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Post acute care of the elderly in Singapore
- Author:
- GOH Soon Noi
- Journal article citation:
- Asia Pacific Journal of Social Work and Development, 21(1), June 2011, pp.31-53.
- Publisher:
- Taylor and Francis
This paper is concerned with understanding the family care of elderly people and their use of post-acute care services such as community hospitals, nursing homes, day rehabilitation centres, and home care. The use of post-acute care services is a result of a complex, inter-related set of physical, social, psychological, organisational, and environmental factors. The aim of this multi-method study was to use Andersen Behavioural Model of Health Service Use to explore how these factors are associated with the use of post-acute care services. The study involved: a survey of 299 elderly patients from a public acute-care hospital using a structured questionnaire; in-depth interviews with 13 of these patients and their family members; and 3 focus groups with service providers. The survey showed that the following factors are associated with the use of post-acute care services: medical and physical conditions; perceived health and utility; knowledge and previous use of service; ethnicity; family size; paid help; housing type; and living arrangements. The results from the interviews and focus group discussions consistently pointed to the affordability of services as an important factor. The question of service accessibility and its implications on practice, policy and research are discussed.
Post-acute home care and hospital readmission of elderly patients with congestive heart failure
- Authors:
- LI Hong, MORROW-HOWELL Nancy, PROCTOR Enola K.
- Journal article citation:
- Health and Social Work, 29(4), November 2004, pp.275-285.
- Publisher:
- Oxford University Press
After in-patient hospitalisation, many elderly patients with congestive heart failure (CHF) are discharged home and receive post-acute home care from informal (family) caregivers and formal service providers. Hospital readmission rates are high among elderly patients with CHF, and it is thought that use of informal and formal services may reduce hospital readmission during the post-acute period. Using proportional Cox regression analysis, the authors examined the independent and joint effects of post-acute informal and formal services on hospital readmission. No evidence of service impact was found. Rather, hospital readmission was associated with a longer length of CHF history and noncompliance with medication regimes. Research, policy, and practice implications are discussed.
Intermediate care - developing voluntary sector services
- Author:
- PEARSON Daniel
- Journal article citation:
- Working with Older People, 6(1), March 2002, pp.32-34.
- Publisher:
- Emerald
Describes how Intermediate care aims to bridge the gap between hospital and home by acting as a one-stop shop for a whole range of different services such as community nursing, social work, physiotherapy and occupational therapy. It is geared toward promoting faster recovery from illness, preventing unnecessary acute hospital admissions, supporting timely hospital discharge and most important of all, enabling people to retain their independence for as long as possible.
Inter-organisational collaboration in palliative care trajectories for nursing home residents: a nation-wide mixed methods study among key persons
- Authors:
- HERMANS Sofie, et al
- Journal article citation:
- International Journal of Care Coordination, 22(2), 2019, pp.69-80.
- Publisher:
- Sage
Introduction: Multiple care organisations, such as home care services, nursing homes and hospitals, are responsible for providing an appropriate response to the palliative care needs of older people admitted into long-term care facilities. Integrated palliative care aims to provide seamless and continuous care. A possible organisational strategy to help realise integrated palliative care for this population is to create a network in which these organisations collaborate. The aim is to analyse the collaboration processes of the various organisations involved in providing palliative care to nursing home residents. Method: A sequential mixed-methods study, including a survey sent to 502 participants to evaluate the collaboration between home and residential care, and between hospital and residential care, and additionally three focus group interviews involving a purposive selection among the survey participants. Participants are key persons from the nursing homes, hospitals and home care organisations that are part of the 15 Flemish palliative care networks dispersed throughout the region of Flanders, Belgium. Results: Survey data were gathered from 308 key persons (response rate: 61%), and 16 people participated in three focus group interviews. Interpersonal dimensions of collaboration are rated higher than structural dimensions. This effect is statistically significant. Qualitative analyses identified guidelines, education, and information-transfer as structural challenges. Additionally, for further development, members should become acquainted and the network should prioritise the establishment of a communication infrastructure, shared leadership support and formalisation. Discussion: The insights of key persons suggest the need for further structuration and can serve as a guideline for interventions directed at improving inter-organisational collaboration in palliative care trajectories for nursing home residents. (Edited publisher abstract)
Care transition types across acute, sub-acute and primary care: case studies of older people with complex conditions and their carers
- Authors:
- HARVEY Desley, et al
- Journal article citation:
- Journal of Integrated Care, 26(3), 2018, pp.189 -198.
