Care home residents are less likely to end up in hospital than users of intensive home care, research has revealed.
Hospital admissions, A&E visits and outpatient appointments among people aged over 75 were lower among council-funded care home residents than those with significant home care packages, found the study by the Nuffield Trust.
The think-tank said the figures indicated that cuts in spending on care homes would increase pressures on the NHS, but added that there could be a variety of causes for the distinction between care homes and home care:
- Care homes could be particularly good at preventing hospital admissions, for instance through action to prevent falls.
- Homes could be better able to support people to manage health problems in a way that avoided trips to hospital, for example by monitoring blood glucose levels among people with diabetes.
- Homes could be providing services that effectively substituted for hospital care, such as nurses.
However, it could also mean that there were problems in accessing hospital care for care home residents, something indicated by the fact that the level of outpatient appointments was lower for care home residents than those who did not use social care at all.
The study, based on data from 2006-7 in four local authority areas, is believed to be the largest to link together individuals’ social care and health records to evaluate interactions between the two systems.
Of over 130,000 individuals whose records were examined:
• 14% accessed council-funded social care and 59% inpatient, outpatient or A&E hospital care.
• 17% of those using hospital care also used council-funded social care, compared with 10% of those who did not use a hospital service.
• Of those accessing council-funded social care, 71% used a hospital service, compared with 57% of non-social care users.
Social care users were divided into four categories: those whose care cost less than £1,000 a year; those whose care cost £1,000 to £5,000 a year; those whose care cost £5,000 a year or more and who spent less than one month in residential care (the “home care” group); those with packages worth £5,000 a year or more who spent more than one month in a care home (the “care home” group).
It found that while 73% of the home care group accessed hospital care during the year, just 58% of the care home group did.
Despite widespread belief in the importance of care integration, the researchers pointed to a lack of data on overlapping health and social care use across large populations, with previous studies having been much smaller scale. They called for further research into the trade-offs between health and social care.
However, they also pointed to limitations in the research, including that it excluded self-funding care users and those who used primary or community healthcare.
The study is due to be published in the Journal of Health Services Research and Policy.