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Diversity in intermediate care
- Authors:
- MARTIN Graham Paul, et al
- Journal article citation:
- Health and Social Care in the Community, 12(2), March 2004, pp.150-154.
- Publisher:
- Wiley
Discusses the evolution of intermediate care (IC) and presents interim observations from a survey of providers in England being conducted as part of a national evaluation. Telephone interviews covering various issues concerning level of provision and style of delivery have been conducted with 70 services. Data are used to discuss the progress, range and nature of IC in relation to clinician viewpoints and academic and official literature on the subject. IC 'on the ground' is a multiplicitous entity, with provision apparently evolving in accordance with the particularities of local need. While protocols for medical involvement in IC generally appear to be well established, there are some tensions concerning integration of services in a locality, care management processes and questions of flexibility and inclusiveness in relation to eligibility criteria.
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.
An evaluation of intermediate care for older people: final report
- Authors:
- GODFREY Mary, et al
- Publisher:
- University of Leeds. Institute of Health Sciences and Public Health Research
- Publication year:
- 2005
- Pagination:
- 533p., bibliog.
- Place of publication:
- Leeds
This project forms part of the national evaluation of intermediate care services in England commissioned by the Department of Health. Information on the National Intermediate Care Evaluation Project (NICEP) and the work being carried out by the other two research teams at Leicester / Birmingham Universities and the Bradford Hospital NHS Trust with Bradford and York Universities. This study examined the structure, content, outcomes and costs of intermediate care. The research questions guiding the study were: What is intermediate care? What are its effects and outcomes?.
Hospital-at-home Integrated Care Programme for the management of disabling health crises in older patients: comparison with bed-based Intermediate Care
- Authors:
- MAS Miquel A., et al
- Journal article citation:
- Age and Ageing, 46(6), 2017, pp.925-931.
- Publisher:
- Oxford University Press
Objective: To analyse the clinical impact of a home-based Intermediate Care model in the Catalan health system, comparing it with usual bed-based care. Design: Quasi-experimental longitudinal study. Setting: Hospital Municipal de Badalona and El Carme Intermediate Care Hospital, Badalona, Catalonia, Spain. Participants: Older patients with medical and orthopaedic disabling health crises in need of Comprehensive Geriatric Assessment (CGA) and rehabilitation. Methods: A CGA-based hospital-at-home Integrated Care Programme (acute care and rehabilitation) was compared with a propensity score matched cohort of contemporary patients attended by usual inpatient hospital care (acute care plus intermediate care hospitalisation), for the management of medical and orthopaedics processes. Main outcomes measures were: (a) Health crisis resolution (referral to primary care at the end of the intervention); (b) functional resolution: relative functional gain and (c) favourable crisis resolution (health + functional) = a + b. The article compared between-groups outcomes using uni/multivariable logistic regression models. Results: Clinical characteristics were similar between home-based and bed-based groups. Acute stay was shorter in home group: 6.1 (5.3–6.9) versus 11.2 (10.5–11.9) days, P < 0.001. The home-based scheme showed better results on functional resolution and on favourable crisis resolution, with shorter length of intervention, with a reduction of −5.72 (−9.75 and −1.69) days. Conclusions: In the study, the extended CGA-based hospital-at-home programme was associated with shorter stay and favourable clinical outcomes. Future studies might test this intervention to the whole Catalan integrated care system. (Edited publisher abstract)
The home-visiting process for older people in the in-patient intermediate care services
- Author:
- HIBBERD Jane
- Journal article citation:
- Quality in Ageing, 9(1), March 2008, pp.13-23.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
Within the current constraints on health and social care services, it is essential that interventions such as home visits for older people can be seen to be appropriately deployed resources for facilitating their safe and timely discharge home. This paper discusses the findings of an evaluation project undertaken in 2003/04 with two in-patient intermediate care services. The service provided a short-term intervention for older people, with an emphasis on rehabilitation to enable a safe return to their own home environment.
