Tameside Older Peoples Partnership

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Tameside Older Peoples Partnership

• Partnerships for Older People Projects 2007
  2009
• Opening Doors for Older People

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The Challenge

• How do you deliver
• An improved quality of life for older people,
• Provide preventative services focused on
  well-being,
• Reduce inappropriate emergency admissions to
  hospital
• When your services are already operating at full
  stretch, in a climate of increased efficiency
  savings?

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Our Aim

• We want to help older people stay at home,
• In good mental and physical health,
• and to remain active and independent for as long
  as possible
• thereby reducing demands on residential and
  hospital care and intensive care at home

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Achieving Our Aim

• We believe that we need to provide tailored
  support for older people and their carers at an
  earlier stage and in different ways than is
  currently possible.
• We need to make sure that this support is found
  and used by older people we are targeting.
• In some cases new services will need to be
  developed and sourced.
• This requires significant imagination, innovation
  and a change of culture across the whole system.

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Tamesides Opening Doors for Older People Project
Intensive Services (Above eligibility threshold)
Sub-threshold targeted preventative services
Universal preventative services
The Open Door

• Commissioned services
• Shopping
• Cleaning
• Gardening
• First Call
• Home maintenance
• Social Enterprise
• Bathing

Community Groups Voluntary Sector Self-help
Groups Faith-based initiatives
Social Care Health Services
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Tamesides Opening Doors for Older People Project

• Aims and Objectives
• The Project has been developed through extensive
  and sustained consultation with, and engagement
  of, local older people and their carers.
• The Project has been sponsored by the Older
  Peoples Partnership (one of 7 partnerships
  making up the Local Strategic Partnership)
• It is designed to test, at a local level, the
  theory that, if older people can access the
  services they need at an early stage, there will
  be a reduction in the demand for intensive health
  and social care services.
• The specific objectives of the Project are to
  reduce or delay admission to residential care,
  hospital, or a need for intensive care at home.
• An additional aim is to increase the level of
  volunteering of people aged 55 in the borough.

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The Project has two, inter-related strands

• Strand 1
• Large Scale Targeted Early Intervention
• Strand 2
• Market Development
• Each Strand is made up of a number of
  sub-projects and activities (See Programme
  Hierarchy Governance Framework slide)

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Strand 1

• Large Scale Targeted Early Intervention
• Strand 1 involves contacting older people and
  their carers who we know, from local experience,
  are most at risk of losing their independence but
  who do not yet require residential care,
  hospital, or intensive care at home
• Initially, this will involve contacting people
  aged 74 83 years with multiple medications and
  conditions to manage, and who may be living in
  isolation
• We estimate over 16,000 people fall into this age
  category

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How will we find people?

• Target Group is by definition Hard to Reach
  (for all of us)
• Case Finding and Signposting
• Older People will be contacted via a combination
  of Case Finding Assertive Outreach, e.g.,
  through GPs, partner agencies, communities of
  faith and interest, community, voluntary and
  other organisations/routes, and signposted to
  POPPs

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Case Finding Signposting

• Home Library Service
• Library Data Base
• Community Groups Tea Dances Art Classes Line
  Dancing Tai-Chi Classes
• Community Pharmacists
• Fire Service Fire Prevention
• Police Crime Prevention Locality Meetings
• Homewatch Schemes
• Identislot
• Community Safetys Community Group Network
• Alcohol Support Worker
• Tenants Groups
• Registered Social Landlords

• Sheltered Housing Wardens
• Neighbourhood Networks
• Street Representatives
• Patrollers
• Community Newsletters
• Community Leisure Centres
• Town Managers
• The Citizen Newspaper
• Local Press Media Radio
• Age Concern Tameside
• Tameside 3rd Sector Coalition
• Help The Aged
• Volunteer Centre
• Citizen Advice Bureau
• Womens Royal Voluntary Service

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More Case Finding Signposting

• Customer Services Staff
• CRM System (12 months)
• Welfare Benefits
• Pensions Joint Service
• Electoral Register
• Accident Emergency Staff
• Primary Care GPs
• Practice District Nurses
• Expert Patient Forums
• Self-help Groups and Clinics (Stroke Heart
  Diabetes etc.)
• SCH Front Door
• CHOICE Shop
• Post Offices/Supermarkets

• Existing sub-threshold providers
• Community Response Service
• Ambulance Service
• Communities of faith/interest
• Local places of worship
• Carers Centre
• Luncheon Clubs
• Community Transport (Point to Point Ring Ride
  etc)
• Shopping Arcades
• Targeted publicity campaigns
• Dental, Optical, Chiropody etc services
• Stay Warm Scheme

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Whats on Offer?

