A study to examine the contribution of support workers to the delivery and outcomes of community rehabilitation and intermediate care services in England

摘要

This study aimed to identify and measure the contribution of support workers to the delivery and outcomes of older peoples' community rehabilitation and intermediate care services in England. Several methodologies were employed including a literature review, cross sectional study, prospective longitudinal study and qualitative semi-structured interviews. The cross sectional study generated data from 186 teams and 327 staff; the prospective study generated 1890 patient records, 680 patient satisfaction responses and 300 staff responses from 20 teams; and the qualitative study collected data from interviews with 150 staff from 10 teams. Results demonstrate that over 80% of teams employ support workers and that support workers are more likely to be utilised in larger teams who cater for clients with ‘medium' levels of care need and who provide care predominantly in the home. Support workers on average deliver between 30 to 40% of direct patient care and spend on average less time per patient contact than qualified professionals. There was little evidence to conclusively demonstrate an association between the proportion of care delivered by support workers and the severity of health and social needs of patients. Equally although there was a trend to suggest greater proportions of support workers within a team is associated with greater proportions of care being undertaken by support workers, this was also statistically insignificant. A greater proportion of care delivered by support workers and a greater proportion of support workers within a team were both significantly associated with improved patient outcomes (as measured by EQ-5D and TOMS) but had no impact on service outcomes (length of stay). Support workers as a group were more likely to report an intention to leave their profession and significantly lower levels of autonomy than qualified staff. Support workers also identified issues around poor career progression and training opportunities and inadequate skill utilisation. Support workers tend to carry out more ‘hands on' care as opposed to the qualified practitioner role of assessment and care planning, develop more of a ‘friendship' with clients and may be responsible for delivering more repetitive rehabilitative therapy. These qualities may partially explain why support worker input was found to enhance patient outcomes. This research shows that there is potential for support workers and qualified professionals alike to be utilised more effectively within community rehabilitation and intermediate care services.