Integrated Children’s Disability Service Occupational Therapy Guidance for the Loan of Equipment

The ICDS-OT service uses an incremental approach to the provision of equipment and adaptations. It is recognised that the Occupational Therapy worker has a responsibility to work economically and efficiently regarding the Council’s resources and must strike a balance between a “preferred” solution from the child and family’s point of view and the resources available. The most cost-effective option must therefore be considered first but if this is not believed to meet the child’s needs then other options will be explored. Workers are expected to demonstrate this in their recording, particularly with recommendations for non-standard stock equipment.

For children who use two addresses (for example shared care arrangements), an assessment of the second address can be offered. However, any intervention (including provision of equipment) at a second address is considered on a case by case basis. This policy is currently under review.

• General home safety equipment that is readily commercially available such as: stair gates, fire guards, cupboard locks, fridge locks, window locks, window restrictors, fixing furniture to walls, radiator covers etc are considered the responsibility of the family to provide. The ICDS-OT team will only provide this type of equipment when the need exceeds the limitations of the non-specialist provision.
• Car seats.
• Commercially available children’s products such as: toilet ring reducers, potties, step stools/bath steps are considered the responsibility of the family to provide. The ICDS-OT team will only provide this type of equipment when the need exceeds the limitations of the non-specialist provision.
• Household furniture.
• Household repairs.
• Provision for short-term health need such as recovery post-surgery (including hospital discharge) or children who have a short-term need arising from a temporary impairment. Safe discharge from a hospital is not the responsibility of the Council; it is a duty of care for the hospital that is discharging the child.
• People with medical health needs only, for example, support with pressure care.
• Provision at Short Breaks settings unless a specific service has been commissioned.

Nottinghamshire County Council contributes to the Integrated Community Equipment Loan Service (ICELS), a Partnership between Health and Social Care across Nottingham City and Nottinghamshire County to provide community equipment. Since 2011 the British Red Cross have been commissioned provide the service which supplies, delivers, services, collects and repairs community equipment.

As part of the contract there is a range of ‘standard stock’ equipment that can be ordered from a catalogue and delivered within 5 working days. If standard stock equipment is assessed to not meet the child’s needs, it is possible to purchase ‘special equipment’ by going through the ICELS Specials Panel where a prescriber’s clinical reasoning is scrutinised by representatives from both health and social care.

ICELS host the 'Trent Region ICELS Cross Border Agreement'. This is currently under review.

ICELS host the ‘Out of Area Hospitals Pathway for Prescribing’ which allows out of area prescribers to access equipment to facilitate hospital discharge. This is currently under review.

All equipment is provided to families on loan from ICELS.

Direct Payments are available towards the purchase of equipment in line with ICELS Direct Payments policy.

Joint health/social care funding

Joint funding for equipment for which there are both health and social care needs can be discussed at an ICELS Specials Panel attended by representatives from both health and social care.

NHS Continuing Health Care funding

If a child is in receipt of 100% Continuing Health Care funding, all equipment is funded by NHS Continuing Health Care. This is applied for via the ICELS Specials Panel.

An unassessed, free of charge short-term equipment loan scheme is currently available to facilitate access to community facilities. This scheme is under review.

Advice will be provided to families to support their purchase of basic eating and drinking equipment such as specialist cutlery, plate guards, keep-warm plates, specialist cups/beakers.

Where the child wishes to attain independence in feeding and has the necessary motivation and cognitive ability to use equipment to achieve this.

Consider:

• Relevant medical factors such as swallow, grasp, bite reflex, tremor, ataxia, visual impairment;
• Behavioural factors;
• Family’s ability to assist with feeding;
• Development;
• Safety of child;
• Posture;
• Social inclusion;
• Consider what is being used at school;
• Child and family’s motivation;
• Joint funding with health and/or education.

To provide a supported / functional position to encourage independence and maintenance of independence in self-care skills.

