Physiotherapy at Home reduces care costs by over 65%

Case study Reablement & physio, Patient experiences 30th Dec 2022

In Fred’s case this intensive physiotherapy resulted in a happier patient, roughly a 65% reduction in care and a saving in care costs of over £1,000 per month.

Fred (not his real name), who is in his 80s, lives at home with his wife. In recent years he has had multiple health problems and in September 2021 had a bad fall and was admitted to hospital. Fred’s son, says that his father then contracted Covid several times. At one point the family were called to the hospital as doctors thought Fred was near the end of his life. When, in April 2022, Fred was discharged home his Barthel score was 15, indicating total dependency. Care was provided by a domiciliary care agency and he needed two carers, three times a day, seven days a week. In May, Lewisham Adult Therapy Team (LATT) referred Fred to HomeLink Healthcare to provide physiotherapy support 

Shirley Forson, HomeLink Healthcare’s Clinical and Operations Lead for Therapies, says: 

“We first supported Fred from May to mid-June and were commissioned to provide six double-handed physiotherapy sessions. The goal was to improve his sitting balance and to enable him to use a Sara Steady with the assistance of a single carer, as he was previously mobile with a Zimmer frame. At the end of six sessions he was discharged having made a small gain, but given the limited number of sessions he didn’t progress as much as he could have done.” 

"The more independent dad can get the better. Originally, he had two carers three times per day. Now one carer comes three times a day Monday to Friday and we don’t have anyone at the weekends."
- Fred’s son

Fred was then readmitted to hospital in June with an unrelated health condition. When, after 10 days, he was discharged and referred back to HomeLink Healthcare. His mobility had deteriorated and he was “totally bed bound”.  

Shirley says:  

“We completed another six double-handed sessions, lasting until mid-July, with the same goals as the first time. Again, progress was limited.” 

Fred was then hospitalised once more and when discharged in August, was referred back to HomeLink Healthcare for a third time. We then supported him for a longer period, discharging him on November 4th after 28 sessions. This time, there was real progress.  

Shirley reports that during this third referral:  

“Fred went from being bedbound, needing double handed support and assistance with everything, to using a walking frame on his own with just someone around to give him reassurance. He can get to the commode by himself and can now get to sitting on the bed on his own, whereas previously he needed two people to help. He can also transfer on and off the stairlift with one person’s assistance, so can once again access both levels of his house.”  

Fred’s Barthel score went from 15 to 74, indicating a massive change to quality of life and independence. Furthermore, his mood has improved and he feels better about his health. HomeLink Healthcare uses the EQ-5D-5L self-assessment, health related, quality of life questionnaire. This measures quality of life over five categories: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each category is rated out of 5, with a score of 5 indicating very poor  and a score of 1 being very good. Fred’s scores improved significantly across all 5 domains as shown in figure 1 below.  

Fred's EQ5D5L score Figure 1: Fred’s EQ-5D-5L score

Shirley says: 

“EQ-5D-5L also has an overall health rating, which asks ‘How good or bad do you feel about your health’ (0 = 0 terrible, 100 fantastic). Fred started at 30 and ended up at 100.”  

This is an atypical case. Shirley says that in the LATT service therapists usually only see patients three times due to staff availability and referrals to HomeLink Healthcare are typically limited to six sessions. It demonstrates, though, that a greater investment in therapy earlier on can improve patient outcomes and reduce costs in the longer term. 

Alex Negurita Community PhysiotherapistAlex Negurita, Community Physiotherapist for HomeLink Healthcare says: 

“Fred made huge improvements between his physiotherapy sessions. It helped that he was so motivated and he really engaged with the exercises in and between sessions. I was impressed with what he was able to achieve, and I am pleased to have been able to help him to become more independent. I wish him and his family the best of luck for the future.” 

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