What is Complex Care? 

Complex care is important because it addresses the needs of individuals with multiple, chronic, and often serious health conditions that require coordinated, ongoing medical and social support. These individuals are often referred to as high-need, high-cost (HNHC) patients or individuals, typically facing significant health and social care challenges that may involve physical, mental, and social factors. 

 1. Improves Health Outcomes 

• Complex care ensures that individuals with multiple health issues receive personalised, coordinated treatment plans, which can improve their overall health and wellbeing.
• It helps manage chronic conditions such as diabetes, heart disease, mental health disorders, and others more effectively, reducing complications and improving quality of life. 

2. Prevents Medical Complications 

• Without proper care coordination, individuals with complex needs may experience gaps in care or conflicting treatments from different providers, which can lead to medical errors or exacerbation of conditions.
• Complex care programs focus on early detection of potential complications, preventing unnecessary hospital admissions. 

3. Cost Efficiency 

• By providing comprehensive and integrated care, complex care helps reduce the need for expensive interventions, such as repeated hospital admissions or long-term emergency care.
• Focusing on proactive and preventive care reduces overall healthcare costs by minimising the use of high-cost healthcare services. 

4. Addresses Social Determinants of Health 

• Complex care considers not just medical needs but also social factors, also known as the social determinants of health, like housing, access to food, transportation, and income, which can equally impact a person’s health.
• These programs often work with social services and social care as well as health care professionals in a multidisciplinary team to address these determinants, creating a more holistic approach to health and social care. 

 5.  Enhances Quality Care 

• Individuals with complex care needs can easily become overwhelmed by navigating different health and social care providers and services. Complex care programs provide a more streamlined, person-centered care experience, improving communication between providers and individuals.
• Having a dedicated care team improves trust and the overall experience of care for patients and their families. 

6. Reduces Caregiver Burden 

• Families and caregivers often play a central role in managing the care of individuals with complex needs. Complex care programs provide support and guidance to reduce the emotional and physical strain on caregivers. 

Complex care management (CCM) is a structured approach that involves coordination across health and social care providers and services to deliver personalised care. The goal of CCM is to improve the quality of life for individuals with intricate health and social needs, reduce hospital admissions, and ensure that care is aligned with the individual’s preferences and goals.  

Complex Care Characteristics – What are they? 

To deliver better quality complex care, there are multiple types of characteristics health and social care providers must be aware of:

• Person-Centered: Complex care puts the individual at the centre of the care process. It focuses on their strengths and goals and builds relationships that enhance their wellbeing.
• Equitable: It recognises systemic barriers to health and social care, working to ensure that all individuals receive care tailored to their unique situations.
• Cross-Sector: It integrates multiple fields of care, from medical to behavioural and social services, to provide comprehensive support.
• Team-Based: It involves a collaborative multidisciplinary team, including medical professionals, behavioural health specialists, social care professionals, and social service providers, ensuring a whole-person approach to care 

People requiring complex care can have a wide range of conditions, including but not limited to: 

• Neurological disorders such as Parkinson’s disease or Huntington’s disease.
• Spinal cord injuries or acquired brain injuries.
• Chronic mental health conditions requiring integrated mental and physical healthcare 

There are many benefits of complex care due to addressing the physical, mental, and social needs of an individual. Some of the biggest benefits when complex care plans are delivered effectively are listed below: 

• Reduced Hospital Admissions  

One of the most significant benefits of complex care is the reduction in hospital admissions. By having skilled, experienced health and social care professionals in place, the likelihood of unnecessary emergency visits are minimised.  

•  Improved Outcomes  

Individuals receiving complex care often experience better health outcomes as there is a better and more proactive management of their condition or conditions. As a result, health and social care professionals also have more manageable workloads preventing stress, burnout, and the high staff turnover.  

• Better Personalised Care  

Ultimately complex care offers tailored services that adapt to the individual's evolving needs. Regular assessments allow for timely updates to the care plan, ensuring that the individual receives appropriate care throughout their life and care adapted to their preferences so they are involved in their care decisions to increase independence and provide them better quality care.  

