Keeping care home residents out of hospital

David Oliver, a hospital geriatrician has written in the BMJ, his views on keeping care home residents out of hospital.

“Care home residents aged over 75 are three times more likely to be admitted as emergencies than over 75s in the general population.

Professional consensus and NICE guidelines have both emphasised that care homes need proactive care planning and equitable access to medical and other healthcare inputs. These should include palliative care and support for dementia and other mental health problems: with 24 hour care available, such residences should allow for rapid “hospital at home”-style interventions in a crisis, or collaboration with ambulance staff and emergency GPs to make conveyance a last resort. Specialist clinicians such as geriatricians or specialist nurse practitioners can work with care homes to support them.

It’s not all about external input from the health services. Care home staff—already undervalued and scarce—need to feel trained, supported, and empowered (by regulators, managers, and primary care teams) to do the right thing for residents rather than feel obliged to use acute admission as the default option.  And residents’ families need honest conversations about the nature of frailty, end stage dementia, and “progressive dwindling.”

Done well and systematically, these things can achieve drastic reductions in ambulance conveyance or hospital admission, as recent cases in Ashford and Walsall have shown. NHS England is now supporting “vanguard” sites for care home medicine. It’s surely time such approaches were mainstream.”

You can read his full article here: http://www.bmj.com/content/352/bmj.i458

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