For the sake of their health: older service users' requirements for social care to facilitate access to social networks following hospital discharge
- Authors:
- McLEOD Eileen, et al
- Journal article citation:
- British Journal of Social Work, 38(1), January 2008, pp.73-90.
- Publisher:
- Oxford University Press
Facilitating older service users’ requirements for access to or re-engagement in social networks following hospital discharge is recognized in social care analysis and policy as critically important. This is because of the associated benefits for restoring physical health and psychological well-being. However, it tends to be a neglected dimension of current social care/intermediate care. This paper draws on a qualitative study of voluntary sector hospital aftercare social rehabilitation projects in five UK localities, which focused on addressing this issue. Through examining older service users’ feedback and experience, the study confirms the health benefits of social care facilitating access to social networks at this crucial juncture. By providing sensitive interpersonal interaction, advocacy and ‘educational’ assistance, social care workers supported older service users’ re-engagement in a variety of networks. These included friendship, recreational and family groups, health care treatment programmes and locality based contacts and organizations. As a result, material, interpersonal and health care resources were accessed, which contributed to restoring and sustaining physical health and psychological well-being. The process of such social care also emerged as critical. This included ensuring that objectives reflected service users’ priorities; integrating ‘low-level’ home care; offering befriending; and challenging the pre-set time frame of intermediate care.
Buying Time I: a prospective, controlled trial of a joint health/social care residential rehabilitation unit for older people on discharge from hospital
- Authors:
- TRAPPES-LOMAX Tessa, et al
- Journal article citation:
- Health and Social Care in the Community, 14(1), January 2006, pp.49-62.
- Publisher:
- Wiley
The study's objective was to determine the effectiveness of a joint NHS/Social Services rehabilitation unit (a form of intermediate care) for older people on discharge from community hospital, compared with 'usual' community services. This was a controlled clinical trial in a practice setting. The intervention was 6 weeks in a rehabilitation unit where individuals worked with care/rehabilitation assistants and occupational therapists to regain independence. Controls went home with the health/social care services they would ordinarily receive. Participants were from two matched geographical areas in Devon: one with a rehabilitation unit, one without. Recruitment was from January 1999 to October 2001 in 10 community hospitals. Study eligibility was assessed using the unit's inclusion/exclusion criteria: 55 years or older and 'likely to benefit from a short-term rehabilitation programme' ('potential to improve', 'realistic and achievable goals' and 'motivation to participate'). Ninety-four people were recruited to the intervention and 112 to the control. The mean (standard deviation) age was 81.8 (8.0) years. The main outcome measure was prevention of institutionalisation assessed by the number of days from baseline interview to admission to residential/nursing care or death ('survival-at-home time'). Secondary outcome measures were time to hospital re-admission over 12 months, quality of life and coping ability. There were no significant differences between the groups on any outcome measure. The findings suggest a stay in a rehabilitation unit is no more effective than 'usual' care at diverting older people from hospital/long-term care. Alternative service configurations may be as effective, having implications for tailoring services more specifically to individual need and/or user preferences. However, the unit did appear to facilitate earlier discharges from community hospital.
