Download Bernie McNally-Health and long-term care for older people access

Health and long-term care for older
people: access, financing, providers:
Experience from a service provider
MS BERNADETTE MCNALLY
DIRECTOR OF SOCIAL WORK
BELFAST HEALTH AND SOCIAL CARE TRUST
UNITED KINGDOM
Welfare state established 1945
 NHS free to all citizens a the point of use
 Social care services to those most in need charges
based on ability to pay (means tested )
National assistance act (1948)
 “to provide residential accomodation for persons
who by reason of age, infirmity, or any other
circumstances are in need of care and attention
which is not otherwise available to them”
Growth in institutional care
 Hospital long stay geriatric wards
 Psychiatric hospitals
 Childrens homes
 Learning disability institutions
 Prisons
asylum
Concerns about quality of care
Development of community care
 Child care: foster care preferred to institutions for




children(experience of family life)
Older people: increasingly supported in own homes
Poor quality of life in institutions(Townsend report
1964)
Hospital plan(1962) major programme of hospital
closure
White paper (1976) redistribution of resources away
from acute hospitals to community services
Community care reforms
Community Care Act (1990) “people first”
 Comprehensive individual assessment
 Focus on those with complex needs
 Mixed economy of care
 People remaining at home
 Reducing hospital provision
Focus on the individual
Comprehensive assessment
 Individual multidisciplinary assessment of complex
needs
 Individual care plan
 Devolved budgets to social worker to purchase
packages of care
 Systematic review process
Mixed economy of care
 Huge growth in independent sector in market conditions
 Private providers coming into the market alongside
statutory and NGO providers
 Providing residential, respite, domicillary and day care
services
 Emphasis on improving quality standards
 Emphasis on value for money
Nursing home
Residential home
Domiciliary
Statutory v Private
Residential Nursing
Care
Managed
(complex
needs)
Non Care
Managed
(low level
care)
Direct
Payments
(Complex)
Direct
Payments
(low level)
TOTAL
Total
768 (12%)
1697 (26%)
3980 (62%)
6445
-
-
2987 (100%)
2987
-
-
43
43
-
-
60
60
768 (8%)
1697 (18%)
7070 (74%)
9535
Expansion of domicillary care
People staying at home
 Closing large institutions
 Domicillary and day care free of charge
 Residential and nursing homes means tested
 Support for carers
 Direct payments
 Increased use of tecnology
People staying at home
Reducing hospital provision
 De institutionalisation of older people from long stay
wards
 Resettlement of mental health and learning disability
clients into community settings
 Timely acute hospital discharges
 Acute hospital admission avoidance
Key components of social care in the 90s
 Flexible and responsive services
 Choice of a range of options
 Foster independence
 Concentrate on those in greatest need
 Purchasing power of care manager (sw)
Rising demand
 Aging population
 Demographic changes
 Medical innovation
 Rising public expectations
 Breakdown in extended family supports
 Breakdown in community infrastructure
UK RISING COSTS
 Spending doubled in a decade £7billion to £14 billion
 1.2 million older people receiving publicly funded
home based social care
 20,000 care homes
 450,000 care home places
Current thinking
 Prevention, rehabilitation, re ablement
 Target low level support not just complex needs
 User empowerment
 Recovery model
 What people can do rather than cant do
 Partnership with users
Reablement
Current thinking
 Focus on interface between acute hospitals and




community services
Timely discharge of old and frail
Hospital avoidance (intermediate care , step down,
home based treatment)
Short term focused rehabilitation
Purchasing power of client (direct payments)
Current thinking
 More choice
 Louder voice for users
 Tackle inequalities
 Improve access to low level support services
 Supporting long term needs
 Chronic disease management
 Fostering independence
 Recovery model
USER EMPOWERMENT
 Real choice
 To be listened to
 To be respected
 To be treated as equals
 To stay healthy
 To go to work
 To have a safe place to live
 Valuing human rights
Interagency partnerships
 Housing: social housing with floating support
 Police: Community safety initiatives
 Leisure services: actively aging
 Transport: free transport for over 60s
 Community: neighbourhood renewal
 Employment:
 Education:
Mullen mews
Mullen mews
Mullen mews
POSITIVE LIFESTYLES
 Walking groups
 Line Dancing
 Chair Based Activity
 Tai Chi
__
 Gym
 Pool – steam / sauna
 Dancing
 Aerobics / Spin
 Badminton
The future
 Personalised budgets (pooling all state services)
 Expert patient (self help condition management)
 Promotion of positive health and wellbeing
 Enabling rather than disabling
 Medicines management
 Stroke management
 Falls prevention
 Actively aging well