Nuffield Trust Report on Care Home Residents Medical Care

[jimbo 111]

The following report was in the Mature Times
jimbo 111

Care home residents get half medical care
Thursday, 29 March 2012
People living in care homes are HALF as likely to visit their local hospital as the rest of the elderly population, research shows.

A study by health think tank Nuffield Trust also showed that those in residential care attended significantly fewer routine medical appointments than those still living in their own homes.

This could be because care homes cater for residents' needs, so hospitalisation is needed less often - or it could be because care homes cut residents off from essential care.

Analysing the health records of over 120,000 older people, the study examined the hospital and social care records from people aged over 75 in four separate areas across the UK.

The research published in the Journal of Health Services Research and Policy looked at the number of people admitted to hospital in the previous year, either as an emergency admission, an outpatient or for an operation.

73 per cent of elderly people receiving care in their homes had been admitted to hospital in the previous year.

But only 58 per cent of those in care homes were admitted in that period.

Similarly those living in care had an average of 1.09 outpatient appointments while those living in their own house had an average of 1.99 - almost twice as many.

This could be because care homes help avoid the need for hospitals - by providing more regular GP supervision or by reducing the risk of falls.

But the figures could reflect problems that people in care have in accessing hospital and medical treatment.

Dr Martin Bardsley, head of research at the Nuffield Trust said the pattern could be a "good thing" or a "bad thing."

He asked: "Is it that for some people care homes are not helping get the access to hospital care that they should have?

"Are we seeing an example of discrimination against some older people living in care homes?

"Probably both."

The findings follow revelations earlier this month of institutional failings in the care home system.

Previously unpublished data gathered by the health care watchdog the Care Quality Commission (CQC) revealed that people suffering from incontinence have to wait more than two weeks for an assessment in almost 40 per cent of homes for the elderly surveyed.

More than a third of care homes surveyed admitted delays in getting medication to residents, while some older people have to wait up to three months for formal checks into painful bed sores.

Dr Jennifer Dixon, director of Nuffield Trust said that even more research was needed to understand the causes behind the findings.

by Lucy Fulford

[TinaT]

The facts show a discrepancy which highlights quite a complex issue.

In my experience observing what happens in my husband's nursing home, and which is probably a reflection of many care homes, the staff have a lot of experience and can 'triage' the importance of visiting hospital in many cases. At home we are dealing usually with just one person and when they fall or become worryingly ill, I think we feel pretty isolated in making a decision about a hospital visit and take the cautious action of going to hospital to maintain our own peace of mind.

When a resident is admitted to hospital the staff (and myself) worry for the resident as we know that because of their dementia, any hospital stay will result in the resident finally coming back in a much worse state both physically because of not eating and mentally because of the distress they have endured. Wherever possible the managers always try to get residents out of hospital quickly and back into the home because of this.

I haven't always agreed with the decision of staff not to take my husband to hospital after serious falls. On one occasion he needed stitching but when I arrived the next day it was obvious to me the wound was too deep to be left and I took him to A & E and was told that it was too late to stitch the wound. The hospital staff did try gluing it but he picked out the glue. What would have been a week of healing with stitches turned into several weeks of healing because of this delay.

As to hospital appointments, I know that a member of staff has to accompany a resident and sometimes is away from duty for many hours, leaving a depleted staff to cope with the everyday tasks. I have always been mindful of this and have taken Ken for all appointments myself. I cannot say that staff being taken from normal duties may be a part of the statistics but worry that this may be so.

I have also seen staff deciding not to take a resident for an appointment because it would be too distressing and stressful for the resident. Usually staff would speak to the local doctor to confirm their decision before missing an appointment.

I have also seen one member of staff fully engaged, three ambulance men fully engaged and one manageress fully engaged wasting several hours trying to coax an extremely angry and reluctant resident to attend an appointment. After three hours everyone gave up and the staff had the difficult job of trying to calm a very agitated resident.

I myself have discussed with a doctor and manageress only last week the suggestion from the doctor that Ken attend hospital for a brain scan as he is now having fits. Both myself and the manageress felt it would not be right as he is frail, very weak and even if the scan confirmed that cancer had now spread to his brain, there would be no treatment to cure this.

He should also attend regular eye hospital appointments because of glaucoma but I decided last year that because he cannot keep still long enough to be tested and was too weak and ill to bear the stress I asked if the hospital could send someone to do a quick test. Someone did come, said that we were to maintain the present dosage of eye drops and we have never seen them since. I have asked recently for someone to attend but the hospital refused.

I have also seen that in Ken's care home there are daily visits from district nurses who can always be asked for advice, and regular visits from the local doctor's practice where advice can be sought. Perhaps when someone is alone in their own home, problems are not immediately dealt with and then become larger problems needing hospitalisation.

Just a few personal observations to the very complex question which these statistics pose.

xxTinaT

[grove]

Very well said Tina & you have put into words what partly felt I after reading the Report ( but was unable to put into Words )

Thanks once again

Love Grove x