What works to support residents’ health in care homes and why

This realist evaluation in 12 English care homes for older people
explored contexts for ‘relational working’ in three service delivery
models alongside the theoretical mechanisms by which this type of
working achieves better outcomes for residents. 

What did it find?
       

  • Healthcare provision for care home residents is reactive and
    patchy. This includes unnecessary hospitalisations; inadequate out of
    hours/emergency care including psychiatric; and a lack of dentists and
    speech and language therapists.
  • Established respectful relationships between NHS practitioners and
    care homes enable ‘relational working’ in the co-design of services and
    in shared healthcare planning for individual residents. Over-emphasising
    NHS agendas such as hospital admissions as a rationale for joint
    working can lead to short-termism and distrust.
  • Commissioners and managers support relational working by formally
    endorsing, incentivising and paying for the protected time of GPs, other
    NHS practitioners and care home staff. This results in practitioners
    prioritising this joint work against the backdrop of routine
    professional work and their wider caseload.
  • GPs’ regular presence in care homes is important, even where nurses
    and other NHS practitioners provide input such as care plans and
    service development. GPs find their input sustainable when supported by
    dedicated NHS care home-specific services, not just services aimed at
    individual residents.
  • Care home staff appreciate a range of clinical input relevant to
    older people: for example, from nurses and others skilled in the care of
    dementia. When supported with this expertise, staff are more confident
    in dealing with challenging behaviours. This reduces distress for
    residents and can lead to less antipsychotic prescribing.
  • Regular, GP-held clinics in care homes facilitated access to
    medicines and more frequent medication reviews. Nurses prescribed and
    reviewed medication, but this did not substitute for GP involvement.
    Pharmacists were rarely involved in reviews across these three sites.

Published by Residential Forum

The Residential Forum is to promote the achievement of high standards of care and support for children and adults living in residential care and nursing homes, supported housing, residential schools and colleges, hospices and hostels. It contributes to improving the quality of service to the public. Members of the Forum are people of standing and experience drawn from the public, private and voluntary sectors, as well as some who can speak for service users and carers.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: