Satement 6 says:
Older people in care homes have access to the full range of healthcare services when they need them.
Read quality statement 6
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Why is this an area for quality improvement?
Although older people living in care homes have the same right to use healthcare services as those living in their own homes, they often have problems getting help from NHS services, including GPs. This may be because GP practices now have many competing demands and don’t always see people living in care homes as a priority compared with older people living alone or with family carers. Many out-of-hours services are provided by locums and working with them can be challenging for care homes because they will not know the people they are treating.
How can care homes improve quality of care?
Understand the right of people in care homes to have equal access to health services
The NHS Constitution sets out the right of older people living in care homes to have equal access to all NHS health services. Care homes need to do all they can to ensure that people have access to the services that they need.
Develop good relationships with local GPs and other services
SCIE’s GP services for older people: a guide for care home managers has advice for care home managers on how to work in partnership with GPs and primary care teams so that residents have better access to good medical services. They should establish effective referral arrangements so that services are available easily and without delay when they are needed, including for out-of-hours appointments. Commissioning for excellence in care homes from the British Geriatrics Society describes the clinical and service priorities for meeting care home residents’ needs, details the outcomes needed from commissioned services and suggests how these can be achieved. Improving health and healthcare from My Home Life has some practical examples of how care homes have worked closely with local services. Health services – understanding your rights to healthcare from Age UK explains the range of NHS services that is available and provides practical advice for older people on using them.
Focus on prevention
Healthcare for older people who live in care homes should not focus only on treatment, but also on prevention. Older people have a better quality of life if they have regular check-ups, are given advice on healthcare and have the opportunity to discuss health concerns with a GP. GPs who get to know their patients well are better able to provide advice on preventative care. They are also likely to notice changes in a person’s health at an early stage. Early diagnosis and treatment of illness should mean less pain and discomfort for an older person and may prevent hospital admission.
Avoid unnecessary hospital admissions
Working with a range of external health services can prevent admissions to hospital. Avoiding unnecessary hospital admissions – the care home, a SCIE TV film, shows how this can work in practice.
Reduce medicines management errors
Many older people living in care homes take a range of medicines. Errors in medicines management are common and can lead to discomfort, pain and distress. Close working between care homes, GPs and pharmacists can substantially reduce errors. The NICE guideline Managing medicines in care homes explains the responsibilities of those involved in prescribing, handling and administering medicines in care homes.
...NHS audiology, eye tests and dentistry are core entitlements for pensioners who live in the community; they should be core entitlements for pensioners who live in care homes...
Honorary Secretary, British Geriatrics Society
Case study: Keeping people well
Lime Court Care Home became concerned that too many of their residents were being admitted to hospital. They began to take a new approach that proactively monitored and recorded the physical and mental health of their residents, and made sure they received external help when needed.
The care home took steps to work better with external health agencies, working with a community matron who could give professional advice quickly and easily. They also established a strong relationship with the mental health service for older adults, who were particularly helpful in reviewing and reducing medication for people with dementia and helping keep them out of hospital. Staff at Lime Court received training and support to understand that infection control was the responsibility of everyone, and an effective way of reducing illness in their residents. They also focused on the effect of falls, auditing when and where they were most likely to occur and changed staff levels and care plans accordingly. They asked the falls prevention team to advise on how best to support those most at risk.
The team already understood the importance of being vigilant when dispensing drugs, but they also worked with GPs and pharmacists to review, reduce and amend prescriptions as appropriate. Recognising the crucial role of nutrition and hydration, Lime Court became part of the ‘Food First’ programme, working with a dietetics team to monitor weight loss and food and fluid intake and identify residents at risk of malnutrition. They sought advice on different types of food to offer and different ways to present it to encourage residents who were reluctant to eat.
This case study is taken from SCIE’s Social Care TV film Avoiding unnecessary hospital admissions among older people: residential care homes.