Week 6: Living well with complex, long-term conditions

Learning Objectives

• Understand the changing context of care and the promotion of well-being.

• Be able to explain what positive risk-taking is and discuss its application to

healthcare.

• Understand care and services with a focus on lay care and community

resources.

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Contents
Learning Objectives ........................................................................................................................ 1

Introduction ..................................................................................................................................... 3

Changing contexts of care ........................................................................................................... 3

Promotion of health and wellbeing, ............................................................................................ 4

Intermediate care ......................................................................................................................... 5

Person-centered approach ........................................................................................................... 5

Positive risk taking ...................................................................................................................... 6

Reablement .................................................................................................................................. 6

Community resources and services ............................................................................................. 6

References ....................................................................................................................................... 9

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Introduction

Even though having excellent genes and having access to healthcare are crucial, neither of these

guarantees good health. Sala-Hamrick et al. (2021) noted that a variety of factors, including age,

diet, physical activity, cigarette smoking, social contacts, and living environment, all have an

impact on our health in the long run. According to Harris and McDade (2018), both the health of

people and the health of our communities is a reflection of the complex interplay between our

biological, psychological, social, intellectual, spiritual, and political circumstances.

The investigation of national and international perspectives with regard to the interaction

between changing care environments and the promotion of health and wellbeing has been a

defining feature of the process of promoting and enhancing the health of individuals and the

community at large (Shahzad et al., 2019). Promoting well-being involves helping people with

complex needs and chronic diseases safely carry out daily tasks like self-care or activities of

daily life. In order for them to feel securely capable of completing what they wish to do on their

own and to ensure that risks are acknowledged and managed appropriately, it also entails talking

to them about risk in a way that is not discouraging (Cramm and Nieboer, 2016).

Changing contexts of care

Between 2005 and 2014, the number of people in England aged 65 and older increased by almost

a fifth, with the oldest age groups witnessing the most dramatic growth; within the same time

frame, the number of people aged 85 and over increased by slightly less than a third (Cingano,

2014). The population of England and Wales has continued to age, with Census 2021 results

confirming there are more people than ever before in older age groups. Over 11 million people –

18.6% of the total population – were aged 65 years or older, compared with 16.4% at the time of

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the previous census in 2011 (ONS, 2022). The number of individuals 65 and older is expected to

increase by almost 50% between 2015 and 2035, while the number of people 85 and older is

forecast to nearly triple, according to predictions produced by Mortimer and Green (2015) and

the Office for National Statistics (2015). The Health and Social Care Information Centre (2014)

reports that as people age, they are more likely to experience chronic sickness, various medical

issues, disability, and frailty.

In response to the demographic shifts, policymakers hope to move more elderly care out of

hospitals and into community settings, including people's homes (Edwards 2014). The changes

have taken many different forms, such as operating outreach clinics out of hospitals, upgrading

primary care physicians and nurses' skills to take on more specialized work in the community,

and acting more proactively to identify and support people with long-term conditions who may

be at risk of hospitalization. It has been thought that providing treatment outside of hospitals

might improve patients' experiences with care while also relieving burden on hospitals and

lowering expenses to the tax payer (Kieft et al., 2014).

Promotion of health and wellbeing,

Health promotion is defined as the deliberate alteration of health-related habits and life situations

through a range of individual, interpersonal, and population-level changes, using the ecological

viewpoint as a point of reference (Sweeney and FitzGerald, 2017). The link between individuals

and their physical and social settings is highlighted by the ecological viewpoint on health

promotion. For behaviors and conditions pertaining to health, there are three degrees of

influence:

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(1) The intrapersonal level: These include attributes like knowledge, attitudes, beliefs, and

personality factors that affect behavior.

(2) The interpersonal level: These are the main social identification, support, and role-definition

groups, which include family, friends, and peers.

(3) The size of the population. Institutional or organizational considerations, social capital

elements, and public policy variables are all included in this level.

Resources and services for health promotion include time-bound, scheduled, structured activities

and events with the goal of assisting people in making educated decisions about their health.

Additionally, at various levels of the community, government, and organizations, health

promotion resources and services encourage legislative, organizational, and environmental

improvements (Kumar, Deshmukh and Adhish, 2014). The interventions are designed to achieve

specific objectives that will improve the health of individuals as well as, potentially, all

individuals at a site. Community level Health promotion services (community nursing;

community hospitals; community therapy services; outreach services; community matrons;

specialist nurses) are designed to take advantage of the pivotal position of their setting within

schools, workplaces, or health care organizations, to reach children, adults, and vulnerable

families by combining interventions in an integrated, systemic manner (Kuo et al., 2021;

Melariri et al., 2022).

