Living Longer Living Better

Transcription

1 MORAY COMMUNITY HEALTH AND SOCIAL CARE PARTNERSHIP Living Longer Living Better An Older Peoples Strategy for Moray A framework for Older Peoples Services in Moray to enable them to live longer and live better (A title chosen by older people in Moray) 1

2 Table of Contents CHAPTER ONE Setting the Scene page 2 Introduction National and Local Policy Context across the Partnership Scope Methodology Process Our vision, Strategic Aims and Principles Structure of this document CHAPTER TWO Older People in Moray: Facts and Figures page 15 Moray Profile Demography and Trends Moray Population Over 65 s population Financial Implications Pyramid of Care Progress since last strategy Challenges ahead Continuing to shift the balance of Care CHAPTER THREE Promoting a Healthy and Active Older Age page 25 Introduction Health Needs Carers Needs Health Promotion Self Care, Self Management and Support Leisure and Lifestyle opportunities in Moray BALL Projects Housing and Housing Support Review of Sheltered Housing and housing options Moray Care and Repair Social Housing

3 Home Equipment Assistive Technology Prevention and Early Intervention Health Issues Health Screening Falls and Older People Nutrition and Older People Dementia Long Term Conditions CHAPTER FOUR Improving Community Based Services page 55 Introduction Primary Care and Extended Community Care Teams Anticipatory Care and Prevention Community Care Services Home Care and enablement Day Services Meals on Wheels and Lunch Clubs Personalisation and Self Directed Care Community Pharmacy Allied Health Professionals Rehabilitation Older Adult Mental Health Services Intermediate Care Palliative and Terminal Care CHAPTER FIVE Improving Nursing, Residential and Hospital Care page 78 Introduction Dr Grays Hospital Community Hospitals In patient Care Unplanned Care Comprehensive Geriatric Assessment Service Planned Care Pre Assessment services Admissions of over 65 s

4 Discharge from Hospital Delayed Discharges Capacity Issues Developing community Hospitals Quality of Care in Hospital Settings Care Homes Quality of Care CHAPTER SIX Making the Strategy work page 98 Introduction Partnership Working Whole Systems Approach Involvement of Older People Information Systems Workforce Development and Redesign Integrated Work force Development Plan Transport Monitoring and Evaluation HEAT targets National Outcomes Acknowledgements Page 110 References Page 111 Appendices 1 Documents consulted and researched 2 Consultation Plan and Questionnaire 3 Consultation results 4 Logical model 5 MCHSCP Joint Finance report

5 CHAPTER ONE Setting the Scene Introduction The demographic picture of Scotland will change over the next years. It is projected that there will be increasing numbers of older people and diminishing numbers of working age adults. In itself, an ageing population tends to increase the demand for health and social care, although its effects are being offset to a significant extent by the fact that our older people are on average healthier than they have ever been. The main impact of the age profile is therefore on the type of demand we face, since older people have a higher incidence of chronic disease and on average a greater number of long term conditions. Older people tend to have higher levels of ill health than those who are under 65. Care of older people accounts for 40% of the health service budget in Scotland and 60% of the social work budget. 1 This is significant in our rural environment not only for the health patterns we can expect to see in Moray, but for the development of the future Health and Social care workforce and the available pool of unpaid carers to support individuals at home. It can be celebrated that we are living longer and better with many older people fit and well, functioning in their communities without professional support. However services must focus on maintaining the physical, psychological and social health and well being of older people and anticipating and pre-empting any decline before it becomes acute. As the Health and Social Care agendas highlight the need for change to ensure services respond to an ageing population, health trends, changing public expectations and workforce availability. Delivering for Health 2 and Changing Lives 3 share some common principles: 2

6 Community Capacity Planning Whole system approaches Prevention and Early intervention User Involvement Carers as partners Self management of care Systematic approach to long term conditions A competent workforce This integrated Health, Housing and Social Care strategy for older people in Moray aims to lay out the foundations the start of the process of redesigning and shaping our services for older people in Moray over the next five years and in the future. Examining the outcomes for older people that we want to achieve, how we are going to achieve them, the timescales, the resources available and the monitoring process. It is acknowledged that this requires a whole systems approach, partnership working and involvement of the whole community taking full account of the projected demographic changes over the next decade. The redesign of services across the whole system underpinned by a sustainable workforce is a long term strategic aim for Moray. Continuing to shift the balance of care to provide increased support at home with less reliance on institutional care will require innovative solutions developed through capacity planning and joint commissioning of services. National and Local Policy Context across the Partnership Many policy documents were consulted in the creation of this strategy across Health, Housing and Social care, these are listed at the end of this document (Appendix 1). However the main drivers which shaped our vision emerged from the documents discussed below. 3

