Transcript Improving Independence – can homecare re

Improving Independence – can
homecare re-ablement make a
difference in the longer term?
Liz Newbronner
CSED Homecare Re-ablement Workstream
• 2006 CSED study into the development of homecare reablement in England
• Working definition of re-ablement used by CSED:
‘Services for people with poor physical or mental health
to help them accommodate their illness by learning or relearning the skills necessary for daily living’
• Study showed that:
– 60 CASSR had a homecare re-ablement service of some kind
– Characteristics of these services varied considerably
– Main distinction was between ‘intake’ and ‘discharge’ or
‘discharge support’ services
Background to the Study
• Limited evidence base about effectiveness of homecare
re-ablement
• Indications of reductions in use of homecare services
following ‘discharge’ from re-ablement
• But no evidence on:
- longer term duration of reductions
- factors that impact on subsequent service use
Aims of the Study
1. To use routine service data from CASSRs to examine
changes over time in subsequent use of social care
services following homecare re-ablement
2. To identify factors that may affect subsequent use of
social care services following homecare re-ablement
3. To consider the focus and research design of a larger
evaluation of homecare re-ablement services
Methods
Selected 4 CASSRs with re-ablement services (2 ‘intake’
and 2 ‘discharge’) established for at least 4 years. In
each site:
• Analysis of routine data for clients with an episode of
homecare re-ablement in 2004-5, including subsequent
social care provision (2005-6 and 2006-7)
• Interviews with homecare re-ablement service manager
and colleagues
• Interviews with one or more care management team
managers in each site
The Study Sites
• Wirral Enablement Discharge Service (WEDS), Wirral
Metropolitan Borough Council (‘discharge support’)
• Homecare Assessment and Re-ablement Team (HART),
Leicestershire County Council (‘intake’)
• Short Term Assessment and Re-ablement Team
(START), London Borough of Sutton (primarily
‘discharge support’)
• Intermediate Home Support Service (IHS), Salford City
Council (‘intake’)
Profile of Re-ablement Service Users
• Four age groups used – up to 64; 65 to 74; 75 to 84; and
85 and over
• Percentage of service users in each age group broadly
similar for all four sites
• Longer established services (Leicestershire and Sutton)
had higher proportion in the 85 and over age group
• In all four sites 80% of service users were categorised as
‘physical disability’, ‘physical illness’ or ‘physical frailty’
Overall Pattern of Homecare and Reablement Service Use
Case study
site
Salford
Wirral
Leicestershire
Sutton
Re-ablement
only
Re-ablement
followed by
homecare
184 (45%)
120 (87%)
491 (36%)
176 (33%)
165 (41%)
15 (11%)
612 (45%)
236 (44%)
Homecare then
re-ablement
followed by
homecare
45 (11%)
3 (2%)
205 (15%)
110 (20%)
Homecare then
re-ablement
only
9 (2%)
0 (0%)
55 (4%)
16 (3%)
• Between a third and a half of service users in Salford, Leicestershire
and Sutton had reablement only
• Percentage of users who had re-ablement followed by homecare
was remarkably consistent across the sites at just over 40%
• Two most ‘mature’ services had the greatest proportion of service
users who had homecare before re-ablement
Time from Re-ablement to First Episode of
Homecare
• Majority of service users who had homecare had their
first episode within one week of leaving re-ablement
• For service users starting homecare later, there are two
‘peaks’ in take up: at the ‘up to three months’ point; at
the ‘over one year’ point
• Patterns may suggest re-ablement users fall into two
broad groups:
- those gaining immediate but relatively short-term benefit
avoiding need for homecare for a few months
- those for whom impact is more sustained and which
delays the need for homecare by a year or more
0%
0%
Figure 3 - Leicestershire
(187 records)
40%
35%
35%
30%
30%
25%
25%
20%
20%
15%
15%
10%
10%
5%
5%
0%
0%
Figure 4 - Sutton
(68 records)
over 1 year
10%
over 1 year
20%
5%
up to 1 year
10%
up to 1 year
15%
up to 9
months
70%
up to 9
months
30%
up to 6
months
80%
up to 6
months
35%
up to 3
months
90%
up to 3
months
25%
up to 1
month
over 1 year
up to 1 year
up to 9
months
up to 6
months
up to 3
months
up to 1
month
Figure 1 - Salford
(83 records)
up to 1
month
over 1 year
up to 1 year
up to 9
months
up to 6
months
40%
up to 3
months
up to 1
month
40%
Figure 2 - Wirral
(10 records)
60%
20%
50%
40%
30%
Change in Homecare Use After
Re-ablement
• Examined the changes in the use of homecare after reablement
• Used snapshot points of 3, 6, 12, 18 & 24 months after
re-ablement
• In Leicestershire and Sutton, percentage of service
users needing less homecare than they did on leaving
re-ablement increased over the two years
• In Salford, percentage of service users needing less
homecare than they did on leaving re-ablement fell after
18 months but percentage of service users needing
progressively more homecare was only slightly higher at
end of 2-year period
• Wirral is very different but still appears to be a significant
change at the 18-month point
Change in homecare use – all service users
30%
30%
20%
20%
10%
10%
0%
0%
less than
same as
less than
same as
more than
D or R
more than
D or R
24 months
40%
18 months
40%
12 months
50%
3 months
50%
24 months
60%
18 months
60%
12 months
70%
6 months
70%
3 months
Figure 8 - Sutton
80%
6 months
Figure 7 - Leicestershire
80%
Change in homecare use – over 85 age
group
30%
30%
20%
20%
10%
10%
0%
0%
less than
same as
more than
less than
same as
Excludes those who died or went into permanent residential care
24 months
40%
18 months
40%
12 months
50%
3 months
50%
24 months
60%
18 months
60%
12 months
70%
6 months
70%
3 months
80%
6 months
Figure 14 - Sutton 85+
Figure 13 - Leicestershire 85+
80%
more than
Intensity of Homecare Use after Reablement
• Examined the intensity of homecare usage after reablement at the snapshot points of 3, 6, 12, 18 and 24
months
• Based analysis on hours of homecare ‘categories’ used
in HH1 returns (2 hours or less; 2-5 hours; 6-10 hours;
and 10+ hours)
• Overall no marked changes in the proportions of service
users in each category at the different snapshot points
• Leicestershire had the smallest proportion of users in the
‘more than 10 hours’ group
Factors Affecting the Longer-Term Impact of
Re-ablement
• Independent providers – culture and contracting arrangements
– Culture
– Staff training
– Time and tasks commissioned
– Contracting system
– Frequency of review
• Re-ablement package – duration and flexibility
• Service users – understanding and attitudes
• Carers – perceptions of risk and on-going support
• Signposting to other services and support
• Culture of re-ablement across social care services
Key Lessons for CASSRs establishing
Re-ablement Services
•
•
•
•
•
•
•
•
•
Staff attitudes, skills and training
Communicating the re-ablement ethos
Capacity and throughput
Flexibility
Access to the re-ablement service
Skill mix and relationship to other professionals
Relationships with carers
Role in assessment/review
A ‘whole systems’ approach
Key Lessons for CASSRs establishing
Re-ablement Services
•
•
•
•
•
•
•
•
•
Staff attitudes, skills and training
Communicating the re-ablement ethos
Capacity and throughput
Flexibility
Access to the re-ablement service
Skill mix and relationship to other professionals
Relationships with carers
Role in assessment/review
A ‘whole systems’ approach
Contact Details
Liz Newbronner – [email protected]
Websites: www.csed.csip.org.uk
www.york.ac.uk/spru
www.actonshapiro.co.uk