Consider:

• Self-propelled/assisted push;
• Dual use (e.g. toileting);
• Method and ease of transfer e.g. hoisted – assisted or independent;
• Level of support required;
• Shape of seat aperture / ability to change this in future;
• Environmental factors – space, layout of bathroom and pipe work;
• Ease of cleaning;
• Ability to use tilt in space for hair wash over bath;
• Duration of time taken to shower.

Where there are not acceptable alternatives (e.g. changing bench/shower chair, and the child is fully dependent on the family).

And / or

The need to accommodate spinal deformities, contractures and/or high/low muscle tone.

Consider:

•  Drainage;
• Cot sides – risk assessment required;
• Padding for safety and comfort;
• Skin integrity/pressure care;
• Ease of hair washing;
• Dual use (e.g. toileting);
• Environment (e.g. size of shower area and access into bathroom);
• Ease of cleaning;
• Ability of materials and accessories to accommodate child’s posture comfortably;
• Anticipated duration of time to take shower.

The need to have two carers and/or/ access to both sides of the child.

And / or

If the environment does not allow the fitting of a ceiling track hoist in the bathroom.

Consider:

• Environment (e.g. space, feasibility to manoeuvre between rooms etc);
• Number of carers;
• Ease of cleaning and drying;
• Drainage of water;
• Child’s body temperature control;
• Child’s sensory needs;
• Involuntary movements;
• Hydraulic or electronic height adjustment;
• Mobile or static;
• Need for dual use when no changing facilities are available (e.g. showering/changing/drying).

Contra-indications:

• Severe respiratory problems can be increased if laid flat;
• Water can collect in the cushioned channels therefore be aware of child’s head position.

Consider for the young children who are unable to sit and require support in the bath.

Consider:

• Moving and handling;
• Extensor spasms;
• The need for regular review due to growth of child;
• Could be used in conjunction with mobile bath.

Consider for young children who are difficult to lift in and out of a standard bath.

Consider:

• Environment – where bath to be used;
• Filling and drainage;
• Storage.

To consider for children who are developing their sitting balance and the family are able to lift them safely in and out of the bath.

Consider:

• Child’s sitting balance;
• Safe fitting (with back brace) and family’s likely compliance with this;
• Accessories required (e.g. lap belt, chest straps, pommel and grab bar);
• Bath surface and contours.

To consider for children who require full postural support in the bath.

Consider:

• Moving and handling transfers;
• Weight of the seat in the bath;
• Ability of materials and accessories to accommodate child’s posture comfortably;
• Adjustability;
• Ease of cleaning;
• Size of bath.

To consider when children are struggling to complete a standing transfer in and out of the bath.

Consider:

• Width and shape of bath edges to accommodate bathboard safely (minimum 25 mm ledge/rim either side of bath for secure fitting);
• Slatted/non-slatted/padded;
• Ability of child to slide along board;
• Depth of bath;
• Bath surface/contours;
• Integral bath handles/position;
• Ability to lift legs over bath side;
• Trunk stability;
• Use of non-slip mat;
• Environmental factor (e.g. space).

To consider for children who require full postural support in the bath.

Consider:

• Moving and handling – ideal when a ceiling track hoist facility is available;
• Use in other locations;
• Cleaning and storage;
• Abnormal movement patterns;
• Longevity of use;
• Carer’s ability to re-mould and position the bath support effectively.

When a child is able to transfer on/off a swivel bather independently or with minimal assistance.

And / or

Where an over-bath shower is already in situ or can easily be installed.

Consider:

• Width of bath edges (minimum 30 mm either side to ensure safe fitting);
• Safety of assisted transfer (e.g. environment);
• Operation and positioning of shower unit;
• Sitting balance;
• Ability to rest feet on bottom of the bath.

Consider when a child becomes too heavy for family to safely lift in and out of the bath.

Or

When the child requires more posture support than a standard bath lift can provide.

Consider:

• Non slip bathmat;
• Width of bath ledges (minimum 30 mm either side) for safe fitting;
• Space required to operate the lifting and lowering mechanism;
• Safety of child when raising and lowering;
• Space in the bath for play.

