4.2 enabling independence through care at home joint improvement team
TRANSCRIPT
Enabling Independence through Care at Home
Alex Davidson Joint Improvement Team Associate
The key messages of Home Care Re-ablement are
> The approach changes the culture of home care from ‘task and time’ to better outcomes
> ‘Doing with’ service users rather than ‘doing to’ or ‘doing for’ service users
> Maximise users long-term independence and quality of life> Appropriately minimise ongoing support required and,
thereby, minimise the whole life-cost of care> Service users making the most of their lives
Home Care Re-ablement – Why do it?
> Compelling evidence • improves confidence, motivation, empowerment, choice and maximised
independence for service users> Service users need less care hours than traditional home care service> Growth in need for Home Care
Demography - Early Discharge from Hospital > Pressure on limited budgets> Resurgence of Outcomes Approach> Personalisation Approach> Shifting the balance of care > Reshaping Older People’s Services> Provides one of the building blocks for Rehabilitation/ Re-ablement Framework> Added value for local authority in house service
Key Findings
> Benefits for Service Users – Independence> Reduction in Care Hours Required - Leicestershire
58% discontinued (no care hours)
17% reduced
17% maintained
8% increased
> Duration of Benefits for 2years – 4 schemes36% to 48% still discontinued (no care hours)
34% to 54% maintained or reduced package
> 65 and > 85 marked reduction
What level of service are you now receiving after Home
Care Re-ablement?
None 28
The same 18
Less 8
More 5
Null 3
Total 62
Did you think the decision about the amount of help was appropriate for you?
Yes 55
No 4
Not Sure 2
Null 1
Total 62
Satisfaction Survey
Reshaping Older People’s Care Re-ablement activity
> Into the Spotlight Conference Dec 2008> National Outcomes Conference Mar 2009> City of Edinburgh Research> Step by Step Guide 2009 (including tools – finance,
workshop etc.)> 4 x Regional Events for Partnerships> ADSW event> Independent Sector Workshop
> Continued Support to Partnerships > Change Fund support
Into the Spotlight Conference Dec 2008National Outcomes Conference Mar 2009
> National and International speakers> Focus on the changes needed – (pre
Reshaping activity)> Workshops – multi agency, users/carers> Engagement of key players
City of Edinburgh Research
> JIT commissioned research into findings of implementation i9n Edinburgh
> Related to Re- ablement research in England
EVALUATION OF CITY OF EDINBURGH COUNCIL HOME CARE RE-ABLEMENT SERVICE
Barry McLeod and Mari Mair RP&M Associates Ltd Scottish Government Social Research 2009
Step by Step Guide 2009 (including tools – finance, workshop etc.)
> Development of materials, toolkits> Compilation of evidence base> Website developments> Set programme of necessary steps,
communication, procurement, finance, implementation etc
Care at Home Services – Online Redesign System
Statutory
Engagement
Data
Collection
Review
Commissioning
Plan
Policy
Direction
Procurement
Stakeholder Involvement
Data and Analysis
Option Appraisal
and
Decision Making
Data
Analysis
Option
Appraisal
Policy
Decisions
Engage Service
Users, Carers,
Providers &TU
Evaluation
&
Vision
Step Process
Procurement
Preparation
Preparation
Policy Evaluation
and Visioning
ANALYSE
PLAN
DO
REVIEW
Care at Home Services – Online Redesign System
Stakeholder
Involvement
Data
and
Analysis
Option
Appraisal
and
Decision
Making
Planning Project – Step Process
Procurement
Preparation
Policy
Evaluation
and
Visioning
Strategic Issues
Outcomes
Care Pathways
Intensive Support
Rehabilitation/Re-ablement/Intermediate/Rapid Services
Practical Supports
Carers Support
Specialist Issues – Care Group/Dementia/Palliative Care
Technology/Telecare/Telehealth
Integration of Social Care, Health And Housing
Political Issues
Equality Impact Analysis
Option Appraisal
Capacity Plan / Service Redesign
Risk Assessment
Financial Planning
Workforce Planning
Decision-Making
Market Analysis
Procurement Planning
Service Specifications
Tendering and Contracting
Transition
Monitoring and Review
Statutory
Engagement
Data
Collection
Review
Commissioning
Plan
Policy
Direction
Procurement
Data
Analysis
Option
Appraisal
Policy
Decisions
Engage Service
Users, Carers,