7 Building a health service fit for the future a national framework for service change NHS Scotland 2005 This framework Identifies the main challenges to health and well being in Scotland as an ageing population, persistent health inequalities, a continuing shift in the pattern of disease towards long term conditions and growing numbers of people with multiple conditions and complex needs. It recognised that a one size fits all approach cannot meet the challenges of providing health care in remote and rural areas and established a national steering group to develop a framework for the provision of services in those areas. It presents a model for sustainable remote and rural services which maximises the contribution of each member of the health and social care team, and encourages further integration of services. Primary care teams are recognised as the bedrock of the health care system. Recommendations are made to extend, as far as is possible, the range of diagnostic tests and specialist support available to those teams to prevent unnecessary onward referral and travel for patients. Delivering for Health an action plan 2005 This describes in practical terms what action we should take to turn our vision of the health service into reality. It builds on the National Framework for Service Change to provide a template for the future NHS Scotland. It describes a fundamental shift in how the NHS works, from an acute, hospital driven service to one that is embedded in the community, is patient focused and is based on a philosophy which moves from care to enablement and rehabilitation. It focuses on the challenges of an ageing population and the rising incidence of long term conditions, preventing ill health and treating people close to home with responses that are proactive and embedded in communities. Supporting professionals, individuals and their carers to deliver sustainable quality services Changing Lives report of the 21st century social work review 2006 This independent review takes a fundamental look at all aspects of social work in order to strengthen its contribution to integrated services and improve outcomes for 4

8 individuals and communities. It sets out a challenging vision for the future direction of social work services. It places emphasis on service redesign, workforce training and leadership and a shift towards early intervention and prevention. It focuses on building the capacity of the workforce to deliver personalised services and create sustainable change. Thirteen recommendations were made themed as follows: Performance Improvement, Service Development, Workforce Development, Practice Governance and Leadership and Management. Better Outcomes for Older People framework for joint services NHS Scotland This Framework promotes the development and mainstreaming of joint and integrated services, as part of the Joint Future drive for better outcomes for individuals and their carers. It demonstrates the exciting changes possible in the shape and nature of modern health, housing, social care and wellbeing services, by developing more joint and integrated services. Services which will assist older people to lead more independent lives and have more personal control over their lifestyles, care and environment. It provides advice and good practice examples. In particular, it signposts the way that joint and integrated services should be provided in the future - in partnership between individuals and their carers, health, housing and social care organisations, in the statutory and independent (both voluntary and private) sectors. Better Health, Better Care action plan for healthier Scotland Scottish Government 2007 This action plan provides an opportunity to review understanding of the challenges set out in the national framework and reflect on new insights that have emerged over the past few years. It is a significant step towards a healthier Scotland and its three main components of Health Improvement, tackling inequality and improving the quality of health care. It seeks to accelerate the progress made - local care whenever possible, embedded in communities and tailored to people s needs, care that is quicker, safer and more effective and efficient. 5

9 All our Futures planning for a Scotland with an ageing population Scottish Executive 2007 This strategy sets the vision for a future Scotland in the context of a changing world and an ageing population identifying six priority areas for strategic action: Continue to improve opportunities for older people to remove barriers and to create more chances for older people to participate and to be involved in their communities as volunteers: through paid work: in learning, leisure, culture and sport. Forge better links between the generations. Improve the health and quality of life of older people. Improve care, support and protection for older people who need it. Ensure that the right infrastructure is in place for a Scotland with an ageing population with housing, transport and planning progressively meeting the needs of all ages. Offer learning opportunities throughout life Co-ordinated, integrated and fit for purpose a delivery framework for adult rehabilitation Scottish Executive 2007 The ethos of this document is one of care to enablement and hospital to community advocated by delivering for health It identifies four priorities: Transform rehabilitation services to put rehabilitation at the heart of service delivery Adopt a whole systems approach to rehabilitation services Give greater priority to rehabilitative priorities 6

10 Reflect evolving outcomes measures for community care that impact on rehabilitation service. It also highlights older people as a key target group. Developing Community Hospitals a strategy for Scotland 2006 The Strategy calls for NHS Boards to create the structures necessary to ensure that Community Hospitals remain central to local health care systems. Community Hospital based services should be maximised to support step-down care from acute hospitals and offer locally based access to services. It supports a new vision of community hospitals as an essential part of the implementation of Delivering for Health, at the forefront of NHS board planning to shift the balance of care into the community. It states plans should be developed through CHPs in an integrated way with local communities and agencies such as local authorities and the voluntary sector. Spotlight on Older People in the UK spotlight Report 2008 Help the Aged we will This report highlights that the main concerns for older people in Scotland are Fuel Poverty, Personal Care and Transport. It reports progress since 2007 against and actions required around its key objectives of Combating Poverty, Reducing Isolation, Challenging Neglect, Defeating Ageism and preventing Future Deprivation. Delivering for Mental Health Scottish Executive Health Department 2006 Sets the policy context for the model of Mental Health Services with the objectives grounded in the principles of Delivering for Health 7

