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Commissioning for Excellence in Care Homes

Download the 2-page guidance here (pdf format)

Nearly 400,000 older people live in care homes in the UK, nearly 20 per cent of those aged 85+. Their health and social care needs are complex. All have some disability, many have dementia, and collectively they have high rates of both necessary and avoidable hospital admissions. Standard healthcare provision meets their needs poorly, but well-tailored services can make a significant difference. 

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Why special commissioning for older people in care homes?

Health needs are different: Most residents have a mix of comorbidities affecting both physical and mental health. Dementia is prevalent, the majority of residents in most care homes being affected to some degree, and depression is common.  

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What activities will achieve these outcomes?

Comprehensive assessment of new residents on admission and the development of a patient-centred care plan within a specified time period.  

Prompt recognition of  residents requiring imminent end of life care, identifying issues and goals and making appropriate treatment plans within a shorter specified time period.

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What are the outcomes needed from commissioned services?

For residents themselves?  

Improved experience through high quality essential care – reducing distress from depression, disorientation, agitation, pressures sores, contractures, constipation, pain and sleeplessness.

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What services should be commissioned to do these things?

There is no definitive evidence which dictates whether these activities will  be better provided by enhanced primary care or specialist services. It is likely that a combination of approaches whereby residents have access to enhanced, proactive, primary care and through this, access to a range of specialist services (such as allied health professionals, old age psychiatrists, community pharmacists and community geriatricians) will deliver the best outcomes.

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