New analysis finds more than 4 in 10 emergency admissions to hospital from care homes could potentially be avoided through better care in the community - with some local NHS initiatives being shown to reduce avoidable emergency admissions by over a quarter.
New analysis from the Improvement Analytics Unit, a joint initiative between NHS England and the Health Foundation, has found that more than four in ten (41%) emergency admissions to hospital involving care home residents could be potentially avoided with better provision of preventative primary care, community support or NHS care in care homes. The analysis comes as the NHS rolls out the Enhanced Health in Care Homes (EHCH) initiative to improve residents’ health and reduce avoidable emergency admissions.
The briefing, Emergency admissions to hospital from care homes: how often and what for?, published today by the Health Foundation, also includes evaluations of four local sites where the NHS worked in partnership with care homes to step up the support they received as part of vanguard initiatives to improve care in care homes. Encouraging results, including decreases in potentially avoidable emergency admissions to hospital of up to 27%, decreases in emergency admissions of up to 23% or reductions in A&E visits of up to 29% from care home residents, were found across three of the four sites. Following the early findings, it was announced in the NHS Long Term Plan that the EHCH model will be rolled out nationwide to give everyone living in a care home improved GP support and more visits from specialists like dieticians and clinical pharmacists.
Up skilling care home staff to deliver more routine care, ensuring that residents have access to the same GP and encouraging better working relationships between NHS and care home staff are all things that are thought to have contributed to care home residents needing less emergency hospital care.
The analysis published today is the first national study of emergency hospital use by care home residents and showed that more than four in ten (41%) emergency admissions to hospital were for ‘potentially avoidable’ conditions such as chest infections, pressure sores and urinary tract infections. It also reveals that nearly 1 in 12 emergency admissions to hospital are for people living in a care home, an estimated 192,000 emergency admissions each year. This makes up 7.9% of the entire number of emergency admissions.
An estimated 340,000 older people in England live in residential or nursing care homes. To improve their care and help reduce emergency admissions to hospital and A&E visits for care home residents, the NHS has been working with care homes across the country to step up the support they receive.
The analysis also finds that, nationally, emergency admissions to hospital and A&E visits were particularly high in patients from residential care homes, where the care of residents is provided by non-clinical staff. There were approximately 32% more A&E attendances and 22% more emergency admissions from residential care homes than from nursing homes, where residents receive in-house nursing care. The report findings suggest the opportunity for reducing emergency admissions and A&E attendances by increasing NHS support may be most significant in residential care homes than in nursing homes.
Adam Steventon, Director of Data Analytics at the Health Foundation, said:
‘Emergency admissions to hospital can expose care home residents to stress, loss of independence, risk of infection and rapid muscle deterioration. Around 70% of care home residents have dementia and can find the hospital environment even more stressful and disorienting as a result. Reducing avoidable emergency admissions and A&E attendances is good for residents and will help reduce pressure on the NHS.
‘Our evaluations show that by increasing NHS support and improving partnership working with care homes it is possible to reduce emergency admissions to hospital and A&E visits among care home residents and local sites have made good progress on integrating services, despite real pressures in social care. It also highlights that better preventative care may help to reduce unnecessary emergency hospital admissions, for example some fractures may be avoided with appropriate risk assessment and falls prevention. However, further progress may be jeopardised without urgent reform and investment for social care. The NHS Long Term Plan rightly identifies that both the wellbeing of older people and pressures on the NHS are linked to how well social care is functioning.’
Professor Alistair Burns, National Clinical Director for Dementia and Older People’s Mental Health at NHS England, said:
‘People want to know their mum or grandad is being properly looked after and helping them to live well and with the best possible quality of life is key to that. That’s why we are rolling out extra support to care homes as part of the Long Term Plan to reduce unnecessary medication and strengthen the ties between GPs and care homes.
‘In some of the vanguard areas, which today’s report with the Health Foundation shows, these measures made a huge difference to residents’ health and when fully rolled out they will mean older people in every part of the country will benefit from personalised, specialist support in their care home.’
In January 2019, the NHS published their 10-year strategic plan for the health service, the ‘NHS Long Term Plan’, including a commitment to improving NHS support in care homes and the national roll out of the Enhanced Health in Care Homes (EHCH) framework across England.