Home care re ablement services researching effectiveness in prevention
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Home care re- ablement services: Researching effectiveness in prevention . Caroline Glendinning Professor of Social Policy University of York Presentation to SSRG Scotland Conference 28 October 2013. Outline . Context – growing interest in re- ablement

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Home care re ablement services researching effectiveness in prevention

Home care re-ablement services: Researching effectiveness in prevention

Caroline Glendinning

Professor of Social Policy

University of York

Presentation to SSRG Scotland Conference

28 October 2013


Outline

Outline

  • Context – growing interest in re-ablement

  • Home care re-ablement – evidence on impacts and cost-effectiveness

  • Success factors – circumstances optimising effectiveness of re-ablement?

  • Effectiveness in social care - wider reflections on the evidence base


Context growing interest in re ablement

Context – growing interest in re-ablement

  • Most English councils now have home care re-ablement services

  • From selective to inclusive/intake services

  • Interest in Australia, New Zealand (particularly providers)

  • New NHS funding for England to invest in re-ablement

    • Autumn 2010 - £70m

    • 2011/12 - £150m

    • 2012-2015 - £300m p.a.


Early evidence on home care re ablement services

Early evidence on home care re-ablement services

  • High proportions receiving re-ablementneeded no further, or less, home care

    • 63% needed no further services

    • 26% needed less home care

    • But would they have recovered anyway?

    • … and how long do the effects last?

  • York/Kent study aimed to

    • Provide evidence on longer-term impacts of home care re-ablement

      • compared outcomes of re-ablementvs. conventional home care services

      • … up to 12 months later


Study design

Study design

  • Comparative study

    • 5 re-ablement councils, 5 ‘standard’ home care councils

  • Users recruited on referral

    • Baseline interviews

    • Re-interviewed after 9-12 months

  • Standardised outcome measures

    • Health

    • Quality of life

    • Social care outcomes

  • Costs of re-ablement, other social care and NHS services used

  • Organisation and delivery of re-ablement services

    • Focus groups

    • Observations

  • Experiences of users and carers


Impact and cost of home care re ablement

Impact and cost of home care re-ablement

  • Re-ablement had positive impacts on health-related quality of life and social care outcomes

    • Compared with conventional home care services

  • Typical re-ablement episode (39 days) cost £2,088

    • Higher than conventional home care

  • But 60% less use of social care services subsequently

  • Over full year, total social care services used by re-ablement group cost £380 less than conventional home care

  • Re-ablement group – higher health service costs

    • Effects of recent hospital discharge?


Is home care re ablement cost effective

Is home care re-ablement cost-effective?

  • Compare improvements in outcomes against costs

    • NICE threshold £20-30K for each outcome gain

  • Re-ablement is cost-effective in relation to health-related quality of life outcomes

  • Re-ablement may be cost-effective in relation to social care outcomes

    • Depends on £ threshold

    • Higher healthcare costs of re-ablement group

    • Probability of cost-effectiveness only


How robust are the results

How robust are the results?

  • Established services not pilot schemes

  • Small samples after 12 months – couldn’t examine:

    • Differences within groups

      • Hospital discharge vs all community referrals

      • Higher vs lower needs for assistance

    • Differences between sites, service models (especially OT or NHS involvement)

  • Standardised outcome measures – but not sensitive enough?


Success factors organisation of services

Success factors – organisation of services

  • Service organisation

    • Thorough initial assessment, regular reassessment

    • User-focused care plans

    • Flexibility

    • Rapid access to OT expertise/equipment

    • Access to other specialist skills

      • Physio; mental health; sensory impairment; dementia

  • Communication and continuity

    • Small teams

    • Clear recording systems

    • Regular discussions

  • Training and supervision

    • On-going reinforcement re-ablement ‘ethos’


Success factors wider environment

Success factors: Wider environment

  • User characteristics

    • Expectations and motivation

    • Dementia?

    • Carer involvement

  • Wider environment

    • Strong/shared vision of service

      • Within adult social care

      • External stakeholders, especially NHS referrals

    • Direct referral for on-going home care

    • Capacity within long-term home care services

    • Approach of long-term home care services


Evidence gaps re ablement

Evidence gaps – re-ablement

  • Across the boundaries – from acute ward to return home

    • Selection

    • Continuity

    • Skillmix

  • Impacts on NHS service use (esp. readmission)

  • Roles and impacts on carers

  • In-house vs outsourced services

    • Costs, commissioning, quality

  • Beyond re-ablement – sustaining improvement


Prevention developing wider evidence base

Prevention – developing wider evidence base

  • NIHR SSCR workshops and survey

  • No standard definition, approaches to evaluation

  • Most popular ‘preventive’ services

    • Re-ablement

    • Telecare/telehealth/other technology-based interventions

    • Information and advice


Challenges in evaluating preventive interventions

Challenges in evaluating preventive interventions

  • Causality, ‘soft’ outcomes’, pilot vs ‘bedded in’, diversity of QoL, cognitive/communication issues

  • Logic model – link interventions > intermediate outputs > outcomes

  • Outcome measures might include:

    • ASCOT, others standardised outcome measures

    • Personal outcomes achieved, QoL domains

    • Falls-related admissions

  • Set against costs

    • Labour-intensive

    • Budget silos

    • Short vs long-term costs


Further information

Further information

SPRU/PSSRU evaluation of home care reablement services: bit.ly/hcreable

NIHR School for Social Care Research: www.sscr.nihr.ac.uk, especially:

  • RF9 – Allen and Millar - prevention

  • MR6 – Netten - outcomes measurement


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