11 Adult Support and Protection (Scotland) Act Scottish Government 2007 The main provisions of the ACT are as follows: Protection of Adults at Risk of Harm Which introduces measures to identify and protect adults at risk from harm and the responsibilities of councils to stop or prevent harm occurring. Adults with incapacity Which amends the Adults with Incapacity (Scotland) Act 2000 with a view to improving how it operates in practice and a two year monitoring project of the implementation of this act. Adult support Miscellaneous amendments and repeals of the Social Work (Scotland) Act 1968 Mental Health Miscellaneous amendments and repeals of the Mental Health (Care and Treatment) (Scotland) Act 2003 This Strategy also links clearly with the following local plans and strategies within Moray Community Health and Social Care Partnership (MCHSCP): Moray Community Health and Social Care Partnership plan Moray Housing Strategy Moray Physical & Sensory Disability Strategy Moray Carers Strategy Moray Community Planning Partnership Social Inclusion Strategy Moray Homelessness Strategy

12 Community Services Development and Improvement Plan Moray Learning Disabilities Strategy Moray Joint Health Improvement Plan (in development) Moray Nutrition Joint Health Improvement Plan (Food in Focus) Grampian Interagency Supporting and Protecting Adults from Abuse revised 2007 NHS Grampian Workforce plan Moray Local Housing Strategy Update 2007 Scope This strategy will focus mainly but not exclusively on the needs of the over 65 age group. This age is not chosen because we feel it is the start of old age or that we see all over 65 s as similar or having the same needs, but because for many it is a point when life circumstances change e.g. retirement and when long term health conditions are most likely to develop. It acknowledges that when we speak of older people and their needs this includes ethnic minorities, incoming migrants, gypsies/travellers, Lesbian, Gay, Bisexual and Transgender older people. Our drive to provide flexible services on a personalised basis tailored to meet individual needs will ensure that specific needs for all older people are met. It is also acknowledged that people with a learning disability although having full access to older peoples services will remain under the care of the Learning Disabilities Team as they grow older. We acknowledge that there are issues to address in our younger age group before we can see a health impact within our older population. Other agendas such as Public Health, Mental Health and Long Term Condition Management will take a broader outlook of services in these areas. Throughout this document people over 65 will be referred to as older people for ease of reading. 9

13 Methodology - Process An initial scoping visit in Moray and a number of mapping workshops around older people s services took place with a range of key stakeholders from Grampian and Moray with support from the Joint Improvement Team (JIT). The JIT is sponsored by the Scottish Executive, COSLA and NHS Scotland. The purpose of the team is to assist Health and Social Care Services to further develop partnership approaches to improve services for the benefit of service users and carers. They have supported Moray throughout the process A further Moray workshop with key stakeholders provided clarity between current reality and the vision for older people in Moray. Four main themes emerged which required development: Older Peoples Pathway Anticipatory Care and Prevention Rehabilitation and Intermediate Care Telehealthcare A focus on Users and Carers, Improving Information Systems and Workforce Development was identified as being required to underpin the service delivery elements of these improvements. A project lead and a strategy development officer were identified and a multiprofessional project Steering Group was established. Four work streams were set up with crosscutting themes of User/ Carer involvement, Telecare and improving communication/information systems. Senior managers from across Health and Social Care were identified as leads for each work stream. See diagram below: 10

14 Joint Steering Group Lead systems Manager Social Work Older Peoples Pathway Planning Lead MCHSCP Anticipatory Care, Prevention and Medicine management Clinical Lead MCHSCP Community Rehabilitation and Intermediate Care Intermediate Care Services Development Officer Workforce Development Lead Nurse MCHSCP Telecare/ Telemedicine User and Carer Involvement Improving Information Systems Extensive policy research was completed regarding services for older people and the views of older people and their carers by the strategy development officer. (Appendix 1) Each work stream was given a brief agreed by the Steering Group and a remit to identify gaps /issues within each area and improvements required and form an action plan. The vision and strategic aims for older people in Moray were agreed by the Steering Group and endorsed by Moray Council Health and Social Care Committee. A consultation plan and questionnaire was then developed (appendix 2) to seek the views of our service users, older people and their carers and the general public on the vision, strategic aims and the title of the Older Peoples Strategy in Moray. A General satisfaction with services was voiced and a number of concerns were raised. These have been incorporated into the strategy and are detailed in Appendix3. 11

