Community Medicine Flashcards
What is a community hospital?
Community hospitals provide a wide range of services including in-patient rehabilitation, outpatient consultations in major specialities such as child health, dental services, therapy and rehabilitation services, minor injuries, minor illness, phlebotomy, sexual health clinics and other out-of-hours treatments
What does domiciliary care involve?
Regular home visits from a fully trained care worker, from 30 minutes through to several hours a day, can be arranged to help you with a wide range of everyday tasks, including:
Personal and continence care
Managing medication
Helping to mobilise in and around the home
Household tasks and meal preparation
Clinical care, including catheter and stoma management and PEG feeding
POC tends to be OD to QDS
What is rehabilitation?
The restoration, to the maximum degree possible, of an individual’s function and/or role, both mentally and physically, within their family and social networks and within the workplace where appropriate.’
Which members of the MDT team might be involved in rehabilitation?
Doctors
Nurses including CNS
HCAs/support workers
OTs
PTs
SALT
Social workers
Pharmacists
What is community geriatrics?
Community Geriatrics deals with frailty and the management of long-term conditions. It forms an important element of the healthcare for older people with frailty. Its emphasis is on ensuring that older people with complex health problems receive expert care within the community, whether at home or in a care home. Community Geriatrics is also concerned with interface geriatrics, i.e. the interface between primary and acute phases of the patient’s journey. Community geriatricians often support community-based multi-disciplinary teams and intermediate care services.
Alternatives to the acute hospital setting?
Community hospital or general practitioner bed
Nursing home—immediate access for short term care
Nursing home (elderly mentally infirm)—immediate access for short term care
Respite care home—immediate access for short term care
Residential home—immediate access for short term care
Hospice
Urgent referral for outpatient treatment or investigation—same day (including x ray)
Urgent referral for outpatient treatment or investigation—next day (including x ray)
Urgent home visit by consultant—within 48 hours
Intensive home support—provided within 2 hours
Intensive home support—provided within 12 hours
Less intensive home support—provided within 12 hours
Continuous minor social support in the home—provided within 2 hours
Interaction of health and social care in the provision of long term care
Integrated care systems (ICSs) are partnerships of organisations that come together to plan and deliver joined up health and care services, and to improve the lives of people who live and work in their area.
The include:
Local authorities
Integrated care partnership (ICP)
Intergrated care board (ICB)
Place-based partnerships
Provider collaboratives
What is the aim of an ICS?
improve outcomes in population health and healthcare
tackle inequalities in outcomes, experience and access
enhance productivity and value for money
help the NHS support broader social and economic development.
What is NHS continuing healthcare?
NHS Continuing Healthcare (NHS CHC) is a non-means tested package of care for adults aged 18 or over which is arranged and funded solely by the NHS outside of the hospital.
In order to receive NHS CHC funding individuals, have to be assessed by integrated commissioning boards (ICBs) according to a legally prescribed decision making process to determine whether the individual has a ‘primary health need’.
What is meant by Discharge To Assess?
Where people who are clinically optimised
and do not require an acute hospital bed, but may still
require care services are provided with short term,
funded support to be discharged to their own home
(where appropriate) or another community setting.
Assessment for longer-term care and support needs is
then undertaken in the most appropriate setting and
at the right time for the person.
Within Discharge to Assess, assessments take place in the community after patients have been discharged from hospital
What are the DtA pathways?
Pathway 0 – Non-complex discharge
Pathway 1a – Reablement, Social Services, Volunteer, Warmer Homes
Pathway 1b – Acute and Community Therapy
Pathway 1c – End of Life care (EOL) and Fast-Track
Pathway 1d – Medicines Management and Nursing
Pathway 2 – Intermediate Care
Pathway 3 – 24-hour care placement (permanent or temporary)
What is nursing home care?
Nursing homes provide skilled nursing care for patients who cannot live at home without 24-hours supervision, but who also do not need to be hospitalized. Stays in nursing homes may be lengthy or short-term, but making sure that patients get good quality care is essential for wellness, comfort, and overall health.
What is residential home care?
Residential care refers to long-term care given to adults or children who stay in a residential setting rather than in their own home or family home. There are various residential care options available, depending on the needs of the individual.
Service users are care for onsite by carers but not nurses (although may be regularly visited by district nurses)
What is intermediate care?
Intermediate care is care provided to acute care patients who are medically stable but too unstable to be treated in alternative healthcare settings such as home, ambulatory, or traditional skilled long term care
Who is responsible for paying for long term care?
In general the local authority is responsible for:
- The assessment of an individual’s care needs, such as their needs for nursing care; and
- The assessment of an individual’s ability to pay for their care.
Each local authority will have a maximum rate they will contribute based on the type and level of care needed. Where the cost of the individual’s chosen care home exceeds the local authority maximum rate, the individual or their family will be required to meet the excess. The local authority will also look to recover some or all of the costs from the individual based on a financial assessment of their income and capital.
The Government has proposed new changes for social care funding in England for those entering care from October 2023. There will be a new cap of £86,000 on the amount anyone will need to spend on their personal care (excluding accomodation costs) over their lifetime.
