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Fit for frailty: part 2: developing, commissioning and managing services for people living with frailty in community settings
- Authors:
- BRITISH GERIATRICS SOCIETY, ROYAL COLLEGE OF GENERAL PRACTITIONERS
- Publisher:
- British Geriatrics Society
- Publication year:
- 2015
- Pagination:
- 35
- Place of publication:
- London
Provides advice and guidance on the development, commissioning and management of services for people living with frailty in community settings. The first section introduces the concept of frailty and sets out the rationale for developing frailty services. The second section explores the essential characteristics of a good service. The third section considers the issue of performance and outcome measures for frailty services. The appendix to the report includes eight case studies of services which are operating in different parts of the UK. The audience for this guidance comprises GPs, geriatricians, health service managers, social service managers and commissioners of services. It is a companion report to an earlier BGS publication, Fit for Frailty Part 1 which provided advice and guidance on the care of older people living with frailty in community and outpatient settings. (Edited publisher abstract)
Commission on hospital care for frail older people: main report
- Author:
- HSJ/SERCO COMMISSION ON HOSPITAL CARE FOR FRAIL OLDER PEOPLE
- Publisher:
- Health Service Journal
- Publication year:
- 2014
- Pagination:
- 16
- Place of publication:
- London
A report from the HSJ/Serco Commission, addressing the problem of how the NHS should care for the country's increasing number of frail older people. The commission's central conclusion is that hospital providers and commissioners should not rely on government plans for greater integration between health and social care as a solution - they must and can take action now themselves to tackle the problem. The report sets out five key findings: there is a myth that providing more and better care for frail older people in the community, increasing integration between health and social care services and pooling health and social care budgets will lead to significant, cashable financial savings in the acute hospital sector and across health economies; the commonly made assertion that better community and social care will lead to less need for acute hospital beds is probably wrong as improving community care may postpone the need for hospital care, but it will make frail older people neither invincible nor immortal; more realism is needed in the debate about the quality and quantity of care that can be provided in an environment of funding that is declining relative to demand; hospitals should not be used to provide care that should more appropriately be provided elsewhere; while acute hospital admission is often the right thing to do for frail older people, being in hospital also creates risks for older people and hospitals need to gear up to provide the very best care for frail older people, who are now their most frequent users, involving geriatricians from the start of the admission together with the other appropriate specialists. Alongside the report HSJ has published a series of case studies showing good practice from around the NHS. Further evidence that led to the commissioners' conclusions and a full bibliography is also available. (Edited publisher abstract)
Informal caregivers' participation when older adults in Norway are discharged from the hospital
- Authors:
- BRAGSTAD Line Kildal, et al
- Journal article citation:
- Health and Social Care in the Community, 22(2), 2014, pp.155-168.
- Publisher:
- Wiley
This paper describes the participation of informal caregivers in the discharge process when patients aged 80 and over who were admitted from home to different hospitals in Norway were discharged to long-term community care. Data for this cross-sectional survey were collected through telephone interviews with a consecutive sample of 262 caregivers recruited between October 2007 and May 2009. The Discharge of Elderly Questionnaire was developed by the research team and was designed to elicit data concerning informal caregivers' self-reported perceptions on participation in the discharge process. A descriptive and comparative analysis of Thompson's levels of participation reported by the older generation (spouses and siblings) and the younger generation (adult children and children-in-law, nieces and grandchildren) was undertaken using bivariate cross-tabulations and chi-square tests for association and trend. Analyses showed that the younger generation of caregivers received and provided information to hospital staff to a greater degree than the older generation. Overall, 52% of the informal caregivers reported co-operating with the staff to a high or to some degree. A multivariate logistic regression analysis was used to analyse factors predicting the likelihood of informal caregivers reporting co-operation with hospital staff. The odds of younger generation caregivers reporting co-operation were more than twice as high as the odds of the older generation. Caregivers of patients with a hearing impairment had higher odds of reporting co-operation than caregivers of patients with no such impairment. The length of hospital stay, the caregiver's and patient's gender and education level were not significantly associated with caregiver's co-operation. The informal caregivers' experiences with information practices and user participation in hospitals highlight important challenges that must be taken seriously to ensure co-operation between families and hospitals when elderly patients are discharged back to the community. (Edited publisher abstract)
Frail old people at the margins of care:some recent research findings
- Authors:
- CHALLIS David, HUGHES Jane
- Journal article citation:
- British Journal of Psychiatry, 180, February 2002, pp.126-130.
- Publisher:
- Cambridge University Press
Community-based care at the margin is a substitute for institutional care. Three factors are considered critical: definitions of eligibility, assessment procedures and balance of care. This research examines determinants of the margin between institutional and home-based care, reviews current practice, identifies the implications and contributes to planning of integrated long-term care services for frail older people. Findings suggest that greater standardisation of approaches to the determination of eligibility for social care and to assessment of need is required. Providing care at home for some of those currently entering care homes is feasible, but will require different service structures and staff roles, including specialist clinicians.
