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Commissioning for excellence in care homes – a guide

The British Geriatrics Society (BGS) has published a guide for health service commissioners and planners which sets out what local services should be in place to meet the health needs of older care home residents.

Nearly 400,000 older people live in care homes in the UK. Their health and social care needs are complex. All have some disability, many have dementia, and collectively they have high rates of both necessary and avoidable hospital admissions. Standard health care provision meets their needs poorly, but well-tailored services can make a significant difference.

Previous reports published by the BGS, Quest for Quality and Failing the Frail, have drawn attention to existing levels of NHS support for care homes and made recommendations as to how care home residents’ quality of health care can be improved.

This new guide outlines what the priority services should be for older care home residents. It also explains what the outcomes should be for residents themselves, for the local NHS and for local care homes as a result of having these services in place. It describes what activities will enable these outcomes to be achieved and suggests how services can be monitored and evaluated to see if they are having a positive impact.

Professor Finbarr Martin said: “There is no reason why older care home residents should be missing out on high quality health care.

“The NHS can play an important role in supporting care home staff to ensure that older residents have a better quality of life.

“The evidence shows that health care services can be designed to deliver better care. Those responsible for planning what health services are needed locally must take notice of this evidence and ensure that they are not ignoring the needs and rights of this frail and vulnerable patient group.

Commissioners and health service planners must involve representatives from the care home sector early on when considering what services need to be considered for older residents. This is more likely to ensure that services are designed appropriately and are sustainable.”

It is likely that a combination of approaches whereby residents have access to enhanced, proactive, primary care and through this, access to a range of specialist services (such as allied health professionals, community pharmacists, old age psychiatrists and community geriatricians) will deliver the best outcomes.

It is important the efforts of existing health professionals are co-ordinated more effectively so that residents don’t fall between the referral criteria for health services.

The guide is available here along with reference material and links to useful resources, including case studies of successful services which have improved quality of care for older care home residents.

Dr Anita Donley, RCP clinical vice-president, welcomed the new guidance: “Older people have complex needs and challenging problems across the spectrum of health and social care wherever they are, so commissioning integrated and coordinated care for older people’s health needs is very important.

“As we look to implementation of Future Hospital: caring for medical patients, the input and leadership of geriatricians will be key, and resources such as these should improve the quality of care for older people both in and out of hospital.”

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