Integrated teams required to deliver healthcare in care homes

Multi-disciplinary teams should be set up to ensure that care home residents get the healthcare services that they need, says Professor Finbarr Martin, president of the British Geriatrics Society.

Nearly 400,000 older people live in care homes across the UK. Many have complex healthcare needs, reflecting multiple long-term conditions, significant disability and frailty. Despite this, older care home residents have highly variable access to NHS healthcare services. 

The British Geriatrics Society (BGS) analysed data collected by the Care Quality Commission (CQC) as part of a special review into healthcare support for care home residents.  Our report, Failing the Frail, concluded that not all commissioners are ensuring that adequate services are provided for this vulnerable group. 

Indeed, our analysis showed that less than half (43%) of primare care trusts commissioned all the services that the CQC considered that older people in care homes may need, such as mental health teams, geriatricians, dietetics, occupational therapy, physiotherapy, podiatry, continence support, falls services and tissue viability. Our analysis also indicated variation in the way in which primary care was delivered by GP practices, despite the entitlement of all residents to general medical services. Traditional general practice in many areas does not appear to be equipped or supported to meet the needs of care home residents.

A structured, proactive and multi-disciplinary approach to care is needed with co-ordinated teams working together, built on primary care and supported by a range of specialists including geriatric medicine, specialist community nursing, mental health and rehabilitation medicine. Healthcare professionals must work in partnership with care homes and social care professionals. This means sharing information, assessments, policies, training and learning to support quality improvement. 

An integrated social and clinical approach should support anticipatory care planning, encompassing preferred place of care and end-of-life plans, with care home residents at the centre of decisions about their care. Since many residents have limited mental capacity, this also means involvement of their families or other nominated advocates

Commissioners and health service planners need to allocate resources and specify services with their local NHS providers that meet the complex needs of their local care home population. Service specifications need to be linked to quality standards based on patient experience and appropriate clinical outcomes, and 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. Statutory regulators should include in their scope of scrutiny, the provision of NHS support to care homes and the achievement of quality standards.

No single model of co-ordinated healthcare has been developed to meet the needs of care home residents, but there are some excellent examples of integrated services and details of these can be found on the BGS website as case studies. On 15 June we are holding a community geriatrics day in Leeds to share best practice and discuss how to work in partnership with care homes to meet the needs of their residents, which you can register to attend.

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