Distribution and utilization of home- and community-based long-term care services for the elderly in North Carolina
- Authors:
- GOINS R. Turner, HOBBS Gerry
- Journal article citation:
- Journal of Aging and Social Policy, 12(3), 2001, pp.23-42.
- Publisher:
- Routledge
- Place of publication:
- Philadelphia, USA
Provision of home- and community-based long-term care is a growing concern in the USA. As more persons grow old, the need for these services is expected to rise. Presented in this article the analysis examines the distribution and utilisation of three home- and community-based long-term care programs in North Carolina for each of the state's 100 counties. Maps were generated to examine how counties differed in respect to service utilisation among the elderly. Great variability was found in number of elderly utilising the services across the state as well as the percent of Medicaid- and/or age-eligible persons who utilised the programs. Multivariate modeling for associations to service utilisation was only possible for one of the long-term care programs. Results indicated that living alone, being non-white, and having a mobility and self-care limitation were all positively related to utilisation. Percent of persons 85 years or older and the ratio of institutionalised long-term care beds were negatively associated with utilisation. It was concluded that states must engage in concerted efforts to ensure equity in access to home- and community-based long-term care.
Learning from older community care clients
- Author:
- SOCIAL POLICY RESEARCH UNIT
- Publisher:
- University of York. Social Policy Research Unit
- Publication year:
- 2000
- Pagination:
- 4p.
- Place of publication:
- York
Reports on a project conducted jointly by the Social Policy Research Unit (SPRU) and Bradford Social Services Elderly Division to obtain older people's views about outcomes. Home interviews with a small random cross-section of older community care clients were conducted by senior social services managers. The implementation of a programme of "customer visits" to enable senior managers to see first hand the outcomes of services and directly discuss them with service users.
False economies of care
- Author:
- HUNTER Mark
- Journal article citation:
- Community Care, 18.3.99, 1999, p.10.
- Publisher:
- Reed Business Information
Looks at a report on social care spending on over 65-year-olds in Wales which has highlighted the way cash shortages are forcing social services departments to focus services on the most severely disabled people at the expense of the majority of others.
Hospital discharge for frail older people: a literature review with practice case studies
- Authors:
- TARABORRELLI Patricia, et al
- Publisher:
- Great Britain Scottish Office Central Research Unit;
- Publication year:
- 1998
- Pagination:
- 4p.
- Place of publication:
- Edinburgh
Outlines the findings of a study that identified and examined recent literatures relating to the discharge of frail older people and assessed the contribution of that literature to current practice. There are two main aspects to the study: an extensive review of the existing literature; and a review of case studies of discharge practice at four Scottish NHS Trusts, selected to represent a range of circumstances and catchment area populations.
Evaluation of continuing care accommodation for elderly people: vol. 1; evaluating continuing care for very frail elderly people
- Authors:
- BOND John, et al
- Publisher:
- University of Newcastle upon Tyne: School of Health Care Sciences
- Publication year:
- 1989
- Pagination:
- 62p.,tables,bibliog.
- Place of publication:
- Newcastle upon Tyne
Report of an evaluation of three experimental National Health Service nursing homes set up by the Department of Health and Social Security in 1983 and 1984.
Characteristics of older Australian community aged care clients who fall: incidents reported by care staff
- Authors:
- BRETT Lindsey, et al
- Journal article citation:
- Health and Social Care in the Community, 30(2), 2022, pp.469-475.
- Publisher:
- Wiley
Falls are the leading cause of injury and hospitalisation for older adults (aged 65 years or older) worldwide. Data collected by community aged care providers are an underutilised source of information about precipitating risk factors and consequences of falls for older adults living in the community. The objective of this longitudinal, observational study was to describe and compare the characteristics of older Australians who did and did not have falls reported by community aged care staff. This study analysed 19 months of routinely collected care management and incident data for 1,596 older clients from a large Australian community care provider. Differences in sociodemographic characteristics, care needs and community care service use were compared between those who had one or more reported falls and those who had none. Fall-related outcomes (injuries, hospitalisations, relocation to residential aged care) were examined. The average age of clients was 82 years and most were women (66%). Seventy-seven (4.8%) clients had one or more reported falls over the study period (total falls = 92). Clients who had falls reported by care staff were more likely to be older adults, male and use more hours of community care services per week. There were 38 falls-related injuries, 5 falls-related hospitalisations and 20 clients relocated to residential aged care after a reported fall. This study demonstrates the potential for using routinely collected community aged care data to understand risk factors and monitor longitudinal outcomes for a population at high risk of falls. (Edited publisher abstract)