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;
Journal of Integrated Care, 25(3), 2017, pp.196-207.
Publisher:
Emerald
Purpose: Quality care transitions of older people across acute, sub-acute and primary care are critical to safety and cost, which is the reason interventions to improve practice are a priority. Yet, given the complexity of providers and services involved it is often difficult to know the types of tensions that arise in day-to-day transition work or how front-line workers will respond. To that end, this innovative study differs from the largely descriptive studies by conceptualising care transitions as street-level work in order to capture how transition practice takes shape within the complexities and dynamics of the local setting. The paper aims to discuss these issues.
Design/methodology/approach: Data were collected from 23 hospital health professionals and community service providers across primary, sub-acute and acute care through focus groups. A thematic analysis and interrogation of themes using street-level concepts derived three key themes.
Findings: The themes of risk logics and dilemmas of fragmentation make explicit both the local constraints and opportunities of care transitions and how these intersect to engender a particular logic of practice. By revealing the various discretionary tactics adopted by front-line providers, the third theme simultaneously highlights how discretionary spaces might represent both possibilities and problematics for balancing organisational and patient needs.
Originality/value: The study contributes to the knowledge of street-level work in health settings and specifically, the nature of transition work. Importantly, it benefits policy and practice by uncovering mechanisms that could facilitate and impede quality transitions in discrete settings.
Purpose: Quality care transitions of older people across acute, sub-acute and primary care are critical to safety and cost, which is the reason interventions to improve practice are a priority. Yet, given the complexity of providers and services involved it is often difficult to know the types of tensions that arise in day-to-day transition work or how front-line workers will respond. To that end, this innovative study differs from the largely descriptive studies by conceptualising care transitions as street-level work in order to capture how transition practice takes shape within the complexities and dynamics of the local setting. The paper aims to discuss these issues.
Design/methodology/approach: Data were collected from 23 hospital health professionals and community service providers across primary, sub-acute and acute care through focus groups. A thematic analysis and interrogation of themes using street-level concepts derived three key themes.
Findings: The themes of risk logics and dilemmas of fragmentation make explicit both the local constraints and opportunities of care transitions and how these intersect to engender a particular logic of practice. By revealing the various discretionary tactics adopted by front-line providers, the third theme simultaneously highlights how discretionary spaces might represent both possibilities and problematics for balancing organisational and patient needs.
Originality/value: The study contributes to the knowledge of street-level work in health settings and specifically, the nature of transition work. Importantly, it benefits policy and practice by uncovering mechanisms that could facilitate and impede quality transitions in discrete settings.
Subject terms:
older people, primary care, health professionals, service transitions, hospitals, health care, hospital discharge;
British Journal of General Practice, 62(595), February 2012, pp.84-85.
Publisher:
Royal College of General Practitioners
Anticipatory care planning involves the identification of patients at high risk of hospital admission and deriving anticipatory care plans (ACPs) for them which aim to shift the balance of care from hospital to community settings. ACPs provide a patient-centred, cost-effective approach to patients with multiple morbidities and illness trajectories that will deteriorate. The aim of this study was to investigate whether ACPs result in a reduction in the number of unplanned hospitalisations. Patients at high risk of admission to hospital were identified from a single general practice in Nairn, Scotland and offered an ACP. These individuals were matched with patients from a control practice. Proactive case management was provided by a case manager who was responsible for conducting the initial patient interviews and for overseeing the provision of care, including mobilising the extended primary care team, initiating home improvements, and accessing voluntary agencies. The findings showed that anticipatory care planning and case management was associated with fewer hospital admissions. In addition, the intervention also resulted in more patients being able to die at home rather than in hospital.
Anticipatory care planning involves the identification of patients at high risk of hospital admission and deriving anticipatory care plans (ACPs) for them which aim to shift the balance of care from hospital to community settings. ACPs provide a patient-centred, cost-effective approach to patients with multiple morbidities and illness trajectories that will deteriorate. The aim of this study was to investigate whether ACPs result in a reduction in the number of unplanned hospitalisations. Patients at high risk of admission to hospital were identified from a single general practice in Nairn, Scotland and offered an ACP. These individuals were matched with patients from a control practice. Proactive case management was provided by a case manager who was responsible for conducting the initial patient interviews and for overseeing the provision of care, including mobilising the extended primary care team, initiating home improvements, and accessing voluntary agencies. The findings showed that anticipatory care planning and case management was associated with fewer hospital admissions. In addition, the intervention also resulted in more patients being able to die at home rather than in hospital.
