The SAIATU Project provided in-home social support services to complement palliative clinical services for individuals with advanced terminal illnesses and their families. It aimed to improve comprehensive care and facilitate in-home end-of-life care. The programme served 40 patients from February to October 2011, providing 479 visits and 467 telephone calls. 79.5% of patients died at home, and family satisfaction with care was high, with an average rating of 8.5 out of 10.

1. Impact of the Provision of Social Care
within a Palliative Care Programme
on Healthcare Costs:
The SAIATU Project

2. The coordination of social and health resources in palliative
care is not an element of excellence, but rather a necessity."
Herrera E ( Washington, 2006 World Cancer Congress)

3. Background & Scope of the Project
The SAIATU Project:
In-home social support services complementary to
palliative c linical ser vices , to improve the
comprehensiveness of care provided to individuals with
advanced terminal illnesses & their families
- Description of the specialised services offered to end-of-life patients & their
families under the SAIATU Programme
- Costs of the various services that have been provided under the SAIATU
Programme
- Satisfaction of family members with the care received under the SAIATU
Programme
- Impact that the SAIATU Programme could have on the use of healthcare
resources (including cost savings) in the care of end-of-life patients
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4. General Comments
Pilot studies in palliative care have been successful
in terms of quality, effectiveness, efficiency & cost-
savings.
The prevalence of chronic illness & lack of home
carers should start to stimulate the development,
within palliative care, of sufficient support from
social community support networks to ensure that
healthcare provided is actually useful.
It is necessary to set up projects
that respond to this reality &
make an effort to assess their
effectiveness & efficiency.
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5. What is required?

6. Description & Analysis of the
SAIATU Programme

7. Description & Analysis of the SAIATU Programme
Methodology
• National & international experience to date on social care &
accompaniment in palliative care
• Scientific literature, websites of related institutions & organisations
Document • Idenfication of successful programmes, tasks, roles, human resources, pilot
analysis studies, etc.
• Questionnaire
• Face-to-face interveiws with professionals
Qualitative • Types of services & the way they are provided, roles/tasks of the
professionals, training, description of the programme, etc.
analysis
• Review of records
• Retrospective analysis
• Demographic characteristics, social value, admission to the programme,
Quantitative activities, bereavement, place of death, etc.
analysis
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8. Description & Analysis of the SAIATU Programme
Overview of the Results
Description of the Analysis of the
SAIATU Programme Programme Activities
A. Background
B. Programme Vision & Mission A. Population
C. Objectives B. Sociodemographic
Characteristics
D. Beneficiaries
C. Admission to the Programme
E. Portfolio of Services
D. Data on Activities
F. Human Resources & Roles
E. Data on Costs
H. Organisation of the
Activities F. Use of Resources
I. Documentation & Data G. Preferences & Place of Death
Management System H. Family Satisfaction
J. Cost Structure
¿Qué necesidades hay?

9. Description & Analysis of the SAIATU Programme
Description of the SAIATU Programme A. Background
B. Programme Vision & Mission
Programme for specialised in-home social care connected with palliative
care, tailored to the needs of individuals with advanced illnesses & their
families.
“ To provide specialised
“To broaden our palliative support & accompaniment
care framework from a to patients with terminal
social perspective in order illnesses & their families
Mission
to provide high-quality care through a continuous social
Vision
that responds to the social care service to enable
needs of patients & their patients to stay at home
families” during the end-of life phase”
¿Qué necesidades hay?

10. Description & Analysis of the SAIATU Programme
Description of the SAIATU Programme C. Objectives
1. To provide support, face-to-face &/or by telephone, for the
care & emotional accompaniment of patients & families at any
time of day, even at night (in exceptional circumstances), every
day of the year
2. To collaborate with other palliative care resources in the
Basque Country to ensure comprehensive care through
specialised social support
3. To facilitate in-home care & meet the wishes of patients who
prefer to die at home & their families, alleviating pain & offering
accompaniment & support in the care of physical symptoms, as
well as emotional & social needs
4. To support family members throughout the course of the
illness & after the death in the bereavement period

11. Description & Analysis of the SAIATU Programme
Description of the SAIATU Programme D. Beneficiaries
E. Portfolio of services
Definition of the target population
Patients with cancer
Patients with progressive chronic illnesses
Portfolio of services
Care protocols
Patients Accompaniment
Monitoring of symptoms
Information
Respite care
Bereavement support
Communication
Care support
BADLs
¿Qué necesidades hay? Family members
24x7x365 Specialised care

12. Description & Analysis of the SAIATU Programme
F. Human Resources & Roles
Description of the SAIATU Programme H. Organisation of the Activities
I. Documentation & Data
Management System
Human Resources & Roles Organisation of the Activities
Provision of services
Coord - Face-to-face
- By telephone
Referral of patients
Shared Nurses
Doctors (RNs & Operation of the programme
Roles aux.)
Documentation & Data Management
System
Social
Workers Description of the documentation
system
¿Qué necesidades hay?

