A POSITIVE VIEW OF INTERMEDIATE CARE FOR OLDER PEOPLE JOHN YOUNG Consultant Geriatrician Bradford...
-
Upload
logan-perdue -
Category
Documents
-
view
216 -
download
0
Transcript of A POSITIVE VIEW OF INTERMEDIATE CARE FOR OLDER PEOPLE JOHN YOUNG Consultant Geriatrician Bradford...
A POSITIVE VIEW OF INTERMEDIATE CARE FOR OLDER
PEOPLE
JOHN YOUNG
Consultant Geriatrician
Bradford
Patient and service need
Feasibility and effectiveness
New paradigm of care
The “proper care and rehabilitation of these (elderly) patients”
Warren, Lancet 1946
Elderly care medicine as the largest specialty
Living at home 1.8 (1.3 - 2.53)
Reduced mortality 0.65 (0.46 – 0.91)
Improved physical
Function
1.63 (1.0 – 2.65)
Improved cognitive function
2.0 (1.13 – 3.55)
Hospital Geriatric Unit v Alternative Care
Odds Ratio (95% confidence limits) at 6 months
Meta-analysis of 5 studies (n=1090)
Stuck et al Lancet 1991
SERVICES RECEIVED BY FRAIL OLDER PEOPLE (N=821)
3 MONTHS POST-DISCHARGE
• CHIROPODY• COM. NURSE• GP HOME VISIT• SOCIAL WORKER• HOME CARE
47%23%34% 5%44%
• REHAB. INPUT ??
THE EXPERIENCE OF COMMUNITY CARE
• Piles of unmet need
• Fragmented service provision
• Poor co-ordination of services
• More caring/doing, less enabling/facilitating
• Multiple assessments
• Multiple waiting lists
BASIS FOR INTERMEDIATE CARENo. 1
UNEQUIVOCAL, UNARGUABLE, UNCONTESTABLE
PATIENT NEED
TO TRANSFORM COMMUNITY SERVICES FOR OLDER PEOPLE
BASIS FOR INTERMEDIATE CARENo. 2
UNEQUIVOCAL, UNARGUABLE, UNCONTESTABLE
SERVICE NEED
TO TRANSFORM COMMUNITY SERVICES FOR OLDER PEOPLE
“Please Sir, can I have some more beds?”
“If we always do what we’ve always done,
We’ll always get what we’ve always got.”
Don Burwick
BASIS FOR INTERMEDIATE CARENo. 3
NEW PARADIGM OF CARE FOR OLDER PEOPLE
Whole systems working
Multi-agency
Person centred care
Single assessment process
“New ways of working”
Joint budgets, staff, equipment etc.
CONFIRMED EXPANSION OF I.C.
TARGET
2004
BEDS +5,000
PLACES +1,700
PTS. +220,000
Capacity targets due to be met in 2004
Hansard, April, 2004
2004
+8,697
+17,339
+331,721
THE EVOLUTION OF I.C.(Needs time)
EMBRYONIC SERVICE(S)
DEFINED I.C. COMPONENTS
WHOLE SYSTEM I.C.
INTEGRATED WHOLE SYSTEM I.C.
(= Multi-agency working)
(=Criteria driven IC)
(=Single telephone & person driven IC)
(=Mainstream service)
IN MATURE I.C. SERVICES (=critical mass & integrated)
Favourable service level outcomes reported:
- Lower DGH demand- Lower care home demand
Hosp. at Home v inpatient hospital care
(Cochrane review: Sheppard & Iliffe)
N = 16 RCTs
How many trials do you want?
EXPERIMENTAL EVIDENCE FOR I.C.
SUMMARY OF HaH FINDINGS
• Feasible
• Flexible: diff. conditions
diff. IC functions
• Clinically safe service
• Similar cost to in-patient care (?)
• Offers genuine alternative to in-patient care
• Increases local health service capacity• Cochrane review: Sheppard & Iliffe
I.C. as a vector for whole
system changes
INTERMEDIATE CARE INTERMEDIATE CARE IS NOT A SCARY IS NOT A SCARY
BUSINESSBUSINESSBasis for I.C.:
• Pressing pt & service need for change
• I.C. as a feasible & effective response
• I.C. as a paradigm shift in community care for OPi.e.
to infiltrate existing services and so create an influence on attitudes, behaviour and skill-base for older people