Subject terms:
hospitals, older people, hospital admission, primary care, care planning, community care, end of life care;
This study examines the relationship between age and the injury outcomes for belted drivers in road vehicle crashes in the United Kingdom. The sample of 1,541 drivers was divided into three age groups: 889 drivers were aged 17-39 years (young drivers); 515 were 40-64 years (middle-aged), and 137 aged 65-84 years (older drivers). Both frontal and side impact crashes in which the vehicles sustained sufficient damage to be towed away from the scene are considered. In-depth information obtained from examinations of the crashed vehicles was combined with clinical data obtained from hospitals to throw light on the mechanisms that led to the injuries. Results show that in crashes of approximately equal severity, older drivers were significantly more likely than middle-aged and young drivers to be fatally injured in both frontal (p<0.001) and side (p<0.05) impact crashes. The results also show that older drivers sustained more injuries to the chest (p<0.0001) and that this body region is particularly problematic. The main sources of the chest injuries were found to be the seat belt in frontal crashes and the door in side impact crashes. As the number of older car users will increase rapidly in most OECD countries in the coming decades, the results suggest that vehicle re-designs are required, including in-vehicle crashworthiness systems, to take into account older people's relatively low tolerance of crash impacts.
This study examines the relationship between age and the injury outcomes for belted drivers in road vehicle crashes in the United Kingdom. The sample of 1,541 drivers was divided into three age groups: 889 drivers were aged 17-39 years (young drivers); 515 were 40-64 years (middle-aged), and 137 aged 65-84 years (older drivers). Both frontal and side impact crashes in which the vehicles sustained sufficient damage to be towed away from the scene are considered. In-depth information obtained from examinations of the crashed vehicles was combined with clinical data obtained from hospitals to throw light on the mechanisms that led to the injuries. Results show that in crashes of approximately equal severity, older drivers were significantly more likely than middle-aged and young drivers to be fatally injured in both frontal (p<0.001) and side (p<0.05) impact crashes. The results also show that older drivers sustained more injuries to the chest (p<0.0001) and that this body region is particularly problematic. The main sources of the chest injuries were found to be the seat belt in frontal crashes and the door in side impact crashes. As the number of older car users will increase rapidly in most OECD countries in the coming decades, the results suggest that vehicle re-designs are required, including in-vehicle crashworthiness systems, to take into account older people's relatively low tolerance of crash impacts.
Subject terms:
independence, hospitals, medical treatment, older people, primary care, ageing, emergency services;
This report uses newly available survey data to examine how health and social care has been disrupted among the older population in England in the early stages of the COVID-19 pandemic. It provides evidence of how widespread were the disruptions to the use of hospitals, GPs and community and social care services, and access to prescription medication, from February 2020 to May 2020. The analysis reveals that disruptions to hospital care were widespread during the early stages of the pandemic – a sixth of the over-50 population in England had hospital treatment or an operation cancelled. Older people, those living in more deprived areas and those with worse self-reported health were most likely to experience a disruption to their hospital care. Disruptions to the use of GP and community health and social care services were also widespread. Almost a quarter of those reporting that they needed to speak to a GP did not, while almost three-quarters of those reporting that they needed community health and social care services did not use these. 12.8% of those who reported ‘poor’ or ‘fair’ health failed to see a GP when attempting to do so, compared with just 5.8% among those with ‘excellent’ health. Those living in the most deprived areas were most affected by disruptions to community services. 37% of those living in the least deprived areas did not access these services even after attempting to do so, increasing to 46% among those living in the most deprived areas. Care-seeking behaviour changed radically in the early stages of the pandemic, with a significant proportion of patients with care needs not actively seeking help. 14% of those requiring GP care, and more than a third of those reporting that they needed community care services, did not contact these services.
