Search results for ‘Subject term:"intermediate care"’ Sort:
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Intermediate care: older people's involvement and experiences
- Authors:
- MANTHORPE Jill, CORNES Michelle
- Journal article citation:
- Journal of Integrated Care, 12(6), December 2004, pp.43-48.
- Publisher:
- Emerald
New service models such as intermediate care may find it difficult to involve older people in services that are time-limited and unfamiliar. Their staff may perceive themselves as having little time to sustain or build relationships with voluntary and community-based organisations engaged in intermediate care. This article shows how such challenges can be met by drawing on the experiences of voluntary sector projects involved in intermediate care services. The article focuses on practitioners' experiences of involving older people in intermediate care assessment and treatment and, secondly on the views of older people about the information they received.
The evaporation effect: final evaluation of the Help the Aged intermediate care programme for older people
- Authors:
- CORNES Michelle, WEINSTEIN Pauline, MANTHORPE Jill
- Publisher:
- Help the Aged
- Publication year:
- 2006
- Pagination:
- 47p.
- Place of publication:
- London
This is the final evaluation of the Help the Aged Intermediate Care Programme for Older People, drawing attention to the hardship caused by the 'evaporation' of intermediate care after a matter of weeks, when the need is clearly for continuing care.
Someone to expect each day
- Authors:
- CORNES Michelle, MANTHORPE Jill
- Journal article citation:
- Community Care, 8.12.05, 2005, pp.36-37.
- Publisher:
- Reed Business Information
The authors describe the findings of a research project on older people's experiences of intermediate care carried out by Help the Aged. The programme operated in seven sites across England and piloted different ways of including volunteers and the voluntary sector in NHS and social services intermediate care. The authors suggests the forthcoming white paper on care outside hospital will need to address how more intensive short-term support, such as that provided by intermediate care, can be cushioned by a tier of low-level continuous voluntary sector support which guarantees older people "someone to expect each day".
Making partnership work
- Authors:
- CORNES Michelle, MANTHORPE Jill
- Journal article citation:
- Working with Older People, 8(3), September 2004, pp.19--24.
- Publisher:
- Emerald
Considers the lessons learnt from Help the Aged's intermediate care programme for older people. Describes the programme and lists partner projects. Gives a case study of voluntary sector care management. The voluntary sector has some way to go before it is taken seriously as a genuine partner. A key message is the need to secure joint financing of any pilot project from day one.
Improving care transfers for homeless patients after hospital discharge: a realist evaluation
- Authors:
- CORNES Michelle, et al
- Journal article citation:
- Health and Social Care Delivery Research, 9(17), 2021, Online only
- Publisher:
- National Institute for Health Research
- Place of publication:
- London
Background: In 2013, 70% of people who were homeless on admission to hospital were discharged back to the street without having their care and support needs addressed. In response, the UK government provided funding for 52 new specialist homeless hospital discharge schemes. This study employed RAMESES II (Realist and Meta-narrative Evidence Syntheses: Evolving Standards) guidelines between September 2015 and 2019 to undertake a realist evaluation to establish what worked, for whom, under what circumstances and why. It was hypothesised that delivering outcomes linked to consistently safe, timely care transfers for homeless patients would depend on hospital discharge schemes implementing a series of high-impact changes (resource mechanisms). These changes encompassed multidisciplinary discharge co-ordination (delivered through clinically led homeless teams) and ‘step-down’ intermediate care. These facilitated time-limited care and support and alternative pathways out of hospital for people who could not go straight home. Methods: The realist hypothesis was tested empirically and refined through three work packages. Work package 1 generated seven qualitative case studies, comparing sites with different types of specialist homeless hospital discharge schemes (n = 5) and those with no specialist discharge scheme (standard care) (n = 2). Methods of data collection included interviews with 77 practitioners and stakeholders and 70 people who were homeless on admission to hospital. A ‘data linkage’ process (work package 2) and an economic evaluation (work package 3) were also undertaken. The data linkage process resulted in data being collected on > 3882 patients from 17 discharge schemes across England. The study involved people with lived experience of homelessness in all stages. Results: There was strong evidence to support our realist hypothesis. Specialist homeless hospital discharge schemes employing multidisciplinary discharge co-ordination and ‘step-down’ intermediate care were more effective and cost-effective than standard care. Specialist care was shown to reduce delayed transfers of care. Accident and emergency visits were also 18% lower among homeless patients discharged at a site with a step-down service than at those without. However, there was an impact on the effectiveness of the schemes when they were underfunded or when there was a shortage of permanent supportive housing and longer-term care and support. In these contexts, it remained (tacitly) accepted practice (across both standard and specialist care sites) to discharge homeless patients to the streets, rather than delay their transfer. We found little evidence that discharge schemes fired a change in reasoning with regard to the cultural distance that positions ‘homeless patients’ as somehow less vulnerable than other groups of patients. We refined our hypothesis to reflect that high-impact changes need to be underpinned by robust adult safeguarding. Strengths and limitations: To our knowledge, this is the largest study of the outcomes of homeless patients discharged from hospital in the UK. Owing to issues with the comparator group, the effectiveness analysis undertaken for the data linkage was limited to comparisons of different types of specialist discharge scheme (rather than specialist vs. standard care). Future work: There is a need to consider approaches that align with those for value or alliance-based commissioning where the evaluative gaze is shifted from discrete interventions to understanding how the system is working as a whole to deliver outcomes for a defined patient population. (Edited publisher abstract)
The voluntary sector and intermediate care
- Authors:
- CORNES Michelle, ANDREWS JoyAnn, LAKEY Shelia
- Journal article citation:
- Working with Older People, 7(1), March 2003, pp.35-40.
