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Reshaping Domiciliary Care Services for Older People

Older people tell us they wish to remain independent in their own homes for as long as possible and Domiciliary Care is one of the services provided by the Southern Health and Social Care Trust (SHSCT) to enable them to do this, when they have care/support needs. Domiciliary care within SHSCT has been challenged by growing demands for the service. In response to these increased demands, the Trust initiated a project to design and test an outcomes-based model that would:
• support better working relationships based on mutual trust and respect, between those providing, delivering and in receipt of the service;
• promote and maintain service user‘s independence, by extending the opportunities and capabilities of people to look after themselves;
• move from the traditional “time for task” service to a more person-centred approach to care delivery with active care review with clients and families;
• ensure a better integrated and responsive care package.

At what level did the PPI take place?

  • Service development/delivery;
  • Commissioning/policy.

PPI helped the project to

  • Improve efficiency of a service;
  • Improve quality;
  • Improve safety;
  • Inform commissioning;
  • Increase ownership.

Background

Strategic reviews and a range of engagements with service users, carers and staff, identified a number of issues with the current Domiciliary Care service, including:
• A “time for task” model which resulted in reduced flexibility and at times poor communication between those commissioning, delivering and receiving the service;
• A lack of timely review which unintentionally increased demand for the service;
• Poor integration with other SHSCT community teams;
• An inability to respond to individual changing needs in a timely way.

Aim of involvement

To design and test an outcomes-based model that would:

  • Support better working relationships based on mutual trust and respect, between those providing, delivering and in receipt of the service;
  • Promote and maintain service user‘s independence, by extending the opportunities and capabilities of people to look after themselves;
  • Move from the traditional “time for task” service to a more person-centred approach to care delivery with active care review with clients and families;
  • Ensure a better integrated and responsive care package.

Method(s) of Involvement

Service users were involved to:

  • Establish what they and their advocates liked about the current model;
  • Let them identify areas for improvement;
  • Propose possible solutions.

To further enhance this partnership approach a communications strategy was developed:

  • Service User/Carer Information Leaflets outlining the new model of care, individual responsibilities and advice on who to contact with concerns;
  • An Information Guide for Keyworkers involved in assessing and commissioning care packages, which supported them in having open and honest conversations with service users on how the new outcomes model of care would affect them;
  • Invites to Trade Unions to discuss the model to further ensure that care staff did not feel threatened by the project;
  • Letters to local GP’s and elected representatives outlining rationale for change.

Outcomes due to involvement

The project ran in two phases. The evaluation of the initial small-scale pilot (1/5/15 – 1/11/15) revealed improved outcomes:
• 5.9 % of service users felt that their care was always rushed and wanted the workers to feel that they had more time to meet their needs;
• 86.2% of service users felt that their independence was always promoted;
• 59.8% of service users felt they had control over their daily life;
• 78.5% of service users stated that the care workers line manager was more visible in the community;
• 64.8% of service users felt they were able to ask for changes in how their care was provided.

Further evaluation of the “Full Scale Model” (1/6/16 – 31/12/16) revealed that:
• 93% of service users felt the service met their assessed needs;
• 66.6% of service users felt that the time the care worker spent with them was adequate and did not feel they were being rushed;
• 73.3% of service users had met the worker’s line manager which increased their confidence in the service provided and gave assurance that staff were supervised.

Increased capacity and efficiency
• 227 referrals made to the Homecare OT for assessment and tailoring of packages to meet need;
• 3,617 hours released creating capacity to support 204 clients discharged from hospital and packages for a further 166 new clients were commenced;
• 2,646 hours reallocated to clients with increased needs.

Impact
• Service Users feel more in control of their care;
• No complaints and positive feedback;
• Better collaboration with other services;
• Care Workers feel more valued.

Timeframe

Current

Further Information

For further information, contact:
Claudine McComiskey (Head of Domiciliary Care Services)
Edenderry House, 18 Gilford Road,
Portadown,
BT63 5EA
Email: claudine.mccomiskey@southerntrust.hscni.net
Tel: 028 3839 8326