The acronym CARIAD can cause some confusion in the Welsh healthcare landscape, as it relates to more than one scheme. While the word 'cariad' means 'love' or 'darling' in Welsh, the healthcare initiatives are technical acronyms. This guide clarifies the two primary schemes you are likely to encounter in the context of senior and palliative care: the 'step up/step down' scheme and the 'CARer-ADministration' package. Understanding the purpose and function of each is crucial for navigating health and social care services in Wales.
Understanding the 'Step Up/Step Down' CARIAD Scheme
The 'Step Up/Step Down' CARIAD scheme is an initiative often managed at the local authority level, designed to provide transitional care and support. The full title is Collaborative Assessment Reducing Interventions, Admissions and Delayed transfers of care. This program was created to address several issues within the health system, primarily focusing on reducing the burden on hospitals and ensuring patients receive care in the most appropriate setting.
Key Functions of the 'Step Up/Step Down' Program
- Preventing unnecessary hospital admissions: For individuals with a short-term illness or injury, the scheme provides an alternative to hospitalisation, offering care in a more community-focused setting.
- Enabling 'step-down' discharges: When a patient is medically stable and no longer requires acute hospital care but isn't ready to return home, this program facilitates their transfer to a supportive environment for further rehabilitation and assessment.
- Supporting reablement: The ultimate goal is to help individuals regain confidence and independence so they can return to their own homes or move to a more appropriate, less intensive care setting.
Where 'Step Up/Step Down' Care Takes Place
Care is delivered in a variety of settings, tailored to the individual's needs. These can include:
- Extra Care Housing schemes
- Residential care homes
- Sheltered housing complexes
Individuals are assessed by a multi-disciplinary team of health and social care professionals to determine the most suitable placement and level of support.
Exploring the 'CARer-ADministration' (CARiAD) Package
The second major scheme is the 'CARer-ADministration' package, which focuses specifically on end-of-life care at home. This package was developed to empower lay carers, such as family members or friends, to administer 'as-needed' subcutaneous medication for common breakthrough symptoms. This allows the patient to remain in their preferred environment at the end of their life, ensuring swift symptom management.
Common Symptoms Covered
The medication administered under this package is for managing distressing symptoms that may occur suddenly. These include:
- Pain
- Nausea and vomiting
- Restlessness and agitation
- Noisy breathing (death rattle)
- Breathlessness
Who is Eligible for the CARiAD Package?
The CARiAD package is for adult patients nearing the end of their life who wish to die at home. Eligibility also requires a willing and able adult lay carer to be trained and assessed as competent to administer the medication. The carer receives comprehensive training and ongoing support from healthcare professionals.
Comparison of the CARiAD Schemes
| Aspect | 'Step Up/Step Down' CARIAD Scheme | 'CARer-ADministration' (CARiAD) Package |
|---|---|---|
| Purpose | To provide transitional care and rehabilitation, reduce hospital admissions and delays. | To empower trained lay carers to manage breakthrough symptoms for people at the end of life at home. |
| Target Group | Medically stable individuals who require a period of assessment or reablement outside of a hospital. | Adults in the final weeks of life who have chosen to be at home, and their willing lay carers. |
| Location | Community-based settings such as Extra Care Housing or registered residential care homes. | In the patient's own home, where the trained carer can administer medication. |
| Intervention | Professional assessment and provision of reablement support from a multi-disciplinary team. | Training for lay carers to administer specific subcutaneous medication 'as-needed'. |
How to Access CARiAD Services
Access to either CARiAD scheme is initiated by a healthcare or social care professional. You cannot apply for these services yourself. The process begins with an assessment of the individual's needs.
- For the 'Step Up/Step Down' scheme: A health professional or social worker involved in the individual's care, such as a Discharge Liaison Nurse or a hospital-based Social Worker, will discuss and arrange a referral if they believe the scheme would be beneficial.
- For the 'CARer-ADministration' package: This is managed by palliative care teams. A clinician from the patient's care team, such as a Specialist Palliative Care Nurse or Consultant, would propose and initiate the package with the patient and their carer.
Addressing Other Meanings of CARIAD
It is worth noting that the word 'Cariad' also appears in other contexts in Wales, which can add to the confusion. These are entirely separate from the healthcare schemes.
- Cariad Care Group Ltd: This is a private domiciliary care provider that offers services in specific regions of Wales, such as the Vale of Glamorgan. This is a business, not a government scheme.
- Cariad (Welsh word): The Welsh word 'cariad' translates to 'love' or 'darling' and is used as a term of endearment. This has no relation to the healthcare programs.
Conclusion: Navigating CARiAD for Quality Senior Care
Understanding the distinction between the 'step up/step down' scheme and the 'CARer-ADministration' package is vital for anyone seeking senior or palliative care in Wales. These schemes demonstrate Wales's commitment to providing flexible, patient-centred care, whether through transitional support after a hospital stay or by enabling compassionate, rapid end-of-life care at home. By knowing which scheme applies to a given situation, individuals and their families can better navigate the healthcare system and advocate for the most appropriate support. For authoritative information on the 'CARer-ADministration' package, you can refer to the official NHS Wales documentation: The CARiAD package.
