Integrated Day Services Audrey Brogan Service Co-Ordinator Coatbridge

1. Integrated Day ServicesAudrey BroganService Co-OrdinatorCoatbridge

2. Research • Long waiting lists for – NLC day care • Day hospitals –holding on to people as there was no where else they could go. • Many older people in day care for years • Almost 30% coming from sheltered housing complexes • Local lunch clubs closing

3. Waiting Lists • What did they do now with their day? • What did their family and friends do? • What did they want to do? • What stopped them doing this? • Where could these activities happen?

4. Findings • People needed information • Some had lost confidence • Some needed practical support to get to places • Transport was a big issue • No one said - day care

5. The New Model • Develop an integrated day service targeting those older people with more complex needs • Develop a community network of alternative options : - information system - locality link officers

6. Integrated Day Service • Day Services Social Work • Day Hospital Mental Health • Day Hospital Frail Elderly • Linked key professionals • Locality Planning Group

7. Locality Planning Group • Case discussions • Access to a range of services • Identifying people who require care management • Highlighting developments required in the community • Supporting the community network • Joint training / shadowing

8. The Community Network • Sheltered housing complexes • Lunch clubs • Community halls • Church halls • Leisure services • Community education • Local artists/activity libraries • Voluntary organisations

9. Role of LLO • Meet Service User • Support case co-ordination • Advise Of Possible Local Community Resources • Arrange To Accompany Service User To Initial Visits • Advise On Transport If Required • Income check • Support volunteers • Support Sheltered Housing Wardens • Feedback to Referred

10. Sinclair Day Service 25 Places available each day 15 Core Places 5 Floating Places 5 Ring Fenced Place Satellite service East Stewart Gardens

11. Access to Services • Holistic Assessment:- C.C.A. or S.S.A. • Referrer to Present Case to Locality Planning Group • Eligibility Criteria for Day Services • If Eligibility Criteria Not Met, Referral Can Be Considered For Locality Link Officer For Day Opportunities • Integrated Service Targeted at People With Complex Care Needs

12. Ring Fenced Places • Full Mental Health Assessment • Physical Screening Tests i.e. Bloods, E.C.G., Blood Pressure etc. • Treatment Groups i.e. Anxiety Management, Depression Education & Counselling etc. • Medication Monitoring • Therapeutic Group Activities i.e. Relaxation Therapy, Music Therapy, Health Promotion (Sleep Awareness, Bereavement & Nutrition etc) • Multi-Agency Reviews

13. Floating/Core Places • Ongoing Assessment Of Needs • Ultimately Case Management • Implementation Of Needs Identified In Care Plan • Emotional & Physical Support • Therapeutic Activities Offered • Independence Promoted • Frequent Reviews • Multi-Agency Liaison

14. Integrated Working • Joint Groups • Cross Referral • Regular Planned Meetings • Ad-hoc Information Sharing • Effective Understanding Of Each Agencies Role

15. Benefits • 2 Services Integrated • Frail Elderly Day Hospital On-Site • Better Communication Between Services • Quicker Access To Services • Shared Skills & Knowledge

16. Case Example • Mrs.B was referred to the LPG by the Consultant Psychiatrist. • Various psychiatric admissions to hospital due to depression and anxiety. Had not been outdoors for long periods due to this. • Mental Health was stabilised as much as possible. Husband could not leave Mrs.B at home alone due to her anxiety. • Outcome gradual discharge from ring fenced place to floating place at SIDS, 2 days each week. • Input from LLO with view to decreasing days at SIDS and link to community groups. • Now at two community groups each week • Secretary of community group committee • One admission to hospital in 4 years

17. Review of Pilot Service Care Reviews Questionnaires Service User Meetings Creative Meetings ‘My Perfect Day’ Talking Points Talking Mats

18. Findings • Positive feedback from carers and service users • Positive outcomes for carers and service users • Decrease in hospital admissions • One stop shop • Early intervention to avoid unnecessary hospital admissions • Decrease in admissions to long term care • Support to appropriate admissions to hospital • Increase in number of people living at home • People using service extensive support needs. • Growth in number of community groups and those attending • Still some people isolated at home but don’t meet criteria for IDS. • Communication with NHSL acute services limited

19. Findings continued • Staff team positive about their role • Staff team more knowledge of linked professionals • Staff practise extended • Job evaluation outcome positive for staff • Staff access to both NHSL and NLC training sessions. • Staff motivated by the changes and developments • Staff motivated by the feedback from people who use the service and their carers. • Staff positive about their roles in shaping and developing the service.

20. Developments • Review of transport system • Extensive needs of service users 1-7 ratio inadequate • Care co-ordination role more extensive • 2 registered nurses • Scalamobile and Stairmatic use and training • Podiatry support • Inhouse training in acute hospitals re IDS • Locality Support Workers Needed • Improve links with Housing services • Review job descriptions and grading of support staff • Further develop knowledge of service at acute hospitals

21. Day Service Today One day service in each town No waiting times for access LLO referral to first visit one week No waiting time for AHP Access to home care immediate Flexible service as needs change Limited admissions to long term care Carers support group Memory clinic referrals to first access two weeks Mental health assessment no waiting times Various care homes closed in North Lanarkshire OAP beds free