IPC: Care pathway study for older people admitted into care

The following study was written by the Institute of Public Care (IPC) for Oxfordshire County Council in order to help them improve their services targeted at preventing or delaying admissions into care and enabling people to remain in their own homes longer.

Faced with major demographic changes, including a significant rise in the older people's population, greater priority is being given to preventive services which maximise health, well-being and independence in later life.

The study is built on an audit of case files for people admitted to care in the local authority area in 2008-2009, plus interviews with older people, care managers and informal carers to provide a picture of their ‘care pathway’ to the point of admission. The study draws up a profile of those admitted, their needs and the services accessed, broken down according to key variables including age, gender and prior living arrangements, especially whether they had been living alone or with family.

A survey of the most common predisposing health conditions is performed, including incontinence, dementia, depression, stroke and susceptibility to falls, supported by illustrative excerpts from interviews. The study reviews mainstream and specialist services available to older people, including social care at home, and primary and acute healthcare, and reports the views of older people and carers of their effectiveness.

Overall, the study reports complex care pathways, and especially high representation among women, over-85s and those previously living alone, with a high proportion admitted following a prolonged hospital stay. Key findings include that half the people admitted had not been receiving an intensive home care package, specialist provision such as fall services was underused, there was insufficient follow-up to early problems such as stroke, and an holistic approach to people’s varied and overlapping health conditions was lacking.

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