Healthcare provision to care home residents is often “erratic and inadequate”, according to a major three-year study that calls on the NHS to see homes as “partners not problems”.
The study, which involved seven UK universities, concluded high quality healthcare for some of the most frail and vulnerable people in society could only be achieved if healthcare professionals, including specialist nurses and nurses in care homes, were able to work much more closely together.
“There is a greater willingness to work together to solve problems and a culture of blame recedes”
Led by the University of Hertfordshire, it involved a review of previous surveys and studies of healthcare provision in care homes, as well as interviews with service commissioners, providers of services to care homes, care inspectors, care home managers, residents and their families.
Researchers also looked in detail at provision at 12 care homes in three areas, each of which organised healthcare support to care homes in a different way.
In one area, care was provided by multi-disciplinary teams working closely with care homes, which included a nurse-led care home service that had been going for 15 years.
In another, GP practices were paid incentives to work with care homes and there were extra payments to homes where staff completed training on caring for residents with complex care needs.
There was a nurse specialist in palliative care designated to care home residents, while other services available to care homes included a team of nurses and therapists, and a dementia advice and support service.
Finally, in the third area healthcare provision was the same for people receiving care in their own homes and those in care homes, with referrals to expert practitioner such as tissue viability and cardiac nurse specialists.
“Care home residents were perceived to be a low priority for out of hours and emergency services”
Some of the homes in this third area had access to a care home nurse specialist to respond to acute deterioration in residents and prevent hospital admissions, as well as a dementia nurse specialist.
More than 180 interviews were carried out with residents, relatives, health professionals and care home staff in this second phase of the study.
While the research identified positive examples of partnership work, it concluded access to healthcare across England as a whole was “ad hoc” and highly unpredictable, with some homes getting a lot of specialist support while residents in others struggled to get a GP appointment.
One issue at all three study sites was the fact most care home support services worked office hours and out of hours provision “did not always fit around the needs of older people living with dementia in care homes”, according to one of the study reports.
This meant confused and vulnerable residents were being admitted to hospital if they needed a psychiatric assessment at the weekend.
“Some out of hours services were perceived as having negative attitudes towards care homes and staff and were sometimes described as ignoring care plans put in place by teams providing more routine support to care homes during the working week,” noted the report.
“Care home residents were perceived to be a low priority for out of hours and emergency services,” it added.
Other issues included a lack of training for care home staff in key areas like dementia care and managing and monitoring residents’ medication, and the fact staff were often unsure who to involve when they were concerned about a resident.
The study – funded by the National Institute of Health Research and titled Optimal NHS Service Delivery to Care Homes – found the best results were achieved, and more hospital admissions avoided, when healthcare professionals worked with care homes on a regular and ongoing basis and were linked in with other NHS services.
It said work with care homes by healthcare professionals, such as specialist nurses and nursing teams, “should be formally recognised by NHS managers as key to the support of integrated working for older people”.
Call for nurses in care homes and NHS to work together
“Recognised referral links with other community and hospital services are more likely to support continuity of care and management of acute episodes in the care home,” said the report.
“Where care home services are a standalone service or an adjunct to an existing role without protected time, practitioners can struggle to co-ordinate residents’ care and involve NHS services when needed,” it noted.
Lead study author Professor Claire Goodman, from Hertfordshire University, said care homes should be seen as part of “the landscape of care”.
“Our study has shown that the provision of healthcare services to care homes is likely to be most effective when NHS services have time to learn how to work with care homes and value the work,” she said.
“When the NHS views a care home as a valued partner, then there is a greater willingness to work together to solve problems and a culture of blame recedes,” she said.
“When healthcare for care homes is co-ordinated and recognised as important by the NHS, then residents benefit and there is a much more appropriate use of hospital services,” she added.