15 86% agreed with our vision. The consultation also showed that our strategic aims were equally important and generally in terms of priority they all needed to be progressed. The title of the strategy was overwhelmingly chosen as Living longer, living better. Our Vision, Strategic Aims and principles Vision To advance a strategic partnership approach that promotes the quality of life of older people and their engagement in the Community. Continuing to shift the balance of care from Acute to Community based care, ensuring that Health and Social care services are organised around and responsive to their needs by the provision of high quality services and support which enable older people to live as independently as possible in a suitable and safe environment with choice and control over their future needs We aim to deliver the following strategic aims: The promotion of active ageing by ensuring that older people have access to recreational activity and healthy living advice and can participate in the life of their local community. Management of long term conditions to ensure optimum independence and promotion of Self Care Expanded Preventative and Anticipatory Care Services enabling more older people to remain independent for longer in their own home Improved 24 hour responsive services for older people reducing unnecessary admissions to hospital, residential and nursing care The development of Intermediate Care Services within the home and close to home preventing unnecessary admissions to hospital, facilitating early hospital discharge and preventing premature admission to residential and nursing care. 12

16 Improved support to carers who provide support to older people allowing them to feel valued, supported and key partners in care Improved integrated health and social care services in the community to ensure high quality, efficient and cost effective services which enable more older people to remain independent and living at home Develop a workforce where there is no ageism and the staff have the skills that meet older people needs, understand needs of older people and foster an enabling and rehabilitative approach Ensure a seamless pathway through hospitals in Moray which meet standards of care for older people and ensure the value of each move is beneficial to enabling them to return to maximum independence as close to home as possible An expanded range of housing and care options for older people to have real choice and control about how and where they live Improved information and advice about services and facilities for both staff and User/Carers These strategic aims can be summarised in three key areas. Promoting a healthy and active older age Improving community based services Improving Nursing, Residential and Hospital care 13

17 Principles The following overarching principles will assist us meet these aims Involvement Independence Choice Assessment Involving older people and their carers at the centre of developing and implementing the strategy Help people to move from dependency to greater independence by improving the way we help people to recover from injury or illness Working with older people and their carers so they have more control over their own health and well-being Ensuring a joined up approach to assessing people s needs, planning and managing their care responding to emerging problems ahead of crisis Structure of this document This document will be structured with examples of good practice and the comments of professionals and older people and their carers gathered during our consultations. Chapter Two will build a picture of older people in Moray and the services available, the progress and changes since our last strategy and the future challenges that we face in Moray. Chapters 3, 4, and 5 will detail our main areas for development and priorities for action which will help us meet these challenges. Chapter 6 will discuss how we will implement the strategy, monitor and evaluate it. Our attached implementation plan details how we will drive the strategy forward. 14

18 CHAPTER TWO Older People in Moray: Facts and Figures Moray Profile Moray stretches from the Moray Firth central coast at its northern edge to the Cairngorm mountain area in the south covering approximately 860 square miles of predominantly rural landscape. It has a population of approximately 88,560(ISD General Practice Populations data) of which 18% of the population are over 65 years of age. Moray has a significantly better than average percentage of people living in the 15% most deprived areas of Scotland. This is reflected in the education, employment and prosperity indicators, with the area rating significantly better than, or not significantly different to, the Scotland average on all indicators. Most people live in the main towns of Elgin, Lossiemouth, Buckie, Forres and Keith. Other smaller communities are also scattered throughout Moray e.g. Aberlour, Dufftown, Fochabers, Cullen and Tomintoul in remote and rural locations. Moray has a fully integrated Community Health and Social Care Partnership led by a joint Management Team. It has a common set of objectives, a shared understanding of its challenges and a cohesive approach to identifying solutions. It is managed operationally as four locality areas: Elgin/Lossiemouth Forres Buckie/Cullen Keith and Speyside The Elgin / Lossiemouth community hosts the acute services at Dr Grays Hospital; a 200 bedded District General Hospital which provides acute services to the greatest density of the Moray population. 15

