Intermediate and Continuing Care: Policy and Practice

289 Pages·2000·1.89 MB·English

Intermediate and
Continuing Care:
Policy and Practice
Edited by
Brenda Roe
Professor of Health Sciences,
Liverpool John Moores University
Roger Beech
Reader in Health Services Research, Keele University
and Academic Lead for Research, Central Cheshire
Primary Care Trust
i
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© 2005 by Blackwell Publishing Ltd
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First published 2005 by Blackwell Publishing Ltd
Library of Congress Cataloging-in-Publication Data
Intermediate and continuing care : policy and practice/edited by Brenda Roe, Roger Beech.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-1-4051-2033-3 (alk. paper)
ISBN-10: 1-4051-2033-9 (alk. paper)
1. Older people–Intermediate care–Great Britain. 2. Older people–Long-term care–Great
Britain. 3. Intermediate care (Nursing care)–Great Britain. 4. Long-term care facilities–Great
Britain. 5. Continuum of care–Great Britain.
[DNLM: 1. Intermediate Care Facilities–organization & administration. 2. Ambulatory Care–
Aged. 3. Health Planning. 4. Health Services for the Aged–organization & administration. 5.
Home Care Services–Aged. 6. Housing for the Elderly. WT 27.1 I61 2005] I. Roe, Brenda H.
II. Beech, Roger.
RA998.G7I58 2005
362.16’0941–dc22
2005016455
ISBN-10: 1-4051-2033-9
ISBN-13: 978-1-4051-2033-3
A catalogue record for this title is available from the British Library
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This book is dedicated to
Pearl Roe (1920–2004) and Esme Elsden
and Izan, Hebba and Alice Beech
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Contents
Foreword by Peter Crome vii
Introduction ix
Contributors xiii
Part 1: Intermediate Care 1
1 Intermediate Care: Policy and Context 3
Jenny Cowpe
2 Identifying the Need and Scope for Intermediate Care 19
Roger Beech
3 Management and Planning of Services 33
Tom Bowen, Paul Forte and Chris Foote – The Balance
of Care Group
4 Coordinating Intermediate Care 50
Wanda Russell
5 Service Development and Evaluation in Intermediate Care 61
Brenda Roe
6 Interdisciplinary Working in Intermediate Care: Generic
Working or the Key to a Person Centred Approach? 78
Anne Marriott, Gaynor Reid, Kathy Jones, Rae de Villiers
and Christine Kennedy
7 Interdisciplinary Training and Development 95
Julie Howden
8 Evidence on the Effectiveness of Intermediate Care 106
Roger Beech
9 Economic Evaluation of Intermediate Care 119
Richard Little
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vi Contents
Part 2: Continuing Care 137
10 Continuing Care: Policy and Context 139
David Challis and Ann Netten
11 Community Care: Service Delivery, Development and Evaluation 155
David Challis and Jane Hughes
12 Alternative Housing and Care Arrangements: The Evidence 183
Robin Darton and Ann-Marie Muncer
13 Care Homes and Continuing Care 204
Anne Netten, Robin Darton and Jacquetta Williams
14 Interdisciplinary Working and Education in Continuing Care 222
Abigail Masterson and Sian Maslin-Prothero
Part 3: Involvement of Carers and Consumers 235
15 Carers and Caregiving in the Context of Intermediate and
Continuing Care 237
Diane Seddon and Catherine Robinson
16 Patient and Public Involvement in Service Design and Evaluation 249
Bie Nio Ong and Geoff Wood
17 Implications for Policy and Practice: The Future 259
Brenda Roe and Roger Beech
Index 271
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Foreword
When I first became a consultant I shared responsibility with a colleague for a
40-bed ‘half-way home’ sited in a large Victorian mansion in a leafy suburb. It
was devoid of facilities, needed refurbishment and the onward move to home
for clients was often delayed for months. Such units were not unusual and this
unit like most others of its kind were closed as the emphasis switched to im-
proving services for older people in the acute hospital. Twenty-five years later,
as part of the Department of Health’s National Service Framework for Older People,
we have seen the opening of similar types of units in the community estab-
lished as part of what are now called intermediate care services. Whilst recog-
nising that not all people presently admitted to an acute hospital need to be
(this includes younger people as well as older individuals), and that hospital
has dangers of its own, it is important that alternatives are patient-orientated,
effective, sustainable in the long term and not just used as a way of meeting
government targets on waiting times and waiting lists. One hopes that the cycle
does not repeat itself!
