Balance of care model

(Not used for acute Cdx)

-1st identify groups in the elderly population with diff care needs ,e.g. As defined by their dependencies But number of resources required gives no indication as to whether this resource is appropriately targeted to those who require it thus

-2nd step; relate information on services to level of dependency. the population Working definiton of dependency based on 2 different dimensions; 1/incapacity of individual ( physical, mental , incontinence level) 2/level of informal support ( family /friends) that is available to them)

-Each combination of dependency defines a dependency group -packages of care defined by dependency group & incl type of resource + standards as to the amount of each type

3rd step gather info on or estimate -using methods chap 7 -a) numbers of people in the population for each dependency group ( local data) & b) Amounts of each resource available

The logic of the model is essentially as follows: 

1/Define a set of dependency groups of patients that are similar to each other in terms 

of their needs for care. 

2/For each dependency group: 

(a) develop alternative modes of care, defined by packages of resources (some 

better than others, but all acceptable); 

(b) estimate numbers in the group to be found in the population served. 

3/For each mode or package of care: 

(a) identify the resources involved; 

(b) agree standards – how much of each resource is needed for each mode; 

(c) agree 

preferences – rank the different modes for each group in terms of desirability. 

4/For each resource: 

(a) determine costs per unit of resource used; 

(b) identify constraints in terms of how much of each resource is available (upper 

limit) and/or what must be used (lower limit). 

5/Identify performance criteria. The Balance of Care model uses: 

(a) coverage – proportion of dependency group receiving any appropriate care 

package; 

(b) quota – numbers with preferred service; 

(c) numbers with any service. 

Arguments in favour of using the Balance of Care model at the local level. 

imp strength is its  its logic and structure. 

This has provided a framework for: 

(a) bringing together the many different agencies and professions involved in providing long-term care for elderly people and stimulating substantive discussions 

about how to define dependency groups and alternative modes of care for each group; 

(b) taking population needs, rather than particular resources or services, as the starting point for planning; 

(c) pulling together and organizing existing information, and identifying needs for additional information.

The fact that the model runs fast on a personal computer has the advantages of: 

 (d) responsiveness. Once the model has been set up, it is possible to evaluate a range of planning scenarios quickly; thus it is possible to try out a planning idea, look at the results, and make successive revisions until a satisfactory balance is achieved. 

(e) portability. The model can be used in different people’s places of work; results can be projected onto a large screen, so that there can be widespread participation in the planning process, which is desirable when so many agencies are involved. 

2 Potential problems and weaknesses. 

These fall into two categories: problems with data and problems with the process. 

Problems with data include the following: 

(a) Collecting local primary data can be costly and time-consuming. If data collection takes a long time, this can lead to planning blight in which even the most obvious planning decisions are not made because the decision makers are ‘waiting for the 

model’. 

(b) The model provides age- and sex-specific rates for each of the dependency groups from several representative areas. These can be applied to the demographic structure of the local population to get round the need for local data.

But very little is known about the accuracy of estimates based only on these two factors and how much real needs vary from one area to another. 

(c) In practice, each additional case cared for in a particular mode will not involve the same marginal cost.

However, the model’s linear approach to cost estimation 

Models for service planning and resource allocation 

 ignores effects such as returns to scale and cost triggers (such as opening a new ward or taking on an additional member of staff). Arguably this is more of a 

problem with using the model for local than for regional or national planning. 

Problems with the process include: 

(d) Meetings required for real collaboration are time-consuming; senior staff may not give the necessary time; juniors may not have the necessary authority to 

commit their organization to any resulting plans. 

(e) Any model of this kind requires estimates of the amounts of resources necessary to provide care of an acceptable standard within each mode (care option). Although experience with the model suggests that it is generally possible to establish a consensus on this,

there can be difficulties, particularly if there is a lack of goodwill or if certain provider agencies are trying to gain an advantage. 

It is commonly argued that as a basis for providing care for individuals, these groups are too crude; two people in the same group could have very different needs for care. But this is a planning tool, not a set of treatment guidelines.