19 Five community Hospitals exist in Moray in the towns of Forres, Buckie, Aberlour, Dufftown and Keith providing 95 in patient beds in total delivering a range of acute and intermediate care services for local areas. Primary community services are built around the Community Hospitals with Community based health and social care teams co-located where possible. This can be referred to as a Community Resource Hub. Health and social care teams exist in Elgin and are aligned to GP practices. The new Lossiemouth practice has co-located health and social care teams. Demography and Trends Major demographic change is underway in Scotland and the population is projected to rise over the next 25 years before declining slowly. Population ageing is continuing to occur and will continue to accelerate over the coming decades as the baby boomers become older. The changes in Scotland are summarised below: Scotland s population is ageing: between 2004 and 2031 the number of people aged 50+ is projected to rise by 28 per cent and the number aged 75 and over is projected to increase by 75 per cent. Fewer children aged 0-15 and people aged 16-64; the numbers are projected to decrease by 15 per cent and 11 per cent respectively by People living longer: life expectancy at birth is projected to increase from 74.3 years for males and 79.4 years for females for those born around 2004 to 79.2 years and 83.7 years respectively by People living longer at older ages: a male aged 65 in 2004 can expect to live for another 15.6 years on average, a female of the same age another 18.5 years. This is projected to increase to 19.6 years for males and 22.1 years for females by

20 More over 50s living alone: In this age group, women are more likely to live alone, but the number of men living alone is increasing faster, as men s life expectancy increases. Geographical variations in the distribution of older people with the over75 s accounting for more than 15 per cent of the population in some areas. However, the pattern of ageing varies within Council areas. An ageing population similar to the rest of Europe, but Scotland faces a larger increase in the number of people aged 65 and over than the rest of the UK. All Our Futures Moray Population Although the Moray population is not projected to increase (-1.9%) compared to Scotland (5%) and Aberdeenshire (18.7%) by 2031 there are significant changes in the projected age structure. As shown in the table 1 below the increase in Moray of people over 65 is steadily rising as per the rest of Scotland. However it is significantly higher compared to the Scottish average. This becomes greater in the over 75 age group with an increase of 104% by Projected percentage change of population (2006 based) by broad age group compared to Scotland (Table 1) General register Office for Scotland All ages Pensionable age Moray Scotland

21 Pensionable age includes the change in women s state pension age from between 2010 and 2020 and the subsequent change of both male and female state pension age to 66 by As female life expectancy is higher than the male rate, as the population ages it is currently more female dominated. This is significant as there are differences in health concerns and life circumstances between the genders and consequently their need for certain services. However the gap is closing which reflects the national trend. Over 65 s Population The current population of Moray is approximately 88,560 based on patients registered with a GP. 18% of the population in Moray are over 65. The projected figures show that by 2031 this would increase to approx 38.8% of the population. There is a varied geographical location of our population of over 65 s in Moray. Although most are clustered around the main towns in Moray there are remote and rural areas to be considered. The following table (figure 3) reflects a whole system snap shot of services in place and details GP Practice population data of all over 65 s registered with GP s in Moray (updated in Jan 2009) by ISD This illustrates the age structures within each locality area. It also details other main services available within theses localities such as Sheltered/Very sheltered Housing, Nursing Homes and residential accommodation, GP Practices, Community Hospitals and details of key staff required to meet the needs of older people. 18

22 Moray Buckie/ Cullen Elgin/ Lossie Forres Speyside % of total % of total % of total % of total Current Population 88,780 14,574 16% 43,199 49% 15,111 17% 15,896 18% Total Over 65's 16,123 3,091 19% 7,248 45% 2,669 17% 3,115 19% % of local Population 18% 21% 17% 18% 20% ,889 1,644 18% 3,980 45% 1,499 17% 1,766 20% ,442 1,076 20% 2,476 45% % 1,021 19% 85+ 1, % % % % Comm Hosp Beds 95 22* 23% 0 0% 18 19% 55 58% Care Home Beds % % % 88 19% Residential Beds % Sheltered Housing Units % % 55 11% 85 17% Very Sheltered Units % 25 45% 16 29% 0 0 Clients receiving meals/wheels % % 38 10% 99 26% Day Care Attendees % % 47 17% 54 19% Dom Care Total Hours % % % % GP Practices GP Headcount % 31 40% 13 17% 18 23% Community Care Officers wte % 9 42% % % District Nurses wte % % % % Community Nurses wte % % 0% % Physios wte % 2 45% % % Occupational Therapists % % % % Dietitians wte % % % % Speech & Language Therapists wte 1.8 Podiatry wte % % % % 19

23 Financial Implications The combined Local Authority and NHS service spend for all services provided within the partnership framework in 2008/09 amounted to 101,762,000. Services to Elderly people are included within this total as noted in the table (appendix 5). Many services are universal and not specifically directed to older people and the totals shown may include all groups. Services include both hospital based provision in Doctor Grays Hospital in Elgin and at localities throughout Moray. Additionally, wide ranging community based services are provided throughout the area by both NHS Grampian and The Moray Council. Local authority spending for Older Peoples Services for 2007/08 was 18,496 million. 39% of this budget was accommodation based services e.g. care home compared to 33% of the budget spent on home care services. It is planned that Moray will increase the spend on home care service annually by 1% in the next three years, reinvesting from spend on care homes continuing to shift the balance of care. Breakdown of Community Care spend 1% 2% 1% 2% 0% 1% 1% 14% Assessment, Casework, Care Management, Occupational Therapy and Criminal Justice Field Work Accommodation-based services 6% Homecare Day Care Equipment and adaptations Other services to support carers Self-directed support (direct payments) 33% Meals 39% Other services Capital Charges FRS17 20

