This report describes the progress made over the first four years of the ten year RCOP programme. It builds on the Reflecting on Progress report published by the Joint Improvement Team (JIT) in November 2013. Both reports describe how partnerships have used their Change Fund to make a difference to the lives of older people […]
European Innovation Partnership on Active Healthy Ageing A Compilation of Good Practices – Integrated Care for Chronic Diseases (2nd edition) This compilation is the product of the collaborative work of the members of the B3 Integrated Care Action Group. In this collective effort, the experts of the Action Group have been pooling their knowledge and […]
The issue we wanted to address was to expand the range of tiered interventions accessible to older people at key points of transition, recognising the limitations of the pre-existing service system. Gap analysis highlighted the need to create alternative inputs in circumstances where:
the older person has had a hospital admission and is clinically ready to leave hospital but requires time to rebuild confidence and regain abilities in a reablement/enablement approach
the older person is at home and due to deterioration in health and wellbeing is at risk of avoidable admission to hospital, the newly developed intermediate care model being able to offer safe care with a lower tariff intervention
the older person is at home and due to deterioration in health and wellbeing or to a change in their social circumstances, [frequently this has taken the form of emergence of adult protection concerns] is at risk of crisis-driven avoidable admission to a mainstream permanent care home. The newly developed intermediate care model is able to offer assessment and a reablement approach which enables more effective care planning and decision making in a less pressured environment and context.
short term support is needed because the carer is unexpectedly temporarily unable to continue in the caring role
planned regular short breaks are required to provide stability, contributing to prevention of unscheduled / crisis triggered transitions.