Older People’s Service Framework: plans to improve quality of life

old-man-on-bench The ongoing reform of the Health Service includes a service framework for older people, which aims to improve services to the elderly in their own homes and reduce the need for hospital admissions.

“Older people are the main users of health and social services and this demand is likely to increase,” Health Minister Edwin Poots has said. Northern Ireland’s population is ageing with over 65s increasing by 40,400 (18 per cent) between the 2001 and 2011 census. Over 85s increased from 23,300 to 31,400 (35 per cent) in that decade. Currently, on an average daily basis, two-thirds of acute hospital beds are occupied by people aged over 65, according to the Department of Health, Social Services and Public Safety.

An older population will be more likely to suffer from disability and dependency or medical conditions such as stroke, vascular disease, or dementia. “It is in this context that it was necessary to review how services are focused, designed and organised within current and future resource limitations,” Poots explained.

Five other service frameworks have been completed to date: cardiovascular health and well-being, respiratory health and well-being, cancer prevention, treatment and care, mental health and well-being, and learning disability. A children and young people’s framework is also being developed.

All seven set out the standards of care that patients, clients, carers and families can expect to receive. They will be used by health and social care commissioners and providers and the Regulation and Quality Improvement Authority (RQIA) to measure performance. The department states that each service framework should be read in conjunction with other relevant frameworks e.g. the older people’s framework will tie in with the respiratory and cancer frameworks.

The older people’s service framework includes 46 standards. It has been out for consultation since 4 October and the process runs until 28 December.

Performance indicators

Each trust will be expected to have a person-centred care module as part of its corporate induction training so that staff know how to allow older people to make informed choices about their own care and treatment. Their equality policies will be reviewed so that older people can expect the same access to assessment, care and treatment as others. Trusts must also have at least one ‘service level agreement’ with the voluntary or community sector to provide information, advice and advocacy services to older people.

The Health and Social Care Board and the Public Health Agency must review current services for older people so that they are tailored to meet their specific needs across their life course. Older people or their carers must also be given access to a comprehensive range of health information, advice and support services to maintain and improve their nutritional and oral health, the framework stipulates.

Health professionals must also explain the increased risk of falling or osteoporosis and fractures caused by falling to the elderly. Interventions such as a ‘co-ordinated falls service’ which includes strength and balance training must be provided by each trust.

The Northern Ireland Adult Safeguarding Partnership (NIASP) strategic plan and annual action plan must include a plan to safeguard older people and prevent their abuse or exploitation. The NIASP must also ensure that regional adult safeguarding procedures include timescales for responding to allegations of abuse. Each trust must establish at least one ‘peer advocacy service’ to support people through the process of disclosing abuse, exploitation, or neglect. In addition, the NIASP will establish an adult safeguarding forum, so that current users of health and care services contribute to the design of future services.

Older carers and carers of older people are to be identified at the earliest opportunity i.e. when front line-staff complete carer awareness training. These carers will be treated as equal partners and will be involved in the planning, delivery and monitoring of services. They must have access to appropriate respite breaks, the service framework states.

Conditions more common in older people include fractures from falling, incontinence, delirium, advanced dementia and sudden unexplained deterioration in their mobility. To deal with these, older people who have fallen will be offered a falls and bone health assessment within two weeks. Those admitted with a fracture will have a specialist geriatric assessment within 72 hours.

Health and social care trusts should have a lead health professional at a senior level responsible for an integrated continence service, the service framework states. Each trust will also have a ‘mental health for older people’ liaison service to co-ordinate and support the delivery of education and training to front-line staff. GPs are to make sure that individuals who have been identified with advanced dementia have an advance care plan within three months.

To ensure that medicines are being managed effectively, the service framework stipulates that older people should have a systematic review of all their medicines at appropriate intervals. Eighty per cent of older people receiving four or more medicines must be offered a medicines review annually (from next year).

When older people first begin to lose their independence, they should be able to access a single point of contact for information and advice about all aspects of community support and health and social care services. Those with health problems should be identified early to increase their independence and reduce the need for a crisis trip to hospital.

Older people with complex health needs, including dementia, should be offered comprehensive, specialist assessments and a period of rehabilitation before they are considered for long-term care, the framework states.

Those coming towards the end of their life, either in nursing homes or at home, should have a ‘key worker’ and access to palliative and supportive care services, rather than dying in hospital.

The Commissioner for Older People, Claire Keatinge, told agendaNi that “standards of health and social care for older people in Northern Ireland must be a key priority for government.” She believes that “older people must be able to have confidence that health and social care provision will meet their needs.” Keatinge adds: “From early intervention that helps older people maintain independent living through to end-of-life-care, it is vital that the highest standards of care are set and delivered.”

Older People’s Service Framework: key themes

Person-centred care: emphasising the importance of older people being involved in planning a response to their care needs

Health and social well-being improvement: underlining the value of preventative strategies thereby reducing treatment costs

Safeguarding: emphasising the protection of vulnerable adults and older people against neglect, abuse or exploitation

Carers: recognising the importance of the role of the carer

Conditions more common in older people: focusing on conditions where early intervention would improve health and well-being

Medicines management: ensuring that prescribing adheres to relevant guidance and highlights the importance of maximising health gains, patient participation in decision-making and good record-keeping

Transitions of care: identifying significant points in the individual’s transition through the care system where there is potential to improve the care experience and effective use of resources.

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