- Publisher:
- Emerald
Purpose: The purpose of the paper is to examine the care transitions of older people who transfer between home, acute and sub-acute care to determine if there were common transition types and areas for improvements. Design/methodology/approach: A longitudinal case study design was used to examine care transitions of 19 older people and their carers as a series of transitions and a whole-of-system experience. Case study accounts synthesising semi-structured interviews with function and service use data from medical records were compared. Findings: Three types of care transitions were derived from the analysis: manageable, unstable and disrupted. Each type had distinguishing characteristics and older people could experience elements of all types across the system. Transition types varied according to personal and systemic factors. Originality/value: This study identifies types of care transition experiences across acute, sub-acute and primary care from the perspective of older people and their carers. Understanding transition types and their features can assist health professionals to better target strategies within and across the system and improve patient experiences as a whole. (Edited publisher abstract)
National Audit of intermediate care report 2013
- Author:
- NHS BENCHMARKING NETWORK
- Publisher:
- NHS Benchmarking Network
- Publication year:
- 2013
- Pagination:
- 110
- Place of publication:
- Manchester
The National Audit of Intermediate Care provides an overview of intermediate care commissioning and provision in England. This is the second year of the audit, which has been extended to cover crisis response and social care re-ablement services. The 2012 audit focused on health based bed and home intermediate care services; and this report presents findings from data collected on these subjects for both 2011/12 and 2012/13 for comparison. The audit is a partnership project between the British Geriatrics Society, the Association of Directors of Adult Social Services, AGILE - Chartered Physiotherapists working with older people, the College of Occupational Therapists - Specialist Section Older People, the Royal College of Physicians (London), the Royal College of Nursing, the Patients Association, the Royal College of Speech and Language Therapists, and the NHS Benchmarking Network. A Steering Group. The focus of this audit is on quality of service provision, and it finds diversity of provision and variations in commissioning. The cost of an intermediate care bed day reported by commissioners ranged from an average of £182 in residential care homes to an average of £260 per bed day in acute hospital settings. The data also continue to suggest that mental health workers are still rarely included in the establishment in intermediate care teams. People with dementia comprise only 12% of service users, and thus continue to be under-represented. (Edited publisher abstract)
The impact of the Marie Curie Nursing Service on place of death and hospital use at the end of life: research report
- Authors:
- CHITNIS Xavier, et al
- Publisher:
- Nuffield Trust
- Publication year:
- 2012
- Pagination:
- 63p.
- Place of publication:
- London
The Marie Curie Nursing Service (MCNS) provides home-based end of life care to around 28,000 people at the end of life in the UK each year. This report looks at the impact of the MCNS on place of death and hospital use at the end of life, and in particular at whether MCNS care allowed more people to die at home and reduced the use and costs of hospital care at the end of life. The evaluation used retrospective analysis and compared 29,538 people who received MCNS care and died between 2009 and 2011 and a matched control group of 29,538 people selected from the population of England who died in the same period. The report describes the study, including its methodology, and presents the results, covering place of death and hospital use and costs. It reports that there was a significant difference in place of death between those who received MCNS care and the matched controls: 76.7% of those who received MCNS care died at home and only 7.7% died in hospital, while 35% of the controls died at home and 41.6% died in hospital; people who received MCNS care were less likely to use all forms of hospital care than those in the control group. It concludes that the results provide evidence that home-based nursing care can reduce hospital use at the end of life and help more people to die at home, and evidence of the potential benefits of home-based nursing care.
The impact of the Marie Curie Nursing Service on place of death and hospital use at the end of life: research summary
- Authors:
- CHITNIS Xavier, et al
- Publisher:
- Nuffield Trust
- Publication year:
- 2012
- Pagination:
- 16p.
- Place of publication:
- London
The Marie Curie Nursing Service (MCNS) provides home-based end of life care to around 28,000 people at the end of life in the UK each year. This paper summarises research which looked at the impact of the MCNS on place of death and hospital use at the end of life, and in particular at whether MCNS care allowed more people to die at home and reduced the use and costs of hospital care at the end of life. The research used retrospective analysis and compared 29,538 people who received MCNS care and died between 2009 and 2011 and a matched control group of 29,538 people selected from the population of England who died in the same period. The paper briefly describes the study methodology and presents key points from the results, covering place of death and hospital use and costs. It reports that people who received MCNS care were significantly more likely to die at home than those who received 'standard' care: 76.7% of those who received MCNS care died at home and only 7.7% died in hospital, while 35% of the controls died at home and 41.6% died in hospital; people who received MCNS care were less likely to use all forms of hospital care than those in the control group. The study concluded that the results provide evidence that home-based nursing care can reduce hospital use at the end of life and help more people to die at home, and of the potential benefits of home-based nursing care.
The care of frail older people with complex needs: time for a revolution
- Author:
- CORNWELL Jocelyn
- Publisher:
- King's Fund
- Publication year:
- 2012
- Pagination:
- 16p.
- Place of publication:
- London
This report summarises the discussion of the Sir Roger Bannister Health Summit held by the Kings Fund in November 2011. Representatives from patient and voluntary organisations discussed the care of very old frail people with complex health problems, and what could be done to build the confidence of older patients with complex needs, and their carers, in the quality of care in hospital and at home. The report outlines five key messages. People are living longer but despite improvements in medicine in the past 25 years many health professional were educated and trained for a different eras. Successive governments have recognised the complexity of the problem and introduced policies and guidance but have not converted the rhetoric into the reality of everyday care. Older people’s services do not have high societal status and are not generally considered attractive options for professionals. The majority of staff have few qualifications, are on low pay and have poor working conditions; effective managers working in a supportive organisation could remedy many of the problems. Actions can be taken at different levels in the system, but they believe that the responsibility for quality of care is firmly located at the level of the team. Recommendations are made for: team leaders; senior leaders; professional bodies; and policy makers, government and commissioners.
Cultural diversity between hospital and community nurses: implications for continuity of care
- Authors:
- HELLESO Ragnhild, FAGERMOEN Solveig
- Journal article citation:
- International Journal of Integrated Care, 10(1), 2010, Online only
- Publisher:
- International Foundation for Integrated Care
Nurses have a pivotal role in discharge planning for frail patients as increasing number of people need post-hospital nursing care in their homes. Despite considerable effort and focus on how to undertake hospital discharge successfully, the problem of ensuring continuity of care remains. The authors highlight and discuss three challenges that seem to be insufficiently articulated when hospital and community nurses interact during discharge planning: how local practices circumvent formal structures, how nurses' different perspectives influence their assessment of patients' need for post-hospital care, and how nurses have different understanding of what it means to be ‘ready to be discharged’. They propose that nurses need to discuss these challenges and their implications for nursing care so as to be ready to face changing demands for health care in future.