Opinion

Care Homes as a hub of Integration

Karen Rogers, Director, Herefordshire Care Homes

There are an estimated 380,000 people live in approximately 17,000 nursing and residential homes in England which equates to three times as many older people living in care homes than in general hospital beds and many of these older people are increasingly living with “Frailty” and  multiple long-term conditions.

Frailty is defined as a specific syndrome with characteristic features defined as “a clinically recognised state of increased vulnerability resulting from age -associated decline in reserve and function that affects the ability to cope with everyday life”

Symptoms often include;  unintentional weight loss, muscle loss, weakness and fatigue . frailty causes older people to decompensate very quickly following even minor illness which often then results in falls , immobility and confusion or even non-specific deterioration.

A long- term condition is one that generally lasts a year or longer and impacts on a person’s life, examples include, respiratory conditions, cancer, dementia, diabetes, arthritis, mental health conditions and complex neurological conditions such as stroke, Parkinson’s disease, MS, Motor Neuron Disease.

Most older people living in care homes now have multiple long-term conditions. (That is 2 or more long term conditions) and many will also have frailty.

Policy makers give health and social care integration a high priority however there are varied definitions, and all cover a significant number of different processes.  Integrated care should be defined as the experience of the person using the service rather than by structures, organisations or the way services are commissioned or funded. This

is because integration is about individuals having a better experience of care and support without organisation barriers.

There is however a clear lack of understanding between care homes and the NHS about how the two sectors should work together meaning that residents often experience disjointed services between their needs and the services they can access and that they are too often treated as a collection of conditions or symptoms rather than as a whole person.

Care Homes are a hub for a wide range of NHS activity, but this is ad-hoc with no recognised way to support working together so Integration between Health and Social Care is really only evident at a level of individual working relationships and reflects patterns of collaborative working rather than integration, for example care homes will liaise with a range of services such as  GP’s ,District nursing, Community pharmacist, physiotherapist, nutrition adviser, mental health social worker, psychiatrist and many other health care professionals.

Impact of poor health and Social Care Integration

The example most of us know is where inadequate provision of social care can lead to deterioration of a person’s health and ultimately admission to hospital and when people who are ready to leave hospital may be unable to do so if there is no home care or care home services available.

Two thirds of hospital bed days are now  occupied by people over 75 and a significant number of these occupied bed days could have been avoided with a more joined up approach to reducing frailty and better information sharing.  Nhs England confirmed that 4,737 patients per day were delayed in October 2018.

The most common reason for delayed transfers of care was due to people waiting for a care package in their home.  The second most common reason was due to people waiting for further  non acute NHS care , and the third most common reason was due to people waiting for a care home placement.  (Nhs England).

Care homes can play a critical role in supporting older people across all sectors, there are thousands of facilities from the small sized services and charities to the large chains and all are sitting at the complex interface with primary ,acute and community care , palliative care, mental health care and statutory home care services.

The most important thing to remember in the goal of integration is that at the heart of all decisions is that integration must be seen as a strategy for improving care from the perspective of the person using the service, improving their quality of life and well- being and the maintenance of their independence without organisational constraints.

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