24 The Pyramid of Care The system of services proposed for older people in Moray can be illustrated as a Triangle of Care (figure 4) People at the end of their life: palliative and end of life care Frail and older people with complex needs: Hospital care, nursing care, intensive domiciliary care Help to limit the impact of illness or frailty: Intermediate care, management of long term conditions, assistive technology, home support Promoting health and active lives: Information, advice, good housing, health and promotion, self care, leisure and lifestyle, community support mechanisms At the top of the triangle, there are services for frail dependent older people and at the bottom there are services to keep older people healthy and active. In the middle there are services to limit the impacts of illness and disability as people age and to help them 21

25 regain their independence after accident, illness or loss of confidence, referred to as Intermediate services. Most resources for older people are focused on a small number of specialist services at the top of the triangle that serve a small number of people While it is right that the needs of frail vulnerable people are our top priority we need to understand the extent to which we can reduce people s frailty by investing in services further down the triangle that help people move from dependency to greater independence. Progress since the last strategy Older Peoples services have undergone significant and positive change since our last strategy Mapping the Future regarding shifting balance of care and improving older peoples pathways through the system of care within Moray some examples are: Planning for an eight bedded Stroke Unit for Moray with support from Grampian Clinical Network for Stroke and the CHD/Stroke strategy Completion of Grampian Stroke Pathway Appointment of consultant physician in general medicine and stroke Appointment of part-time consultant geriatrician Completion of Grampian Falls Strategy Integrated Occupational Therapy Service Creation of a 24hr pool of Community Care Assistants as a flexible and responsive generic source Developing a joint equipment store 22

26 Success in reducing delayed discharges from 63 in 2002 to 0 over 6 weeks in 2008 sustaining delayed discharge targets Co-location of AHP s and community health and social care staff in most areas Home from Hospital pilot allowing assessment of people in their own homes and earlier hospital discharge and ensuring access to free personal care Increase of Care Officer complement to locality areas Reduction of NHS long term care beds to 0 A number of government initiatives have also progressed since the last strategy allowing older people to benefit and help them live longer: Free personal Care Tele-care Development Care and Repair Housing Support National concessionary Travel scheme Care Commission established Publication of National Care Standards Fuel Poverty programmes Central Heating Programmes 23

27 Challenges ahead - Continuing to Shift the Balance of Care Shifting the Balance of Care is a key theme within Health and Community Care policy which is intended to bring about improvements in service delivery and health outcomes. It is a term used to describe change at a number of levels, for example: Shifting the focus of care towards health promotion, prevention, a proactive and anticipatory approach and management of long term conditions Shifting the location of care towards more community-based facilities Shifting the roles and responsibilities of patients and professionals We must build on our recent successes to redesign an optimal pathway for older people continuing to shift the balance of care, working in partnership with older people and professionals and embedding an enablement and rehabilitation approach into our services. The long term outcomes for this strategy and beyond are as follows: Promote the capacity of communities to care for themselves Approach health and wellbeing measures to ensure the health of our ageing society Ensure our services have the capacity and are built around the individual needs of our increasing ageing population now and in the future, redressing the balance of care if required. Ensure that our workforce has the capacity and skills to meet the needs of our ageing society 24

28 CHAPTER THREE Promoting a Healthy and Active Older Age Introduction Health takes on a particular significance in later life. The proportion of people with a long term illness and a disability increases with age: 13% of people aged 70 years and over have both a long term illness and disability compared to 2% of year olds. That said, however, the majority (65%) of people over 50 years in Scotland are living without a long term illness or disability and 45% of people aged 65 and over live at home, the majority in good health. 4 The health behaviours of older people are significant for a number of reasons: The likelihood of smoking falls with age Older people are more likely to drink alcohol frequently than younger age groups Older people are less likely to have exceeded the recommended weekly number of units of alcohol than younger age groups Older people are less likely to undertake the minimum recommended amount of physical activity Health Needs Older Peoples Health needs differ from those of the younger age groups because they are: More likely to live alone More likely to have functional dependency and sensory impairment More likely to have chronic disease 25

