Providing appropriate, sustainable care to older people for the coming decades is a challenge that all EU member states are facing, because of demographic changes, cost containment and empowerment. An increasing number of older people have long-term, complex needs which may require support from any combination of primary, residential or acute hospital care, as well as social care and practical support. A key solution to this challenge is integrated care – a well-planned and well-organised set of services and care processes, targeted at the multidimensional needs and problems of an individual client, or at a group of people with similar needs or problems. Members of the integrated care team work closely to offer timely detection, appropriate assessment, treatment and care, so that the older person‘s health and well-being might be significantly enhanced. This resource book for managers provides guidelines for those involved in the development of integrated care services, focusing on the management of integrated care at the client level, the organisation level and the system level, this book will be invaluable to managers and professionals in the health and social care field.
Providing appropriate, sustainable care to older people for the coming decades is a challenge that all EU member states are facing, because of demographic changes, cost containment and empowerment. An increasing number of older people have long-term, complex needs which may require support from any combination of primary, residential or acute hospital care, as well as social care and practical support. A key solution to this challenge is integrated care – a well-planned and well-organised set of services and care processes, targeted at the multidimensional needs and problems of an individual client, or at a group of people with similar needs or problems. Members of the integrated care team work closely to offer timely detection, appropriate assessment, treatment and care, so that the older person‘s health and well-being might be significantly enhanced. This resource book for managers provides guidelines for those involved in the development of integrated care services, focusing on the management of integrated care at the client level, the organisation level and the system level, this book will be invaluable to managers and professionals in the health and social care field.
Extended abstract:
Author:NIES Henk, BERMAN Philip C., eds. Title: Integrating services for older people: a resource book for managers Publisher: European Health Management Association, 2004
Summary
This resource book for managers provides guidelines for those involved in the development of integrated care services, focusing on the management of integrated care at the client level, the organisation level and the system level.
Context
Providing appropriate, sustainable care to older people for the coming decades is a challenge that all EU member states are facing, because of demographic changes, cost containment and empowerment. An increasing number of older people have long-term, complex needs which may require support from any combination of primary, residential or acute hospital care, as well as social care and practical support. A key solution to this challenge is integrated care – a well-planned and well-organised set of services and care processes, targeted at the multidimensional needs and problems of an individual client, or at a group of people with similar needs or problems. Members of the integrated care team work closely to offer timely detection, appropriate assessment, treatment and care, so that the older person‘s health and well-being might be significantly enhanced.
Contents
The editors' foreword gives the background, discusses definitions and terminology and implementing the concept, and explains how the book developed, that it users should mainly be managers of care-providing organisations and managers and officials responsible for commissioning long-term care for older people, how to use it, topics covered, the geographical spread of content, and how to get involved. Chapter 1 discusses the concepts and background of integrated care. Chapter 2 considers integrated organisational structures. Chapter 3 is on involvement, empowerment and advocacy. Needs assessment is covered by Chapter 4. Chapter 5 covers care pathways. Case management is the theme of Chapter 6. Chapter 7 is about integrated teams. The workforce is discussed in Chapter 8 and cultural change in Chapter 9. Leadership is the theme of Chapter 10. Chapter 11 considers strategic planning. Information management is discussed in Chapter 12, and quality management in Chapter 13. Almost all chapters have sections on definitions, implementation, objectives and intended outcomes, models and approaches, the implementation process, staff, monitoring and evaluation, staff, barriers, supports, references and further reading, and sometimes a conclusion. Some also give web links. Much information is given in figures and tables.
352 references
Subject terms:
hospitals, intermediate care, older people, primary care, residential care;
University of Leicester. Nuffield Community Care Studies Unit
Publication year:
1999
Pagination:
200p.
Place of publication:
Leicester
Acute hospital care is not necessarily the best way to look after all older people when they are ill. Their illnesses may not require the extensive range of services offered in an acute hospital and the admission and stay in an acute hospital, in itself, can be harmful for some frail people. The results of the systematic review of literature comparing alternative models of care with ‘conventional’ care for older people indicated that stroke units, early discharge schemes and in-patient rehabilitation delivered better outcomes at discharge in terms of mortality, physical function and discharge destination. However, it was unclear whether the improvements are maintained over the longer term or why they were achieved. The most significant finding was the lack of firm evidence about the quality, costs and effectiveness of different places of care. However, there is some evidence that admission avoidance schemes may have potential for reducing costs without worsening outcomes.
Acute hospital care is not necessarily the best way to look after all older people when they are ill. Their illnesses may not require the extensive range of services offered in an acute hospital and the admission and stay in an acute hospital, in itself, can be harmful for some frail people. The results of the systematic review of literature comparing alternative models of care with ‘conventional’ care for older people indicated that stroke units, early discharge schemes and in-patient rehabilitation delivered better outcomes at discharge in terms of mortality, physical function and discharge destination. However, it was unclear whether the improvements are maintained over the longer term or why they were achieved. The most significant finding was the lack of firm evidence about the quality, costs and effectiveness of different places of care. However, there is some evidence that admission avoidance schemes may have potential for reducing costs without worsening outcomes.
Subject terms:
hospitals, intermediate care, older people, outcomes, hospital discharge, social policy, unmet need;
Reports on two innovative approaches to providing intermediate care for older people. Homerton University Hospital NHS Foundation Trust has developed one post that addresses the needs of informal carers, and another that ensures older people who need help with their finances are able to access expert advice and support.
Reports on two innovative approaches to providing intermediate care for older people. Homerton University Hospital NHS Foundation Trust has developed one post that addresses the needs of informal carers, and another that ensures older people who need help with their finances are able to access expert advice and support.
University of Birmingham. Health Services Management Centre
Publication year:
2003
Pagination:
24p.
