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Investing in prevention for older people at the health and social care interface
- Author:
- OXFORD BROOKES UNIVERSITY. Institute of Public Care
- Publisher:
- Oxford Brookes University. Institute of Public Care
- Publication year:
- 2011
- Pagination:
- 17
- Place of publication:
- Oxford
Describes a new investment model designed to stimulate improved and more cost-effective outcomes for older people at the interface of health and social care. Its emphasis is on reducing demand by providing targeted preventative services as a mainstream intervention – rather than as add-on or pilot-based service – and integrating provision so that it straddles health and social care. The paper begins with an assessment of the demographic and other drivers of rising demand on services, before assessing the shortcomings of demand-reduction strategies to date. Among these, it identifies primarily a lack of clarity on the relationship between funding and outcomes, noting the potential failure of coordination between multiple separate funders and the danger that prevention strategies run alongside the mainstream interventions they are supposed to replace, and show up as an additional cost. Drawing on earlier interview and case file audit research conducted by IPC among care home populations, the paper then identifies key characteristics and conditions found among those admitted, including continence problems, dementia, stroke and falls. The limitations of existing care approaches to these conditions are outlined and a new investment-based model described, based on: assessment of resources available, outcomes desired, evidence base available, likelihood of benefits occurring, the extent of savings they would offer, and the timescale over which those benefits would accrue. The merits of this framework are then demonstrated by applying it to falls to illustrate the potential savings from reduced demand and the better outcomes for users. The paper concludes with implications for local commissioning strategies. (Edited publisher abstract)
Positioning turnaround services for older people: discussion paper
- Author:
- OXFORD BROOKES UNIVERSITY. Institute of Public Care
- Publisher:
- Oxford Brookes University. Institute of Public Care
- Publication year:
- 2010
- Pagination:
- 19
- Place of publication:
- Bath
This paper advocates a model for targeting health and social care provision in older old age called ‘Turnaround’. Turnaround is advocated in the context of older population changes which make it imperative that authorities limit the need for high cost provision such as residential care and intensive home care support. The approach would aim to develop provision that lessens the likelihood of admission to hospital or care, or demand for high intensity community provision, through a holistic approach which focuses on improvement, recovery and rehabilitation. It would comprise a mixture of any or all of the following: a combined community care capacity bringing together home care, assistive technology, care and repair and some nursing skills; some enhanced health care based capability; a focus on improving mobility; a focus on improving diet and nutrition; delivering social contact; and welfare benefits and income maximisation where alleviable poverty is a driver towards poor health and care. Turnaround is presented as an interdisciplinary, flexible approach based on identifiable, agreed and proven methodologies, which could identify target populations with the characteristics likely to drive towards high levels of intervention. It could therefore promote the fullest possible recovery in a way that is most acceptable to service users/patients. A three-level model of delivery is discussed, and the process is laid out in terms of the steps of recognition, assessment, intervention and monitoring. Suggestions for measuring outcomes are also made. (Edited publisher abstract)