29 More likely to have co-morbidity (i.e. multiple medical problems acute and chronic) More likely to be on multiple medications, with greater risks as a result More likely to have cognitive impairment and other mental health disorders More likely to develop complications of acute illness and its management: and more likely to develop hospital acquired infection. More likely to stay longer in hospital: and more likely to require rehabilitation following acute illness and trauma. More likely to die National framework, 2005 Despite these facts many older people are fit and well, active contributors in many aspects of life for example looking after grandchildren or looking after others. Community groups, churches and voluntary organisations provide social contact for older people and for those living alone which has a particular beneficial effect on their health e.g. avoiding depression. However older people can become frail and have complex needs. Frail older people can be defined as people who are usually over 75 and often over 85 with multiple diseases (which may include dementia). These older people are the fastest growing group of the population and tend to present at hospital with symptoms such as falls, immobility and confusion. A preventative, anticipatory approach with management of long term conditions is vital for these older people and this will be discussed further in the Chapter 4 Improving Community Services. However it is important to recognise that this must include the needs of carers of older people who are often older themselves. 26

30 Carers Needs The impact of caring can be significant. Recent research into unpaid care in Scotland shows that older people are significant recipients of unpaid care, and usually by an elderly spouse or family member. Carers are twice as likely to suffer from physical and mental health problems as people with no responsibility and up to half of all carers who support spouses or partners with dementia suffer from depression. 6 Given this vital role of carers in supporting older people at home we need to strengthen in particular, support for older carers and carers at risk of, or suffering from frailty, depression and isolation. Their ability to care will be enhanced if they are supported and trained allowing them to feel valued, supported and key partners in care Strategic Aim Improve support to carers who provide care and support to older people allowing them to feel valued, supported and key partners in care Moray Carers Strategy has the following priorities: Priorities To ensure services recognise the important role of carers and provide an assessment process which meets current and future needs To ensure carers are informed of the services and support available to them in a freely and widely accessible way To develop a respite service that supports carers to maintain their caring role and remain healthy both physically and psychologically To maintain the health and wellbeing of carers Young and old 27

31 Health Promotion It is important people reach older age in good health. Health promotion and well-being measures have a great deal to offer in reducing illness and extending independence. As do individuals themselves by deciding to stop smoking, drinking sensibly, eat a healthy diet and take appropriate exercise. Physical activity helps maintain functional ability and prevents disability and immobility and is particularly important in maintaining independence and reducing social isolation of older people. Our Strategic challenge Aim in Moray is to maintain healthy active fulfilling older age for our older people. Our strategic aim reflects this: To promote active ageing by ensuring that older people have access to recreational activity, healthy living advice and can participate in the life of their local community Primary Care and mainstream public health/health promotion programmes play a vital role in Moray promoting health and independence and fostering a self care approach. Some examples are: Flu /Pneumococcal immunisation is encouraged annually with accessible clinics in each area Smoking Cessation continues to be promoted A recent visit of mobile breast screening unit extended an invitation to those 70+ Speyside Leg Club Drink sensibly campaign continues Jog Scotland groups established National Long Term Condition Collaborative launched National Mental Health Collaborative launched 28

32 It is important that older people have access to a full range of health advice including for example sexual health and drug and alcohol advice and information. Priority We must ensure that health and social care staff have the skills to deliver health promotion and a self care approach to older people and provide information and advice. Self Care, Self Management and Support Health and social care teams must promote, encourage and support individuals to self manage their own care (where appropriate and with support), working with voluntary agencies and self-help groups to support the development of self care if older people are to remain at home. The Dufftown self caring Community initiative is a good example It targets the 16+ age group focusing on areas of prevention of long term conditions, anticipatory care of those with one or more long term conditions and maintaining the health of those in good health. It has close links to their Community Gym facilities. All referred individuals will be offered a series of health checks over an 18 month period using a community development approach. The project aims to enable people in the community to identify their own self-care needs and develop the ability to access appropriate services. It is envisaged that if outcomes for the Dufftown population are met, this model or something similar can be rolled out to other areas. Priority To promote self care, self management and support for older people across Moray 29

33 The national NHS Minor Ailment Service has been rolled out in Moray providing free advice and free treatment from the community pharmacist for minor illnesses and complaints such as: backache, constipation, cough and indigestion. Leisure and lifestyle opportunities in Moray Moray Library services provide mobile services for remote and rural areas. They are presently developing a strategy for services to older people. The key purpose is to raise awareness of the range of services available, to consider and address specific needs of older people and to encourage widest possible participation. It will actively support Moray s commitment to enabling older people to remain in their homes for as long as possible through the development of targeted services by providing access to leisure and learning and by encouraging healthy, involved, active lifestyles There are a number of opportunities for older people in Moray which are geared at improving health and wellbeing for those that are able: Walk Moray was launched April This jointly funded partnership project aims to improve the health of communities in Moray through a structured programme of community health walks led by trained local volunteer walk leaders. Local Community Gyms e.g. Shand Community Gym in Dufftown Local Leisure Centres provide a range of activities for older people Health Point currently undergoing review Healthy Living Centre GP referral programme Community Groups e.g. Hip bumpers in Keith The national Lifelong Learning Strategy looks to colleges and universities to respond to the needs of our ageing population to provide appropriate training and learning opportunities. 30

