The Balance of Care Approach: Modelling complexity in services for older people Paul Forte & Tom...
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Transcript of The Balance of Care Approach: Modelling complexity in services for older people Paul Forte & Tom...
The Balance of Care Approach:Modelling complexity in services for older people
Paul Forte & Tom Bowenwww.balanceofcare.com+44 7818 066653
ORAHS 2010, Genoa, Italy, 19-23 July 2010
Contents
• The Balance of Care approach:
- whole system demand-supply modelling
• An example of a telecare application:
- model development and application
- changing care pathways
Areas of strategic importance for health and social care
• Organisational issues: – supporting partnership working; innovative
connections; workforce development
• Information issues: – sharing of data, information and intelligence;
common definitions
• People issues:– harnessing drive of health and social care
professionals– facilitating client and carer engagement
The Balance of Care model
OlderPeople
Highdependency
Lowdependency
Mediumdependency
The Balance of Care model
OlderPeople
Highdependency
Lowdependency
Mediumdependency
Acutecare bed
Community nurse
Independent sector
NHS
LocalAuthority
Care home
Physiotherapist
Care assistant
Day care centre
Occupational therapist
The Balance of Care model
Highdependency
Lowdependency
Independent sector
Local authority
Care home
Care assistant
OlderPeople
Day care centreoption 3
Mediumdependency
option 2
Acute care bed
Option 1Community nurse
Physiotherapist
NHS
Occupational therapist
Balances to be struck…
Care Professionals Non-Clinical Managers
Health Services Social Services
High Dependency Low Dependency
Developing a model for telecare
• Support for social services to develop business cases for telecare in the wider context of the organisation and provision of local health and social services
• Identification of potential increased cost effectiveness through:– reduced admission to long-term care homes– reduced cost of home care packages– savings to the NHS (eg. through reduced admissions
to hospital)
Model demo here
Telecare Valley
P3 - Case management - frail older people No. of
Clients: 550
Unit Cost: £24,780 £20,658 £12,258 £ £ £ Totals
Allocation: 50% 40% 10% 100%
Allocated Clients: 275 220 55 0 0 0 550
Code Service Description Current Home with Avoid adm Opt 4 Opt 5 Opt 6 Cost
S1 Community nurse 49 52 52 £694,375
S2 Physiotherapist 1 1 £6,875
S3 Care Assistant 1095 730 730 £6,945,950
S4 OT 2 2 £13,750
S5 Geriatrician £
S6 Rehab asst £
S7 Care home EMH £
S8 Care home (non-EMH) £
S9 Acute bed 21 21 0 £4,158,000
S10 Comm hospital bed £
S11 Telecare 52 52 £214,500
S12 CPN £
S13 Night sitter £
S14 Extra care housing £
S15 Day care £
Total Cost: £6,814,445 £4,544,804 £674,201 £ £ £ £12,033,450
Quality Score: 80% 100% 100% 90%
Total Service Usage by Scenario
Service Annual Units Current Baseline Low invest Extended
Community nurse WTE 0 18 19 19
Physiotherapist WTE 0 0 0 0
Care Assistant WTE 0 644 785 722
OT WTE 0 4 8 8
Geriatrician WTE 0 0 0 0
Rehab asst WTE 0 0 0 0
Care home EMH Places 0 218 186 186
Care home (non-EMH) Places 0 1124 787 787
Acute bed Beds 0 32 28 28
Comm hospital bed Beds 0 0 0 0
Telecare Packages 0 0 865 2165
CPN WTE 0 0 0 0
Night sitter WTE 0 0 2 2
Extra care housing Places 0 0 190 190
Day care Places 0 0 0 0
Resource modelling for dementia services
• Same model structure but adapted for a dementia patient classification and care options
• Local application and costing• Support for joint strategic planning
MildCarer No carer Carer No carer
Community psychiatric nurse 1 hr pa 1 hr pa 1 hr pa 1 hr paCommunity support wkr (psych) - - - -Health Care Supt wkr (PCT prov) - - - -Home care supt (soc ser) - - - -
ModerateCarer No carer Carer No carer
Community psychiatric nurse 1 visit pcm 1 visit pcm 1 visit pcm 1 visit pcmCommunity support wkr (psych) 2 visit pcm 4 visit pcm 2 visit pcm 4 visit pcmHealth Care Supt wkr (PCT prov) - - 2 hrs pcm 4 hrs pcmHome care supt (soc ser) - - 1 hr pw 6 hrs pw
SevereCarer No carer Carer No carer
Community psychiatric nurse 1 visit pcm 1 visit pcm 1 visit pcm 1 visit pcmCommunity support wkr (psych) 3 visit pcm 6 visit pcm 4 visit pcm 8 visit pcmHealth Care Supt wkr (PCT prov) - - - -Home care supt (soc ser) 2 hr pw 5 hrs pw 3 hr pw 6 hrs pw
Not frail Frail
Not frail Frail
Not frail Frail
Simplified Care Options
Potential Resource Requirements for Key Services
Staff Type WTE Annual CostCommunity psychiatric nurse 181 £4.7 millionCommunity support worker (psych) 400 £6.0 millionHealth Care Supt worker (PCT prov) 82 £1.2 millionHome care support (Adult services) 238 £5.0 millionTotal community staff 901 £16.9 million
Care Homes places (inc respite) 2007 £67.8 million
Category descriptionsCategory Label Intended Population Base Data Source for Telecare Valley
Care home residents - not EMH
Permanent care home residents over 65 supported by council (excluding Elderly Mental Health)
England residents at 31-03-2004 / 150
Care home residents - EMH Permanent care home residents over 65 supported by council (Elderly Mental Health)
England residents at 31-03-2004 / 150.
Case management - frail older people
Numbers over 65 receiving intensive home care (> 10 hours per week). These are assumed to be the people who would be included in case management schemes for frail older people.
Based on England number receiving intensive home care (over 10 hours) at 31-03-2004 / 150.
Other long term care needs Numbers over 65 receiving home care (5- 10 hours per week). These are assumed to be the people who require continuing social care support, but do not have chronic healthcare needs appropriate for case management.
Based on England number receiving 5-10 hours of home care at 31-03-2004 / 150
Other low intensity needs Numbers over 65 receiving home care (< 5 hours per week)
Other England low intensity home care (<5hrs per week) at 31-03-2004 / 150
Unsupported at home >65 Total resident population 65 years and over, not receiving a social care service
England 2001 Census, resident population over 65, divided by 150, and net of estimated values for P1 to P5 inclusive.
P6 Unsupported at home (aged over 65)
P1 Care Home Residents(not EMH)
P2 Care Home Residents(EMH)
P3 Frailty CaseManagement
(Severe)
P4 Other long term careneeds
(Moderate)
P5 Other low intensityneeds(Minor)
Patient categories
Meaningful groups of population >65 years for telecare planning purposes