Improving home care sustainability in Ireland. Are user charges a promising option?

There are often concerns that population ageing will cause health and long-term care expenditures to grow uncontrollably. A key question facing decision-makers is what, if anything, can be done in response? In this report we consider whether user charges would improve the financial sustainability of home care in Ireland, a country which is ageing at a rate similar to other high income countries.

We find that user charges are an inefficient tool to try to reduce the home care financing gap. Evidence suggests that the revenues raised for home care through user charges are negligible in other high income countries. Additionally, while user charges may cause some people to reduce their demand for care, service-users are typically unable to distinguish between high-value and low-value care. Some service-users who do continue to use services will experience financial hardship if required to pay user charges out-of-pocket, while others will forgo care. In ...

‘Sometimes you need an eye-opener’: A qualitative study on nursing assistants' experiences of developing communication skills through an educational intervention on person-centred communication

To explore nursing assistants' (NAs') experiences of developing communication skills while participating in an educational intervention on person-centred communication. The findings describe NAs' experiences concerning the communication skills needed for building relationships with older persons and handling emotionally challenging situations. The educational intervention increased their knowledge and awareness of the importance of communication skills and how such skills are developed and refined.

General practitioners' perceptions of distributed leadership in providing integrated care for elderly chronic multi-morbid patients: a qualitative study

Distributed Leadership (DL) has been suggested as being helpful when different health care professionals and patients need to work together across professional and organizational boundaries to provide integrated care (IC). This study explores whether General Practitioners (GPs) adopt leadership actions that transcend organizational boundaries to provide IC for patients and discusses whether the GPs’ leadership actions in collaboration with patients and health care professionals contribute to DL.

How to implement person-centred care and support for dementia in outpatient and home/community settings: Scoping review

Little prior research focused on person-centred care and support (PCCS) for dementia in home, community or outpatient care. We aimed to describe what constitutes PCCS, how to implement it, and considerations for women who comprise the majority of affected persons (with dementia, carers). Despite the paucity of research on PCCS for dementia, synthesis of knowledge from diverse studies into a Framework provides interim guidance for those planning or evaluating dementia services in outpatient, home or community settings. Further research is needed to elaborate the Framework, evaluate PCCS for dementia, explore determinants, and develop strategies to implement and scale-up PCCS approaches. Such studies should explore how to tailor PCCS needs and preferences based on input from persons with dementia, and by sex/gender and other intersectional factors such as ethnicity or culture.

Provider and Manager Perspectives on the Use of an Integrated Clinical Pathway for Community-Dwelling Older Adults: A Qualitative Case Study

Integrated care pathways (ICPs) could improve the organisation and delivery of care for community dwelling older adults. An ICP was developed and implemented in Québec to support home care processes. This study explores the perspectives of home care staff on the use of an ICP to support the organisation and delivery of health and social care to community-dwelling older adults with complex needs.

Indicators of an Integrated Home Care Model Shaped by the Needs of Patients Discharged from the Emergency Department

Developing community care models aims to satisfy the needs of patients’ in-home care comprehensively. This is crucial to decrease adverse events and prevent rehospitalization.

The growing burden of chronic diseases, patients experiencing fragmented care, and increasing demand for coordination across providers in the health and social sector correlates with the need for the integration of care. The starting point in developing an integrated care strategy should be identifying and assessing population needs.

Models of integrated care may enhance patient satisfaction, increase the perceived quality of care, and enable access to services. The term ‘new models of care’ refers to a wide range of interventions aiming to address issues of integration across healthcare and between health and social care. Improved discharge planning and flow of care, and improved sharing of knowledge between practitioners, are essential components of new models of integrated care. Discharge of the patient from the hospital to the ...

Integrated delivery and continuity of care in times of crisis

Ensuring continuity of care in response to the Covid-19 crisis has been a key issue for public health and social care services across Europe. Whilst the implementation of local partnerships for integrated care delivery have been identified as a success factor, in many cases the reality on the ground has been one of a fragmented market. One, where providers of home care, residential care and supported living have been under pressure due to the lack of protective equipment, the fear of infection, and a reduction in the number of professionals.

Still a fragmented un-resourced system

In light of the Covid-19 crisis, care services have been reaping a bitter harvest of years of failure to invest adequately in public health and social care systems. While older people’s care services have been affected across Europe, the situation has been particularly difficult in two countries: the UK and Spain.

In Spain, the ...

