Title: Dependency Curve The where and when of assessment
1Dependency CurveThe where and when of assessment
- Alistair Main
- Consultant Geriatrician
- Chair of South Birmingham Older Peoples
Partnership Group - (South Quadrant Group)
2The Dependency Curve
3The 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
4The Dependency CurveResponse to a crisis
5The Dependency CurveResponse to a crisis
D E P E N D E N C Y
6The Dependency CurveResponse to a crisis
D E P E N D E N C Y
T I M E
7The Dependency CurveResponse to a crisis
Threshold to admission
D E P E N D E N C Y
T I M E
8The 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
9The 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
10The 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
11Compressing 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
12The 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
13The 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
14The 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
15The 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
16The 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
17The 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
18The 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
19The 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
20The 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
21The 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
22The 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
23The 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
24The 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
25In Older PersonMuch more scope to intervene.
26The 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
27The 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
28The 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
29The 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
30The 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
31The 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
32Overall aims
- Improve general health and well-being of older
people - reduce admissions
- expedite better discharges
- reduce the need for institutionalisation
33The 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
34The Dependency Curve