• Check Support
• On contact Older People are offered a
  standardised Check and Support visit in their
  own home, using a questionnaire which has been
  designed to look at a variety of factors known to
  affect a persons well-being, health and
  independence
• The visit looks beyond what are traditionally
  seen as health social care factors
• The Check Support questionnaire is known as
  CORA
• Community Options for Remaining Active

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The CORA Questionnaire

• Basic Elements of CORA
• Modelled on the themes in the Outcome Framework
  for the Performance Assessment of Adult Social
  Care
• Available in Electronic, Web and Paper Based
  Versions (Laptop/Digital Pen Technology)
• Suitable for use by Volunteers known as CORA
  Personal Advisors
• Comprehensive but short enough to be covered
  during a 1 1.5hr conversation/visit
• Includes risk assessment/weightings
• Plain language(s) accessible formats
• Supported by a suite of Answers to
  underpin/support each question (information,
  advice, signposting) which were drawn up in close
  collaboration with relevant stakeholders

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Individual Well-Being and Healthy
Communities (Adapted from A New Outcomes
Framework for Performance Assessment of Adult
Social Care CSCI 2007)
Improved Health Emotional Well Being I am as
healthy as I can be
Improved Quality of Life I am able to live a
fulfilled life
Making a Positive Contribution I can participate
as a full equal member of my community
Exercise of Choice and Control I have the same
life chances as other adults
Freedom from Discrimination or Harassment I have
a equal chance to live free from fear,
discrimination prejudice
Economic Well-Being I am financially stable
have as much control as possible over my money
Personal Dignity and Respect I feel valued by
others
Maximising positives outcomes for people who use
services Demonstrating Equality and Diversity
Commissioning and use of Resources
Community Consultation
Director of Adult Social Services Corporate
Leadership
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CORA OUTCOME THEMES
Improved Health Emotional Well Being I am as
healthy as I can be
Improved Quality of Life I am able to live a
fulfilled life
Making a Positive Contribution I can participate
as a full equal member of my community
Exercise of Choice and Control I have the same
life chances as other adults
Freedom from Discrimination or Harassment I have
a equal chance to live free from fear,
discrimination prejudice
Economic Well-Being I am financially stable
have as much control as possible over my money
Personal Dignity and Respect I feel valued by
others
Falls? Weight? Hearing? Eyesight? Nutrition? Medic
ation? General Health? Hospital Admissions? Mood?
Life Changes? Getting out? Social
Engagement? Disabilities? Memory? Safety and
Security?
Involvement in Community User
Groups? Volunteering?
Access to Information? Telecare Assistive
Technology?
Equality of Access? Transport? Feeling
safe? Actual discrimination and/or harassment ?
Difficulty handling own money? Help with Council
Tax? Benefits Check? Keeping Warm?
Are you a Carer? Dressing? Washing
Bathing? Home Maintenance?
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Volunteering

• Using Volunteers
• CORA Check and Support visits are carried out
  by a team of volunteers aged 55 or over, who are
  trained and supported by a community sector
  organisation Age Concern Tameside, which is
  operating the service on behalf of Tamesides
  Older Peoples Partnership.
• The Project offers volunteers the opportunity to
  support and assist isolated older people in
  improving their health and general well-being
• It is intended to recruit up to 100 volunteers
  over the life of the Project

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Personalised Information Feedback

• After each CORA Check and Support visit the
  older person is given face to face, customised
  information and advice based on the responses
  they gave during the initial home visit
• The advice includes directing or signposting
  the older person to services or other sources of
  help, for example
• Befriending, Falls Prevention and schemes
  offering help with managing medication,
• Social and Luncheon Clubs, Neighbourhood Day Care
  Services,
• Crime Prevention, Fire Safety,
• Financial Benefits Advice,
• Assistive Technology,
• Home Maintenance and Gardening services etc..