Innovative Integrated Health And Social Care Programs In Eleven High-Income Countries

High-income countries face the challenge of providing effective and efficient care to the relatively small proportion of their populations with high health and social care needs. Recent reports suggest that integrated health and social care programs target specific high-needs population segments, coordinate health and social care services to meet their clients’ needs, and engage clients and their caregivers. We identified thirty health and social care programs in eleven high-income countries that delivered care in new ways. We used a structured survey to characterize the strategies and activities used by these programs to identify and recruit clients, coordinate care, and engage clients and caregivers. We found that there were some common features in the implementation of these innovations across the eleven countries and some variation related to local context or the clients served by these programs. Researchers could use this structured approach to better characterize the core components of innovative integrated ...

Evaluation of integrated care services in Catalonia: population-based and service-based real-life deployment protocols.

Comprehensive assessment of integrated care deployment constitutes a major challenge to ensure quality, sustainability and transferability of both healthcare policies and services in the transition toward a coordinated service delivery scenario. To this end, the manuscript articulates four different protocols aiming at assessing large-scale implementation of integrated care, which are being developed within the umbrella of the regional project Nextcare (2016-2019), undertaken to foster innovation in technologically-supported services for chronic multimorbid patients in Catalonia (ES) (7.5 M inhabitants). Whereas one of the assessment protocols is designed to evaluate population-based deployment of care coordination at regional level during the period 2011-2017, the other three are service-based protocols addressing: i) Home hospitalization; ii) Prehabilitation for major surgery; and, iii) Community-based interventions for frail elderly chronic patients. All three services have demonstrated efficacy and potential for health value generation.

The core components of Community Paramedicine – integrated care in primary care setting: a scoping review

Since the beginning of 2000, the primary healthcare services around the globe are challenged between demands of home care and number of staff delivering it. The delivery of healthcare needs new models to reduce the costs, patient's readmission and increase their possibilities to stay at home. Several paramedicine programmes have been developed to deliver home care as an integral part of the local healthcare system. The programmes varied in nature and the concept of Community Paramedicine (CP) has not been established, demanding clarity. The aim of this review was to identify and describe the core components of CP, and identify research gaps for the further study.

New models of home care

Policy-makers have outlined their ambitions to provide joined-up care closer to home and enable people to remain independent and in their own homes. Home care will be a central component of realising these ambitions. However, there are serious concerns about the state of the home care market
and the quality of care service users receive.
In this case, the present report summarises the evidence on innovations and models of home care that demonstrate potential in the following key opportunity areas:
1. Technology and digital
2. Co-ordinated care planning
3. Recruitment and retention
4. Autonomous team working
5. Alternative approaches to commissioning
6. Personalisation
7. Integrated care approaches
8. Community assets and connections
9. Family-based support and communal living
.

Derivation and validation of the Personal Support Algorithm: an evidence-based framework to inform allocation of personal support services in home and community care

Personal support services enable many individuals to stay in their homes, but there are no standard ways to classify need for functional support in home and community care settings. The goal of this proyect was to develop and evidence-based clinical tool to inform service planning while allowing for flexibility in care coordinator judgment in response to patient and family circumstances. 

Developing accountable care systems: lessons from Canterbury, New Zealand

The health system in Canterbury, New Zealand, has undertaken a significant programme of transformation over the past decade. As a result of the changes, the health system is supporting more people in their homes and communities and has moderated demand for hospital care, particularly among older people. Change was achieved through developing a number of new delivery models, which involve better integration of care across organisational and service boundaries, increased investment in community-based services, and strengthening primary care. The experience in Canterbury offers useful lessons for the NHS in terms of how to redesign care in this way. Key approaches include the development of a clear, unifying vision of ‘one system, one budget’; sustained investment in giving staff skills to support them to innovate and giving them permission to do so; and developing new models of integrated working and new forms of contracting to support this. The transformation has taken ...

Open Forum Events: Urgent Care - Improving Patient Flow Conference

The Urgent Care: Improving Patient Flow conference agenda has been developed to explore the current patient flow trends within the hospital urgent care system. Delegates will gain a greater understanding of how the problems occur from the start of the process, with the patient having attended the A & E department, through to the discharge process, returning back into the community and home. Our line-up of expert speakers will provide insight, opinion and stimulate debate as to how to relieve the burden on hospitals and reduce the pressures of compromised patient flow. We will showcase a number of initiatives and examples of best practice from throughout the health and social care system and there will be ample opportunity for interactive discussion and networking amongst fellow professionals and peers.