13. Description & Analysis of the SAIATU Programme
Description of the SAIATUSAIATU
Descripción del programa Programme J. Cost structure
Total costs of the SAIATU Programme
ITEMS To 31/12/2011 % of total costs To 31/10/2011
Personnel costs 114,826.69 68.5% 97,536.82
Insurance 955.35 0.6% 781.65
Health & safety measures 165.20 0.1% 135.16
Medical examinations 312.00 0.2% 255.27
Consultancy/Advice 599.43 0.4% 490.44
Telephone charges 1.472.72 0.9% 1,012.37
Total 118,331.39 70.5% 100,211.72
UNFORESEEN ADDITIONAL COSTS To 31/12/2011 % of total costs To 31/10/2011
Training/Education 3,000.00 1.8% 2,250.00
Co-working costs 990.00 0.6% 810.00
¿Qué necesidades hay?
Communication costs 2,485.00 1.5% 2,033.18
Salary increases (new pay deal) 42,924.08 25.6% 35,119.70

14. Description & Analysis of the SAIATU programme
programm
Period A. Population
Programme Activities
Feb-Oct 2011 B. Sociodemographic characteristics
n = 40
Marital status
Mean age: 75 years old
[SD11.89]
Cancer diagnoses: 90% (n=35).
Non-cancer diagnoses: 10% (n= 4)
Urotelial
Urothelial 2,9%
.
Rectum
Recto 2,9%
Pleural Mesothelioma
Amyotrophic lateral sclerosis
Mesotelioma pleural 2,9%
.
Oesophagus
Esófago
Squamous cell
2,9% Bone marrow aplasia
Epidermiode del labio .
2,9%
Carcinoma of the lip
Estómago
Stomach 5,7%
. Ischaemic cardiomyopathy
. .
Renal
Renal 8,6%
Mama
Breast
.
8,6% Chronic renal failure
. .
Cerebral
Brain 8,6%
Pulmón
Lung 17,1%
.
Colon
Colon 14,3%
.
Prostate
Prostata .
22,9%

15. Description & Analysis of the SAIATU programme
Programme Activities Social A. Population
Assessment B. Sociodemographic characteristics
Role of the primary caregiver Social support
On admission to the SAIATU No. of Families
Programme (n=30)*
No social resources 9
With social resources 21
Private support & external carers 12
Social resources Economic resources 5
Technical resources 4
Requests for technical resources, No. of Families
met by the programme in all cases (n=12)*
100% role as primary caregiver
• 57% partner Technical resources 10
• 38% children
Coordination with other services 2
¿Qué necesidades hay? of cases in which there was recorded expenditure
• 5% others (e.g., grandchildren,
nephews/nieces)
*Analysis

16. Description & Analysis of the SAIATU programme
Programme Activities C. Admission to the Programme
60
Awareness of the illness
50
40 16 3 3
8 1 Nv
NV
30
No
No
20
34 37 36 Yes
Si
32
10
0
Diagnóstico Prognosis Diagnosis
Diagnosis Pronóstico Diagnostico Prognosis
Pronostico
Level of Independence
Level of Independence Number of patients (n=38)* Rate
Independent 0 0%
Mild dependence 5 13.1%
Moderate dependence 10 26.3%
¿Qué necesidades hay?
Severe dependence 9 23.7%
Complete dependence 14 36.9%

17. Description & Analysis of the SAIATU programme
Programme Activities Assessment of C. Admisison to the Programme
symptoms
Average of 5 symptoms /patient Weakness 42.8% Insomnia 8.6%
Tiredness 42.8% Nausea 8.6%
Pain 37.1% Vomiting 8.6%
Physical symptoms Dysphagia 31.4% Dyspnoea 5.7%
Constipation 31.4% Coughing 5.7%
Anorexia 28.6% Hiccups 5.7%
Weight loss 11.4% Diarrhoea 5.7%
Confusion 2.8%
Existential suffering 31.4%
Sadness 17.1%
Psychological & emotional aspects Depression
Anxiety
8.6%
5.7%
Apathy 2.8%
Dry mouth 25.7%
Ulcers 20.0%
Assistence needed for walking 17.1%
End-of-life signs Jaundice 5.7%
Agony 2.8%
Pruritus 2.8%
¿Qué necesidades hay? Oedema
Aphonia
2.8%
2.8%

