There is a real problem with a growing population of frail elderly and particular those in care homes. Elderly patients in care homes have increasingly complex conditions. It is not uncommon for homes to have residents regularly attending casualty (revolving door effect), regularly calling paramedic services and primary care services. Weekends and nights are a particular issue. It is not uncommon for a GP or primary care nurse to have done a weekly ward round earlier in the day only to be called back later to see residents as they cannot be managed by staff. Often the caller lacks confidence and cannot assess the patient in simple health terms. There is an onus on the carer not to make mistakes and not to take to much responsibility.
We also all know that elderly people do better if they can be treated outside of hospital.
Many care homes are now increasingly large may be with over a hundred residents offering many extra services at high weekly cost to residents but they do not provide basic acute health care assessment. As more and more homes open in a particular area this can have huge implications on a practice or practices in the catchment area.
The idea would be to make it mandatory for large care homes or groups of smaller homes to employ a first responder on duty at all times to make basic assessments of sick patients, liaise with primary care teams and rapid response teams where appropriate in order to avoid unnecessary transfer to hospital. The First Responder/Matron could be a former senior HCA, Nurse Practitioner or Paramedic and would also have a role to up-skill on topics around appropriate treatment and illness prevention in the elderly. They would become proactive ‘champions’ in adequate hydration, nutrition, reducing medication errors and harms and timely diagnosis of infection. They would liaise with casualty departments to return an elderly person back to the care home as soon as safe to do so with their new care plan.
Although large homes could be asked to provide these posts within their staff budgets as they stand, smaller care homes may need some financial support or work in networks where possible with a mobile responder. This support could come as incentivised payments based on reduction of admissions to casualty compared to average local data.
We owe it to our increasing elderly population to reduce any need to visit or stay in hospital which is often very distressing and can be counterproductive. Residents in care homes are much more likely to be escalated up the line and be transferred to hospital. We need also to ease the burden on primary care and paramedic services for unnecessary home visits so they can concentrate on other tasks to hand. We need to raise confidence in our care homes so that they can manage residents/patients much more holistically for the future.
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