Are we using support workers effectively? the relationship between team characteristics and support worker utilisation in older peoples community based services in England

Objective: To examine whether patient and/or team characteristics are associated with support worker contribution to staffing activity. Design: A prospective longitudinal study involving 20 older peoples’ community rehabilitation teams capturing the staffing mix of each team; patient health status, dependency and demographic information; and staff activity data for the duration of care for all new referrals to each team over a three month recruitment period. Subjects: 462 staff (367 qualified, 155 support) and 1913 patients from 20 older peoples’ community rehabilitation teams. Measures: Therapy Outcome Measures (TOMs), EQ-5D and Level of Care need measured patient admission health status and dependency. Proportions of care delivered by support staff were calculated using staff activity data for each patient admitted to the study. Results: Support workers deliver up to 36% of direct patient care and spend less time per patient contact (35.95 mins, SD 37.68, range 0-600) than qualified professionals (75.76 mins, SD 32.85, range 0-334). A higher proportion of input from support workers was found to be associated with decreasing patient dependency at admission (5% increase in face to face support worker time for every 0.1 unit increase in EQ-5D, 95% CI 0.3-9.6, p=0.038), older age (2.0% increase in support worker time spent with patient for each increase in age of 10 years, 95% CI 0.6-3.4, p=0.006) and being female (females have an additional 5.1% of their total contact time with support workers compared to males, 95% CI 1.9-8.4 p=0.002). Other significant factors included referral source, intensity of care, usual living arrangements and proportion of support staff in a team. Conclusion: Support workers deliver a high proportion of care to older people in the community and do so according to a number of patient and team level factors potentially enabling more target use of both qualified and support worker time.