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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


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


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


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


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


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


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?


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?


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


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


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


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


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


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

http://bit.ly/hcreable

http://bit.ly/hcreable

http://www.sscr.nihr.ac.uk/

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