Intermediate Care Provision in Angus

1. Intermediate Care Provision in Angus Phillip Gillespie Service Manager Augmented Care Susan MacLean Service Manager Home Care

2. Introduction In this presentation we will use a case example to demonstrate how Intermediate Care can: • Reduce pressure on the acute sector • Assist with winter pressure management • Reduce the length of hospital admissions • Prevent premature admission to residential and nursing home care (Glasby 2001)

3. Case Example – Mr R Background • 78 years old • Lives alone • 2002 bad fall at home – resulted in fractured hip • Repair unsuccessful • Hip joint removed/ wheelchair bound • Social care officers every morning/ 2 evenings per week • Domestic assistance / community alarm • Severe arthritis and angina • Support at home with care package relatively stable

4. Case Example – Mr R June 2005 • UTI and Chest infection resulted in concerns about physical condition and ability to cope • Breakdown in mobility / confined to bed • Confusion • Admitted to Independent Intermediate Care (Nursing Home) • Mr R discharged home within 2 weeks with no increase in services.

5. Independent Intermediate Care(Step up care) from community • Time limited, comprehensive assessment involving nursing, allied health professional and social work staff • Comprehensive assessment, resulting in a structured individual care plan that involves active therapy, treatment, and opportunity for recovery • Have a planned outcome of maximising independence and typically enabling patients/users to resume living at home

6. Prevention of admission scheme (POA) Mr R developed Viral Flu • Unable to prepare meals • Nauseous /weak and unsteady • Care Manager discussed situation with GP /GP refers to POA • Existing care package was augmented by SCO lunchtime/teatime/evenings / laundry • Package supplemented by occupational therapy • Discharged from POA after 2 weeks. No increase in service required following review

7. Early Supported Discharge (ESD) April 2006 Mr R admitted to acute hospital with suspected DVT • Emergency admission • Discharged on ESD following two days in hospital • Physio to progress mobility • OT kitchen and transfer assessment and practice • Discharged from the scheme after 14 days following review • No increase in service • Continues to be care managed

8. Early Supported Discharge / Prevention of Admission Scheme • Aim “to provide a rapid assessment of needs and provision of services to facilitate a speedy, safe and supported recovery.” • Referral 9.00am – 9.00pm 7 days per week • Individuals must have identified rehabilitation and / or care needs and be capable of being managed at home. • Integrated care package (Social Care /OT / Physio /District Nursing) for 14/28 days. Social Care service augments existing care package • Regular reviews held with aim of reducing inputs as recovery progresses and independence is maximised • E-care pilot

9. Conclusion • By having a range of Intermediate Care provision this provides the right type of care at the right time, in the right setting • During acute episodes Mr R was able to retain a degree of control and autonomy in his care • Effective mechanism to plan and co-ordinate delayed discharges • Range of intermediate provision enables the partnership to be more responsive and more flexible in dealing with Health / Social crisis • Maximises independent living, enables people to remain at home as an alternative to care

10. Intermediate Care Provision in Angus