How should healthcare services to care homes be configured – results from the Optimal Study

Adam Gordon is Clinical Associate Professor in Medicine of Older People at the University of Nottingham. He tweets @adamgordon1978 Claire Goodman is Professor of Health Care Research at the University of Hertfordshire.  She tweets @HDEMCOP Here they describe findings from the Optimal Study, funded by the National Institute of Health Research and delivered by a collaboration of researchers from the Universities of Hertfordshire, Nottingham, Surrey, City University London, University College London, Kings College London and Brunel University.

The UK care home sector, with 425,000 beds, is just over three times the size of the acute hospital sector.  It is home to some of the oldest and most vulnerable members of UK society.  The average resident is over 85, has multiple health conditions, cognitive impairment and physical dependency.  Providing care to such older adults is recognised to be complex and challenging.

‘Proud Carer’

Karolina Gerlich is a proud carer and a NACAS Director. She has worked as a carer for the past 7 years, and brings experience of business management and providing training. She is studying for a degree is Psychology with the Open University and for a BTEC HND in Health and Social Care. Follow @NacasUK

The National Association of Care & Support Workers (NACAS) was founded in 2016. The association is directed by care workers and aims to improve health and social care through our members. We are working hard to improve training standards and ensure that care profession gets the respect and recognition it deserves.

There are a variety of titles given to those who provide care professionally; our members are home-carers, care-home carers, personal assistants, support workers, healthcare assistants, as well as managerial staff. Regardless of the job title, we all provide care to people, and often spend a great deal of time with them.

A call for collaboration…

Cassandra Leese is a Nurse, Clinical Supervisor and a wannabe dog owner.  She occasionally remembers to tweet @contrarylass

In today’s economic climate, when health and social care are really feeling the crunch, I often find myself feeling morose about the future. Day after day we see the terrible pressures our overstretched services are under, read about the heartbreaking death of another promising doctor burnt out from battling it out in secondary care; or hear about another valuable service making drastic cuts. And selfishly, I’m rather cross that all this seems to have come at a time when I’m incredibly excited to have finally found my place in the nursing landscape, that of gerontology and geriatrics. Coming along to my first BGS West Midlands meeting this spring was a welcome reprieve from the madness spewed daily by the tabloids and renewed my faith that the good guys are still out there!

Multi-morbidity – the case for change

David Paynton is a GP in an inner city surgery. He is also the Clinical Lead for Commissioning for the RCGP.

Generalists are the solution.

For too long policy makers have ignored what clinicians on the front line have been telling them, people with multiple conditions not only exist but are the mainstream.

It is our failure to recognise this fact that has put pressure in the system as the NHS struggles to keep its head above water especially when one adds social factors, depression and mental health into the mix of complexity.

The RCGP “responding to the needs of patient with multi-morbidity” has created a powerful case for change with the need to substitute ever-increasing investment into super specialism by a call for the generalist to support those with multi-morbidity in the community.

Joining up care for older people with frailty

Across the UK, innovative collaborations between GPs and specialist geriatricians are paving the way to better care for older people with frailty

A new joint report from the Royal College of GPs and the British Geriatrics Society has been published today, showcasing how GPs and geriatricians are collaborating to design and lead innovative schemes to improve the provision of integrated care for older people with frailty.

Advancements in medicine are a great success story, and as a result our patients are living longer, but they are also increasingly living with multiple, long term conditions and that brings a number of challenges for general practice and the wider NHS.

Older patients make up the majority of those attending GP surgeries and acute hospitals so getting the right combinations of care in the right place and at the right time is crucial to avert avoidable admissions and delayed discharge from hospital.

Patients don’t just have dementia

Beverley Marriott is Birmingham Community Healthcare Foundation Trust Nurse Practitioner – Community Matron based at Heart of England Good Hope Hospital. She is currently undertaking a Fellowship in Older People at Kings College London. Here she reminds us that we need to see the whole person when looking at someone with dementia.

Many of us work within dementia care on a daily basis. As a community matron on an AMU department supporting safe and timely discharges for patients with dementia, I understand the importance of getting it right and what happens when we get it wrong.

Dementia has reached a critical point – over recent years the government has seen improvements in diagnosis, raising public awareness and promoting dementia friendly settings. However to deliver this level of improvement requires, time, resources and focus. 

Benchmarking Older People’s Care in Acute Settings

Lindsey Ashley is the Communications Manager for the NHS Benchmarking Network and is a strong advocate for benchmarking our NHS services.

It is recognised in the NHS and the media that older people are a major service user cohort for health and social care services, both in hospital (the acute setting) and in the community. It is well described that the population is ageing, as people are living longer, and as a result, there are more older people as a proportion of the overall population. Whilst overall life expectancy is rising, there are also significant inequalities across the country in terms of life expectancy.

Making it happen! An Acute Clinical Team in action

Firdaus Adenwalla is a consultant geriatrician in ABM University Health Board.  He is part of the Neath Port Talbot Acute Clinical Team providing an intermediate care service for the community. 

The media reminds us daily of how our health service is not keeping pace with our changing world. The negativity around health care, hospitals overflowing, not enough doctors, not enough nurses, GP practices closing, and the list goes on. Increasing demand, improved technology and our increased life expectancy, all compound the notion that our health service cannot meet our needs.

Get healthcare providers to improve care together, that’s the challenge

Noor Heim is an assistant professor who currently works for the University Medical Center in Utrecht. In this blog, she discusses her recent Age & Ageing paper on research she has done in the Leiden University Medical Center.

Integration of treatment and care from multiple disciplines is particularly critical in care for older people. Most older people admitted to a hospital suffer from more than just one (chronic) condition. As a consequence, coherent care for older patients involves more than just one discipline. Furthermore, the fact that patients are discharged from hospital quicker and sicker, with higher demands of care, increases the need for integration of (transitional) care between settings. Given the number of older adults who permanently lose the ability to perform one or more activities of daily living during and after a hospital admission, one has to conclude things need to be improved. However, it has proven challenging to accomplish improvements and maybe even harder to study (and to quantify) the benefits of the efforts taken.

Comprehensive Geriatric Assessment in Primary Care

Lynn Lansbury is NIHR CLAHRC Principal Investigator in Academic Geriatric Medicine at the University of Southampton. Here she talks about CGA in Primary Care, which she shares on Twitter @CGA_GP

Adam Gordon’s blog introduced a timely study. With an ageing population it is important that we develop services that are fit for the changing demographic. There is convincing evidence that Comprehensive Geriatric Assessment (CGA) has a place in best practice for the care of older people. The evidence base is particularly strong in acute settings and studies have also been carried out in people’s homes. The Proactive Healthcare for Older People in Care Home (PEACH) study explores CGA in care homes Thus there is interest in identifying the place of CGA in other settings. Our new study, Comprehensive Geriatric Assessment in Primary Care (CGA-GP): The Fit for Later Life Project funded by NIHR CLAHRC Wessex, investigates the GP surgery as a setting.