18. Description & Analysis of the SAIATU programme
Programme Activities D. Data on Activities
Activity from February-October 2011: 40 patients
Total no. of visits 479
Mean time on - Visits in the previous 3 days 72 15.1%
the programme
→ 26.2 days - Bereavement visits 69 14.4%
Total no. of telephone calls 467
Mean no. of - Bereavement calls 67 14.3%
patients on the
programme at Mean time on the programme 26.2 days [SD=34.50]
any one time
120
→ 3.88 100
80
60
40
20
0
Feb Mar Abr May Jun Jul Ago Sep Oct
Evolución visitas
Visits 24,5 49,7 67,6 63,5 99,6 69,3 49,9 31,3 23,6
Telephone calls
Evolución llamadas 9,2 28,7 55,3 41,3 104 83,4 60,9 54,7 30,3
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Patients registered
Evolución pacientes en curso 1,67 3,14 3,89 3,14 7,28 6,17 4,53 3,25 1,85

19. Description & Analysis of the SAIATU programme
Programme activities E. Data on Costs
Distribution of time by type of service provided
Activity Total time (hours) % of total time
Care/support visits 1,006.50 79%
Bereavement visits 119 9%
Monitoring telephone calls 126.3 10%
Bereavement telephone calls 18.54 1%
Total 1,270.34 100%
Unit costs per activity
Activity Total cost (€) No. Unit cost (€)
Care/support visits 111,259.70 410 271.37
Bereavement visits 13,154.40 69 190.64
Monitoring telephone calls 13,961.44 400 34.90
Bereavement telephone calls 2,049.07 67 30.58
Total 140,424.60 946 148.44
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20. Description & Analysis of the SAIATU programme
Programme Activities F. Use of Resources
Activity in primary care, specialised care & the HaH service for SAIATU patients
Activity Mean 95% Confidence Interval
Nurse home visits 6.86 [0.97 – 12.74]
Nurse health centre appointments 3.29 [2.21 – 4.36]
GP Home visits 5.11 [2.91 – 7.32]
GP health centre appointments 5.09 [4.00 – 6.17]
Specialist outpatient appointments 2.34 [1.28 – 3.41]
Hospital A&E attendances 1.03 [0.64 – 1.41]
Hospital admissions 0.63 [0.33 – 0.93]
Inpatient bed days 8.87 [4.38 – 13.35]
Days on the HaH programme 31.92 [18.91 – 44.93]
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21. Description & Analysis of the SAIATU programme
Programme activities G. Preferences & place of death
H. Family satisfaction
79.5% died at home vs. 20.5% died in hospital
Overall satisfaction rating (14 relatives)
(0: low,10: very high) Satisfaction
0 0 (0%)
1 0 (0%)
2 0 (0%)
3 0 (0%)
4 0 (0%)
5 2(14%)
6 0 (0%)
7 0 (0%)
8 1 (7%)
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9 1(7%)
10 10 (71%)

22. The Programme s Impact on
Use of Healthcare Resources
In these difficult economic times, the
argument for good quality end-of-life
care has moved away from ethical to
economic considerations .
(Eugene Murray, 2012)

23. The Programme s Impact on Healthcare Resources
use
Retrospective observational cohort study on the intensity of care (resource use) provided
to end-of-life patients & their families under the SAIATU programme vs. traditional
healthcare (primary care [PC] + specialised care [SC], with or without support from
hospital-at-home [HaH] teams)
Definition of the groups
SAIATU
Exposed group composed of cancer patients cared for
under the SAIATU programme from the start of the
programme, 1st Feb 2011, to the cut-off date, 31st Oct 2011
PC
+
SC
Unexposed group (not on the SAIATU programme)
composed of cancer patients cared for through PC + SC on
a outpatient & inpatient basis, but not the HaH service
PC
+
SC
+
HaH
Unexposed group (not on the SAIATU programme)
composed of cancer patients cared for through PC + SC on
an outpatient, inpatient & hospital-at-home basis (HaH).
Note: we are using PC to stand for primary care, NOT palliative care

