News Release

Embargo: not for publication or broadcast before 00:01 am Wednesday 29 March

Older people and post-hospital care:
What you get depends on who you see and where you live

The assistance received by older people upon discharge from hospital elderly care units often depends upon who they see and where they live, according to research published by Policy Studies Institute. The type of staff member who coordinates care assessment and the size of the social services department budget influence the services that people receive. The needs of patients do not necessarily predict service outcomes, since care assessment is professional-led and services-led as much as needs-led.

A stay in hospital can be a turning point in the lives of older people, since hospital staff help older people decide whether or not they need help to return home, or whether they need residential care.

The good news is that multidisciplinary assessment was common practice in the 54 elderly care units surveyed, and staff thought that care assessment procedures had improved. The case review of 456 patients in three hospital elderly care units found that virtually all patients were assessed, and over 90 per cent received nursing or social care upon discharge from hospital. These were vulnerable older people aged 75 years and over. Most were widows who lived alone, had some physical difficulties and also multiple medical conditions. But the researchers cautioned that these results cannot be generalised to all hospitals, as medicine for the elderly wards are more likely to follow ‘best practice’ in multidisciplinary assessment than other hospital wards.

• Multidisciplinary assessment: coming up for care

Multidisciplinary assessment was best practice and also common practice in most of the 54 hospital elderly care teams surveyed. Care assessment of patients with multiple needs was a staff intensive activity that typically involved at least five different types of staff. Teamwork must reconcile different staff perspectives, since this study showed that services are influenced by professionals as well as patients’ needs. While the boundary between the health and social services sectors remains disputed, the health and social services staff within these hospital units work together in assisting their older patients ‘coming up for care’ upon discharge from hospital.

• Staff satisfaction: doing better but feeling worse

Nearly 90 per cent of social workers (in the 54 hospital elderly care units) said that care assessment had improved in recent years. Procedures were more transparent, formal and standardised, and service outcomes were better for high dependency patients, but notably, were worse for lower dependency patients. But, although they were 'doing better', social workers were 'feeling worse', since their relations with patients and families had deteriorated. They spent less time with clients and had to explain why assistance was being rationed.

• Teams work: variations in assessment procedures and outcomes

The study analysed service procedures and outcomes for 456 patients (controlling for patient characteristics) of three types of hospital elderly care teams. The team where nurses coordinated care assessment referred the fewest patients to other staff. The occupational therapy coordinated team referred the most patients to occupational therapists and physiotherapists. The social work coordinated team referred more patients to all types of staff.

District nursing, received by one third of patients, was predicted by the characteristics of the patients. Entry to institutional care (by 20 per of patients) also was predicted by the characteristics of the patients. However, social services help, received by one-third of patients, was not predicted by patient characteristics. Rather, patients who lived in the social services department area with the largest per capita budget got the most services. Delay in being discharged from hospital (one-quarter of patients) was most common in the nurse-led team (perhaps because this team was slowest in referring patients for a care assessment), but was also associated with not having a family carer and by entry to residential care.

Judith Healy, one of the authors of the report, said: ‘Despite agreement among staff on which older patients need home nursing and residential care, getting other community services remains more of a lottery. Given the tendency for referrals and care assessments to be influenced by professional interests, multidisciplinary assessment of older people with multiple needs remains ‘best practice’.

Judith Healy (author) 020 7299 4745

Christina Victor (author) 020 8725 5487

Michelle McNally (PSI press office) 020 7468 0468

Notes to Editors

1. Coming up for care: assessing the post-hospital needs of older patients by Judith Healy, Anna Thomas, John Seargeant and Christina Victor is published by Policy Studies Institute, 100 Park Village East, London NW1 3SR (020 7468 0468), price £15.00.
2. The report was commissioned by the Department of Health, Policy Research Programme, Human Resource and Effectiveness Initiative.
3. The research included a telephone survey of social workers in 54 hospital elderly care units (covering nearly half the social services departments across England); site visits and interviews with multidisciplinary staff in ten hospital elderly care teams; a review of case notes (N=456) of patients discharged from three selected hospital elderly care units; and a follow-up of community services received by patients in the month after discharge from hospital.
4. Judith Healy, formerly senior research fellow at Policy Studies Institute, now works for the World Health Organization at the European Observatory on Health Care Systems, based at the London School of Hygiene and Tropical Medicine. Her current research interests are health care reforms in the countries of Europe. Anna Thomas was formerly a research fellow at PSI working primarily on health and social care issues. Prior to this she trained as a research psychologist. She now lives and works in the Netherlands. John Seargeant is Director of Policy and Research at the Development Trusts Association. Christina Victor is reader in Health Services Research at St George's Hospital Medical School and has a long-standing research interest in the discharge of older people from hospital.