- Publisher:
- Emerald
Outlines progress on seven partnership projects linking voluntary sector services to NHS-led or local authority-led intermediate care services. The projects include a rapid response small repairs and adaptations service and an Extra Care residential intermediate care bed scheme.
Mainstreaming interprofessional partnerships in a metropolitan Borough
- Authors:
- DOYLE Dave, CORNES Michelle
- Journal article citation:
- Journal of Integrated Care, 14(5), October 2006, pp.27-36.
- Publisher:
- Emerald
This article draws on 'practice wisdom' to reflect on the development of interprofessional partnerships for older people in a metropolitan borough in the North West of England. The authors suggest that most interprofessional partnership working continues to set outside mainstream services, and that integration and seamless service remain a significant challenge. The authors focus on local plans for service reconfiguration ('Go Integral') and their likely implications for non-traditional services such as intermediate care and falls prevention. The article concludes by showing how social care and social work values can be used to glue the system together so that it becomes easily accessible and meaningful to older people.
Increasing access to Care Act 2014 assessments and personal budgets among people with experiences of homelessness and multiple exclusion: a theoretically informed case study
- Authors:
- CORNES Michelle, et al
- Journal article citation:
- Housing Care and Support, 21(1), 2018, pp.1-12.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to present a case study describing the progress that is being made in one city in England to increase access to Care Act 2014 assessments and personal budgets among people with experiences of homelessness and multiple exclusion. Design/methodology/approach: A case study employing a “study group” to describe and reflect on local development work. Findings: The authors focus on the “systems change” activity that was undertaken by one voluntary sector partnership project to address issues of referral and access to adult social care. This included the development of a “Multiple Needs Toolkit” designed to support voluntary sector workers to communicate more effectively with adult social care around the application of the new Care Act 2014 eligibility thresholds. The authors discuss the role of “persistent advocacy” in increasing access to assessments and also the limitations of this as regard the potential for poorer joint working. Originality/value: Throughout, the authors draw on the “ambiguity-conflict” model of policy implementation to assess if the learning from this single case study might be applied elsewhere. (Edited publisher abstract)
Improving hospital discharge arrangements for people who are homeless: a realist synthesis of the intermediate care literature
- Authors:
- CORNES Michelle, et al
- Journal article citation:
- Health and Social Care in the Community, 26(3), 2018, pp.e345-e359.
- Publisher:
- Wiley
This review presents a realist synthesis of “what works and why” in intermediate care for people who are homeless. The overall aim was to update an earlier synthesis of intermediate care by capturing new evidence from a recent UK government funding initiative (the “Homeless Hospital Discharge Fund”). The initiative made resources available to the charitable sector to enable partnership working with the National Health Service (NHS) in order to improve hospital discharge arrangements for people who are homeless. The synthesis adopted the RAMESES guidelines and reporting standards. Electronic searches were carried out for peer‐reviewed articles published in English from 2000 to 2016. Local evaluations and the grey literature were also included. The inclusion criteria was that articles and reports should describe “interventions” that encompassed most of the key characteristics of intermediate care as previously defined in the academic literature. Searches yielded 47 articles and reports. Most of these originated in the UK or the USA and fell within the realist quality rating of “thick description”. The synthesis involved using this new evidence to interrogate the utility of earlier programme theories. Overall, the results confirmed the importance of (i) collaborative care planning, (ii) reablement and (iii) integrated working as key to effective intermediate care delivery. However, the additional evidence drawn from the field of homelessness highlighted the potential for some theory refinements. First, that “psychologically informed” approaches to relationship building may be necessary to ensure that service users are meaningfully engaged in collaborative care planning and second, that integrated working could be managed differently so that people are not “handed over” at the point at which the intermediate care episode ends. This was theorised as key to ensuring that ongoing care arrangements do not break down and that gains are not lost to the person or the system vis‐a‐vis the prevention of readmission to hospital. (Edited publisher abstract)