Without Home First , it would have felt like I was dropped on the doorstep .”
‘ Perhaps they had needs around further equipment , or telecare , or support packages ,’ she explains . ‘ Those people that were struggling with activities of daily living or had history of self-neglect . And then it was about working with them to look at assessing and re-enabling interventions and getting them into their own homes .’
Although the trust had occupational therapists on its acute wards that were already doing that work at the early stages , Teresa says : ‘ What we were finding was that they didn ’ t have the scope to be going out to the patient ’ s home and continuing that piece of work after discharge . So that was where the big difference was .
‘ It was about looking at how we might prevent the individual ’ s loss of skills and , if they were working with carers , doing some work alongside them , making sure their environments were safe , and supporting with appropriate packages or equipment , retraining , or compensatory techniques . Whatever we needed to do .
‘ And then also thinking about how they might integrate back into community activities and really support them in accessing those , as opposed to just making that referral .
‘ Occupational therapists on the ward just wouldn ’ t have had the scope or capacity to do all that additional work .’
Giving that extra occupational therapy support – for up to four weeks in the person ’ s own home – helped the team to get people off the wards and home quicker , but also helped to prevent readmission .
Teresa says : ‘ When we looked at our readmission rates , there were far less people coming back onto the acute wards .’
Amazingly , Gemma says that the readmission rate was 4.3 %, in comparison to 10.6 % for a standard discharge . She adds : ‘ Our community mental health teams don ’ t always have occupational therapists . Where we do , quite often they are doing generic work , so there wasn ’ t capacity for post-discharge follow up .
‘ So , the Home First occupational therapists are working very closely with lead practitioners in the community mental health teams as well , to support that discharge .’
The project was extended further and the data is impressive . Between January and November 2021 , the Home First occupational therapists supported 62 discharges and saved an average of 28 bed days per patient . In financial terms , this equates to just over £ 500,000 of bed days saved .
Successes and looking to the future
Service user feedback led to the team receiving very positive comments , with themes clustered around people feeling they had been listened to , valued and supported , with staff helping to allay any concerns they had .
Particular concerns tended to be around people ’ s fear of transition to home , however people fed back that Home First helped with both the transition and them being able to manage on their own . In general , the home visits were positively received and staff were complimented on their compassion and kindness .
Gemma concludes : ‘ The original pilot was for three months and , in part due to the impact of the pandemic , it was then extended to six months , across three wards . When that finished , we completed an evaluation and presented back in our respective areas .
‘ What happened was each area did something slightly different with it , and what Teresa and I are working on with the rest of the group is , how do we get an overarching strategic approach to using Home First ?
‘ It still exists two days a week in West Sussex and in East Sussex there are two full-time substantive posts linked to our acute wards .’
Teresa adds : ‘ What we need to do is get a consistent funding stream for all our later life wards that is the same across the trust .’
‘ You catch us at a really interesting time ,’ Gemma exclaims . ‘ The conversation keeps going and there has been a lot of key learning for us , as occupational therapists , about : How do you promote the work ? How do you talk about it ? How do you make sure it ’ s in all the right forums and align it ? How do you really demonstrate impact in a way that people can hear ?
‘ So we have had to do an awful lot of learning around showing cost benefits and projected cost benefits , and that ’ s been a really interesting learning curve for us .
‘ One of the biggest challenges has been about being in the right place at the right time . Again , you ’ re not always invited to where you need to be , so we ’ ve had to be good at politely stepping in and saying “ We can help out here ”.’
Gemma goes on to add : ‘ It ’ s really powerful how our ward consultants and the multidisciplinary team have taken this on .’
18 OTnews June 2022