Rowenna Davis visits a scheme in Wales that aims to treat older people in their own homes and avoid hospital admissions
When elderly people take a turn for the worse, they usually end up in hospital. But what if emergency health and social services could go to them?
In part of south-west Wales, that is exactly what happens. A unique multi-agency team has set up a service that reduces pressure on hospital beds by enabling older patients to receive quality treatment in the comfort of their own homes.
The group from Torfaen Intermediate Care Services, part of Gwent Healthcare NHS Trust, has developed the community programme to offer expert assessment, diagnostics and treatment in the patient’s home. The service is led by community-based consultant geriatrician Bim Bhowmick, who is supported by an advanced clinical assessment team (Acat) working with local GPs, social services and hospital trusts.
Emergency care co-ordinator Jill Parfitt oversees the social services side. Her role is to free up hospital beds by establishing emergency short-term care plans for patients in their homes. By working with Acat and the other partners she can offer support on the day of referral.
“What’s different about us is the speed of response,” says Parfitt. “When we take calls the family are often crying and pulling their hair out – they don’t want to hear that a social worker can come in one or two days. They need help immediately.”
Generally, by the time the paperwork needed for assessment and referral is complete, the problem has either disappeared or become so acute that the user has been forced into admission. Such a cumbersome system doesn’t just fail users it also clogs up desperately-needed hospital beds for critically ill patients. At present, older people account for as many as half of emergency hospital admissions, and – judging by Acat’s work – three-quarters of those could be treated at home.
Scared of repercussions
“Professionals are used to sending patients to hospital – they’re scared of the potential repercussions if they don’t,” says Bhowmick, who pioneered the service and is clinical director of Torfaen Intermediate Care Services. “Patients’ families also put pressure on admissions, because they think that’s where you get the best standard of care. But they have begun to develop confidence in home treatment. We are seeing a cultural change in communities and GPs.”
Challenging the belief that hospital should always be the first port of call in the event of a problem is difficult, but it can have huge benefits. Over the past year, the team has seen 1,200 patients in their homes and prevented 975 unnecessary hospital admissions.
Assuming that these admissions would have lasted 15 days each on average, the savings from reduced bed costs is estimated at £3m. Almost all referrals are from GPs who remain responsible for the patient and are fully informed about treatments. Patient care is managed at home for between 24 hours and two weeks.
Take the case of Colin Parker, 84, who was taken into hospital after complications with a knee replacement. Once inside, he picked up an infection on the ward that led to a significant deterioration in his condition. When he was discharged, his 76-year-old wife, Abbi, was at a loss what to do.
“My husband was coughing, ill and confused and I had no instructions about how to deal with him,” she says. “I called the GP and they said it wasn’t bad enough for hospital admission, but that they’d call in the Acat team. I’d never heard of them. But within an hour, there was a knock at my door and my life was transformed. They went straight into action.”
Colin’s treatment followed the community service’s normal pattern. Straight after the GP referral, Acat health workers went to his house and conducted the tests that would normally take place in A&E. Then a nurse arrived to make a more thorough assessment of his situation and put a treatment plan in place. Because Colin’s case was serious, a consultant geriatrician arrived in the evening to check his progress.
Thanks to the team’s connection with social and voluntary services, other measures were put in place to help Colin remain in his home, including physiotherapy and social support. Health workers continued to keep an eye on Colin’s progress until his recovery one month later.
According to Abbi, being treated in his own home was a huge comfort to her husband. Like Colin, many older people hate being admitted to hospital and the trauma of the transition can worsen their condition. “Who on earth wants to be in hospital unless they have to be? It’s obviously much more reassuring to be treated in your own home,” says Abbi.
Other professionals are starting to look at the Welsh model with interest after it picked up the 2008 Bupa Foundation Care Award. “This system is meeting some of the biggest challenges in NHS modernisation,” Bhowmick says. “We have to give people choices over services, including the option of being treated in the happiness of their own homes. That is how policymakers are thinking and it will be the future.”
Published in the 15 January 2009 edition of Community Care under the heading Home Advantage