Post on 15-Jan-2016
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Home care re-ablement services: Researching effectiveness in
prevention
Caroline Glendinning
Professor of Social Policy
University of York
Presentation to SSRG Scotland Conference
28 October 2013
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Context – growing interest in re-ablement
Home care re-ablement – evidence on impacts and cost-effectiveness
Success factors – circumstances optimising effectiveness of re-ablement?
Effectiveness in social care - wider reflections on the evidence base
Outline
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Most English councils now have home care re-ablement services
From selective to inclusive/intake services
Interest in Australia, New Zealand (particularly providers)
New NHS funding for England to invest in re-ablement Autumn 2010 - £70m
2011/12 - £150m
2012-2015 - £300m p.a.
Context – growing interest in re-ablement
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High proportions receiving re-ablement needed no further, or less, home care 63% needed no further services 26% needed less home care But would they have recovered anyway? … and how long do the effects last?
York/Kent study aimed to Provide evidence on longer-term impacts of home care re-
ablement compared outcomes of re-ablement vs. conventional home
care services
… up to 12 months later
Early evidence on home care re-ablement services
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Comparative study 5 re-ablement councils, 5 ‘standard’ home care councils
Users recruited on referral Baseline interviews
Re-interviewed after 9-12 months
Standardised outcome measures Health Quality of life Social care outcomes
Costs of re-ablement, other social care and NHS services used
Organisation and delivery of re-ablement services
Focus groups
Observations
Experiences of users and carers
Study design
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Re-ablement had positive impacts on health-related quality of life and social care outcomes Compared with conventional home care services
Typical re-ablement episode (39 days) cost £2,088 Higher than conventional home care
But 60% less use of social care services subsequently
Over full year, total social care services used by re-ablement group cost £380 less than conventional home care
Re-ablement group – higher health service costs Effects of recent hospital discharge?
Impact and cost of home care re-ablement
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Compare improvements in outcomes against costs NICE threshold £20-30K for each outcome gain
Re-ablement is cost-effective in relation to health-related quality of life outcomes
Re-ablement may be cost-effective in relation to social care outcomes Depends on £ threshold Higher healthcare costs of re-ablement group Probability of cost-effectiveness only
Is home care re-ablement cost-effective?
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Established services not pilot schemes
Small samples after 12 months – couldn’t
examine: Differences within groups
Hospital discharge vs all community referrals
Higher vs lower needs for assistance
Differences between sites, service models
(especially OT or NHS involvement)
Standardised outcome measures – but not
sensitive enough?
How robust are the results?
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Service organisation Thorough initial assessment, regular reassessment User-focused care plans Flexibility Rapid access to OT expertise/equipment Access to other specialist skills
Physio; mental health; sensory impairment; dementia
Communication and continuity Small teams Clear recording systems Regular discussions
Training and supervision On-going reinforcement re-ablement ‘ethos’
Success factors – organisation of services
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User characteristics Expectations and motivation Dementia? Carer involvement
Wider environment Strong/shared vision of service
Within adult social care External stakeholders, especially NHS referrals
Direct referral for on-going home care Capacity within long-term home care services Approach of long-term home care services
Success factors: Wider environment
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Across the boundaries – from acute ward to return home Selection Continuity Skillmix
Impacts on NHS service use (esp. readmission)
Roles and impacts on carers
In-house vs outsourced services Costs, commissioning, quality
Beyond re-ablement – sustaining improvement
Evidence gaps – re-ablement
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NIHR SSCR workshops and survey
No standard definition, approaches to evaluation
Most popular ‘preventive’ services Re-ablement
Telecare/telehealth/other technology-based interventions
Information and advice
Prevention – developing wider evidence base
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Causality, ‘soft’ outcomes’, pilot vs ‘bedded in’, diversity of QoL, cognitive/communication issues
Logic model – link interventions > intermediate outputs > outcomes
Outcome measures might include: ASCOT, others standardised outcome measures Personal outcomes achieved, QoL domains Falls-related admissions
Set against costs Labour-intensive Budget silos Short vs long-term costs
Challenges in evaluating preventive interventions
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SPRU/PSSRU evaluation of home care reablement services: bit.ly/hcreable
NIHR School for Social Care Research: www.sscr.nihr.ac.uk, especially: RF9 – Allen and Millar - prevention MR6 – Netten - outcomes measurement
Further information