The Balance of Care Approach: Modelling complexity in services for older people Paul Forte & Tom Bowen ORAHS 2010, Genoa, Italy, 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 Older People High dependency Low dependency Medium dependency

The Balance of Care model Older People High dependency Low dependency Medium dependency Acute care bed Community nurse Independent sector NHS Local Authority Care home Physiotherapist Care assistant Day care centre Occupational therapist

The Balance of Care model High dependency Low dependency Independent sector Local authority Care home Care assistant Older People Day care centre option 3 Medium dependency option 2 Acute care bed Option 1 Community nurse Physiotherapist NHS Occupational therapist

Balances to be struck… Care ProfessionalsNon-Clinical Managers Health ServicesSocial Services High DependencyLow 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: CodeService DescriptionCurrentHome withAvoid admOpt 4Opt 5Opt 6Cost S1Community nurse4952 £694,375 S2Physiotherapist 11 £6,875 S3Care Assistant £6,945,950 S4OT 22 £13,750 S5Geriatrician £ S6Rehab asst £ S7Care home EMH £ S8Care home (non-EMH) £ S9Acute bed21 0 £4,158,000 S10Comm hospital bed £ S11Telecare 52 £214,500 S12CPN £ S13Night sitter £ S14Extra care housing £ S15Day care £ Total Cost: £6,814,445£4,544,804£674,201££££12,033,450 Quality Score: 80%100% 90%

Total Service Usage by Scenario ServiceAnnual UnitsCurrentBaselineLow investExtended Community nurseWTE01819 PhysiotherapistWTE0000 Care AssistantWTE OTWTE0488 GeriatricianWTE0000 Rehab asstWTE0000 Care home EMHPlaces Care home (non-EMH)Places Acute bedBeds03228 Comm hospital bedBeds0000 TelecarePackages CPNWTE0000 Night sitterWTE0022 Extra care housingPlaces00190 Day carePlaces0000

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

Simplified Care Options

Potential Resource Requirements for Key Services

Category descriptions Category LabelIntended Population BaseData 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 / 150 Care home residents - EMHPermanent care home residents over 65 supported by council (Elderly Mental Health) England residents at / 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 / 150. Other long term care needsNumbers 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 / 150 Other low intensity needsNumbers over 65 receiving home care (< 5 hours per week) Other England low intensity home care (<5hrs per week) at / 150 Unsupported at home >65Total 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.

Patient categories Meaningful groups of population >65 years for telecare planning purposes