(Edited publisher abstract)
This report uses newly available survey data to examine how health and social care has been disrupted among the older population in England in the early stages of the COVID-19 pandemic. It provides evidence of how widespread were the disruptions to the use of hospitals, GPs and community and social care services, and access to prescription medication, from February 2020 to May 2020. The analysis reveals that disruptions to hospital care were widespread during the early stages of the pandemic – a sixth of the over-50 population in England had hospital treatment or an operation cancelled. Older people, those living in more deprived areas and those with worse self-reported health were most likely to experience a disruption to their hospital care. Disruptions to the use of GP and community health and social care services were also widespread. Almost a quarter of those reporting that they needed to speak to a GP did not, while almost three-quarters of those reporting that they needed community health and social care services did not use these. 12.8% of those who reported ‘poor’ or ‘fair’ health failed to see a GP when attempting to do so, compared with just 5.8% among those with ‘excellent’ health. Those living in the most deprived areas were most affected by disruptions to community services. 37% of those living in the least deprived areas did not access these services even after attempting to do so, increasing to 46% among those living in the most deprived areas. Care-seeking behaviour changed radically in the early stages of the pandemic, with a significant proportion of patients with care needs not actively seeking help. 14% of those requiring GP care, and more than a third of those reporting that they needed community care services, did not contact these services.
(Edited publisher abstract)
Subject terms:
Covid-19, access to services, primary care, community care, adult social care, user views, surveys, hospitals, older people, health inequalities;
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)
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)
Subject terms:
case studies, service transitions, older people, primary care, complex needs, home care, community care, hospitals;
International Journal of Integrated Care, 17(1), 2017, Online only
Publisher:
International Foundation for Integrated Care
Introduction: Health care systems for older people are becoming more complex and care for older people, in the transition between hospital and primary healthcare requires more systematic collaboration between nurses. This study describes nurses’ perceptions of their collaboration when working between hospital and primary healthcare within the older people care chain. Theory and methods: Using a qualitative approach, informed by grounded theory, six focus groups were conducted with a purposive sample of registered nurses (n = 28) from hospitals (n = 14) and primary healthcare (n = 14) during 2013. The data were analysed using dimensional analysis. Findings: Four dimensions of collaboration were identified: 1) Context and Situation, 2) Conditions, 3) Processes and Interactions and 4) The Consequences of nurse-to-nurse collaboration within the older people care chain. These four dimensions were then conceptualised into a model of nurse-to-nurse collaboration. Discussion and conclusion: Improved collaboration is useful for the safe, timely and controlled transfer of older people between hospital and primary healthcare organisations and also in healthcare education. The findings in this study of nurse-to-nurse collaboration provides direction and opportunities to improve collaboration and subsequently, the continuity and integration in older people care in the transition between organisations.
(Edited publisher abstract)
Introduction: Health care systems for older people are becoming more complex and care for older people, in the transition between hospital and primary healthcare requires more systematic collaboration between nurses. This study describes nurses’ perceptions of their collaboration when working between hospital and primary healthcare within the older people care chain. Theory and methods: Using a qualitative approach, informed by grounded theory, six focus groups were conducted with a purposive sample of registered nurses (n = 28) from hospitals (n = 14) and primary healthcare (n = 14) during 2013. The data were analysed using dimensional analysis. Findings: Four dimensions of collaboration were identified: 1) Context and Situation, 2) Conditions, 3) Processes and Interactions and 4) The Consequences of nurse-to-nurse collaboration within the older people care chain. These four dimensions were then conceptualised into a model of nurse-to-nurse collaboration. Discussion and conclusion: Improved collaboration is useful for the safe, timely and controlled transfer of older people between hospital and primary healthcare organisations and also in healthcare education. The findings in this study of nurse-to-nurse collaboration provides direction and opportunities to improve collaboration and subsequently, the continuity and integration in older people care in the transition between organisations.
(Edited publisher abstract)
Subject terms:
integrated care, interprofessional relations, nurses, service transitions, primary care, hospitals, older people, collaboration;
Background: acute medical units allow for those who need admission to be correctly identified, and for those who could be managed in ambulatory settings to be discharged. However, re-admission rates for older people following discharge from acute medical units are high and may be associated with substantial health and social care costs. Objective: identifying patient-level health and social care costs for older people discharged from acute medical units in England. Design: a prospective cohort study of health and social care resource use. Setting: an acute medical unit in Nottingham, England. Participants: four hundred and fifty-six people aged over 70 who were discharged from an acute medical unit within 72 h of admission. Methods: hospitalisation and social care data were collected for 3 months post-recruitment. In Nottingham, further approvals were gained to obtain data from general practices, ambulance services, intermediate care and mental healthcare. Resource use was combined with national unit costs. Results: costs from all sectors were available for 250 participants. The mean (95% CI, median, range) total cost was £1926 (1579–2383, 659, 0–23,612). Contribution was: secondary care (76.1%), primary care (10.9%), ambulance service (0.7%), intermediate care (0.2%), mental healthcare (2.1%) and social care (10.0%). The costliest 10% of participants accounted for 50% of the cost. Conclusions: this study highlights the costs accrued by older people discharged from acute medical units (AMUs): they are mainly (76%) in secondary care and half of all costs were incurred by a minority of participants (10%).