24. Comparative Analysis of the Intensity of Healthcare
Differences in Intensity of Healthcare between the 3 groups: Primary Care
SAIATU PC+SC p1 PC+SC+HaH p2
Nurse home visits 0.86 1.42 0.999 2.26 0.997
[0.97 – 12.74] [0.38 – 2.46] [0.71 – 3.81]
Nurse health centre 3.29 3,34 0.939 2.12 0.980
appointments [2.21 – 4.36] [1.66 – 5.02] [1.35 – 2.89]
GP home visits 5.11 1.68 0.999 2.06 0.996
[2.91 – 7.32] [0.65 – 2.71] [1.08 – 3.04]
GP health centre 5.09 4.36 0.878 3.66 0.985
appointments [4.00 – 6.17] [3.54 – 5.18] [2.62 – 4.70]
Total primary care 20.34 10.80 0.999 10.10 0.999
visits + appointments [13.31 – 27.37] [8.18 – 13.42] [7.24 – 12.96]
Comparison: SAIATU vs. PC+SC
[1]
[2] Comparison: SAIATU vs. PC+SC+HaH
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25. Comparative Analysis of the Intensity of Healthcare
.
Differences in Intensity of Healthcare between the 3 groups: Specialised Care
SAIATU PC+SC p1 PC+SC+HaH p2
Specialist 2.34 4.68 0.001* 4.30 0.001*
outpatient [1.28 – 3.41] [3.34 – 6.02] [3.30 – 5.30]
appointments
Hospital A&E 1.03 1.86 0.000* 1.40 0.42*
attendances [0.64 – 1.41] [1.53 – 2.19] [1.10 – 1.70]
Hospital 0.63 1.82 0.000* 1.56 0.000*
admissions [0.33 – 0.93] [1.55 – 2.09] [1.22 – 1.90]
Inpatient bed 8.87 19.17 0.001* 23.88 0.006*
days [4.38 – 13.35] [15.13 – 23.20] [16.49 – 31.28]
Days on the 31.92 21.39 0.976
HaH [18.91 – 44.93] [14.49 – 28.29]
programme
Comparison: SAIATU vs. PC+SC
[1]
[2] Comparison: SAIATU vs. PC+SC+HaH
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26. Comparative Analysis of the Intensity of Healthcare
No. of outpatient appointments No. of hospital admissions
16 60%
0
14 0.59 1.82 1.56
2.34 4.68 4.30
No. or % of patients
1 50%
12
2
40%
10 0
3
8 30% 1
4
6 2
5
20%
4 3 ó3
≥ +
6
2 7 10%
0 8≥ 9
0%
SAIATU
SAIATU AP+AE
PC+SC AP+AE+HaD
PC+SC+HaH SAIATU
SAIATU PC+SC AP+AE+HaD
AP+AE
PC+SC+HaH
No. of A&E attendances
20
18
Mean 16
0
values 14 1.03 1.86 1.40 1
in blue 12
10
2
3
8
6 4
4 5
2 6
0
SAIATU AP+AE AP+AE+HaD
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SAIATU PC+SC PC+SC+HaH

27. Comparative Analysis of Costs related to the Intensity of Healthcare
SAIATU PC+SC p1 PC+SC+HaH p2
Cost per activity 6.719 15.326 <0.001
[4.082-9.356] [12.224-18.428] *
Cost per activity 18.709 23.431 0.343
+ days on [13.177-24.241] [18.247-28.617]
programmes
Note: * values for the SAIATU group were significantly lower by one-tailed Mann-Whitney U test
+ Mean & 95% confidence interval
The mean cost per activity was significantly lower for
the SAIATU than for the PC+SC group (p<0.001).
The difference between the costs related to the
SAIATU with HaH group & the PC+SC+HaH group
was not statistically significant (p=0.343).
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28. Conclusions
- The present project organises the new portfolio of services
provided by a social care service within palliative care.
- Despite being a pilot study (i.e., the performance is expected to
improve in the future), the SAIATU Programme shows how
resources developed from a social care perspective, can be cost-
effective & efficient for a healthcare system:
- Reducing the use of hospital resources & associated costs
- Promoting an increase in at-home treatment with a
greater participation of primary care professionals
- While being rated as satisfactory by families
- With the lack of previous examples, SAIATU could become a model programme in the
field. In this study, we observed a great impact on cost efficiency but the data used were
retrospective; accordingly, the scale of the programme should be extended & a prospective
study undertaken to validate these preliminary results.
- For this, the first steps need to be defining the services within the social sector in detail,
as well as clarifying the vision, mission, strategic plan, processes, etc. of the programme.

29. “The inclusion of social services in the
provision of palliative care is the
natural way to expand”.
(Bosanquet)

30. Enterprising Solutions for Health (EH) S.L.
Edificio Galia Puerto, 1ª Planta
Crtra. de la Esclusa, 11. 41011 Seville, Spain
Tel. & Fax: (+34) 955 658276
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