A Quest for Quality in Care Homes
An Inquiry into the Quality of Healthcare Support for Older People in Care Homes: A Call for Leadership, Partnership and Improvement
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This report marks the start of a process of partnership to develop impetus, resources and clinical guidance that will support the NHS to play part in improving the experience and the quality of life of residents in care homes.
Its recommendations were developed through collaborative inquiry of stakeholders drawn from care homes, social care, NHS (including primary care) and academia.
The report describes current NHS support for care homes. It tells a story of unmet need, unacceptable variation and often poor quality of care provided by the NHS to the estimated 400,000 older people resident in UK care homes.
It describes what should and could be done and calls for national action by government and local action by NHS commissioners, planners and clinical services to improve the quality of NHS support to care homes.
It highlights the need to build joint professional leadership from the health, social, and care home sectors, statutory regulators and patient advocacy groups to find the solutions that none of these can achieve alone.
- Residents of Care homes have complex healthcare needs, reflecting multiple long-term conditions, significant disability and frailty.
- The social care model is central but insufficient to meet residents’ health needs.
- As the independent sector grew to take on this area of care over the last three decades, the NHS gradually withdrew its expertise and support. Most geriatricians and old age psychiatrists now play no part.
- Regulation can highlight problems and promote improvement but care home providers cannot achieve this without necessary support.
- No model of co-ordinated healthcare has been developed to meet the needs of care home residents. ‘Traditional’ general practice in many areas does not appear equipped or supported to fill this void.
- Our report shows that many care home residents are denied equitable access to suitable NHS primary and secondary healthcare. While NHS policy makers, commissioners or managers acknowledge that there are problems, they have little consensus on their obligations to address this. Ensuring effective healthcare for individual residents and effective support for care homes seems to be a low priority. As a result, residents are denied the necessary healthcare resources, support and expertise they need and many are inappropriately admitted to hospital.
- Care homes will continue to be an important component of care provision for frail older people. But healthcare for residents remains a “Cinderella” service in the NHS. This is a betrayal of older people, an infringement of their human rights and is unacceptable in a civilised society.
What is needed?
1. A health service suitable for the specific needs of this population. This means a structured and pro-active approach to care, with coordinated teams working together built on primary care and supported by a range of specialists (for instance geriatric medicine, mental health and rehabilitation medicine).
2. The residents and their relatives must be at the centre of decisions about care. Their voices and those of their advocates must be heard, and their choices and priorities known and respected.
3. A multi-disciplinary approach. This should include nationally consistent access to specialist community nursing and the full range of allied health professionals which would be available to older people living at home.
4. A partnership approach with care homes and social care professionals. This means shared information, assessments, policies, training and learning to support quality improvement and clinical governance to tackle key challenges that affect the quality of life of residents.
1. Local NHS planners/commissioners should ensure that clear and specific service specifications are agreed with their local NHS providers. These need to link with quality standards based on patient experience and appropriate clinical outcomes.
2. Care home residents should be at the centre of decisions about their care. An integrated social and clinical approach should support anticipatory care planning, encompassing preferred place of care and end of life plans.
3. Service specification for providing healthcare support to care homes should guarantee a holistic review for any individual within a set period from their move into a care home, leading to healthcare plans with clear goals. This will guide medication reviews and modifications, and clinical interventions both in and “out of hours”.
4. Healthcare services to support the achievement of these goals (see Recommendation 3) should be integrated. This should combine enhanced primary medical and nursing care with dedicated input from departments of old age medicine, mental health services, and other specialisms such as palliative care and rehabilitation medicine according to local needs.
5. The UK nations’ health departments should clarify NHS obligations for NHS care to care home residents.
6. Statutory regulators should include in their scope of scrutiny, the provision of NHS support to care homes and the achievement of quality standards.
7. Multi-agency and multi-professional national leadership should be promoted to support development and dissemination of good healthcare practice in care homes, supported by clinical guidance and quality standards.