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Personalised Information Feedback (Cont)

• Where appropriate, direct assistance with
  arranging visits, appointments, services, etc may
  also be offered
• Volunteers may also make referrals to Health and
  Social Care and Other Services on behalf of the
  person
• All people taking part in the CORA Check and
  Support scheme will be offered a six-month
  follow up visit or self assessment.

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CORA Check Support Service
Risk Assessment Analysis
Personalised Information Feedback
Provides the vehicle for extensive signposting
and delivery of personalised information, advice
and support on services to support older person
in remaining active, independent and well in the
community
Targeting Hard to Reach older people living
independently in the community 73 84 years of
age, isolated and/or with multiple medications or
conditions
Triggers are built into CORA to identify people
at risk and/or who may need to be (urgently)
referred to statutory or other services
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Strand 2

• Customer Voice Market Development
• Strand 2 of the project involves using the CORA
  Check and Support visits to get the views of
  older people and their carers on the type of
  services they need to support their independence
  well-being
• Information obtained in this way will then be
  used to develop local social enterprises
  re-shape community based preventative services,
  using funding obtained from the POPP grant and,
  progressively, funding from elsewhere within the
  local health social care and other systems

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OLDER PEOPLES PARTNERSHIP (Programme Sponsoring
Group)
LOCAL STRATEGIC PARNERSHIP
USER/CARER REFERENCE GROUP
PROGRAMME MANAGEMENT BOARD (Programme Director
Martin Garnett)
DEPARTMENT OF HEALTH
HIGH LEVEL PROJECT WORKING GROUP (Programme
Manager John Dunne)
STRAND 1 LARGE SCALE TARGETED EARLY
INTERVENTION (Project Manager Vicki Gee)
STRAND 2 DEVELOPMENT OF THE SOCIAL CARE AND
HEALTH MARKET (Project Manager Mark Simpson)
PROJECT 1 DEVELOPMENT OF CORA
PROJECT 2 CASE FINDING ASSERTIVE OUTREACH
PROJECT 4 MARKET DEVELOPMENT
PROJECT 5 PRACTICE BASED COMMISSIONING
PROJECT 3 VOLUNTEER DEVELOPMENT
PROJECT 6 WHOLE SYSTEM CHANGE (SUSTAINABILITY)
POPPs REVISED PROGRAMME HIERARCHY AND GOVERNANCE
FRAMEWORK
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The CORA Check and Support Pathway
CORA Check Support Home Visit (Electronic or
Paper based)
Assertive Outreach
Analysis of Risk Weighting
Market Development
Self Administration (Web or Paper based)
Identification of Target Group
Self Identification
Progressive development of new and existing
services driven by information obtained via CORA
Check Support process
Case Finding
Personalised Information Feedback (In person,
writing, internet, phone) to include one or more
of the following- - Personalised Information
Advice - Signposting - Direct Assistance -
Referral On - Stronger Voice - 6 Month Follow up
Declined/No Response (Send acknowledgement
leaving way open for future contact. Schedule for
6 month follow up)
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Progress so far

• Case Studies
• The Older Persons Perspective
• The Volunteers Perspective
• Key facts and Figures
• Some of the learning so far

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The Older Persons Perspective

