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An examination of factors influencing delayed discharge of older people from hospital
- Authors:
- CHALLIS David, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 29(2), 2014, pp.160-168.
- Publisher:
- Wiley
Methods: To examine factors influencing delayed discharge of older people from hospital data were collected retrospectively from inpatient records and adult social care services on older patients referred to the latter prior to hospital discharge. Results: Data on two related measures, delayed discharge and length of stay, were analysed separately within a four-stage sequential framework. Using bivariate analysis, cognitive impairment and dependency were found to be significantly associated with delay. Patients admitted to trauma and orthopaedics specialties were significantly more likely to be delayed on discharge. Respiratory illness was negatively associated with delay. Factors related to care received as an inpatient associated with delayed discharge from hospital were not being in the responsible consultant's bed for part of their stay, two or more moves between specialties and receipt of rehabilitation services. Admission to a care home and receipt of domiciliary care if returning to a private dwelling on discharge were associated with delay. In the multivariate analysis, dependence and cognitive impairment impacted differently on delay and length of stay . Hospital variables were the most important predictors of length of stay and social care variables in respect of delayed discharge. Conclusion: Patient characteristics and especially the organisation of care in hospital and the provision of services on discharge are related to the likelihood of delayed discharge and LOS. Improved services and structures to systematically assess and treat patient needs in hospital, together with the timely provision of services providing post-discharge services tailored to individual circumstances, are required. (Edited publisher abstract)
Commissioning social care for older people: influencing the quality of direct care
- Authors:
- CHESTER Helen, HUGHES Jane, CHALLIS David
- Journal article citation:
- Ageing and Society, 34(6), 2014, pp.930-950.
- Publisher:
- Cambridge University Press
The delivery of personalised support to vulnerable older people is largely contingent on those staff who provide direct care. These care workers play an invaluable role in supporting vulnerable older people that may have increasingly complex needs either at home or in care homes. Internationally, concern has been raised both about the recruitment and retention of care workers; and their skills and competencies because of their importance in the delivery of quality care services. Using both primary and secondary data, this paper explores commissioning and contracting arrangements for domiciliary care and care home provision in England and their influence on the recruitment and retention of staff in these services. The implications of the findings are discussed in the context of two factors which influence continuity of care, a proxy for quality services for older people: training opportunities for staff and factors affecting the supply of labour from which direct carers are traditionally recruited. It is suggested that some of the drivers of quality in the provision of care may not be susceptible to the influence of commissioners and providers. Nevertheless, training may aid the recruitment and retention of care workers and provide one way in which they can promote a higher standard of care for older people. (Publisher abstract)