Transcript The Balance of Care Approach: Modelling complexity in services for older people Paul Forte & Tom Bowen www.balanceofcare.com +44 7818 066653 ORAHS 2010, Genoa, Italy,

The Balance of Care Approach:
Modelling complexity in services for older people
Paul Forte & Tom Bowen
www.balanceofcare.com
+44 7818 066653
ORAHS 2010, Genoa, Italy, 19-23 July 2010
Contents
• The Balance of Care approach:
- whole system demand-supply modelling
• An example of a telecare application:
- model development and application
- changing care pathways
Areas of strategic importance for
health and social care
• Organisational issues:
– supporting partnership working; innovative
connections; workforce development
• Information issues:
– sharing of data, information and intelligence; common
definitions
• People issues:
– harnessing drive of health and social care professionals
– facilitating client and carer engagement
The Balance of Care model
High
dependency
Older
People
Medium
dependency
Low
dependency
The Balance of Care model
Acute
care bed
High
dependency
NHS
Community nurse
Older
People
Medium
dependency
Physiotherapist
Occupational therapist
Day care centre
Local
Authority
Care assistant
Low
dependency
Care home
Independent sector
The Balance of Care model
Acute care bed
High
dependency
NHS
Option 1
Community nurse
Older
People
Medium
dependency
Physiotherapist
option 2
Occupational
therapist
Day care centre
option 3
Local authority
Care assistant
Low
dependency
Care home
Independent sector
Balances to be struck…
Care Professionals
Health Services
High Dependency
Non-Clinical Managers
Social Services
Low Dependency
Developing a model for telecare
• Support for social services to develop business cases
for telecare in the wider context of the organisation
and provision of local health and social services
• Identification of potential increased cost effectiveness
through:
– reduced admission to long-term care homes
– reduced cost of home care packages
– savings to the NHS (eg. through reduced admissions to
hospital)
Model demo here
Telecare Valley
P3 - Case management - frail older people
£
550
£
Totals
Unit Cost:
£24,780
£20,658
£12,258
Allocation:
50%
40%
10%
Allocated Clients:
275
220
55
0
0
0
550
Current
Home with
Avoid adm
Opt 4
Opt 5
Opt 6
Cost
49
52
52
£694,375
1
1
£6,875
730
730
£6,945,950
2
2
£13,750
Code Service Description
£
No. of
Clients:
100%
S1
Community nurse
S2
Physiotherapist
S3
Care Assistant
S4
OT
S5
Geriatrician
£
S6
Rehab asst
£
S7
Care home EMH
£
S8
Care home (non-EMH)
£
S9
Acute bed
S10
Comm hospital bed
S11
Telecare
S12
CPN
£
S13
Night sitter
£
S14
Extra care housing
£
S15
Day care
£
1095
21
21
0
£4,158,000
£
52
52
Total Cost:
£6,814,445
£4,544,804
£674,201
Quality Score:
80%
100%
100%
£214,500
£
£
£ £12,033,450
90%
Services
Day care
Current
Extra care housing
Night sitter
CPN
Telecare
Comm hospital bed
Acute bed
Care home (non-EMH)
Care home EMH
Rehab asst
Geriatrician
OT
Care Assistant
Physiotherapist
Community nurse
Cost (£'000)
Current and Projected Expenditure by Service
Projected
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
Total Service Usage
by Scenario
Service
Annual Units
Current
Baseline
Low invest
Extended
Community nurse
WTE
0
18
19
19
Physiotherapist
WTE
0
0
0
0
Care Assistant
WTE
0
644
785
722
OT
WTE
0
4
8
8
Geriatrician
WTE
0
0
0
0
Rehab asst
WTE
0
0
0
0
Care home EMH
Places
0
218
186
186
Care home (non-EMH)
Places
0
1124
787
787
Acute bed
Beds
0
32
28
28
Comm hospital bed
Beds
0
0
0
0
Packages
0
0
865
2165
CPN
WTE
0
0
0
0
Night sitter
WTE
0
0
2
2
Extra care housing
Places
0
0
190
190
Day care
Places
0
0
0
0
Telecare
Resource modelling for dementia
services
• Same model structure but adapted for a
dementia patient classification and care
options
• Local application and costing
• Support for joint strategic planning
Simplified Care Options
Mild
Community psychiatric nurse
Community support wkr (psych)
Health Care Supt wkr (PCT prov)
Home care supt (soc ser)
Not frail
Carer
No carer
1 hr pa
1 hr pa
-
Frail
Carer
No carer
1 hr pa
1 hr pa
-
Moderate
Not frail
Frail
Carer
No carer
Carer
No carer
Community psychiatric nurse
1 visit pcm 1 visit pcm 1 visit pcm 1 visit pcm
Community support wkr (psych) 2 visit pcm 4 visit pcm 2 visit pcm 4 visit pcm
Health Care Supt wkr (PCT prov)
2 hrs pcm 4 hrs pcm
Home care supt (soc ser)
1 hr pw
6 hrs pw
Severe
Not frail
Frail
Carer
No carer
Carer
No carer
Community psychiatric nurse
1 visit pcm 1 visit pcm 1 visit pcm 1 visit pcm
Community support wkr (psych) 3 visit pcm 6 visit pcm 4 visit pcm 8 visit pcm
Health Care Supt wkr (PCT prov)
Home care supt (soc ser)
2 hr pw
5 hrs pw
3 hr pw
6 hrs pw
Potential Resource Requirements for
Key Services
Staff Type
WTE Annual Cost
Community psychiatric nurse
181 £4.7 million
Community support worker (psych)
400 £6.0 million
Health Care Supt worker (PCT prov) 82 £1.2 million
Home care support (Adult services) 238 £5.0 million
Total community staff
901 £16.9 million
Care Homes places (inc respite)
2007 £67.8 million
Category descriptions
Category Label
Intended Population Base
Data Source for Telecare Valley
Care home residents - not
EMH
Permanent care home residents over 65 supported
by council (excluding Elderly Mental Health)
England residents at 31-03-2004 / 150
Care home residents - EMH
Permanent care home residents over 65 supported
by council (Elderly Mental Health)
England residents at 31-03-2004 / 150.
Case management - frail older
people
Numbers over 65 receiving intensive home care (>
10 hours per week). These are assumed to be the
people who would be included in case management
schemes for frail older people.
Based on England number receiving intensive
home care (over 10 hours) at 31-03-2004 /
150.
Other long term care needs
Numbers over 65 receiving home care (5- 10 hours
per week). These are assumed to be the people who
require continuing social care support, but do not
have chronic healthcare needs appropriate for case
management.
Based on England number receiving 5-10
hours of home care at 31-03-2004 / 150
Other low intensity needs
Numbers over 65 receiving home care (< 5 hours
per week)
Other England low intensity home care (<5hrs
per week) at 31-03-2004 / 150
Unsupported at home >65
Total resident population 65 years and over, not
receiving a social care service
England 2001 Census, resident population
over 65, divided by 150, and net of estimated
values for P1 to P5 inclusive.
Patient categories
P6 Unsupported at home
(aged over 65)
P1 Care Home Residents
(not EMH)
P3 Frailty Case
Management
(Severe)
P5 Other low intensity
needs
(Minor)
P2 Care Home Residents
(EMH)
P4 Other long term care
needs
(Moderate)
Meaningful groups of population >65 years for telecare planning purposes