There is no consensus on how services should be provided to care home residents, warns Claire Goodman
In England, most long-term care for older people is provided by independent care homes. These older people are often in the last years of life, have a degree of cognitive impairment and live with multiple health and social care needs. They rely on primary care services for medical care and access to nursing, specialist services and secondary care.
Care homes are often the solution for the NHS. In addition to long-term care, they may provide intermediate, respite and end-of-life care. Through continuing care funding, they take responsibility for people who would be in hospital if a care home was not available. Under the new commissioning structures, it is possible that care homes will assume more duties that were based in hospital. For example, one care home organisation is providing in-house care for a hospital’s dialysis patients.
“The Optimal study seeks to understand the key elements of healthcare provision necessary to achieve high-quality healthcare for care home residents and appropriate use of NHS services”
Care homes are important collaborators with the NHS, but it is not a straightforward partnership. NHS service delivery is often determined by local custom and practice. For example, in some areas district nurses visit care homes with nursing provision to provide specialist advice on wound care, or specialist palliative care nurses will support staff to provide end-of-life care.
Elsewhere, these services are unavailable or restricted to homes without nursing provision (residential homes) and provided on a resident-by-resident basis at the discretion of local services. Other homes benefit from NHS-funded nursing specialist teams that offer training and support to staff and resident assessment.
Many clinical commissioning groups are now looking at how they can support care home residents and reduce demand on emergency and hospital services. While there is guidance on commissioning, there is no consensus how services should be provided and it is possible that approaches will become more varied. It is likely that some approaches will be more of a priority and effective than others, for example access to specialist nursing expertise or staff involvement in decision making and whether their expertise is valued.
The Optimal study, funded by the National Institute of Health Research (NIHR), is a collaboration between six universities - the University of Hertfordshire, the University of Nottingham, the University of Surrey, Brunel University, City University and University College London. It seeks to understand the key elements of healthcare provision necessary to achieve high-quality healthcare for care home residents and appropriate use of NHS services.
The three-year study has two stages. The first stage has mapped all the ways in which the NHS works with care homes, interviewed key stakeholders and reviewed the evidence of what works and in what circumstances. The second stage will use the findings from stage one to compare approaches with improving residents’ access to healthcare. To understand what elements are most effective and in what circumstances, we will track the impact of different approaches used by the NHS to provide healthcare to older people in 12 care homes in three areas over a year.
If you would like to know more about this study or share your experiences, please email: firstname.lastname@example.org.
● Optimal is funded by the NIHR Service Delivery Research programme. Department of Health Disclaimer: the views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Health Service Research Delivery Programme, the NIHR, the NHS or the Department of Health
Claire Goodman is professor of Health Care Research at the University of Hertfordshire. The Optimal team are Sue Davies, Adam Gordon, Justine Schneider, Tom Dening, Christina Victor, Julienne Meyer, Finbarr Martin, Brian Bell and Heather Gage