Four in 10 emergency admissions to hospital from care homes could be avoided with better provision of preventive primary care, community support, or NHS care on site, finds a new analysis* by the Improvement Analytics Unit, a joint initiative between NHS England and the Health Foundation.
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 as part of the NHS Long Term Plan.
The analysis 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.
Falls 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% by care home residents, were found across three of the four sites.
These initial findings prompted the nationwide roll out of the EHCH model to give every care home resident better GP support and more visits from specialists like dieticians and clinical pharmacists.
Upskilling care home staff to deliver more routine care, ensuring that residents have regular access to the same GP, and promoting better working relationships between NHS and care home staff, are all thought to have contributed to reductions in emergency care need.
The analysis is the first national study of emergency care use by care home residents. It shows that more than four in 10 (41%) emergency admissions to hospital were for “potentially avoidable” conditions, such as chest infections, pressure sores, and urinary tract infections.
It also reveals that care home residents account for nearly one in 12 emergency admissions, adding up to an estimated 192,000 each year ─ almost 8% of the total number.
An estimated 340,000 older people in England live in residential or nursing care. The analysis found that emergency admissions and A&E visits were particularly high among patients from residential care homes, where care is provided by non-clinical staff.
There were nearly a third (32%) more A&E attendances and 22% more emergency admissions from residential care homes than from nursing homes, suggesting that increasing NHS support in residential care homes may have greater impact on these figures.
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.”
He continued: “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.
“However, further progress may be jeopardised without urgent reform of, and investment in, 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, added: "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.”
*Wolters A, Santos F, Lloyd T, et al. Emergency admissions to hospital from care homes: how often and what for? Improvement Analytics Unit, July 2019.