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Dependency Curve The where and when of assessment

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Dependency Curve. The where and when of assessment. Alistair Main. Consultant Geriatrician ... The model for service planning for older people used by a joint ... – PowerPoint PPT presentation

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Title: Dependency Curve The where and when of assessment


1
Dependency CurveThe where and when of assessment
  • Alistair Main
  • Consultant Geriatrician
  • Chair of South Birmingham Older Peoples
    Partnership Group
  • (South Quadrant Group)

2
The Dependency Curve
3
The Dependency Curve
  • Its origins
  • a simple teaching diagram used to convey the
    nature of acute illness in frail older people
  • The model for service planning for older people
    used by a joint strategic group of the former SSD
    and BHA

4
The Dependency CurveResponse to a crisis
5
The Dependency CurveResponse to a crisis
D E P E N D E N C Y
6
The Dependency CurveResponse to a crisis
D E P E N D E N C Y
T I M E
7
The Dependency CurveResponse to a crisis
Threshold to admission
D E P E N D E N C Y
T I M E
8
The Dependency CurveResponse to a minor crisis -
young person
Threshold to admission
D E P E N D E N C Y
T I M E
9
The Dependency CurveResponse to a major crisis -
young person
Threshold to admission
D E P E N D E N C Y
T I M E
10
The Dependency CurveResponse to a major crisis -
young person
Threshold to admission
D E P E N D E N C Y
Length of stay
T I M E
11
Compressing LOS Young person
  • Not much scope (Already very short)
  • Mainly preventing unnecessary admissions
  • Self management of trivia
  • Better primary care management of chronic
    diseases in younger people eg COPD
  • Improved responsiveness of primary care
  • reverse recent increased trends in 999 calls

12
The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Young person
T I M E
13
The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
High Baseline dependency
Young person
T I M E
14
The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
High Baseline dependency - Osteoarthritis and
limited mobility - Housebound - Carer stress -
Mild cardiac failure
(Young person)
T I M E
15
The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Minor crisis on top of background dependency
complex admission
Young person
T I M E
16
The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Acute problem makes background worse - need for
acute care, attention to backgound problems and
rehabilitation
Young person
T I M E
17
The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Slower recovery
Young person
T I M E
18
The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Decision - medically fit - discharge
Young person
T I M E
19
The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Premature discharge fails
Young person
T I M E
20
The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Decision - medically fit has stayed too long
- institutionalise
Young person
T I M E
21
The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Premature and rushed decision to institutionalise
Young person
T I M E
22
The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Ideal
Young person
T I M E
23
The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Practical
Young person
T I M E
24
The Dependency CurveResponse to a minor crisis -
older person
Threshold to admission
D E P E N D E N C Y
Longer LOS
Young person
T I M E
25
In Older PersonMuch more scope to intervene.
26
The Dependency CurveInterventions
Threshold to admission
D E P E N D E N C Y
Proper assessment Community support Health
promotion Proactive health care NSF - Standard 8
A
Young person
T I M E
27
The Dependency CurveInterventions
Threshold to admission
D E P E N D E N C Y
Crisis intervention - Intermediate Care -
Intensive support at home NSF Standard 3, 6
A
B
Young person
T I M E
28
The Dependency CurveInterventions
Threshold to admission
D E P E N D E N C Y
C
Proper assessment in AE Appropriate placement in
hospital Diversion to alternative care NSF
Standard 3,5,6
A
B
Young person
T I M E
29
The Dependency CurveInterventions
Threshold to admission
D
D E P E N D E N C Y
C
Better Care in hospital Standard 4 and 5,6,7
A
B
Young person
T I M E
30
The Dependency CurveInterventions
Threshold to admission
D
E
D E P E N D E N C Y
C
Time and help to recover Better discharge Support
at Home Prevent institionalisation Standard 3, 7
and 8
A
B
Young person
T I M E
31
The Dependency Curve
  • Its adoption by BHA and BSS
  • The bed-blocking crisis
  • Joint Working Group (BHA and BSS)
  • Used as strategic model to tackle the problems
  • First Report Nov 2001
  • Second report April 2002
  • reinforced by They deserve Better
  • Revisited as a model for planning services in
    SBPCTs Joint Planning Group

32
Overall aims
  • Improve general health and well-being of older
    people
  • reduce admissions
  • expedite better discharges
  • reduce the need for institutionalisation

33
The Dependency Curve
  • A model for preventive care, health and social
    well-being and reactive care
  • A model for the when and where of
  • Assessment
  • Intervention
  • Measuring the impact of intervention

34
The Dependency Curve
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