The greater emphasis on primary care, in both its commissioning andproviding
roles requires re-engineering of what often seems like the dividing wallbetween
the hospital and the community. This is particularly so when it comes to the
continuing care of older people, many of whom suffer from chronic diseases.
Bringing the expertise to where the person lives requires training for primary
health care and social care teams and much more flexible referral arrangements.
This is particularly important in care homes, where numerous studies have
described the inadequacies of the present health care systems. It is interesting to
reflect that the Certificate of Additional Qualification in Geriatrics in the USA
is equally open to family physicians as it is to those who have first trained in
internal medicine in hospital.
Thus, this book is extremely timely. Brenda Roe and Roger Beech are to be
congratulated on assembling a team of policy makers, researchers and practi-
tioners whose expertise and clarity of thought will be of benefit to all those
interested in this area. I can thoroughly recommend it.
Peter Crome
Professor of Geriatric Medicine, Keele University
President-Elect, British Geriatrics Society
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Introduction
Intermediate care is a key standard within current UK health policy, and local
services have been developed since the early 1990s with little strategic planning.
Recently social services and health services have been working together in part-
nership with local voluntary organisations and stakeholders to develop strategy
and services. To date, there has been little empirical evidence available to shape
the development of these services, despite evaluation and user and consumer
involvement being explicit within government policy. There is an emerging
body of knowledge on the development, organisation and evaluation of inter-
mediate care but there remains insufficient evidence of economic evaluation.
Intermediate care is not a universal term and does not feature in the interna-
tional literature, which therefore makes comparison between countries and ser-
vices difficult. For example, many different terms are used in the UK forservices
which come under the umbrella of intermediate care, such as hospital at home,
rapid response teams, rehabilitation and recovery teams, acute medical trauma
or early discharge, and ‘nurse-led beds’ in care homes. In the USA, intermediate
care is taken to mean ambulatory urgent medical care similar to ‘walk in’ or‘out
of hours’ general practice centres in the UK. ‘Subacute care’ would be a morecom-
parable term in the USA to our understanding of intermediate care in the UK.
The purpose of this book is to draw together what we know about intermedi-
ate care services. Main reference is given to UK services although, wherepossible,
reference to international literature and studies is provided. Intermediate care
services are being developed with no reference or national debate on how they
relate to continuing care in the community. There is a long history of continuing
care provision within the health and social welfare literature, which this book
also draws upon. Continuing care is developing with care in the community, by
the community or closer to home, as opposed to large long-stay institutions.The
development of assisted living, retirement communities and extra care housing
is also emerging in the UK, having already been established in the USA. Inter-
mediate and continuing care form part of the ‘care continuum’ and should be
viewed together as part of a whole system. This book advocates such a whole
system approach to the development, organisation and evaluation ofintermediate
and continuing care, including policy and context. Essential to this are carers
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x Introduction
and the involvement of users and the public in the development and evaluation
of services. End of life issues also form part of the ‘continuum of care’ andrequire
consideration within the whole system approach.
This book is aimed at health and social care providers as well as managers,
researchers and academics. It comprises three parts and involves contributing
authors who have knowledge and experience of policy, management andresearch
in health and social care. Part 1 looks at intermediate care, with some chapters
forming ‘how to guides’ on the development and organisation of services. Part
2 looks at continuing care, while Part 3 considers the involvement of carers and
consumers. All chapters provide a current ‘state of the art’ and include asummary
with recommendations for services and care, as well as for future research.
In Chapter 1, Jenny Cowpe sets the policy and context for intermediate care,
looking at past policy and history within a national and local context. She goes
on to look at current and future developments including success factors as well
as outstanding policy and implementation issues. In Chapter 2, Roger Beech
identifies the need and scope for intermediate care using performanceindicators
to support planning and the use of utilisation review as a particular technique.
In Chapter 3, The Balance of Care Group, comprising Tom Bowen, Paul Forteand
Chris Foote, look at the management and planning of services for intermediate
care. The authors argue for developing a whole systems perspective using the
Appropriateness Evaluation Process as part of a methodology involvingsurveys
and workshops. They provide an illuminating case study looking at alternatives
to acute admission and discharge planning.
In Chapter 4, Wanda Russell considers the coordination of intermediate care,
addressing key questions of whom services are aimed at, what is offered and
who provides them. She discusses who the users of the services are and how
they are referred, processes and systems of implementation and delivery, mon-
itoring, public involvement and evaluation. In Chapter 5, Brenda Roe goes on to
look at service development and evaluation in intermediate care. She includes
the development of services and professionals and argues for a whole system
integrated approach. The role of evaluation for service monitoring and develop-
ment is also discussed. Brenda identifies barriers and constraints to thedelivery
of intermediate care and concludes by describing the range of schemes and
services available.
