Changing Life Paradigm: Case Conference

Ageing process has no gender or ethnic boundaries hence the baby boomers are entering the care systems (Evandrous et al 2001; Lewis 2007).Thus, demographic change brings with it a number of factors underpinning our relationships with holistic functional activities of daily living, the family and the wider society. The outcome of these could sometimes lead to a changing life paradigm such as disabilities, frailty, chronic health conditions, long-term hospital admission and increasing demand for care giving.

The presumption in practice is that older people are likely to spend more time in acute hospital bed and that could contribute to delays in future hospital admissions and escalation of costs in all cost centre. Therefore, good practice promotes the need for and potential of case conference. Community care for adults and older people is multidisciplinary dimension and depends on good teamwork between the different disciplines involved. Good teamwork could be accelerated by good communications – horizontal, vertical and liaison to all concerns. To that endeavour, case conferences are to be held on a regular basis to discuss patient's progress and discharge plan. This forum needs to involve individuals and professionals such as the patient/family member, the patient's consultant/doctor, primary nurse, physiotherapists, occupational therapists, social workers, community nurses and representative from provider agency.

Ideally, the case conference team discusses the patients' progress in their individual fields and considers any problems that may arise on discharge. In this way, domestic problems can be overcome before discharge and the patient can be discharged safely as soon as he/she is medically fit to go home. In the process, the community services will have already been notified and can ensure that care is arranged and can commence as necessary. However, where physical and environmental factors are uncovered, there is a need for a home visit super headed by an occupational therapist, accompanied by physiotherapist, social worker, the patient/family members and sometimes a representative from provider agencies. This procedural practice helps to address potential difficulties that could slowdown planned hospital discharge.

Good Practice

Good patient/service users' care plan would right from onset look at the potential of home visit as a complement to case conference and that harnesses smooth hospital discharges for example:

It reduces revolving hospital admission syndrome.
It reduces potential accident at home.
It reduces potential care breakdown at home.
It reduces blame culture between health and social care.
It minimizes health and social care costs.
It enhances support systems for informal caregivers.
It reduces complaints from family members against poor quality of care.
It would reduce pressure on A&E.
By contrast, social work practice observations reveal that, case conference is sometimes a Cinderella service hence some hospital Consultants/doctors and clinicians tend to exert professional power over social workers and discharges patients/service users with a view to create bed vacancies. Power imbalance is one of the recipes, which has heightened revolving hospital admission syndrome, and exacerbation of costs in both sectors. In summary, case conference is a remedial strategy that should form the bedrock of effective hospital discharges (DoH 2003; Lymbery 2003, 2004; Ugwumadu 2011).

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