Investigating the longer-term impact of home care re

Report
Caroline Glendinning
Emeritus Professor of Social Policy
Social Policy Research Unit
University of York
College of Occupational Therapists/Skills for Care
22nd July 2014

Background and early evidence

Major studies


SPRU (York)/PSSRU (Kent) 2008-10

Perth (W Australia) 2005-07
Concluding remarks

England 2000 onwards: development home
care re-ablement services in most councils

Scotland 2013: Joint Improvement Team
survey

25/30 councils had home care re-ablement
services

17 of these planning to expand

From selective to inclusive services

Australia, New Zealand – growing provider
interest


High proportions receiving re-ablement needed no
further, or less, home care on discharge than
those who received standard home care

63% needed no further home care on discharge

26% needed less home care than comparison group
But would they have recovered anyway?

… and how long do the effects last?
Aimed to investigate longer-term impacts of home
care re-ablement services, including:

Compare home care re-ablement vs standard home
care

Assess user outcomes and use of NHS and social
care services for up to 12 months

Estimate unit costs home care re-ablement services

Assess cost-effectiveness home care re-ablement

Describe organisation and content of home care reablement services

Examine user and carer experiences

5 re-ablement councils, 5 conventional home care
councils

Users recruited on referral – baseline interviews
 Re-interviewed after 9-12 months

Data collected on:

Users’ health, quality of life, social care outcomes at
baseline and follow-up, using standardised measures

Social care and NHS etc services used by both groups

Costs of re-ablement services (staff, overheads etc)

How re-ablement services organised and delivered

Experiences of users and carers

Re-ablement had positive impacts on health-related
quality of life and social care outcomes


Compared with conventional home care service use
Typical re-ablement episode (39 days) cost £2,088

More expensive than conventional home care

But 60% less use of social care services
subsequently

Over full year, total social care services used by reablement group cost £380 less than conventional
home care

Re-ablement group – higher health service use and
costs

Effects of recent hospital discharge?
CE = compare improvements in outcomes
against costs

NICE threshold £20-30K for each outcome gain

Re-ablement was cost-effective in relation to
health-related quality of life outcomes

Re-ablement may be cost-effective in relation
to social care outcomes



Depends on £ threshold
Higher healthcare costs of re-ablement group
Probability of cost-effectiveness only


Poor initial understanding of re-ablement

Previous experiences of standard home care

Context of referral - crisis, hospital discharge

Value of repeated information
Appreciated frequent visits, monitoring


Quality of relationships crucial
Reported greater independence

improved confidence, relearned self-care skills

People discharged from hospital/recovering from accident/illness
reported greater gains than those with long-term/progressive
conditions

Felt shortcomings

More help with mobility/activities outside the home

Anxiety about end of re-ablement

Potential for greater carer involvement?
Assessed impact of ‘restorative’ home care on
subsequent service use for 2 years
 750 older people randomised



Service use records




Restorative home care
Standard home care
Home care
A+E attendance
Hospital admissions - number and duration
Calculated costs of all services used
Compared to standard home care, restorative
home care group:

Less likely to use on-going personal care services

Used fewer hours of home and (especially) personal
care services

Less likely to be assessed as needing residential care

30% less likely to have attended A+E

31% less likely to have unplanned hospital admission

Had lower total (health + social care) service costs
(average £1574 - £2380 less)
Growing body of evidence that re-ablement reduces
service use and costs in short and longer terms.
But outcomes and cost-effectiveness depend on:




How services are organised

Specialist service vs generic/extended assessment

Delays in onward referral
Who receives re-ablement

Inclusive vs selective services

Eligibility thresholds
What’s included in re-ablement interventions

Home care only vs wider range of skills/inputs

Rapid access equipment/AT
How long intervention lasts
[email protected]
Research
Works
2011-01
Home care re-ablement services:
investigating the longer-terms impacts
SPRU: Caroline Glendinning, Kate Baxter,
Parvaneh Rabiee, Alison Wilde, Hilary Arksey
PSSRU: Karen Jones, Lesley Curtis, Julien Forder
www.york.ac.uk/spru
Home care re-ablement is a relatively new, short-term
intervention in English social care. It aims to reduce
needs for long-term support by helping people (re)learn
daily living skills. A large-scale study examined the
longer-term impacts of home care re-ablement; the
cost-effectiveness of re-ablement; and the content and
organisation of re-ablement services. People receiving
re-ablement were compared with those who received
conventional home care; both groups were followed
for up to one year.
Key findings
● There were no net cost savings to health and social care in the first year of re-ablement, compared
with conventional home care. However, home care re-ablement is almost certainly cost-effective
because of improved outcomes for users.
● Re-ablement was associated with a significant decrease in subsequent social care service use. The
http://php.york.ac.uk/inst/spru/
research/summs/reablement2.php
costs of the social care services (excluding the cost of re-ablement itself) used in the 12-month study
period by people in the re-ablement group were 60 per cent less than the costs of the social care
services used by people in the conventional home care group.
 However, these lower costs were almost entirely offset by the higher cost of the re-ablement
intervention. The average total (including re-ablement) cost per person of the social care services
used by the re-ablement group was just £380 lower than the costs of the social care services
used by the comparison group.
 Re-ablement resulted in improvements in users’ health-related quality of life and social
care-related quality of life up to ten months after re-ablement, in comparison with users of
conventional home care services.
● Taking into account any differences between the two groups at the start of the study, there was
no significant difference in the average costs of healthcare services used by the re-ablement and
comparison groups over the full 12 months.

similar documents