Chapter 6 involves another group contribution from Anne Marriott, Gaynor
Reid, Kathy Jones, Rae de Villiers and Christine Kennedy. They look at inter-
disciplinary working within intermediate care and argue for generic working as
the key to a person centred approach. The development of interdisciplinary
working and how it compares to multidisciplinary working is discussed. The
authors use the development of their own Rehabilitation Link Team and service
within East Cheshire Primary Care Trust as a case study. They consider care
management and processes along with the benefits and limitations of inter-
disciplinary working. In Chapter 7, Julie Howden builds on her own experienceof
running courses on interdisciplinary training and development for intermediate
care. She considers interdisciplinary joint working and training compared with
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Introduction xi
the multidisciplinary approach, interprofessional education and curricula, and
some common learning programmes. Learning styles and teaching strategies,
along with the gains and benefits of interdisciplinary training and development,
are also included.
The final two chapters in Part 1 consider the evidence underpinning inter-
mediate care. In Chapter 8, Roger Beech looks at the evidence on effectiveness,
which includes both quantitative and qualitative empirical evidence from sys-
tematic reviews and local evaluations. Implications for current services and
directions for future research are considered. In Chapter 9, Richard Little presents
a guide to economic evaluation, commencing with some basic economics and
evidence. He goes on to look at key questions and potential methods for com-
parison, costs and benefits.
In Part 2, David Challis and Ann Netten set the scene for continuing care, its
policy and context. To mirror Part 1 they include past policy and history, look-
ing at long-term commitment to community based care, past developments and
the modernisation of social care services. They also consider workforce issues,
the acute and continuing care interface, performance, regulation, best value,
commissioning of services, funding of long-term care and future demand. In
Chapter 11, David Challis and Jane Hughes look at service delivery and the
development and evaluation of community care. The chapter includes service
development, delivery, coordination and continuity, locations and carepackages,
information needs and systems to support continuing care.
In Chapter 12, Robin Darton and Ann-Marie Muncer consider alternative
housing and care arrangements. This includes sheltered housing and private
retirement housing and their provision, and more recent developments in extra
care housing and assisted living. Costs and funding issues of these alternatives,
the characteristics and needs of residents, and staffing issues are discussed. Fin-
ally, the authors look at retirement communities and extra care housing, using
two developments in the UK as examples. The chapter concludes by identifying
future research needed to fill the gaps in current knowledge. Care homes and
continuing care are the focus of Chapter 13 presented by Ann Netten, Robin
Darton and Jacquetta Williams. They begin by identifying the supply and charac-
teristics of homes, their funding, their costs and their prices. Quality of care and
quality of life are also included, as are lengths of stay and resident outcomes.
Areas where more research is required are identified and conclusions and recom-
mendations drawn.
Part 2 is completed by Chapter 14 by Abigail Masterson and Sian Maslin-
Prothero. The chapter discusses interprofessional care and interdisciplinary
working in the context of community care and continuing care, with specific
reference to people living with continuing care needs and chronic conditions.
The authors start out by looking at policy, then go on to consider interdisciplin-
ary working and education, competence and regulation. This chapter builds on
Chapter 7 in Part 1, by taking a specific focus on continuing care.
Part 3 comprises two chapters looking at the involvement of carers and con-
sumers. Chapter 15 by Diane Seddon and Catherine Robinson looks at carers
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xii Introduction
and caregiving in the context of intermediate and continuing care. The authors
begin by looking at the challenges of caregiving and set this into a policy con-
text. They then go on to include carers’ experiences of services and support. The
valuable roles of consultation and working in partnership to deliver intermedi-
ate and continuing care are also explored. In Chapter 16, Bie Nio Ong and Geoff
Wood look at patient and public involvement in service development and evalu-
ation. They define what involvement is, the challenges and tensions in receiving
and giving care, how to judge quality of care and how individuals can have
meaningful influence over service provision.
In Chapter 17, Brenda Roe and Roger Beech summarise the book by drawing
together what is known about intermediate and continuing care, identifying
areas for future research and reflecting on implications for policy and practice.
We are indebted to the contributing authors who shared our vision for this
book and who made it possible, despite the competing demands of heavy work-
loads and schedules. We should also like to thank Beth Knight at Blackwell
Publishing for appreciating the scope and value of this book.
Brenda Roe and Roger Beech
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