Home from Hospital Service Health Care & Well-being Forum 11 th December 2014 Suzanne Hilton Chief...
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Transcript of Home from Hospital Service Health Care & Well-being Forum 11 th December 2014 Suzanne Hilton Chief...
Home from Hospital Service
Health Care & Well-being Forum
11th December 2014Suzanne Hilton
Chief Executive
Age UK Bolton
The Challenge• Older people rely
more on GP & acute services
• Two thirds of people admitted to hospital are 65 plus
• Older people stay longer once admitted
• 80% of delayed transfers are over 70
• In last 10years re-admissions risen 88%
• Re-admissions in 30days cost NHS £2.2bn
The Bolton Context47,000 over 65s
37% live alone
Almost 50% of over 75s live alone
14% of over 65s care for another
12% more deaths in winter-27,000p.a. 206 everyday
Estimate 3,700 over 65s will be discharged over the winter months
October 13 to March 14 9.4k attendances at A&E by over 65s- mild winter
Epidemic of Loneliness
• Loneliness linked to poor health, morbidity & depression- Worse than smoking 15 cigarettes a day
• People who regularly experience loneliness are 2 x more likely to develop Alzheimers
• 25% of people 52+ feel lonely sometimes or often
• At 80+ nearly half feel lonely often
• 1 million people over 65 feel lonely all the time
• Families at a distance (where children live more than 1 hour’s drive away 50% older people see them only every 2-6months)
AUKB Home from Hospital
Short Term/Time Limited Medium Term/On-going
Presence in A&E and on wards Befriending Service and afternoon teas to tackle loneliness & isolation
Early discharge planning and full assessment before deflection or discharge from hospital
Medication & appointment reminders
Involvement with MDTs Lunch & Leisure Clubs- hot meals in a social setting
Getting home safely- opening up, putting the heat on, organising aids & adaptations prior to arrival
Support at follow-up medical appointments
Immediate practical support- collecting prescriptions, organising meals delivery, washing- up, help to deal with correspondence built up whilst in hospital etc.
One to One support and encouragement to work on rehabilitation goals identified by healthcare professionals. Plus support to regain confidence in daily independent living tasks
AUKB Home from Hospital
Short Term/Time Limited Medium Term/On-going
Home checks-falls prevention, fire safety Chair-based exercise to promote steadiness, mobility and independence
Follow-up calls and visits for emotional and practical support
Falls prevention checks
Information & Advice e.g. help with benefit applications for help with the cost of additional support
Handyman service for help with gardening and DIY to manage the home
Signposting to other services, GPs, Careline, Care & Repair, Single Point of Access
Hobby and creative activities and digital inclusion support to stay connected with family and friends at a distance
Liaison with family, friends & neighbours Befriending support to tackle loneliness and isolation
Medication & appointment reminders
Reduction in unnecessary hospital re-admissions & crisis care
interventions
Age UK Tried and Tested Model
The EvidenceSheffield Hallam evaluation of Age UK Rotherham scheme and PSSRU other Age UK services including Stockport & Salford in GM:
R.o.I.- Between £1.50 and £6.30 for every £1 invested in H.f.H schemes
Reduced avoidable re-admissions an crisis social care interventions
Reduced hospital stays, A&E visits & hospital based physio’ by up to 50%
Further 15% reduction in GP appointments
Rotherham saved £74k p.a. in bed days, additional up to £18k p.a. for hospital transport and forecast £358k-£717k across health & social care services in 12months.
Partners & FundingPartners
Age UK Bolton- lead delivery partner & funder
working with Senior Solutions
Bolton FT Hospital – host & in-kind support
Funding
CCG -£55k (£30 AUKB + £25k SS)
AUKB - £30k
BMBC - £30K
Outcome Measure
Reduced emergency and avoidable (re)admissions
% of older people supported by HfH readmitted as inpatients or attending A&E compared to % of wider 65+ cohort
Reduced & delayed admissions to residential care
Recorded number of 65+ still at home 30 days after discharge
Improved experience of care for older people and their carers
Evaluation feedback questionnaires from HfH clients
Increased number of older people who feel supported to manage their own health and long term conditions
HfH clients still at home 30 days after dischargeEvaluation of feedback questionnaires on personal recovery goals
Increased satisfaction with care & support provided to older people
Evaluation feedback questionnaires from HfH clients
Going Live
• Staff team recruited
• Building volunteer team- ahead of profile
• Setting up base in the hospital
• Aligned to Staying Well
• Developing data capture, referral mechanisms and monitoring and evaluation systems
• Launches on 15th December