Place of publication:
Birmingham
Often, accounts of hospital discharge refer to the problem of ‘bed blocking’ as a short-hand term for people (often older people) who it is believed are occupying a hospital bed when they no longer need the services provided in an acute setting. While such phrases are in widespread usage, this terminology is felt by many to carry a highly pejorative meaning, implying that the older people concerned are themselves to blame for the situation. As is increasingly clear, however, this is often totally inaccurate, as it is the system itself which causes many such ‘blockages’, not the individual patient (who often wishes to return home as soon as possible).
Often, accounts of hospital discharge refer to the problem of ‘bed blocking’ as a short-hand term for people (often older people) who it is believed are occupying a hospital bed when they no longer need the services provided in an acute setting. While such phrases are in widespread usage, this terminology is felt by many to carry a highly pejorative meaning, implying that the older people concerned are themselves to blame for the situation. As is increasingly clear, however, this is often totally inaccurate, as it is the system itself which causes many such ‘blockages’, not the individual patient (who often wishes to return home as soon as possible).
Subject terms:
hospitals, intermediate care, older people, hospital discharge, social care provision, community care, delayed discharge;
MCC Building Knowledge for Integrated Care, 10(6), December 2002, pp.15-21.
Publisher:
Pavilion
The third in a series of articles about trying to develop better evidence for a service on the health/social care interface. All are based on experiences of carrying out a comparative study of residential rehabilitation for older people. Previous articles dealt with methodology and implementation, this article reflects on the completion of the project and the first stages of dissemination.
The third in a series of articles about trying to develop better evidence for a service on the health/social care interface. All are based on experiences of carrying out a comparative study of residential rehabilitation for older people. Previous articles dealt with methodology and implementation, this article reflects on the completion of the project and the first stages of dissemination.
Subject terms:
hospitals, intermediate care, older people, rehabilitation, residential care, evidence-based practice, health;
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.
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.
Subject terms:
home care, hospitals, intermediate care, older people, hospital admission, prevention;
Describes how an intermediate care initiative helped reduce bed pressures on the district hospital and improved the level of care delivered to patients.
Describes how an intermediate care initiative helped reduce bed pressures on the district hospital and improved the level of care delivered to patients.
Subject terms:
hospitals, intermediate care, older people, patients, hospital admission, community care, health care;
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)
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)
Subject terms:
discharge planning, older people, hospital discharge, service transitions, intervention, evaluation, intermediate care, early intervention, hospitals;
A review of Cardiff and Vale Integrated Health and Social Care (IHSC) partnership (the Partnership), carried out between March and June 2016, to assess ambitious whether their plans to integrate health and social care services have led to improvements in levels of delayed transfers of care from hospital. The review found that the independence of older people is being prioritised through joint working and the implementation of an integrated service model. It also found good use of the intermediate care fund, but highlights that there are no contingency plans in place if the fund was to stop. It also found that partners had develop a strong governance, performance monitoring and evaluation arrangements. Although delayed transfers of care remain the second highest in Wales, performance is steadily improving. The report concludes that partners are working well together to manage delayed transfers of care, whilst realising their plans for a whole systems model. The report makes two recommendations. The appendices includes four good practice case studies of initiatives that other health and social care services in England and Wales are using to reduce delayed transfers of care.
(Edited publisher abstract)
A review of Cardiff and Vale Integrated Health and Social Care (IHSC) partnership (the Partnership), carried out between March and June 2016, to assess ambitious whether their plans to integrate health and social care services have led to improvements in levels of delayed transfers of care from hospital. The review found that the independence of older people is being prioritised through joint working and the implementation of an integrated service model. It also found good use of the intermediate care fund, but highlights that there are no contingency plans in place if the fund was to stop. It also found that partners had develop a strong governance, performance monitoring and evaluation arrangements. Although delayed transfers of care remain the second highest in Wales, performance is steadily improving. The report concludes that partners are working well together to manage delayed transfers of care, whilst realising their plans for a whole systems model. The report makes two recommendations. The appendices includes four good practice case studies of initiatives that other health and social care services in England and Wales are using to reduce delayed transfers of care.
(Edited publisher abstract)
Subject terms:
integrated care, delayed discharge, joint working, performance evaluation, joint financing, prevention, older people, intermediate care, local authorities, hospitals;
INSTITUTE FOR RESEARCH AND INNOVATION IN SOCIAL SERVICES
Publisher:
Institute for Research and Innovation in Social Services
Publication year:
2014
Place of publication:
Glasgow
Produced as part of a pathway mapping activity with practitioners, this document looks at the care older people experience when discharged from hospital in Scotland and the challenges practitioners face. Four of the most common care pathways are identified and illustrated: returning straight home (with or without family support); early supported discharge or intermediate care at home; step down or intermediate care; and admission straight to a care home. The document also presents key findings from a literature review on delayed discharge and the pathway between hospital and home to highlight some of the key problems and solutions. The resource has been developed as part of a 20-month project to redesign the pathway from hospital to home for older people across Scotland.
(Edited publisher abstract)
Produced as part of a pathway mapping activity with practitioners, this document looks at the care older people experience when discharged from hospital in Scotland and the challenges practitioners face. Four of the most common care pathways are identified and illustrated: returning straight home (with or without family support); early supported discharge or intermediate care at home; step down or intermediate care; and admission straight to a care home. The document also presents key findings from a literature review on delayed discharge and the pathway between hospital and home to highlight some of the key problems and solutions. The resource has been developed as part of a 20-month project to redesign the pathway from hospital to home for older people across Scotland.
(Edited publisher abstract)
Subject terms:
care pathways, hospital discharge, hospitals, intermediate care, care homes, admission to care, older people, delayed discharge;