1. PRACTICE ISSUE ONE: Assessment and Care Management
The concepts of single shared assessment (SSA) and care management are not particularly new but challenges remain in relation to their implementation. The goal is to ensure timely assessment and the provision of appropriate services while at the same time avoiding duplication. Effective collaborative working is essential to ensure that care is being provided by and managed by the most appropriate professional(s) and reviewed as appropriate. The evidence base around the effectiveness of SSA on maintaining older people with higher level needs at home is inconclusive. Clarkson and colleagues (2009) found that when single assessment procedures were applied, the probability of detecting need was higher than before, thus allowing earlier intervention that might enable older people to remain at home for longer. In addition Miller and Cameron (2011) noted that, whilst the evidence of benefits was fairly limited, improved communication, service user and carer involvement and improved partnership working could be attributed to the process of SSA. However, Eccles (2008) argued that SSA has not delivered on its stated aims and the benefits are unclear. Care management, as a process, should be targeted at those with higher level or frequently changing needs. However research suggests that it has drifted from this original vision and has often been applied inappropriately (Challis, 2001; Stalker and Campbell, 2002). Again, the evidence base is inconclusive with no one model of care management being identified as most effective (Reilly et al, 2010). It is further unclear whether care management as a process can reduce bed days or prevent hospital admissions (Sargent et al, 2007).
Questionnaires were sent to two social service departments across England with the aim of determining whether intensive care management at home could be used as an alternative to institutional care. Completion rates of 85 per cent and 77 per cent were achieved. The research found that although there is a policy of diverting people from residential to homecare, there was little evidence of intensive care management at home. Levels of care management were not always differentiated between or applied appropriately, resulting in a failure to address inappropriate admissions. Challis et al (2001) Intensive care management at home: an alternative to institutional care, Age and Ageing 30: 409-413
Implications for practice
For SSA to be effective:
- Assessment tools should be locally developed and flexible in order to reduce duplication and engage both health and social care staff
- Engagement of key stakeholders including GPs is important in developing preventative responses to assessment
- Clarity about capacity to deliver services is essential to ensure staff do not become disengaged.
For care management to be effective:
- The core elements of care management require to be adhered to – assessment, care planning, implementation and review
- It needs to be targeted at those with higher level or frequently changing needs and caseloads require to be contained
- The process of care-management requires to be consistently applied and transparent across disciplines.