Intermediate Care Framework for Scotland

Resource

The Intermediate Care Framework first published in July 2012 and aims to encourage the development of these services in Scotland. The Framework defines Intermediate Care as follows: “The function of Intermediate Care is to integrate, link and provide a transition (bridge) between locations, between different sectors and between different states”. Click on the download link […]

Read more

Intermediate Care – Step Up, Step Down

Examples of Practice

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.

Read more

Intermediate Care – Fife

Examples of Practice

The aim of establishing ICASS in Fife was to transform community services by bringing together uni-disciplinary teams to utilise fully resources available in line with demand, and to coordinate care through a single point of access (SPOA). It contributes to our commitment to ensure the closer integration of the range of community services under one system.

It aims to improve quality of care and outcomes for older people whilst allowing them to remain independent within their own homes or communities, provides alternatives to hospital admission, reduces the number requiring long term institutional care, reduces length of stay for those who require a hospital admission.  It aims to address the following:

  • Moving from an inpatient model of care to a robust community based model of care involving older people and their carers and families in care planning
  • Bringing together teams to make more efficient use of resources to meet the needs/demands of the increasingly elderly population
  • To provide a single point of access
  • To provide alternatives to hospital admission
  • To reduce length of stay if an admission is necessary
  • To provide assessment and care in the person’s own home or a homely setting
  • To achieve and sustain maximum potential and independence; and
  • To reduce numbers going into long term institutional care.

Read more

Step Up Care

Examples of Practice

Annan is a small market town with the acute hospital 16 miles away.  Feedback from local
peoples stated if they were unwell they wished to stay as close to home as possible.  The issues were:

  • Avoiding unnecessary admission to the acute setting
  • Effective utilisation of local resources
  • Providing Services Closer to home
  • Taking a person centred approach to care

Read more