?
• Do you get any help from anyone?
• What is the difficulty you are experiencing now? 
• How are you managing right now to do the things you are concerned about?
• Are there risks to you or others? 
• What kind of home do you have e.g., house or bungalow?
• Who owns it? 
• Where’s the bathroom, bedroom and toilet? Can you access it?
• Can you safely access your property? Any steps?
• Do you have a pendant alarm? think about 12-week TEC pilot, further information can be found here;
• Do you have difficulty getting on and of your bed, chair, toilet - consider NRS Trusted Assessor;
• Do you have issues with bathing or bath – can you lift your legs over and out of bath easily if yes may be managed by bath board, then request a NRS trusted assessor;
  • If the person cannot lift leg in and out easily;
  • or is incontinent;
  • or epileptic;
  • or has tried equipment and which is no longer suitable;
  • Consider other options.

Action: refer to OT for assessment.

London ADASS

RCOT

Care Act Guidance

The Disability Discrimination Act The Disability Discrimination Act 1995

Disabled Facilities Grant Legislation Housing Grants, Construction and Regeneration Act 1996

Health and Safety at Work Health and safety at work act 1974: Manual Handling Operations Regulations 1992 (MHOR)

Technology Enabled Care (TEC)/Assistive Technology Procedure