The care of older people in care homes

National Institute for Health Research (NIHR) Themed Review: Advancing Care: Research with care homes

There are more than twice as many people living in care homes in England and Wales, than there are people staying in hospital. Yet we know far more about effective treatments in hospital and less about what works most effectively to improve care for older people in care homes. Research in care homes is a relatively new and emerging field.

Advancing Care provides an overview of recent NIHR research on improving the health and care of care home residents. It highlights current research taking place now and explores new approaches being developed in this important area.

The review brings together NIHR research on three themes relating to the care of older people in care homes: Living well – maintaining good health and quality of life, ageing well – managing long term conditions associated with ageing, and dying well – ensuring a good quality end of life. It features:

  • 23 published studies
  • 21 ongoing studies
  • Quotes from care home owners, managers, staff and researchers
  • Where next for care home research?
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The state of adult social care services 2014 to 2017

The state of adult social care services 2014 to 2017 presents findings from the Care Quality Commission’s comprehensive programme of adult social care inspections.

The CQC has published its The state of adult social care services 2014 to 2017 report, which is the first time that such focused analysis on a national scale has been possible following the formal introduction of the CQC’s new regulatory regime for adult social care in 2014.

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Image source: http://www.cqc.org.uk

The report found that more than three-quarters of adult social care services were currently rated as ‘good’ (77%) and 2% were currently rated as ‘outstanding’.

However, there was considerable variation with nearly a fifth (19%) of services being rated as ‘requires improvement’ and 2% as ‘inadequate’ on ensuring residents are safe.

Age UK says these figures reveal a ‘Russian roulette’ for care and has urged the Government to make a much greater investment into care services.

The full report can be downloaded here

Related:

 

Person-centred care for older people in care homes

The Social Care Institute for Excellence has published  Person-centred care for older people in care homes

This resource covers the implications of the personalisation agenda for owners and managers of care homes. It summarises information, advice and guidance which will support care home owners and managers as they develop a person-centred (or personalised) approach to care in their homes.

The resource covers the following areas:

Download the full publication: Person-centred care for older people in care homes

Video: What is person-centred care?

 

Age and sex differences in hospitalisation of nursing home residents: a systematic review

Hoffmann, F. & Allers, K. BMJ Open6:e011912

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Objectives: Nursing home residents (NHRs) are frequently suffering from multimorbidity, functional and cognitive impairment, often leading to hospital admissions. Studies have found that male NHRs are more often hospitalised. The influence of age is inconclusive. We aimed to investigate the epidemiology of hospitalisations in NHRs, particularly focusing on age-specific and sex-specific differences.

Design: A systematic review was performed in PubMed, CINAHL and Scopus. Quality of studies was assessed.

Setting: Studies conducted in nursing homes were included.

Participants: Nursing home residents.

Primary and secondary outcomes: Outcome measures were the prevalence, incidence or duration of all-cause hospitalisation by age or sex.

Results: We identified 21 studies, 13 were conducted in the USA. The proportion of residents being hospitalised ranged across studies from 6.8% to 45.7% for various time periods of follow-up. A total of 20 studies assessed the influence of sex and found that hospitalisations are more often in male NHRs. A total of 16 studies conducted multivariate analyses and the OR of hospitalisation for males was between 1.22 and 1.67. Overall, 18 studies assessed the influence of age. Some studies showed an increasing proportion of admissions with increasing age, but several studies also found decreasing hospitalisations above the age of about 80–85 years. 8 of 13 studies conducting multivariate analyses included age as a continuous variable. Only 1 study reported stratified analyses by age and sex. 2 studies investigating primary causes of hospitalisation stratified by sex found some differences in main diagnoses.

Discussion:Male NHRs are more often hospitalised than females, but reasons for that are not well investigated. The influence of age is less clear, but there seems to be no clear linear relationship between age and the proportion being hospitalised. Further studies should investigate age and sex differences in frequencies and reasons for hospitalisation in NHRs.

Read the full article here

Guidance: Needs assessments on hospital discharge

CQC | Published online: 29 September 2016

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Image source: CQC

There have been some concerns expressed that care home providers will not readmit people after periods in hospital without conducting full, in person assessments of need.

We would like to make clear the legal requirements around this and offer some best practice guidance. This approach applies equally to community adult social care services.

Regulation 9 of the 2014 Regulated Activities Regulations

This is clear that providers must undertake a needs assessment before providing a service, and do so in collaboration with the person being cared for or someone with legal powers to make relevant decisions.

This is an important requirement and one of the fundamentals of providing good care.

Read the full overview here

Read the full guidance here

Enhanced Health in Care Homes model

One in seven people aged 85 or over is living permanently in a care home. The evidence suggests that many of these people are not having their needs properly assessed and addressed. As a result, they often experience unnecessary, unplanned and avoidable admissions to hospital, and sub-optimal medication.

The enhanced health care homes model  lays out a clear vision for providing joined up primary, community and secondary, social care to residents of care and nursing homes, via a range of services.

Seven key components and eighteen sub-components which define the care homes model are put forward, with practical guidance explaining how organisations and providers can make the transition and implement the whole model.

These plans can help transform the way care is delivered, with staff from across health and social care organisations working together as part of multidisciplinary teams  to deliver high quality and financially sustainable care.

The enhanced health in care homes (EHCH) care model is one of a number of new care models that are delivering whole population healthcare. It will become a core element of the multispecialty community provider (MCP) and primary and acute care system (PACS) models.

Transition between inpatient mental health settings and community or care home settings

NICE has published Transition between inpatient mental health settings and community or care home settings (NG53).

This guideline covers the period before, during and after a person is admitted to, and discharged from, a mental health hospital. It aims to help people who use mental health services, and their families and carers, to have a better experience of transition by improving the way it’s planned and carried out.

Additional link: NICE press release