Care homes and NHS healthcare services must work more closely together to improve levels of care for older people, according to a new study led by researchers at the University of Hertfordshire.
Complex healthcare needs
Most long term care for older people is provided by independent care homes. These older people have complex needs, and are the oldest and frailest of the population. Yet their access to NHS services is inconsistent and determined by local custom and practice rather than the particular needs of the care home residents.
Professor Claire Goodman, at the University of Hertfordshire's Centre for Research in Primary and Community Care, said: "It is very clear that closer working and better integration of NHS services can promote more effective healthcare of older people living in care homes, and there are many good examples of where individual practitioners or services have tried to achieve this.
"However, our research found that there was not a particular model of working that ensured older people received consistent care, and few systems in place to evaluate what is being achieved. Over ten years ago, research highlighted that NHS provision to care homes was inequitable. Our findings suggest this is still the case and, if anything, it is worse."
Many different NHS services visit older people in care homes, and they are very aware of the need to improve the way they work with the care homes to deliver their service. This has led to the development of a range of initiatives that range from the funding of NHS beds in care homes to the creation of specialist roles designed to promote better working between primary care and the care homes.
However, the study showed that tensions exist between the ways that the NHS services and the care homes provide care to older people. NHS services focus on diagnosis, treatment and support at specific times, whereas care homes prioritise on-going support and relationships that nurture a continuous review of the older person's care.
Joint review of healthcare needs
The study also found that access to NHS services and identification of older peoples' health care needs hardly ever involved joint review or discussion with care home staff, and even more rarely did it include the older person or one of their family.
Moving forwards, NHS services need to see care homes as partners in care and not just the solution to the problem of where to place older people who can no longer live at home. For care home residents, the recognition and inclusion of care home staff or a relative in the discussions on their health care needs provides the support for a more resident-focused care service. By adjusting ways of working, the NHS services can ensure it provides healthcare which takes into account the older person's priorities and concerns as well as the care home staff that provide the care.
The three year study is published by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme.