The Balance of Care Approach:Modelling complexity in services for older people

Paul Forte & Tom Bowenwww.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

OlderPeople

Highdependency

Lowdependency

Mediumdependency

The Balance of Care model

OlderPeople

Highdependency

Lowdependency

Mediumdependency

Acutecare bed

Community nurse

Independent sector

NHS

LocalAuthority

Care home

Physiotherapist

Care assistant

Day care centre

Occupational therapist

The Balance of Care model

Highdependency

Lowdependency

Independent sector

Local authority

Care home

Care assistant

OlderPeople

Day care centreoption 3

Mediumdependency

option 2

Acute care bed

Option 1Community nurse

Physiotherapist

NHS

Occupational therapist

Balances to be struck…

Care Professionals Non-Clinical Managers

Health Services Social Services

High Dependency 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  No. of

Clients: 550

    Unit Cost: £24,780 £20,658 £12,258 £ £ £ Totals

    Allocation: 50% 40% 10%      100%

    Allocated Clients: 275 220 55 0 0 0 550

  Code Service Description Current Home with Avoid adm Opt 4 Opt 5 Opt 6 Cost

  S1 Community nurse 49 52 52      £694,375

  S2 Physiotherapist   1 1      £6,875

  S3 Care Assistant 1095 730 730      £6,945,950

  S4 OT   2 2      £13,750

  S5 Geriatrician             £

  S6 Rehab asst             £

  S7 Care home EMH             £

  S8 Care home (non-EMH)             £

  S9 Acute bed 21 21 0      £4,158,000

  S10 Comm hospital bed             £

  S11 Telecare   52 52      £214,500

  S12 CPN             £

  S13 Night sitter             £

  S14 Extra care housing             £

  S15 Day care             £

    Total Cost: £6,814,445 £4,544,804 £674,201 £ £ £ £12,033,450

    Quality Score: 80% 100% 100%      90%

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

Telecare 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

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

MildCarer No carer Carer No carer

Community psychiatric nurse 1 hr pa 1 hr pa 1 hr pa 1 hr paCommunity support wkr (psych) - - - -Health Care Supt wkr (PCT prov) - - - -Home care supt (soc ser) - - - -

ModerateCarer No carer Carer No carer

Community psychiatric nurse 1 visit pcm 1 visit pcm 1 visit pcm 1 visit pcmCommunity support wkr (psych) 2 visit pcm 4 visit pcm 2 visit pcm 4 visit pcmHealth Care Supt wkr (PCT prov) - - 2 hrs pcm 4 hrs pcmHome care supt (soc ser) - - 1 hr pw 6 hrs pw

SevereCarer No carer Carer No carer

Community psychiatric nurse 1 visit pcm 1 visit pcm 1 visit pcm 1 visit pcmCommunity support wkr (psych) 3 visit pcm 6 visit pcm 4 visit pcm 8 visit pcmHealth Care Supt wkr (PCT prov) - - - -Home care supt (soc ser) 2 hr pw 5 hrs pw 3 hr pw 6 hrs pw

Not frail Frail

Not frail Frail

Not frail Frail

Simplified Care Options

Potential Resource Requirements for Key Services

Staff Type WTE Annual CostCommunity psychiatric nurse 181 £4.7 millionCommunity support worker (psych) 400 £6.0 millionHealth Care Supt worker (PCT prov) 82 £1.2 millionHome care support (Adult services) 238 £5.0 millionTotal community staff 901 £16.9 million

Care Homes places (inc respite) 2007 £67.8 million

Category descriptionsCategory 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.

P6 Unsupported at home (aged over 65)

P1 Care Home Residents(not EMH)

P2 Care Home Residents(EMH)

P3 Frailty CaseManagement

(Severe)

P4 Other long term careneeds

(Moderate)

P5 Other low intensityneeds(Minor)

Patient categories

Meaningful groups of population >65 years for telecare planning purposes