Intermediate care

Gradinger et al. (2020) defined intermediate care as a range of integrated services aimed at

facilitating timely discharge from hospitals, promoting faster recovery, minimizing unnecessary

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hospitalizations, preventing premature admissions to long-term care, and maximizing

individuals' ability to live independently. Typically, these services are delivered for a duration of

up to six weeks, often lasting only one to two weeks. Four service models for intermediate care

include reablement, crisis response, home-based intermediate care, and bed-based intermediate

care.

Person-centered approach

According to Edgar, Wilson & Moroney (2020), The person-centred approach focuses on placing

the individual at the core of their support and goal planning process. This approach revolves

around identifying and utilizing their strengths, addressing their specific needs, considering their

preferences and priorities. It entails treating the person as an equal partner and exploring the

potential benefits of intermediate care, irrespective of their living situation, socioeconomic

status, or health conditions.

Positive risk taking

Involves balancing the positive benefits gained from taking risks against the negative effects of

attempting to avoid risk altogether (Newman. 2022).

Reablement

According to Clotworthy, Kusumastuti and Westendorp (2021), reablement is a form of

assessment and intervention offered to individuals in their home or care facility, with the

objective of assisting them in regaining skills, building confidence, and enhancing their

independence. Typically, these interventions span a duration of up to six weeks. Reablement

services are provided by a multidisciplinary team, often led by social care practitioners.

Embracing risk-taking is an essential aspect of human progression that fosters personal growth

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and development. Positive risk-taking empowers individuals with complex needs and chronic

conditions to make choices regarding their safety and pursue their goals.

Community resources and services

In numerous countries, the community care sector, with a particular focus on nurses, plays a

crucial role in managing the care of older individuals with chronic conditions in their homes,

thereby alleviating pressures on secondary care services. Nurses are responsible for delivering

personalized patient care through comprehensive assessments. Furthermore, it is expected that

nurses also provide reablement services, although this is not a formal component of community

nursing in the United Kingdom (National Academies of Sciences et al., 2021b, 2021a).

Reablement services, typically provided by occupational therapists and commonly integrated

within social care, encourage individuals to independently carry out tasks whenever possible. It

is important to differentiate homecare reablement services from other community rehabilitation

services, such as home-based intermediate care, which tend to have higher staffing ratios of

healthcare professionals including nurses and therapists. Occupational therapists deliver short-

term homecare to facilitate recovery after hospital discharge, supporting patients in regaining the

ability to perform daily activities such as dressing and meal preparation. The primary goal is to

enhance patient independence through individualized goal setting (Whitehead et al., 2014).

Community nursing services are indispensable within the NHS, often being the determining

factor in enabling individuals to remain well at home rather than transitioning to residential care.

With an aging population and a rise in frailty and chronic conditions, coupled with a policy focus

on shifting care from hospitals to community settings, district nursing assumes a crucial role in

the present and future of healthcare (Baillie et al., 2014; Sun et al., 2023). Community nursing

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services encompass a wide range of nursing interventions provided in patients' own homes,

playing a significant role in promoting independence, managing long-term conditions, and

preventing/treating acute illnesses (Mah et al., 2021). Common services delivered by community

nursing include medication reviews and administration, bowel care, advice and support, end-of-

life care, continence management, health education, injections, intravenous therapy,

monitoring/screening, general nursing care, nasogastric tube feeding, pain control, percutaneous

endoscopic gastrostomy feeding, phlebotomy, prescribing, pressure area care, referral to other

services, risk assessment, skin care, urinary catheterization, ongoing catheter care, wound care,

among others. These services cater to various needs but are often required by vulnerable

populations such as disabled adults, frail older individuals with long-term conditions, and those

nearing the end of life (Skilbeck, Arthur and Seymour, 2018).

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References

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Cingano, F. (2014) Trends in Income Inequality and its Impact on Economic Growth. OECD
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Clotworthy, A., Kusumastuti, S. and Westendorp, R.G.J. (2021) ‘Reablement through time and
space: a scoping review of how the concept of “reablement” for older people has been defined
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