Adrian Scaife

Tunstall’s Adrian Scaife muses over a recent blog by Professor John Young about developing more proactive care for older people living with frailty.

Professor John Young, NHS England National Clinical Director for Integration and Frail Elderly, in his recent blog From FLOF to proactive care (FLOF meaning found lying on the floor) posed the question: could or should our health and care service offer more for the ‘frail elderly’ than an emergency response?

In his blog, Professor Young outlined the experience of Mrs Greenaway who had fallen and was admitted to hospital. I was moved to response because I recognise Mrs Greenaway. She is one of the silent majority who get on with their lives as best they can, would only ask for help as a last resort and are unknown to the health and care system until a crisis point is reached. I wanted to bring a little more detail to the original story and describe an alternative outcome for Mrs Greenaway.

As Professor Young said:

“…the ingredients for successful proactive care programmes for people living with long-term conditions are well understood, namely, case finding, care continuity, supported self-management and personalised care planning.”

Mrs Greenaway’s current care delivery

Having got out of bed at 2am to use the toilet, Mrs Greenaway tripped over a rug that had been there for the last 20 years while getting back into bed. She was found at 8am by which time she was cold, stiff and distressed.

A trip to A&E via ambulance resulted in a diagnosis of no fractures but she was admitted for further assessment. Unfortunately, she picked up a hospital acquired infection and her stay was extended. After seven days she was discharged back to her home feeling less confident in her abilities to remain independent and living in her own home.

Proactive care delivery

Mrs Greenaway was identified as being at potentially at higher risk by a routine case finding exercise carried out at her GP surgery. She received a visit from a new type of community worker who was empowered to complete a holistic assessment and signpost/refer to a multitude of services. In talking to Mrs Greenaway, the community worker identified a number of services that would be useful to maintain Mrs Greenaway’s independence.

  • Benefits review
  • Visit from warmer homes team
  • Home repair service
  • Befriending service
  • Falls prevention team

The falls team completed a home assessment and worked on increasing Mrs Greenaway’s balance with the objective of minimising the probability of falling. They also referred Mrs Greenaway for a technology enabled care service (TECS) solution to reduce the consequences of any falls.

  • Mrs Greenaway lost her footing and fell at 2am.
  • The alarm was raised at 2.20am at the local community alarm centre via a bed occupancy sensor and a Lifeline that identified she had not returned to bed within her usual time.
  • A responder was despatched and arrived at 2.50am, who found Mrs Greenaway on the floor and unable to get up. Using the training provided by the local ambulance service the responder assessed the situation and concluded that Mrs Greenaway hadn’t broken any bones and was safe to lift using a lifting cushion. The responder helped Mrs. Greenaway up and back into bed.
  • On Saturday morning Mrs Greenaway woke up in her own bed feeling more tired than usual but looking forward to seeing her home carer at 8am and her daughter later in the day.

@AdrianScaife is a member of the Tunstall Advisory Services team.