Emergency admissions for care home residents

July 25, 2019

New analysis has found that 41% of emergency admissions to hospital involving care home residents could be avoided.

The research from the Improvement Analytics Unit, a joint initiative between NHS England and the Health Foundation, argues that better provision of preventative primary care, community support or NHS care in care homes could result in fewer admissions to hospital.

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, also includes evaluations of four local sites where the NHS worked with care homes to step-up the support they received.

Results included 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. 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 regular 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. The research found that care home residents were being admitted to hospital with ‘potentially avoidable’ conditions such as chest infections, pressure sores and urinary tract infections. It also revealed that 7.9% of emergency admissions to hospital are for people living in a care home, an estimated 192,000 emergency admissions each year.

The analysis also finds that, nationally, emergency admissions and A&E visits were particularly high in patients from care homes without nursing.  There were approximately 32% more A&E attendances and 22% more emergency admissions from these care homes than from care homes with nursing.

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 response to the report into emergency admissions for care home residents by the Health Foundation, Association of Directors of Adult Social Services Vice-President, James Bullion, said, 'We welcome this report into emergency admissions. It’s always regrettable when an emergency admission could have been avoided with better care.

'We’ve consistently maintained that investment in social care, primary and community services and the need to focus more on supporting people at home is the most effective way to prevent hospital admissions. This is why we need the new government to prioritise this by stabilising existing funding, and provide a sustainable solution for adult social care so that councils are better able to meet the need of their residents without the need for emergency hospital admissions.'

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