While integrated care is being discussed, Lucy Lewis, consultant practitioner trainee specialising in frailty and older people at Health Education England (Wessex), gives some startling figures that reinforce the value of social care systems and the call for increased funding.
Whether you are a clinician working in the acute sector, community health teams or primary care, we must all acknowledge the contribution of social care to people’s wellbeing, particularly within our specialism of older peoples’ healthcare. We have a responsibility to advocate for the equivalent respect and appreciation we as a society bestow upon the NHS, to also be given to this vital public service, with future funding increases reflecting this.
Health and social care services need to work together to provide services which are responsive in crisis while proactively establishing preventative measures to ensure appropriate care and treatment are accessed by individuals at the right time and place. Integrated services should be designed around the bespoke needs of the individual. This requires social care, housing providers, the voluntary sector and the National Health Service to work collaboratively. If sufficient funds are allocated to provide robust social care systems in the community, we have the potential to:
- maximise the persons’ independence by promoting recovery through re-enablement
- reduce potential for hospital admission
- postpone and or prevent transfer to long term care
- (following hospital admission), reduce the persons’ ‘hospital acquired vulnerability’, for example pyjama paralysis, loss of autonomy over bathing/showering times and for many, self-administration of medications.
In the United Kingdom, more than 400,000 people over the age of 80 years are providing unpaid social care to an estimated value of £5.9 billion annually with 90 per cent of over 85-year-old carers looking after someone who is over 75 years. Younger people aged 65 years and above are also providing informal, unpaid care, sometimes up to 100 hours per week. This may be in addition to working if not yet retired and looking after grandchildren. Even though having care responsibility can be mutually preferable to a formal package of care for both the person receiving care and the family carer, over a quarter of older carers have reported feeling socially isolated, with 69 per cent feeling that being a carer has negatively affected their psychological wellbeing.
A typical scenario
‘Dorothy’, 92 years old, had been living independently in her warden-controlled flat since her husband died two years ago. In the last year, she had fallen four times leading to three presentations to the emergency department including one hospital admission of 15 days. She and her daughter, Alison, 70 years, have noticed changes in her memory and Alison is starting to experience carers’ stress as she is supporting Dorothy informally.
During her last hospital stay, a package of care for two visits per day was arranged by social services. This took seven days from being medically optimised to commence, during which time Dorothy became less mobile, became more passive and reliant on others to complete washing and dressing tasks. She then developed a chest infection requiring anti biotics. A referral to the community memory services has confirmed vascular dementia. A further presentation to the emergency department recently following Dorothy accidentally double dosing on her medications.
She was assessed by the older persons’ assessment team and didn’t require admission. Her medications were rationalised and reduced to twice per day with exception of one drug which she needed to continue taking three times per day. A review by the rapid response community health team later that day was arranged. The hospital social worker reviewed her case and arranged that her package of care be increased to four times per day to include medication administration.
Dorothy was happy to be returning home and Alison felt relieved that she could continue to support her Mum between care visits.
We have all met Dorothy and Alison and we will work with more and more people like them in the future. Yes, Dorothy had some healthcare needs but by providing adequate social care her independence can be maintained for longer, Alison continues her role as caring daughter while having some of the care responsibility reduced.
In order to provide a sustainable system, the financial settlement for social care must be long term funding which prioritises:
- eligibility to accessing appropriate social care being extended to ensure unmet or under-met needs are met
- investment in the people working in social care, ensuring they are valued, and increasing recruitment and retention.
Lucy Lewis is a consultant practitioner trainee specialising in frailty and older people at Health Education England - Wessex. Follow them on Twitter @HEE_Wessex. This blog is part of a series to support Health for Care’s campaign for a sustainable future for social care – read more here.