Linking health and social care service funding to service user outcomes, instead of staff tasks, will improve support for older people with frailty, according to new best practice guidance.
The Fit for Frailty guidance (part two) recommends a move away from traditional ‘activity based’ contracts – where services are costed on time and delivery of tasks – to the model that sees providers paid for helping service users to achieve agreed goals.
This would ensure that outcomes relevant to older people with frailty, including quality of life, loneliness and pain, are properly considered in the development of services, the guidance says.
It also states that older people with frailty have the ‘most to gain’ from health and social care integration, and joining up services, such as personal budgets, is essential.
Key characteristics of a good service for frailty
- Effective recognition, diagnosis and referral
- A person-centred ethos and practice
- Integration of care in multiple settings
- Expertise of staff
- Practice underpinned by comprehensive geriatric assessment
- Use of tools to assist case-finding
Professor John Young, national clinical director for integration and frail elderly at NHS England, and a member of the Fit for Frailty working group, said:
“Services which properly take into account the needs of older patients with frailty are already successful realities throughout the UK, but they are far from widespread. This guidance aims to help commissioners build on those examples, and make them routine.”
Prevention strategy
The guidance, published by the British Geriatrics Society, also recommends the creation of a series of health and care pathways to help prevent avoidable admissions to hospital and delayed discharges.
For example, it sets out a ‘pull out of hospital’ pathway, which would include providing safe alternatives to admission, sharing information about care plans and ensuring post-acute care is readily available and accessible.
Caroline Abrahams, charity director at Age UK, said: “At the moment older people who are living with frailty too often end up in a crisis situation with no other choice but to be admitted into hospital or a care home.
“By being proactive and taking account of the needs of the whole person, the crisis could be prevented and longer-term quality of life improved.”
Other recommendations
The guidance also recommends services to:
- Ensure all older people with frailty receive a review of medical, functional, psychological and social needs, based on the principles of comprehensive geriatric assessment.
- Make interventions available to older people that improve their overall physical, mental and social functioning, focusing on an individual’s strengths, not deficits.
- Develop shared care and support plans by involving older people with frailty, their families and domiciliary care staff throughout all stages of the process.
The document follows Fit For Frailty (part one), which gives advice on the care of older people living with frailty in community and outpatient settings, including the development of personalised plans and routine assessments to identify the condition.
Gill Baker, vice president for clinical quality at the British Geriatrics Society and project lead for Fit for Frailty, added: “It is the job of clinicians and service providers to ensure that individual differences are accommodated, in order to restore control, preserve dignity and facilitate person-centred care for older people living with frailty and those close to them.”
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it all sounds very good and is definitely the sort of direction needed – however I worked in the senior care profession in the 1980s and 1990s and many of these issues were proposed back then in the legislation for Community Care and Care in the Community Acts – I served on various working parties in one local authority Social Services department specifically tasked to consider how to implement the proposals from 1991.
How is it that we need to ‘find’ these proposals again 25 years on? What happened to the delivery of those changes back in 1991?
There is nothing new about the concept of personalised care plans based on thorough assessment processes or in multi-agency co-operation in delivering support and services which aim to promote the independence and individual needs of the person needing help to live their lives with dignity and self-determination in their own homes (or in a supported caring establishment) for as long as they wish to do so.
It seems that resources are spent repeatedly on reworking the same concerns and merely re-writing the conclusions and yet still we don’t get the results of better and more effective care provision for older people.
It all comes down to money in the end and if there is no will to fund these proposals then little chance exists for a better deal for older people. Local and national governments simply do not have the resources to implement the proposals that study after study claim to be essential and instead spend millions in ineffective so-called monitoring bodies that fail with alarming regularity to prevent the very abuses that they are supposed to be looking out for.
I am afraid to grow old and/or to be ill in this country and many of my generation feel this anxiety very deeply too.
this all sounds very positive. However, back in 1991 legislation was enacted to focus on just the same ‘person-centred’ assessment and provision for those older people in need of support to maintain their independence and allow them to remain at home with dignity and respect. I was involved in working parties set up by one local authority in the late 1980s to address the issues raised by those proposals and to plan ways of implementing the policies. So why are the same questions , answers and conclusions still being asked and repeated reports merely re-wording the issues and the conclusions? Surely a better use of scarce resources would be to spend money on actually implementing and maintaining those services – and possibly a review (to keep the bureaucrats busy) to show how these actions have actually made a positive difference to the lives of older people.
The body set up to monitor standards seems unable to use a ‘person-centred’ approach to assessments of care provision so what hope is there for agencies to adopt those standards when the inspection body is content to tick boxes and give positive ratings to establishments which have then been found to be failing – in some cases catastrophically so.
This country is one where the majority of older people (like myself) now feel afraid to grow old and/or ill because the standard of care and support is such a lottery. There are good organisations and high standards to be found in some places but finding them is a difficult and challenging process in itself and rather than co-operate many agencies seem inclined to ‘pass the buck’ between themselves while the person in need gradually gives up asking and goes without or has a crisis which leads to them being hospitalised or in residential care unnecessarily and not in line with their preferred options.
Almost 25 years on from the 1991 Act and still too much remains unimproved.