Marketing focuses on a customer’s whole journey. The care journey for the frail is much more worrying and important.
A Five-Minute Read
Marketing drives insight by looking at a customer’s purchase and consumption journey. By understanding the decision-making process, marketeers can try to influence choice. By studying the whole consumption process they can understand customer satisfaction. A different journey was described in a new working paper from the Kennedy School of Government at Harvard. It looks at the “break points” in the journey in and out of care in the UK. Their objective was to identify the key policy leverage points for improvement. There are five of them.
Falls and Fractures
Over one third of the over 65s will have a fall in a given year. Half the over 80’s fall. The decline in muscle strength and balance with age undermines gait and stability. For those who break a hip, half will end up being dependent on others for the rest of their lives. For the rest a fall brings fear and often a restriction in activities “to be safe”.
There are solutions. The incidence of falls in Japan is one third less. There is much more of an emphasis there on exercise, including Tai Chi. Vitamin D is prescribed. There is an active campaign to deprescribe drugs, particularly those that influence concentration. Other solutions are more prosaic. Decluttering the homes of people likely to fall can have a big effect.
Unnecessary Hospital Admissions.
Older people are far more likely to be admitted to hospital once they are in A&E. Unfortunately, they are more likely to be taken to A&E. Carers and Care homes are less confident and worry about their liability. Paramedics tend to take people to hospital. GPs are less available than they once were.
There are many successful experiments to alleviate the problem. Placing a GP at the entrance to a hospital can have a big impact. Up to one third of all people can be treated and sent home. “Unscheduled Care Hubs” can dramatically reduce admissions. They are staffed by GP’s, geriatricians, specialist nurses and physiotherapists. They can solve many problems and avoid hospital admissions.
Deconditioning in Hospital
Hospitals can be seriously bad for your health. Older patients arrive traumatized. They are confused. Their immediate medical needs will be dealt with well. However, the process of being in hospital is debilitating. Physically they may be offered bad food and woken throughout the night. Mentally they lose that control over their environment. They can easily slip into “learned helplessness”. They often lose weight, and many become incontinent within a few days of being admitted.
The impact lasts beyond their stay in hospital. “Post Hospital Syndrome” means up to one fifth return to hospital within 30 days. More than half of those return visits are for a different reason than the original admission.
Delayed Transfer
The average over 65-year-old will have a discharge delay of between one to three days. This is the time between when they are medically fit and actually leaving the hospital. Often this comes because of delays within the processes of the hospital. Delays in diagnosis, delays in tests and delays in prescriptions. Discharges drop over the weekend. Often the information is not available from the care system. To assess whether a person is fit to return home the hospital needs to know what support is available.
Much is made of “bed blocking” or the occupying of beds unnecessarily. For older people this is not the real issue. All the time they are in hospital they are more likely to get secondary infections. All the time they are “institutionalized” they are losing control. The likelihood of “Post Hospital Syndrome” grows.
Temporary Intermediate Care.
For a young person returning home from hospital it can be hard work. To adapt to the normal day to day. For an older person the impact is much larger. They need help to adapt. They need specialist care. The care that “does things with” rather than “does things to”, as the report describes. They need help to rebuild their confidence in being able to run their day-to-day life. They need to be taught to take control of their lives again. For them that can be their regular carer. Working with them on everyday tasks and reassuring them. For others it may need specialists. A physiotherapist to help get the muscle tone back. For still others it may mean an intermediate stop. A return to the model of a convalescent home or a cottage “hospital”. Studies show that if effective intermediate care is put into the journey, returns to hospitals drop. So too do the moves to institutional care.
Fit for the new demographic
The number of people over 65s can only grow all over the world. The number of over 80’s is growing dramatically. The NHS was created in the UK in 1948. At that time there were less than 300,000 over 80’s in the UK. There are now 1.5m. Care costs rise dramatically with age. Economically all the changes described above make sense. All will save the very high costs of institutional care from exploding. There are shortages of people with the skills for some of these tasks. Socially allowing people to age well at home must surely be a priority.
New models are being tried all over the world. A.I. is being used to predict the likelihood of falls. Fall detectors are being installed in homes. Doctors and the NHS want to do the right thing. Prevention is a priority for the new Government. Finding the capacity to change is the problem.
If you enjoy the Newsletter please recommend it to friends and send them to Substack to subscribe. It is free. Alternatively try the button below. All the Newsletters and lots more background is on my website thebusinessofage.com