Integrating Physiotherapy into an Adult Social Care Occupational Therapy service.

Purpose

The Occupational Therapy (OT) service at Leicester City Council (LCC) faced some difficulties when they were working with a person who required Physiotherapy (PT) input in the community. Namely the long waitlist for input and an inability to establish a person’s baseline level of mobility when this was needed before recommending care packages, equipment or adaptations. The impacts on LCC were an increased need for formal care, equipment and adaptations as well as increases in OT staff’s workloads and/or delays in picking up new cases. Additionally, the cost to the person is highlighted as delays in accessing PT input can lead to further deterioration in their abilities (dependence) and/or the need to wait longer for equipment/ adaptations which may put them at risk.

Reduction of care costs
For example, improving a person’s abilities from needing two carers to one carer leads to a reduction in cost from £476 to £238 per week saving £12,376/year.

Enabling someone to be able to make and transport a meal can save two 30-minute calls per day at £15/hour leading to a saving of £5460/year.
Reduction of the need for major adaptations
This is a cash saving to the council as well as providing people with more activity during their day which should help to maintain/improve their physical abilities.

On care costs alone, the 12-week pilot saved more money for the LA than the cost of the one FTE PT position.

Approach

A 12-week pilot of PT input in the health transfers and contact and response teams was conducted. An experienced Physiotherapist was recruited to setup the service in conjunction with the principal OT. Referral criteria, pathways and assessment forms were created for the service launch. The service was launched, and education given to the respective teams regarding the criteria and referral pathway.

To evaluate the service, we collected the following data:

  1. PT outcome measures – walking speed, balance and goal attainment.
  2. Current care needs and cost. Final care needs and cost of the person’s care needs following PT input

Current need for major adaptations. Final need for major adaptations following PT input.

Outcomes

The pilot led to the following positive outcomes:

  1. A reduction in people’s care needs
  2. A reduction in people’s need for major adaptations.
  3. Improved balance and walking speeds leading to increased independence in mobility, ADLs and community participation.
  4. Improved independence leading to subjective reports of improved quality of life and feelings of empowerment.
  5. Faster decision-making timeframes for adaptations leading to a reduced wait time for people awaiting decisions and for staff who are assessing their needs.
  6. In addition, other staff from adult social care have expressed how having access to a PT/OT has enhanced their knowledge, decision making and improved the person’s journey.

 

Case study 1
  • 83 year old female in the community
  • Dementia, communication difficulties, Anxiety (fear of falling), fall resulting in hospital admission and ongoing back pain
  • Baseline - Receiving all nursing cares on the bed with two carers, four times a day. Unable to sit for greater than 30 seconds due to pain. Unable to stand or walk.
  • Intervention – GP review of pain medications. Joint sessions with carers and family for mobility
  • Result – Reduced pain and fear of falling. walking with one assist to her chair in the lounge and engaging more in family life. Care needs halved (£476/week to £238/week).

 

Case study 2
  • 89 year old female admitted to a community assessment bed in a residential care home.
  • Fall at home. Head injury (treated conservatively). Infection and delirium
  • Baseline - Hoist transfer and two assist with bed mobility
  • Intervention - Exercise prescription, mobility practice and progression
  • Result – Now walking with one person and a frame. Care needs halved (the equivalent of a reduction of (£476/week to £238/week in the community). Discharged to her own home with an ongoing care package

 

Case study 3
  • A 76 year old female living in the community
  • Admitted to hospital following a fall and cervical spine fracture. Treated conservatively.
  • Baseline – Two assist to transfer only with the frame from bed to chair. Receiving care four times a day from two cares on the bed only. Living downstairs.
  • Intervention – Exercise prescription and progression. Progression of mobility. Patient and family education.
  • Result – Returned to upstairs living. Walking with the frame and one person to supervise in the morning but otherwise walking independently around the home during the day. Reduction of care needs {Four times a day (£238) to once a day (£79.33)}. Accessing the community with family support.

 

Case study 4
  • 76 year old female admitted to a temporary assessment bed
  • Admitted to hospital with sepsis and confusion
  • Baseline – One assist with a frame. Very anxious regarding returning home, considering long term residential placement (Cost £508).
  • Intervention – exercise prescription and progression. Progression of mobility.
  • Result – Independently walking with the frame. Discharged home with package of care which was eventually stopped as she gained full independence.

Cost and savings

One FTE (37 hours) PT position was created for the pilot.

Reduction of care costs.

For example, improving a person’s abilities from needing two carers to one carer leads to a reduction in cost from £476 to £238 per week saving £12,376/year.

Enabling someone to be able to make and transport a meal can save two 30-minute calls per day at £15/hour leading to a saving of £5460/year.

Reduction of the need for major adaptations.

This is a cash saving to the council as well as providing people with more activity during their day which should help to maintain/improve their physical abilities.

On care costs alone, the 12-week pilot saved more money for the LA than the cost of the one FTE PT position.

Implications

Direct employment of a Physiotherapist(s) by a local authority (LA) to offer targeted rehabilitation related to social care needs can lead to cost savings for the LA and improved outcomes for people accessing their services.

The PT service is ongoing in LCC and the initial scope of the input is being expanded. We are looking at areas to expand the service into based on feedback from staff, observation of cases and trials of input in other areas.

Other local authorities can consider adding this service and we know of one other LA that is looking to implement this into their service.

Top three learning points

  1. Targeted PT addressing goals related to people’s social care needs can lead to increased independence and a cost saving to Adult Social Care (ASC).
  2. People view independence differently and working towards areas where they can realistically be more independent can see improvements in a short timeframe. For example, improved balance and the provision of a way of carrying items from the kitchen to the dining table/ lounge can eliminate the need for lunch and tea calls.
  3. Measurement of service level outcomes alongside more traditional PT outcomes will strengthen service proposals when bringing these to funders.

Fund acknowledgements

The pilot was funded by the local CCG through the Better Care funding pathway.

Additional notes

For further information about this work please contact Mark Adams.