Telerehabilitation for patients with chronic obstructive pulmonary disease (COPD) in Denmark

A pilot programme to test home-based telerehabilitation for COPD patients was designed and implemented by researchers at Aalborg University; a supportive political and legislative environment provided a platform for furthering the development of e-health and telemedicine; partnerships with stakeholders outside the health sector supported the development of telemedicine and helped drive service delivery transformations; patients were given a more active role in care and new collaborative partnerships between patients and providers were developed; success of the initial pilot led to a larger-scale study with greater involvement of regional and municipal actors.

Introducing home care services in Bulgaria

The introduction of home care services was proposed as a patient-oriented solution for ensuring appropriate service provision closer to home; a pilot approach allowed the gradual rollout and testing of an existing home care model being implemented abroad, which was adapted to meet the Bulgarian context; efforts to introduce home care included creating new roles and responsibilities for the health workforce and developing information and communication resources; establishing the necessary health system conditions, including the development of a supportive legal framework, is an important area of focus for advancing the sustainability and scale of the current transformations.

Integrating health care and housing to promote healthy aging.

In recent decades, the influence between health status and social conditions has been broadly studied; one of the conditions that has been strongly linked to health status has been housing.

Population ageing and the increase of chronic conditions are two of the drivers that have made that housing conditions become an important factor influencing health.

Many different proposals have been made regarding home care, most of them trying to take hospital care to patient’s home; in this post, some different aspects are discussed, mainly related to what Medicare could do in order to improve housing conditions and its influence in patient’s health: (I) increasing the emphasis on vulnerable population covered by Medicare’s Publicly Assisted Housing Programme, (II) tackling elderly falls as a main health problem and striving to reach the Health People 2020 goal of a 10 percent reduction in the rate of emergency-department visits due to ...

Hospitals Turning to Non-medical Home Care as Primary Discharge Preference

The International Hospital Federation is organizing a webinar about "Hositals Turning to Non-medical Home Care as a Primary Discharge Preference". 

Timing: 08:30 California (UTC -7) | 17:30 Geneva (UTC +2)| 23:30 Singapore (UTC +8)

Topic: Payers and providers are turning to non-clinical home care as the preferred option upon discharge from hospital and skilled nursing facilities. Hospitals are realizing that home care is the most cost-effective option for post-acute care and they are hungry for the analytics and patient data generated by technology-enabled home care providers in order to extend the hospital system into the home and reduce avoidable readmissions. Best-selling readmissions author, Josh Luke and home care innovator, Kyle Hill will enter an in-depth discussion on how data analytics can serve as a key tool for helping hospitals and families manage costs outside the hospital walls.

To join, please register at http://bit.ly/WebinarRegApril2016

Presenters:
Josh ...

Family Caregivers in Cancer: Roles and Challenges - PDQ for health professionals

This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about challenges and helpful interventions for caregivers of cancer patients. It is intended as a resource to inform and assist clinicians who care for cancer patients.

Kaiser Permanente holds a wide array of these evidence-based information summaries on a variety of health topics within their online health encyclopedia, available on their website for whoever might want or need this information.

The Right Medicine: Improving Care in Care Homes.

The increase of polypharmacy together with the population aging is making care homes a central point to develop health care programmes, specially related to medicines management and integration of different health care proffessionals.

The Royal Pharmaceutical Society has recently published a report addressing the main issues of medicine use in care homes. The needs identified by the authors include developing better communication systems, reducing falls in care homes, decreasing inappropriate use of psychotropic medicines, improving coordinated end of life care and lowering waste of medicines at home.

The report includes some recommendations such as giving pharmacists a major role in care homes medicine management, strengthening coordination between physicians and pharmacists or developing programmes of regular medicines review and staff training in integrated teams with other practitioners.

WHO’s global survey on assistive technologies

WHO has launched a global survey to gather views on the most necessary and useful assistive technologies such as hearing aids and wheel chairs. The survey will feed into the first ever WHO mandated list of essential assistive technologies, similar to the WHO Essential Medicines List. These practical tools – some low, some higher technologies – are becoming increasingly necessary to the many people in high- and middle-income countries who are living longer due to better healthcare. Similar devices are used by people with disabilities, allowing them to live more autonomously and participate in their communities. This list will represent a tool for governments to plan and focus efforts to help populations acquire the 50 priority products, thereby improving the everyday lives of the elderly and people with disabilities. The survey may be taken via a link on this WHO page.