Simple but effective: Innovative older people’s project report and resources published

Fusion48 News

2 October 2015

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“A great opportunity to consider and develop the role of ‘Elderly Care Facilitators'”

The key features of this project are as follows:

  • The population across the 6 practices which make up Newcastle South Locality is around 37,000, about 2% of whom are over 85 years old and about 7% in the age range 75-84 years. 
  • The intervention in this project was a home visit by an Elderly Care Facilitator to complete a very comprehensive and holistic older person’s assessment - ideally carried out in the presence of a relative, friend or carer, and completed and recorded through a series of highly structured and clinically coded templates. 
  • There were two target population groups for this intervention. Firstly, all people aged over 85 years and all people with dementia and all people know to be housebound were offered an assessment visit. Secondly, all people in the age range 75-84 years were sent the Tilburg questionnaire by post and those who scored highly on returned questionnaires were also offered an assessment visit.  
  • Following the assessment visits, action plans were drawn up and further support offered through a very wide range of voluntary, public sector, community, health and care services. 

This project is remarkable for a number of reasons, including:

  • Great engagement with older people - over the period of two years 90% of people who were aged over 85 years, housebound or had dementia accepted a home visit assessment and 75% of the people aged 75-84 years returned the screening questionnaire (visit indicated in 27% of these) 
  • Excellent inter-agency collaboration - between different GP practices and between health, care, voluntary, public and community services
  • Has provided an unprecedented ’needs assessment’ for almost the whole population aged over 85 years in this area and for a substantial proportion of the population aged 75-84 years
  • Substantial impact for individuals - for example 36% of older people were not claiming all the benefits they were entitled to (attendance allowance new claims as a result of the project had an estimated annual value >£275,000), 24% had newly identified mobility problems, 4% newly identified memory problems
  • Data from home assessments collected in a very systematic way and coded data entered into the electronic primary care record - therefore potential to follow up and analyse longer term impact and outcomes.
  • Provides interesting learning about this approach to screening and proactive intervention in this population
  • It has been carried out with very minimal investment and its success is almost entirely due to the vision of the lead GP and the widespread willingness of these primary care teams to ‘get organised and get on with it’.
  • A great opportunity to consider and develop the role of ‘Elderly Care Facilitators'

The full report is available here

The website for the lead practice (Madeley Practice) is here 

An interview with Bea, one of the Elderly Care Facilitators, is here