Waiting times for Occupational Therapy (OT) assessment were increasing and consultation with OT staff across Angus identified that they were spending a significant amount of their time in the office dealing with general OT enquiries, taking and prioritising referrals and dealing with service user complaints about delays. This prevented staff from seeing service users and arranging essential equipment and adaptations. The process for dealing with some minor adaptations had also been identified as cumbersome and time consuming for staff and resulted in delays in the adaptation being put in place.
The facility was established to pilot a model that would:
prevent unnecessary permanent admission to residential care
prevent unnecessary admission to hospital.
facilitate discharge from hospital and contribute to managing delays in discharge from acute or community hospitals.
deliver support to ensure a safe and full re-integration into the Service Users home and local community.
assist Service Users’ in setting and achieving their planned goals, placing the emphasis on the Service Users needs. Goals will be set with the service users and reviewed weekly or as required throughout their stay
support Service Users to regain and maintain daily living skills.
support carers in their role during a person’s stay in the unit and after the assessment period is complete.
respond quickly and flexibly to the changing needs of the Service Users to support their return home.
East Ayrshire Community Health Partnership have been working collaboratively with Council , Health Board, private and voluntary sectors colleagues over a number of years to reduce admissions and readmissions to hospital, encourage independence and support older people to remain at home. At the same time older people are telling us that they wish to stay in their own homes whenever it is safe and practical to do so, to be helped to be more independent; and to have choice and control over how they manage their lives. Intermediate Care and Enablement Services is recognised as a key approach to meet the challenge to re-shape health, care and support services for older people.
Identifying older people at risk of admission/ readmission to hospital. High rates of multi-morbidity in older population. Evidence suggests that ‘anticipatory’ discussions with older people with long term conditions regarding their future care choices can reduce avoidable admissions
Demographic change, an ageing population and increasing incidence of long-term conditions and co-morbidities and the need to develop co-ordinated responses across primary health, social and specialist care.