When a child becomes too heavy for family to safely lift or assist in and out of the bath.

And / or

When a child is able and willing to take on some independence in bathing.

And / or

When a child is able to transfer on/off a bathlift independently or with minimal assistance.

Consider:

• Sitting balance / trunk balance;
• Type of bath (acrylic / cast iron);
• Bath lift to remain in situ or taken out of bath;
• Storage of equipment;
• Potential for entrapment when lift lowering;
• Integral bath handles;
• How low will bath lift sit in bath;
• Reclining back needed;
• Accessories required.

1. Will considered when bathing equipment is unable to meet the transfer need;
2. Can be considered to assist family with safe transfers of the child.

Will be considered if a child requires positioning/support additional to that which a commercially available potty would provide, or as a consequence of developmental delay they are physically too big for commercially available potties.

Consider:

• Stability;
• Height off ground;
• Transfers on/off;
• Appropriate positioning (where potty will be used);
• Storage in house.

Will not be considered for a hospital discharge.

Will be considered when access to a toilet cannot be achieved or is not considered safe or dignified.

Will be considered as an interim measure whilst awaiting long term provision.

Consider:

• Size (paediatric or adult);
• Height (fixed or height adjustable);
• Static or wheeled;
• Transfers;
• Stability;
• Appropriate positioning (where commode will be used);
• Storage in the house.

Will not be considered where commercially available equipment would meet the child’s needs.

Consider:

• Stability;
• Aperture;
• Shape of bowl;
• Other family members.

Will be considered to promote independent transfers.

Will be considered to provide an increased level of support.

Consider:

• Combined children’s toilet seat/frame (e.g. Rifton HTS mounted on toilet);
• Transfers;
• Height and width of frame;
• Location of soil pipe;
• Use in conjunction with steps/toilet platforms;
• Fixed, free standing or toilet mounted;
• Hand grips;
• Other family members.

Will be considered when wheelchair access to the toilet is difficult.

Will be considered when this will reduce the number of transfers undertaken.

Will be considered when postural support levels may need to increase/decrease.

Will be considered if combined use for showering/toileting is appropriate.

Will be considered to assist in toilet training.

Consider:

• Dual use of chair, e.g. toileting and shower seat function;
• Child’s ability to independently use chair;
• Transfers;
• Family’s ability to position child as needed;
• Stability;
• Shape of toilet and whether close coupled;
• Ability to access for child/carer to maintain personal hygiene;
• Storage;
• Compatibility if using in conjunction with wash/dry toilet;
• Manoeuvrability;
• Storage.

May be provided to facilitate independence or assist in gaining independence.

Or

To assist carers to carry out social and personal care and support safe moving and handling.

Consider:

• Size of bed (length/width – junior bed/adult bed/bespoke size);
• Are side rails required (see Side Rails);
• Is the need a health requirement e.g. pressure care; consider involvement of tissue viability nurse, respiratory care by health professional? If so, apply to ICELS Specials panel for funding;
• Relevant medical factors e.g. epilepsy, muscle spasms, maintaining body temperature, ataxia, respiratory and pressure care;
• Is a sleep system used?
• Ease of transfers for child/family;
• Family situation and needs of the household;
• Long term needs and adaptations solutions;
• Environmental factors;
• Continence;
• High kneeling/pulling into standing;
• Safety awareness;
• Unable to independently reposition self (cognitive or physical delay);
• Tasks the bed is to be used for as well as sleeping. e.g. changing, physio exercises;
• Moving and handling equipment;
• Access to power point.

An oversize cot has an internal length from and including 140cm to 180cm with a physical barrier which will prevent the child from getting out of bed by themselves. The physical barrier can be movable, e.g. sliding sides, drop sides, folding sides and is intended for children who are able to stand up in bed.

