Home First

Last year, a new Home First service was piloted within the Sussex Partnership NHS Foundation Trust with the aim of discharging patients in a safe and timely manner to allow them to recover in the comfort of their own homes. Fiona Dexter and Evelyn Assiak are two of the OTs involved with the Home First service and here they outline the reasoning behind this service and share the success of the pilot

Evidence has shown that people recover from physical or mental ill health quicker when they are able to recover in their own familiar environment. This wealth of evidence shows increased length of stay and delayed discharges are not helpful to an individual and can at times be damaging. Sussex Partnership NHS Foundation Trust proposed and piloted the Home First service to provide a service for older people. The similar Discharge to Assess pathway has been utilised in the physical setting of health, but it has not been explored as readily within a mental health setting. Home First is essentially part of a Discharge to Assess approach, supporting patient flow and providing up to four weeks post discharge occupational therapy intervention to patients on acute later life wards to support earlier and safer discharge. Using the Winter Pressures Fund initially, the pilot was set up for three months. Unfortunately, the time taken to recruit staff to be seconded and “backfill” into their substantive posts, and the effects of the COVID-19 pandemic, resulted in the pilot not commencing until January 2021 and being extended to five months. The Home First pilot covered East Sussex, Brighton and Hove, and West Sussex, and spanned the later life, functional, and acute mental health wards. PURPOSE OF HOME FIRST

Home First began by identifying patients on the ward who may benefit from the service and those who could work with the ward OT and staff to complete relevant assessments. The aim was to build rapport with the individual and work with them to identify support needs

and set occupational goals they would like to achieve post discharge. However, some areas of support did not become evident until the individual had returned home. Additionally, the role involved signposting to other relevant services and community support for the individual and their family and carers as appropriate. Issues that requiried support on discharge during the pilot were identified and were wide and varied. These included, support getting a cat to the vet, organising laundry, clothes shopping, food shopping, meal planning, activity and hobby planning, equipment, support with banking, medical appointments, social engagements, arranging for plumbers, locksmiths and BT engineer appointments. Four weeks of Home First input enabled the service to be responsive to issues as they arose, for example, addressing the problem of water leaking through a ceiling in an individual’s home. If this was not addressed quickly and effectively it may have led the discharge to fail due to the stress and anxiety this could have caused for the individual.

CRITERIA

Priority for the service was given to patients over 65 years old, living alone and going back to their usual place of residence, who were working with a lead practitioner. Patients on a ward outside the area could also be accepted onto the Home First caseload and passed to the Home First pilot in their area, if deemed appropriate upon discharge. STAFFING

It was proposed each area taking part would have a fulltime band 6 OT and a band 3 support worker. However, due to the challenges of recruitment and staff being able to be released for secondments, the resources and model varied across localities. Additionally, the COVID-19 pandemic affected all the wards on the pilot. All the wards taking part had issues with patients and staff contracting the virus. This, on occasion, resulted in the wards being closed to admissions, and discharges being unable to take place. The pilot was conducted at a time of the NHS being under unprecedented pressures.

The Home First pilot was taken to The OT Show as a Poster Presentation and recently won the Trust’s Positive Practice Award for Innovation

MoHost (2006) and Reqol 10 (2018) were used as outcome measures along with a patient evaluation. MoHost data indicated increased participation of service users in activities of daily living. Reqol 10 indicated significant improvements in the majority of participants. 56% of service users reported a clinically significant increase in their quality of life. The pie chart shows that the satisfaction feedback from patient/carer evaluations were consistently positive and supportive of the service.

ESTIMATED FINANCIAL SAVINGS

The Home First intervention supported 31 discharges over the pilot across three wards. This can be estimated as a total of 625 bed days saved, representing a cost saving of £270,828. Additionally, lower readmission rates for Home First service users can be evidenced against those who were discharged following the standard route, this shows the success of the service providing the right support at the right time for patients. FUTURE OF THE SERVICE

Some areas now have substantial funding for the Home First service from varied funding sources. We are proposing a full Home First service across all five later life wards, which could yield a significant cost benefit based on outcomes from our pilot data. The Home First pilot was taken to The OT Show as a Poster Presentation and recently won the Trust’s Positive Practice Award for Innovation.

If you would like to find out more about the Home First service you can contact Fiona Dexter on fiona.dexter@spft.nhs.uk or Evelyn Assiak on evelyn.assiak@spft.nhs.uk.

MO-VIS LAUNCHES NEW HID GAMING JOYSTICKS

mo-vis is delighted to announce the launch of the HID gaming joysticks – the latest addition to its growing portfolio of specialist control systems.

There are two HID models available: the Micro and Multi which enable the user to operate computers and game controllers independently despite having very limited muscular strength, which can result in reduced dexterity and movement. The Micro requires a minimum of 8.5 gr of force, while the Multi requires a minimum force of 50 gr and both models can be operated by the hand, fingers or chin. The HID joysticks have been developed for people with tetraplegia and neuro and muscular diseases as well as other advanced diseases such as amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS). Both models are a composite human interface device (HID) which means they both contain three HID classes – the HID mouse, HID keyboard and HID joystick. The joysticks connect via USB to a PC, Xbox game console, Android, iOS or any other USB host device that is compatible with HID equipment. This means the user can connect the HID interface directly to the USB port of their game console as long as there is native support. Both models are also compatible with Bluetooth adapters. mo-vis is best known for its proportional drive controls for powerchairs which have been designed for people who need the most sensitive joysticks possible, as well as for people with excessive force and everyone in between. The mo-vis Micro and Multi Joysticks, which are very small proportional joysticks have been designed for people with limited muscle strength and movement. The All-round (Light) Joystick from mo-vis is a compact version of a standard powerchair joystick which can be placed anywhere the user has easy access to and is suitable for most powerchair users as it can be used as a standard, chin or attendant joystick. Completing the joystick range is the Heavy Duty Joystick which is a large format, hard wearing, proportional joystick designed for all-round heavy-duty use. This model can be used as a hand or foot operated joystick and is perfect for users who apply excessive force. For healthcare professionals or carers looking for help with manoeuvring their clients’ powerchair the Scoot Control from mo-vis is ideal. The Scoot Control is a steering device which is compatible with most types of powerchairs and can be connected directly to the wheelchair electronics (R-net), to control the powerchair and its functions such as lights, horn and speed settings. Battery and speed information is available via LED displays. The Scoot Control is suitable for use indoors and outside. To complement the joystick range, mo-vis has developed additional devices that can help improve people’s level of mobility. The input controls systems, such as the Twisters, Actuator Keypad and Multi Switch are solutions designed to assist in operating connected devices. Other simple, but practical accessories for people using powerchairs are the Hand Warmer, USB charger and several mounting systems. The mo-vis products will be exhibited at Naidex in July through several of mo-vis’ UK dealers and distributors, including Baldertech, Permobil, Precision Rehab, Recare and others. For more information on the full range of joystick controls available from mo-vis, email: contact@mo-vis.com, call +32 9 335 28 60 or visit

www.mo-vis.com