Managing the hospital and social care interface: Interventions targeting older adults

The Nuffield Trust | March 2018  | Managing the hospital and social care interface: Interventions targeting older adults

This research report examines the relationship between the health and social care sectors, particularly the tensions between the two due to rising pressures on hospitals, when the think tank calls for increased collaboration between the two.

Managing the hospital
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It explores the actions and strategies that providers and commissioners have put in place to improve the interface between secondary and social care, with a focus on what hospitals can do. With particular focus on:

• collaboration to prevent avoidable hospital admissions
• the interface between hospitals and social care providers when patients are
discharged from hospital
• the relationship between commissioners and social care providers
• wholescale organisational integration.



The report suggests increased

  • collaboration to prevent avoidable hospital admissions
  • the interface between hospitals and social care providers when patients are discharged from hospital
  • the relationship between commissioners and social care providers
  • wholescale organisational integration.

It uses seven case studies to support this and makes five recommendations for national policy-makers. In conjunction to this, the think tank makes  seven recommendations for hospital leaders, derived from discussion with hospitals, integrated care organisations and local authorities  throughout the course of this research.

These are:

  1. Think imaginatively about the workforce. We have already set out the recruitment and retention challenges facing the social care sector, and the way national policy needs to change to help address them. But there are also things that local providers can do.
  2. Do not make decisions about social care, without social care. Hospitals
    that make decisions about providing or commissioning social care
    without consulting their local authority or social care providers may risk
    destabilising the social care market.
  3. Think carefully about different types of integration. Organisational,
    service-level and patient-level integration all have their own strengths and
  4. Consider pooling budgets to facilitate progress. Most of our case studies
    benefited from a shared budget to initiate and sustain integration efforts.
    Some of this came from ‘vanguard’ funding, but most of the case study sites
    also drew on the Better Care Fund.
  5. Make sure that integrated teams have appropriate processes to support
    them. Where integrated teams work effectively, they have appropriate
    processual and managerial support. Shared governance and accountability
    processes mean that everyone is working to the same set of standards.
  6. Make sure that commissioners are on board. Collaboration and buy-in
    from all local commissioners and providers, including primary and
    community care, was a key factor in successful implementation for most of
    the case study sites.
  7. Collaborate with housing partners. There are good examples of
    collaboration with housing partners at the local level.

NIHR Signal Multiple illnesses and end-of-life care drive high healthcare costs in old age

Hazra N C, Rudisill C, Gulliford M C. Determinants of health care costs in the senior elderly: age, comorbidity, impairment, or proximity to death? Eur J Health Econ. 2017. [Epub ahead of print].

Ageing on its own does not drive healthcare costs. Instead, this research found that the increasing number of health conditions and age-related impairments along with the proximity to death are more strongly linked to healthcare costs than age alone.

This UK study investigated healthcare costs in people over 80 years old. Costs increased to the mid-90s before declining again. Proximity to death was the strongest predictor of cost, which was higher for people aged 80-84: £10,027 per year versus £7,021 per year for those over 100. Multiple illnesses also had a strong influence, with each additional health complaint progressively increasing costs.

This suggests that to provide person-centred and efficient healthcare services for all, planning should take account of the number and types of conditions rather than age alone.

Experiences of domiciliary care

Home care: what people told Healthwatch about their experiences  | Homewatch

This report analyses the experiences of over 3,000 people, their families and front line staff with home care services.  The information is intended to be used to inform the development of new service contracts, to shape care packages around what people want and to set out new ways to monitor performance from a user perspective.