An evaluation of a multidisciplinary team for intermediate care at home
- Authors:
- BEECH Roger, et al
- Journal article citation:
- International Journal of Integrated Care, 4(4), 2004, Online only
- Publisher:
- International Foundation for Integrated Care
This paper describes an evaluation of a multidisciplinary Rapid Response Team (RRT). This service aimed to provide a home based alternative to care previously provided in an acute hospital bed which was acceptable to patients and carers and which maintained clinical care standards. The service was provided for the population of Hereford, a rural town in the middle of England. A mixed-method descriptive design using quantitative and qualitative techniques was used to monitor: the characteristics of service users, the types and amounts of care received, any ‘adverse’ events arising from that care, and the acceptability of the service to patients and carers. A collaborative approach involving key stakeholders allowed appropriate data to be gathered from patient case notes, RRT staff, local health and social care providers, and patients and their carers. A suite of self-completed questionnaires was, therefore, designed to capture study data on patients and activities of care, and workshops and semi-structured interview schedules used to obtain feedback from users and stakeholders. Service users (231) were elderly (mean age 75.9), from three main diagnostic categories (respiratory conditions 19.0%, heart/stroke 16.2%, falls 13.4%), with the majority (57.0%) having both medical and social care needs. All patients received care at home (mean duration 5.6 days) with only 5.7% of patients having to be re-admitted to acute care. Overall, patients and carers had positive attitudes to the new service but some expressed concerns about their ability to influence the choice of care option (24.1% and 25.0% of patients and carers, respectively), whilst 22.7% of carers were concerned about the quality of information about care. The findings of this evaluation suggest that the Rapid Response Team provided an ‘acceptable’ alternative to an extended period of care in an acute setting. Such schemes may have relevance beyond the NHS of the UK as a means of providing a more appropriate and cost efficient match between patients' needs for care, the types of care provided, and the place in which care is provided.
Shared Lives intermediate care: evaluation report
- Author:
- NATIONAL DEVELOPMENT TEAM FOR INCLUSION
- Publisher:
- National Development Team for Inclusion
- Publication year:
- 2019
- Pagination:
- 53
- Place of publication:
- Bath
An evaluation of Shared Lives intermediate care, a pilot programme to develop Shared Lives as a ‘home from hospital’ service for older people. The evaluation looks at the impact of the programme for people who are ready to leave hospital, but unable to return home. It draws on qualitative data from people in Shared Lives arrangements, Shared Lives carers, health and social care professionals, as well as data gathered from the seven pilot sites. The findings show that by the end of the Shared Lives Intermediate Care Pilot programme, which ran from October 2016-April 2019, there had been 31 home from hospital referrals into a Shared Lives arrangement. This included people with learning disability, mental health problems and physical disability. Although referrals were low, overall the evaluation demonstrate the potential benefits of Shared Lives Intermediate Care for the health outcomes of people with multiple or complex needs, in particular, people with mental health issues. Key challenges experienced by the pilots included getting health professionals to trust the Shared Lives model and make referrals. There were also capacity and resource issues, with two sites withdrawing from the pilots. The report makes recommendations for Shared Lives Schemes and services. (Edited publisher abstract)
Supported discharge teams for older people in hospital acute care: a randomised controlled trial
- Authors:
- PARSONS Matthew, et al
- Journal article citation:
- Age and Ageing, 47(2), 2018, pp.288-294.
- Publisher:
- Oxford University Press
Background: Supported Discharge Teams aim to help with the transition from hospital to home, whilst reducing hospital length-of-stay. Despite their obvious attraction, the evidence remains mixed, ranging from strong support for disease-specific interventions to less favourable results for generic services. Objective: To determine whether older people referred to a Supported Discharge Team have: (i) reduced length-of-stay in hospital; (ii) reduced risk of hospital readmission; and (iii) reduced healthcare costs. Methods: Randomised controlled trial with follow-up to 6 months; 103 older women and 80 men (n = 183) (mean age 79), in hospital, were randomised to receive either Supported Discharge Team or usual care. Home-based rehabilitation was delivered by trained Health Care Assistants up to four times a day, 7 days a week, under the guidance of registered nurses, allied health and geriatricians for up to 6 weeks. Results: Participants randomised to the Supported Discharge Team spent less time in hospital during the index admission (mean 15.7 days) in comparison to usual care (mean 21.6 days) (mean difference 5.9: 95% CI 0.6, 11.3 days: P = 0.03) and spent less time in hospital in the 6 months following discharge home. Supported discharge group costs were calculated at mean NZ$10,836 (SD NZ$12,087) compared to NZ$16,943 (SD NZ$22,303) in usual care. Conclusion: A Supported Discharge Team can provide an effective means of discharging older people home early from hospital and can make a cost-effective contribution to managing increasing demand for hospital beds. (Publisher abstract)