Homecare Overnight Service

Examples of Practice

The complexity of people with care needs has increased over recent years.  The service means that people with high level needs can be supported at home with care delivered overnight.  Previously this was only possible in a residential or hospital setting.  Prior to the investment from the Change Fund there were two Overnight teams.  The investment from the Change Fund allowed another three teams to be established.  This has allowed people to move home from hospital, or remain at home, whereas previously a move away from home would be the only feasible outcome for meeting their needs.  In some cases the requirement for care overnight was the only stumbling block to meaning someone could be cared for in their own home.

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Enhanced Hospital Discharge

Examples of Practice

The early identification of carers in order to provide information and support before the caring role begins to have a negative impact on the health and wellbeing of the carer.

The aim was to identify carers at the point of hospital discharge, and to provide information and support to the carers of older people in Falkirk at this vital time at the start of their caring journey or when their caring role was changing.

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Rapid Response

Examples of Practice

In 2009/10 there were 6,243 unplanned admissions to hospital of over 65s in Perth and Kinross.  In the same year £35 million, over one third of the total Health and Social Care spend on people over 65 yrs, went to providing hospital based care.

Change Fund money has been used to implement a number of projects to try and reduce the number of unplanned admissions to hospital by providing community based alternatives.  One of these alternatives is the Rapid Response Service.

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Developing Risk Prediction to Support Preventative and Anticipatory Care in Scotland – Enhancing SPARRA (Version 3)

Examples of Practice

Information Services Division (ISD) was keen to further develop the Scottish Patients at Risk of Readmission and Admission (SPARRA) tool to identify patients who may benefit from a more anticipatory approach to their care; planning for events or exacerbations to reduce the risk of emergency hospital admission.

SPARRA is a tool which predicts a patient’s risk of emergency admission; a patient with a SPARRA score of 50% has a one in two chance of being admitted to hospital in the following year.

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Smithfield Court Rehabilitation Service, Aberdeen

Examples of Practice

To provide a service designed to promote recovery and a return to independent living for service users.  Rehabilitation for adults with physical, social, communication and/or sensory difficulties, and for some with reduced confidence following illness, accident or other crisis situation.  The objective is to provide an holistic range of social care, therapies and activities to enable service users to achieve and maintain their best possible function and to support their return to independent living.

The overall goal is to decrease dependence on health and social care support, increase community integration and improve the quality of life of individuals whilst also supporting their carers.  The client group is older people and adults recovering from illness, accident or acquired brain injuries.  During the development of the service a gap for rehabilitation for younger people was identified and the facilities were further developed to enable their discharge from a specialist unit to continue their rehabilitation in a home setting.

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