Full report available here

Additional link: Healthwatch press release

Impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures

Inadequate health literacy (HL) is associated with impaired healthcare choices leading to poor quality-of-care | Geriatric Nursing


Our primary purpose was to estimate the prevalence of inadequate HL among two populations of AARP®Medicare Supplement insureds: sicker and healthier populations; to identify characteristics of inadequate HL; and to describe the impact on patient satisfaction, preventive services, healthcare utilization, and expenditures. Surveys were mailed to insureds in 10 states. Multivariate regression models were used to identify characteristics and adjust outcomes. Among respondents (N = 7334), 23% and 16% of sicker and healthier insureds, respectively, indicated inadequate HL. Characteristics of inadequate HL included male gender, older age, more comorbidities, and lower education. Inadequate HL was associated with lower patient satisfaction, lower preventive service compliance, higher healthcare utilization and expenditures. Inadequate HL is more common among older adults in poorer health, further compromising their health outcomes; thus they may benefit from expanded educational or additional care coordination interventions.

Full reference: MacLeod, S. et al. (2017) The impact of inadequate health literacy on patient satisfaction, healthcare utilization, and expenditures among older adults. Geriatric Nursing. Volume 38 (Issue 4) pp. 334–341

Reducing hospital admissions by improving continuity of care in general practice

This briefing summarises research that analysed data from over 230,000 anonymised patient records for older people aged 62 – 82 years | The Health Foundation

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  • Continuity of care is an aspect of general practice valued by patients and GPs alike. However, it seems to be in decline in England.
  • Our analysis, published in The BMJ and summarised in this briefing, looks at the link between continuity of care and hospital admissions for older patients in England. We looked specifically at admissions for conditions that could potentially be prevented through effective treatment in primary care.
  • We found there to be fewer hospital admissions – both elective and emergency – for these conditions for patients who experience higher continuity of care (ie those who see the same GP a greater proportion of the time). Controlling for patient characteristics, we estimate that if patients saw their most frequently seen GP two more times out of every 10 consultations, this would be associated with a 6% decrease in admissions.
  • To improve continuity for patients, general practices who are not already doing so could set prompts on their booking systems and encourage receptionists to book patients to their usual GP. Patients could also be encouraged to request their usual GP.
  • Clinical commissioning groups and NHS England Area Teams could work with general practices to support quality improvement initiatives that maintain or improve continuity of care.
  • Future national initiatives should have a well developed understanding of how and why the policy will impact on continuity in a particular context.

Read the full overview here

Read the full report here


Inequalities In Mental Health, Cognitive Impairement And Dementia Among Older People

UCL Institute of Health Equity | Published online: 30 September 2016

Image source: IHE

This report focuses on inequalities in the experience and prevalence of poor mental health, cognitive impairment and dementia and the impact of social isolation, lack of mental stimulation and physical activity, before and after retirement, and in later old age.  These issues can exacerbate the risks of poor mental health, cognitive impairment and dementia in later life and are experienced disproportionately by people in lower socio economic groups.

The report also provides a brief summary of life course social determinants that increase the risk of poor mental health, early onset of cognitive decline and the symptoms of dementia.  In particular, the report examines the role of ‘cognitive reserve’, built throughout the life course, through educational and employment opportunities, and providing older people with a wider and more flexible set of skills, abilities and resources to delay onset of cognitive decline and dementia, and to cope better with the conditions should they occur.

The report also makes recommendations, at a national and local policy level, in addition to providing example interventions for action on the social determinants of poor mental health, cognitive decline and dementia.

Read the full report here

Enhanced Health in Care Homes model

One in seven people aged 85 or over is living permanently in a care home. The evidence suggests that many of these people are not having their needs properly assessed and addressed. As a result, they often experience unnecessary, unplanned and avoidable admissions to hospital, and sub-optimal medication.

The enhanced health care homes model  lays out a clear vision for providing joined up primary, community and secondary, social care to residents of care and nursing homes, via a range of services.

Seven key components and eighteen sub-components which define the care homes model are put forward, with practical guidance explaining how organisations and providers can make the transition and implement the whole model.

These plans can help transform the way care is delivered, with staff from across health and social care organisations working together as part of multidisciplinary teams  to deliver high quality and financially sustainable care.

The enhanced health in care homes (EHCH) care model is one of a number of new care models that are delivering whole population healthcare. It will become a core element of the multispecialty community provider (MCP) and primary and acute care system (PACS) models.

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