• Mrs P is aged 81 years and lives alone since her
  husband died a few years ago. She has multiple
  illnesses, and takes several medications.
• Mrs P has always enjoyed gardening, but recently
  had a fall in the garden whilst tending it. She
  lay on the floor for several minutes after being
  slightly knocked out, before she came round and
  was able to get to her feet by rolling on to her
  knees. She is now afraid to do any gardening in
  case she falls again. This has really upset her
  as she used to love gardening. Mrs P told us
  that she is very interested in the assistive
  technology available, in case she falls in the
  future. She feels it may also give her the
  confidence to begin to potter about in the garden
  again. She is also interested in accessing
  gardening services through Age Concern Tameside,
  who offer a twice yearly clear up service, for
  the heavier gardening.
• Mrs P also loves reading, but has stopped going
  to the library. She uses a walking stick so would
  be unable to carry her books even if she were
  able to get to the library. She is interested in
  the Home Library Service as an alternative.
• Mrs P was pleased to receive the information
  contained in her personalised information pack,
  saying that even if she didnt need all of it
  now, it was there for her for the future.
• Mrs P is well supported by her family, but felt
  the information in her pack would enable her to
  sort things out for herself without calling upon
  or mithering her family.

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The Volunteers Perspective

• Mrs B, 71 years of age. I am a Volunteer CORA
  Advisor with Age Concern Tameside. I find it
  rewarding, and feel I am doing something for
  older people in Tameside. All the clients have
  been receptive to CORA, and have been very
  welcoming towards myself. I have found that the
  clients love to have a chat, as we work through
  the answers to the questions. As well as being a
  social opportunity for the client, it gives me,
  as a CORA Advisor, more information about the
  persons lifestyle and well-being than I might
  otherwise get from just the questionnaire.
• In my experience, the CORA Advisor has to be
  adaptable to the clients needs and situation,
  for example, I have reworded a couple of the
  questions sometimes, eg the questions relating to
  finances. Some people may become wary and wonder
  why we are asking about money issues. As yet
  there have been no refusals to answer any of the
  questions, and everyone has been positive.
• When I go out to do the feedback visit, I have
  found that most people do not want me to go
  through it all in detail, and that they would
  rather have a chat again, as they can read
  through the detailed written information later.
  In these situations, I try to have the chat, but
  bring specific points and signposting into the
  conversation. This seems to have worked well so
  far.
• I really enjoy the work that I do with the older
  people, and as well as giving them information on
  services that are available in the community, I
  am now much more informed myself.
• I would encourage anyone who has a few hours to
  spare, to contact Age Concern Tameside, and to
  consider being a volunteer CORA Advisor.

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Requests for Service as at 22nd August 2007

• Total 193
• Female 122
• Male 71
• Age Range
• Under 50 Nil
• 50 59 5
• 60 64 11
• 65 69 16
• 70 74 26
• 75 79 35
• 80 84 23
• 85 89 15
• 90 12
• Not yet known 50

• Ethnic Community
• White British 137
• Chinese
• Black African
• Black Caribbean
• Black (Other)
• Indian 16
• Pakistani 20
• Bangladeshi 7
• Other (Please Specify)
• Not yet known 13

Note We do not have DoB or Ethnic Community
information of all people requesting service at
this stage in the process
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Volunteers as at 22nd August 2007

• Total 38
• Female 25
• Male 13
• Age Range
• Under 50 1
• 50 59 1
• 60 64 9
• 65 69 13
• 70 74 6
• 75 79 5
• 80 84 3
• 85 89
• 90

• Ethnic Community
• White British 27
• Chinese 0
• Black African 0
• Black Caribbean 0
• Black (Other) 0
• Indian 4
• Pakistani 1
• Bangladeshi 1
• Other (Please 0
• Specify)
• Not known 5

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The Learning So far.

• Expanding the Target Group to make it more
  accessible
• Locally POPPs is ahead of PBC focus on 3 to 4
  demonstration sites
• Broaden the age range of Volunteers to 50
• Resistance to laptops underestimated/unproven
• Electronic/digital pen technology more
  complicated than it looks
• National Quality of Life Questionnaire
• Links to SCH front door and review function
• Link to LAA

• PSOs and Partnership Agreement
• Sustainability
• Uptake of services
• High levels of Co-operation and Collaboration
  across the Council and partnerships is vital
• Success of Assertive Outreach, Case finding and
  Marketing
• Retention of Volunteers
• CRB Checks of Volunteers
• Setting local Performance Indicators Targets
• Difficulties proving a causal link between POPPs
  and admission to hospital, residential care etc..