(Publisher abstract)
Background: acute medical units allow for those who need admission to be correctly identified, and for those who could be managed in ambulatory settings to be discharged. However, re-admission rates for older people following discharge from acute medical units are high and may be associated with substantial health and social care costs. Objective: identifying patient-level health and social care costs for older people discharged from acute medical units in England. Design: a prospective cohort study of health and social care resource use. Setting: an acute medical unit in Nottingham, England. Participants: four hundred and fifty-six people aged over 70 who were discharged from an acute medical unit within 72 h of admission. Methods: hospitalisation and social care data were collected for 3 months post-recruitment. In Nottingham, further approvals were gained to obtain data from general practices, ambulance services, intermediate care and mental healthcare. Resource use was combined with national unit costs. Results: costs from all sectors were available for 250 participants. The mean (95% CI, median, range) total cost was £1926 (1579–2383, 659, 0–23,612). Contribution was: secondary care (76.1%), primary care (10.9%), ambulance service (0.7%), intermediate care (0.2%), mental healthcare (2.1%) and social care (10.0%). The costliest 10% of participants accounted for 50% of the cost. Conclusions: this study highlights the costs accrued by older people discharged from acute medical units (AMUs): they are mainly (76%) in secondary care and half of all costs were incurred by a minority of participants (10%).
(Publisher abstract)
Subject terms:
social care provision, costs, older people, hospital admission, hospitals, economic evaluation, primary care, health care;
Journal of Interprofessional Care, 23(4), July 2009, pp.341-354.
Publisher:
Taylor and Francis
The provision of integrated, person-centred care is particularly important for older people with mental health problems. Nevertheless, a series of reports at the end of the last century highlighted unacceptable differences in collaborative working practices in England, variations that a national service framework specifically aimed to address. This study utilised a cross-sectional survey of old age psychiatrists to explore the extent to which, some three years after the publication of this guidance, structures to deliver integrated care across the interfaces between specialist old age mental health and primary, acute and social care services were in place. Three hundred and eighteen (72%) consultants responded. Measures to facilitate integrated practice were generally poorly developed: many areas missed targets to agree protocols for the management of older people with mental health problems with primary care; more than 45% of respondents reported the presence of fewer than two of four indicators of integration with the acute sector; and approaching 30% of respondents reported the presence of fewer than four of 13 markers of integration with social care. The implications of these findings and the challenges inherent in providing integrated care for this client group are discussed.
The provision of integrated, person-centred care is particularly important for older people with mental health problems. Nevertheless, a series of reports at the end of the last century highlighted unacceptable differences in collaborative working practices in England, variations that a national service framework specifically aimed to address. This study utilised a cross-sectional survey of old age psychiatrists to explore the extent to which, some three years after the publication of this guidance, structures to deliver integrated care across the interfaces between specialist old age mental health and primary, acute and social care services were in place. Three hundred and eighteen (72%) consultants responded. Measures to facilitate integrated practice were generally poorly developed: many areas missed targets to agree protocols for the management of older people with mental health problems with primary care; more than 45% of respondents reported the presence of fewer than two of four indicators of integration with the acute sector; and approaching 30% of respondents reported the presence of fewer than four of 13 markers of integration with social care. The implications of these findings and the challenges inherent in providing integrated care for this client group are discussed.
Subject terms:
hospitals, integrated services, mental health services, older people, policy, primary care, social services, evaluation;
This book provides information about the main entitlements to health care for older people, particularly NHS services provided in England. Chapters include: knowing your rights; asking for and getting help; GPs and primary care services; opticians and eyesight; hearing services; therapies and other support; mental health; going in to hospital; coming out of hospital; organ and blood donation; death and dying; and making complaints.
This book provides information about the main entitlements to health care for older people, particularly NHS services provided in England. Chapters include: knowing your rights; asking for and getting help; GPs and primary care services; opticians and eyesight; hearing services; therapies and other support; mental health; going in to hospital; coming out of hospital; organ and blood donation; death and dying; and making complaints.
Subject terms:
hospitals, mental health services, NHS, older people, primary care, rights, therapies, therapy and treatment, complaints;