An oversize cot may be provided where a Restraint Risk assessment has been completed identifying that solutions employing lower levels of restraint will not meet the child’s needs and that an oversize cot is necessary and in proportion to the risks involved.

Consider:

• Sides/door mechanism – fold back, hinged door, removable;
• Type of fasteners on cot sides e.g. latches, spring clips, allen key;
• Full padding or partial padding;
• Internal bed measurements with padding;
• Behaviour management issues;
• Continence/smearing;
• Tasks the bed is to be used for as well as sleeping. e.g. changing, physio exercises;
• High kneeling/pulling into standing;
• Safety awareness.

A side rail is a physical barrier (either integral to a specialist bed or an accessory to a specialist bed) which when closed/fully raised is intended to reduce the risk of a child accidentally slipping or rolling off the mattress.

1. Side rails should not be provided unless a risk assessment has been completed. The risk assessment should take into account factors identified in MHRA’s Safe Use of Bedrails 2020, including whether the risk of falling from bed could be reduced by means other than side rails (e.g. Floorbed).

Consider:

• Potential for entrapment - refer to MHRA Safe use of bedrails (March 2020);
• Height of the cot sides – refer to British Standard EN 50637_2017;
• The child’s possible reaction to being enclosed/need for visibility;
• Breathability of any bumpers;
• Mobility of the child in bed;
• Body temperature control;
• Accessibility for the carer and how side rails are lowered/put into place (drop down/fold down);
• Internal bed measurements with bumpers;
• Fixing of any bumpers (permanent or removable);
• Compatibility of cot sides to bed e.g. movement, how to secure safely;
• Depth of mattress;
• Is a sleep system being used?
• Air flow;
• The child’s specific need for review e.g. schedule of 12 months;

These should be considered where the child is unable to independently move from lying into sitting.

Or

To assist in repositioning when a child experiences pain.

Consider:

• Access to a power point;
• Can cause mattress to slip down bed;
• Double or single bed;
• Independent or carer use of controls;
• Other bed aids in use;
• Tissue viability;
• Slipping down the bed;
• Mattress compatibility – foam or pocket spring, depth;
• Siblings.

These should be considered where a child has difficulty with bed transfers and bed mobility and is not to be used to prevent children falling out of bed.

Consider:

• Bed type e.g. slatted, divan;
• Bed size / single or double;
• Use in conjunction with other accessories;
• Mattress depth;
• Entrapment of head, neck, limbs;
• Securing to the bed.

To be considered to enable independent or easier assisted transfer on and off the bed.

Or

To improve the carers working position where the carers safety is being compromised with the bed being too low.

Consider:

• The need to be able to transfer both on and off the bed;
• Compressed height of mattress;
• Castors;
• Hoist access – Mobile, ceiling track or gantry;
• How many legs on the bed;
• Stability of bed when raised;
• Who raising the bed for – child or carer;
• Consider timescale for review - if raisers are required for the child’s independent or assisted transfers, review will be necessary as the child grows.

A mobile floor hoist is a portable, self-contained hoisting unit. It provides carers with a safe, practical option which can be wheeled into position quickly and used in multiple locations. Good practice indicates that if the need is permanent, ceiling track hoists should be provided in preference to a mobile hoist.

Consideration should be given when the child is unable to reliably and consistently weight bear for an assisted transfer and/or is totally dependent on a carer for all transfers.

Will be considered when the need is either short or long term.

Will be considered when carers are finding it increasingly difficult to either lift a child or assist with transfers.

Will be considered as a temporary provision whilst family’s await installation of a ceiling track hoist.

Consider:

• Maximisation of child’s independence in transfers – liaise with physio;
• Environment where hoist is being used (space, storage, flooring etc);
• Access of hoist with furniture/equipment/wheelchair etc;
• Weight of child;
• Height of lift required for clearance;
• Physical health of carer;
• Parking and charging of the hoist;
• Long or short-term use – If long term, see section on ceiling track hoists;
• Siblings;
• Sling compatibility with spreader bar e.g. loops, clips;
• Type of spreader bar required;
• Does bed require raising and implications of this?

