The care of older people in care homes

National Institute for Health Research (NIHR) Themed Review: Advancing Care: Research with care homes

There are more than twice as many people living in care homes in England and Wales, than there are people staying in hospital. Yet we know far more about effective treatments in hospital and less about what works most effectively to improve care for older people in care homes. Research in care homes is a relatively new and emerging field.

Advancing Care provides an overview of recent NIHR research on improving the health and care of care home residents. It highlights current research taking place now and explores new approaches being developed in this important area.

The review brings together NIHR research on three themes relating to the care of older people in care homes: Living well – maintaining good health and quality of life, ageing well – managing long term conditions associated with ageing, and dying well – ensuring a good quality end of life. It features:

  • 23 published studies
  • 21 ongoing studies
  • Quotes from care home owners, managers, staff and researchers
  • Where next for care home research?

Investigation into NHS continuing healthcare funding

National Audit Office

National Audit Office has published findings of investigation into NHS continuing healthcare.

NHS continuing healthcare (CHC) is a package of care provided outside of hospital that is arranged and funded solely by the NHS for individuals who have significant ongoing health care needs.  Funding for ongoing health care is a complex and highly sensitive area, which can affect some of the most vulnerable people in society and those that care for them. The number of people assessed as eligible for CHC funding has been growing by an average of 6.4% a year over the last four years.  In 2015-16, almost 160,000 people received, or were assessed as eligible for, CHC funding in the year, at a cost of £3.1 billion.

Acting without delay – How the independent sector is working with the NHS to reduce delayed discharge

NHS Confederation, June 2017

This report from the NHS Partners Network highlights examples where the independent sector is working with the NHS to avoid delayed discharges of care.  Reducing delayed discharge – where often frail and elderly patients are unable to leave hospital due to necessary care, support or accommodation in the community being unavailable – is arguably one of the biggest priorities for the NHS.

Delayed discharges and transfers of care (DTOCs) have a significant impact on the ability of NHS acute trusts to provide routine treatment such as elective surgery. It is vital, both for the patient and the trust, to be able to discharge patients speedily to avoid adverse effects to patient flow.

Recognising and managing frailty in primary care

This updated document summarises guidance and evidence for managing frailty. It is based on national guidance and existing sources of synthesised and quality-assessed evidence | University of York Centre for Health Economics | Yorkshire and Humber AHSN Improvement Academy

Image source: Keromi Keroyama – Flickr // CC BY 2.0

  • Frailty is a distinct health state where a minor event can trigger major changes in health from which the patient may fail to return to their previous level of health.
  • Simple tests that have been recommended by NICE for frailty in primary care are gait speed, self-reported health status and the PRISMA 7 questionnaire.
  • Exercise programmes, particularly high intensity interventions, may improve gait, balance and strength and have positive effects on fitness.
  • Medication review forms part of the holistic medical review of people with frailty.
  • Supported self-management can improve health outcomes. However, the value of case management is still to be proven.
  • Discussion about end-of-life care is important to most older people, but is often neglected.

Full document: Effectiveness Matters. Recognising and managing frailty in primary care

Innovations to improve care for older people

The Health Foundation has published details of four projects funded through the Innovation for Improvement programme.

The projects are using new and interesting approaches to improve care for older people and include people managing their own risk of getting a pressure ulcer; remote assessment using smart glasses; extending primary care teams; and continence promotion in care homes.

Support for carers

Thomas S, Dalton J, Harden M, Eastwood A, Parker G. Updated meta-review of evidence on support for carers. Health Serv Deliv Res 2017;5(12)

The University of York Centre for Reviews and Dissemination has published Updated meta-review of evidence on support for carers.

This review updates what is known about effective activities to support carers of ill, disabled or older adults.  The report concludes that there is no ‘one size fits all’ intervention to support carers but potential exists for effective support in specific groups of carers.

 

Care for older people

‘Worked up? Speak up’ – Care for older people campaign launches | Care Quality Commission

 

The aim of this campaign is to get more people aged 60 and over, and their friends and families, to share their experiences of health and social care. Research has shown that older people are less likely to complain about services and less aware of the different ways they can share their views.