Providers &TU
Evaluation
&
Vision
Preparation
Local Baseline Data
Resources
Finance
Market / Balance of Providers
Workforce
Dependency Measurement
Need And Demand
SOA Related
Outcome/Performance/Quality/Cost Indicators
Benchmarking
Definition of objectives and issues
Leadership commitment
Governance arrangements
Project management arrangements
Resourcing
Work programme and time-line
Stakeholder involvement
Communication Arrangements
Percentage Days
As Percentage of Days Per Year
Annual Leave and Public Holidays more than 5 years 28 Sickness Levels 10 26 Training 5 Percentage Cover Rate 22.7 59 260
1Service Users 2Number of Service User Per Week 103Number of Service Users Every 6 Weeks 604Number 6 Weeks Periods Per Annum 8.7
5Volume of Referrals 6Number Every 6 Weeks 607Average Number of Hours 108Total Hours Per Week 1 6009Other adjustments
10Two to visit adjustment - 12% of cases - hours per week 72.011Handover costs - 2 hours per service user - per 6 weeks 20.012Total Hours Per Week 2 692.013Total Staff 1 - 40 HPW WTE 17.314Team Meetings weekly - 3 hours - add 8% Staff 1.4 815Supervision 6 weekly - 2 hours - add 1% Staff 0.2 116Telephone Contact time - 1 hour per week - add 3% Staff 0.5 317Total Staff 2 19.418Cover 19Adding 22.7% for cover - Annual Leave etc 4.420Total Staff 3 23.8
21Adding Travel Time Total Hours Travel Time 22Travel Time Rural @ 33%% 228 692 22823Adding further 22.7 % for cover 5224Total Hours PW 28025Total Staff additional staff rural for travel 826Grand Total Staff Rural 31.627Percentage staff to service users 52.6
28Travel Time Urban @ 8% 55 692 5529Adding further 22.7% for cover 1330Total Hours PW 6831Total Staff additional for urban 232Grand Total Staff Urban 25.733Percentage staff to service users 43
Capacity Planning Tool
4 x Regional Events for PartnershipsADSW eventIndependent Sector Workshop
> Multi-agency – LA Social Work, Housing, NHS, Independent Sector, users and carers
> Regionally based, local data> Mixture of input and group work> Use of toolkits, evidence, local data.
How do we spend the £4.5 billion …
Other Social Work
Care Homes
Home Care
FHS
PrescribingCommunity
Other Hospital care
Emergency admissions
£1.4bn
£0.8bn£0.4bn
£0.4bn
£0.4bn
£0.3bn
£0.6bn£0.2bn
Talking PointsService user defined outcomes
Quality of life Process Change
Feeling safeHaving things to doSeeing peopleAs well as can beLife as want (including where you live)
Listened toHaving a say Respect Responded to Reliability
Improved confidenceImproved skillsImproved mobilityReduced symptoms
The continuum of intermediate care (adapted from Brophy 2008)
Re-ablement & recuperation Clinical Rehabilitation
Residential care including step up step down
Links to mainstream & preventative social care
Independent sector resources & re-
ablement / including discharge from
hospital
Rapid response & supported
discharge team
Social Care Healthcare
Residential beds, with nursing care
community hospitals
Acute care at home & specialist teams
for clinical rehabilitation
Links to acute clinical care, A&E & primary &
community healthcare
Self Care
Greater Pressure? - Workforce
> Nursing/care workforce very large> Largely female> Somewhat older than rest of workforce> Nurses – short hours, relatively well-paid, low
turnover> Care assistants – short hours, poorly paid, high
turnover
20
Increasing Pressure - Growth in FPC Costs
21
2003-04 2004-05 2005-06 2006-07 2007-080
50
100
150
200
250
300
350
400
CH Nursing CareCH Personal CareHome Care
Expe
nditu
re (£
m)
Older people receiving intensive home care (10+ hours per week), 2008/09
(rate per 1,000 population aged 65+)
0
5
10
15
20
25
30
35
Rate
per
1,0
00 p
op
ula
tio
n a
ged
65+
Balance of care: Supported in care homes and intensive home care, 2008/09
0%
20%
40%
60%
80%
100%Supported in care homes Intensive Home care (10+ hours per week)
Continued Support to Partnerships
> Focussed workshop intervention when requested
> But on specific issues, not more of the same
> Mentoring and Networking> Benchmarking
And now?
> 18 Partnerships have introduced or are introducing re-ablement services
> Change Fund activity all have re-ablement focus
> Dementia addition being progressed.
Thank you
For any more information please visit
www.jitscotland.org.uk
Alex Davidson
07801 952257
Gerry Graham [email protected]
07788 951182