34 Income maximisation/ access to benefit checks can also have a positive impact on Health and wellbeing of older people. Other Low level services such as gardening, befriending, shopping and lunch clubs are also very significant in enabling older people to live healthily and independently as are local church groups. It is essential that locality areas take stock of the services and facilities within their areas and provide information and advice to older people and staff, work with voluntary agencies to further improve and develop services which enable older people to remain independent and healthy and involved in their local community. Ball projects are an excellent example: Priority Improve and develop local services and facilities to meet the needs of locality areas working with voluntary agencies and older people BALL Project Be Active Life Long groups are now established in eight areas in Moray. There are approximately 200 over 65 s involved. The project endorses the view that older people who are able, should be encouraged to stay active in their community for as long as they choose. Key objectives are: To provide opportunities and choice for older people in Moray Improve confidence, self esteem and mental health To engage older people in the planning and running of their groups To improve the quality of life by increasing mobility, lessening the risk of falling Improve physical health in general To foster companionship 31

35 To develop sustainable programmes by supporting people to become self sufficient Physical activities include Keep Fit, Dance, Team Games, New Age Curling, Carpet Bowls, Yoga, Tai Chi and Walks Creative Activities include Drumming, Singing, Painting, Craft Work, Photography, Storytelling, Music Making and Computers Social Activities include Quizzes, Visiting speakers, Information and Advice, Beetle Drives and visiting other BALL Groups Priority Secure appropriate funding to expand and progress BALL project. Housing and Housing Support Housing Issues, including tenure, housing quality and housing support are of fundamental importance to the health and independence of older people. Strategic Aim To expand the range of housing and care options for older people to have real choice and control about how and where they live The Moray Local Housing Strategy (LHS) aims to ensure that good quality, affordable housing is available to meet the needs of people living in or requiring housing in Moray. It identifies the main housing problems in Moray as: A lack of affordable housing This is a longstanding issue and considered to be the main reason behind Moray s homelessness problems. 32

36 High levels of fuel poverty the joint second highest in mainland Scotland High levels of disrepair in the private sector due to the large proportion of older houses A growing elderly population with housing and support needs. The shortage of affordable housing is a severe and increasing problem as identified in the housing needs study. It impacts on all age groups and Moray Council and its strategic housing partners are making strenuous efforts to address this problem. All aspects of the LHS are relevant to Older People but strategic objectives 6 and 7 are particularly relevant for Older People with complex needs: To maximise the choice of housing support and care combinations for all special needs groups and in particular to enable all those wishing to stay at home to do so with the appropriate support where possible. To meet the requirements for special needs housing within communities for those not wishing or unable to remain in their own home but who wish to remain in their community. The main type of special needs housing provided in Moray for older people is Sheltered Housing. There are 25 sheltered housing schemes in Moray which provide varying amounts of care and support for 523 sheltered housing units. At present housing support is limited to, and restricted to specific tenure types and specific designated units i.e. sheltered units. Care is available in all tenure types and is commissioned separately from any support available through housing services. This restriction in access to support results in a potential gap in provision for some older people and does not lead to a seamless service for the individual. From a service point of view there can also be duplication and inefficiency as well as ineffectiveness. Moray is planning a combined support and care trial in two Hanover schemes with the intention that service users can be supported through to high levels of dependency as an alternative to residential provision. 33

37 Priority Ensure housing support is available through all tenure types Review of Sheltered Housing and Housing Options for Older People In 2007 The Moray Council employed a consultant to carry out a strategic review of sheltered housing and housing options for older people. Their findings were discussed with the Council and Partner agencies at a workshop. A key point from the workshop was the recognition that the majority of older people would continue to live in ordinary housing by choice. Issues associated with this were; Prompt adaptations were important There was a concern that most new build private housing was not suitable for older persons The acute shortage of affordable rented housing was emphasised Good information and advice was critical Low level practical support was important Support by people was important The workshop recognised that the current sheltered housing was valued by its tenants but that building more sheltered housing could not be justified. There was some concern over demand for some sheltered units. Some sheltered units provide Care as part of the service and it was agreed that the extension of this could be appropriate. It has been agreed that each sheltered housing scheme should be reviewed in conjunction with a review of other services in the locality. It was also recognised that the Care and Support Older people needed should not be determined by where they live. 34