Delivering complex care comes with a range of challenges due to the multiple needs and conditions individuals can live with. This, in turn, means care coordination is required among multiple care providers and services. Below are some key challenges in delivering effective complex care: 

1. Care Coordination Across Multiple Providers 

Individuals with complex care needs often see numerous specialists, primary care physicians, and social care providers. Ensuring that all these parties communicate effectively and provide a unified care plan can be challenging. This can be exacerbated further by gaps in communication, duplication of services, and sometimes even missed opportunities for care.  

2. Fragmented Health and Social Care Services  

Another key challenge occurs when there is limited integration between health and social care services as this makes it harder to establish person-centred care plans that both reflect the needs and preferences of the individual. Gaps in digital literacy and technological barriers can further complicate this lack of coordination.  

3. Limited Access to Resources  

Many individuals requiring complex care face barriers in accessing their needed services including transportation, housing, and medications, as well as home care support. 

More remote areas are at more risk of receiving the specialist care required, limiting the effectiveness of complex care programs.  

4. Provider Burnout  

Another key challenge most social care professionals also experience is the high dependency on social care, especially when one is discharged from the hospital. This leads to high caseloads and administrative burdens, when workloads are already high and many care workers are already suffering from burnout or stress.  

In fact, in 2022-2023, approximately 390,000 adult social care workers in England left their roles. Of these about one-third left the social care sector altogether. This high turnover rate reflects ongoing challenges in the industry, including low pay, limited career progression opportunities, and the demanding nature of the work. 

5. Funding Challenges  

Ultimately the low budgets but increasing demands is another key challenge when managing complex care. Many complex care programs rely on government or grant funding, which can be inconsistent or vary by region. In some areas,  

Value-based or outcomes-based care models, while promising, have not been universally adopted, and fee-for-service models may not reward the time and coordination required for complex care. 

Overall, delivering complex care requires overcoming systemic, financial, logistical, and cultural barriers to provide coordinated, person-centered care that addresses not just medical needs but also social and psychological challenges. 

With the growing need for efficient and effective care management in the complex care space, software solutions have digitally transformed how care is delivered.  

Care management software, for example, has revolutionised how providers manage, monitor, and deliver complex care services. These solutions not only streamline communication among healthcare professionals but also ensure that care plans are consistently updated and followed. 

Care management software from providers such as Access Workspace for Care offers a complete framework to support the delivery of complex care with multiple solutions all located within one platform, from care planning to care compliance.  

Below are some ways that Access care management software can transform the complex care landscape: 

1. Comprehensive Care Plans 

Creating and maintaining care plans is a central component of complex care. With Access care planning software, providers can develop personalised, data-driven care plans that are accessible to all members of the care team. This allows for real-time updates and ensures that care providers are always operating with the most current information about an individual’s condition to enable care plans to be adapted accordingly when needed.  

2. Proactive and Preventive Care 

Through investing in digital solutions, social care teams can shift away from delivering more reactive home care and instead deliver better proactive and preventative care. 

Through built-in reminders and scheduling tools, our care management software allows providers to stay on top of necessary interventions such as medication refills, specialist visits, or preventative screenings.  

At the Access Group, we also go one step further by offering our Access Technology Enabled Care (Access TEC) ecosystem which enables data to be turned into actionable insights. As a result, social care providers and the wider care circle can be notified of changes in an individual’s behaviour or health before something more critical takes place. By setting up smart alerts, individuals can be left reassured they can remain living independently with 100% confidence support will be there when needed. 

Here proactive care reduces the likelihood of exacerbating complex care conditions that could lead to hospitalisations or emergency interventions, as well as speed up discharge delays by offering safer places for individuals to be discharged to instead of depending on residential care homes, which as a result, helps to reduce pressure on both health and social care professionals.  

3. Data-Driven Decisions 

Complex care is data-heavy, involving multiple sources of information such as medical histories, treatment records, and social determinants of health. Access care management software leverages data analytics to provide insights into outcomes, allowing providers to make informed decisions about care adjustments.  

Our Access Medication Management, for example, enables better risk assessments to be conducted by understanding what medications are administered to individuals throughout the day and what side effects that causes them, for example, dizziness which could influence how they live their daily lives. As a result, schedules and visits can be organised to ensure individuals receive the right care at the right time.  

Equally, it allows social care providers to record administration accurately and get alerts when medication is missed, all through our easy-to-use mobile app, Access Point of Care, so no one ever goes without the care and support they need whilst helping them keep to their routines and prevent any severe side effects from missed or late medications.