As for mobile hoists, but where the use of a mobile hoist is not possible due to environmental limitations.

Consider:

Access to charging point.

• Position and space of gantry hoist feet/legs;
• Ceiling height;
• Bed height;
• Short or long-term use – If long term, see section on ceiling track hoists;
• Child’s weight;
• Clearing space for installation;
• Accessibility for equipment and carer;
• Position for overhead unit when not in use;
• Environment where gantry is to be used;
• Levelling of gantry for safe use.

Slings should be provided whenever the need for a hoist has been identified. Correct sling provision is important and should be assessed for on an individual basis.

Consider

• In-situ sling or removable;
• Ease of fitting and removal (1 or 2 carers required);
• Environments to be used;
• Requirement for toileting sling;
• Use of slings in wet and/or dry conditions (e.g. bathing);
• Sling attachments e.g. loops or clips, removable or tuck in;
• Hoist compatibility;
• Head support;
• Chest straps;
• Hip tapes;
• Boned or un-boned;
• Comfort/level of support required;
• Safety – e.g. behaviour, spasms, ataxia;
• Material;
• Tissue viability;
• Respiratory function;
• Equipment to be positioned in/on e.g. seating.

Provision should be considered when child can reliably weight bear but is unable to move their feet for a safe assisted transfer.

Or

To assist personal care/toileting regime.

This equipment cannot be used unassisted.

Criteria:

• Height of child;
• Height of knee blocks;
• Availability of raiser block for equipment;
• Height of surface/equipment transferring to and from;
• Upper body strength and grip;
• Behaviour;
• Reliability of sit to stand;
• Balance;
• Space;
• Ability of family to position equipment;
• Storage;
• Upstairs and/or downstairs use (consider dwelling).

Provision should be considered when the child is unable to weight bear through their legs but has adequate upper body strength and control to complete an independent or assisted transfer.

Consider:

• Good trunk balance;
• Height of surface/equipment transferring to and from;
• Distance between surfaces/equipment;
• Removable arms?
• Safety awareness;
• Clothed or naked transfer;
• Tissue viability and shear;
• Frequency of use;
• One sided weakness issue;
• Who will position the board?
• Where will the board be kept?
• Style of board.

Provision to be considered when a child is unable to re-position themselves.

Or

When family need to move a child safely.

Or

To assist family in sling application when rolling is inappropriate.

Consider:

• Size – length & width;
• Friction levels of material;
• Tissue viability;
• Number of carers;
• Accessibility of bed;
• Is the slide sheet to be left in position?
• Pain.

Provision should be considered when a child has weight bearing ability but limited upper body strength to facilitate standing from a seated position.

Consider:

• Height of child;
• Height of knee blocks;
• Availability of raiser block for equipment;
• Height of surface/equipment transferring to and from;
• Shoulder stability;
• Balance;
• Behaviour;
• Reliability of sit to stand;
• Respiratory function;
• Pelvic stability and control;
• Suitability of sling;
• Environment – space, flooring etc;
• Is a hoist needed for other transfers?
• Number of carers required;
• Frequency of use;
• Development of toilet regime;
• Charging;
• Storage;
• Upstairs and/or downstairs use (consider dwelling).

Should be considered to facilitate a child’s access to essential facilities where they use a wheelchair.

Provision should be considered for a short or interim measure.

Consider:

• Height of step;
• Depth of step;
• Thresholds (internal and external);
• Integrity of door sill if ramp is to rest on this;
• Doorway width;
• Gradient;
• Upstands;
• Space/ turning space;
• Weight of ramp;
• Floor surface and stability;
• Direction wheelchair is to be pushed;
• If to be fixed or removable;
• Type of wheelchair (manual, powered, Whizzybug).

Should be considered to facilitate a child’s access to essential facilities.

Consider:

• Height of existing step;
• Floor surface and stability;
• Any need for grabrails.