The National Service Framework for Older People made intermediate care services a priority over a decade ago but little work had been done to describe and assess progress until last year’s first ever National Audit of Intermediate Care (NAIC). The results were published in September 2012 and show that while large numbers of older people are benefitting from intermediate care services – with the majority returning to their original place of residence after receiving intermediate care – there is considerable variation in how services are provided.
Intermediate care has dual objectives of preventing unnecessary acute hospital admissions and supporting timely discharge for those ready to leave hospital. The overall capacity of intermediate care is small relative to acute hospital provision. Estimates of potential demand for intermediate care services compared to the capacity identified in the audit, suggest overall capacity may be less than half of potential demand. This gap between demand and capacity raises the question of whether the current scale of intermediate care is sufficient to make an impact on hospital utilisation including reducing emergency admissions and time spent in acute care wards.
The question of how to best fund care of frailer older people in their latter years remains unresolved. Current rules require all older people with assets above £23,250 to personally fund all care requirements and all assets [including property] are included in financial assessments. The arrangements have been criticised by many for forcing those who have worked hard to build assets through their life to
In the past 13 years there had been two independent commissions, three public consultations and now three white papers. The latest of these, the Dilnot report, called for a system for the elderly whereby there was universal coverage: the total cost of care would be capped at £35,000 with social support for old people extended to those with assets of £100,000, incurring a total estimated cost of £4.2 billion in 2025.
The social care issue is thorny and has multiple facets:-
Can we afford it? – the present economic climate brings to harsh reality the ability of the welfare state model to provide for all aspects of life on limited resources
Who should fund it? – the government, families or the third sector
Universal coverage? – Should any legislation cover all people without any exclusions or prejudice? What happens to those, with financial means, who do not wish to contribute to their own care?
Financial fairness? – What is “fair”? Who should pay? How much should they pay?
Equity of provision across the UK? – How do we minimise variability in how legislation and policies are exercised between regions?
What are your views on funding for long term care? Join the debate.
The BGS is proud to announce the publication of the Silver Book, an essential guide to for all those involved in delivering emergency care to meet the needs of older patients and to promote continuous improvement in the standards of care.
The Silver Book recommends ways in which emergency admissions can be reduced and the experience of those admitted improved. It considers all the clinical contacts which a patient might have during an emergency and suggests minimum standards and responses. A core focus of the Silver Book is the skills and competencies needed by healthcare staff to ensure they are better able to assess and manage frail older people. Continue reading →