Care homes provide the majority of long-term healthcare to older people but provision is uneven. Our study shows how services can work together better.
Care homes provide the majority of long-term healthcare to older people. They rely on primary care for access to medical support and referral to specialist services, yet studies consistently show that healthcare provision for care home residents across England is unpredictable and uneven.
For the NHS, care homes are a conundrum; they provide care that used to be supplied by the health service, but are often perceived as a poor alternative that generates avoidable demand on hospitals.
So what needs to be put in place to ensure effective collaboration? For our recent study, researchers from seven UK universities tracked the care received by 232 care home residents over 12 months. We reviewed the evidence of what works, when and in what circumstances, and can suggest several key elements that contribute to effective cross-organisational working.
We found that when extra NHS provision was offered, either on a resident-by-resident basis or focused on a single issue – such as prevention of hospital admission – there could be unintended consequences. It could lead to a sense of “them and us” and mutual recrimination if the desired improvements in healthcare were not achieved.
In contrast, if the focus was on the care home as the provider of care to frail older people, there were more opportunities for NHS staff to discuss and plan with care home staff how additional investment or training from the NHS could improve residents’ healthcare. This approach clearly supported and sustained working relationships between the NHS and care homes.
Ensuring that the right mix of people are involved in the design of healthcare provision from the outset, for instance, helps to develop a shared view about what needs to be done. Single care home teams, for example, or nurse and therapist specialists, can make an enormous difference to how residents experience healthcare. Yet by working apart from other services they risk being isolated, unable to access the relevant expertise to address the multiple needs of residents.
As the majority of care home residents live and die with dementia, understanding the associated symptoms and behaviours of this condition in particular is crucial to working with care homes. Our study found that access to specialist dementia care benefits residents, and improves the confidence and skills of NHS and care home staff.
Healthcare professionals should not be expected to fit care home work within existing caseloads. They need protected time that allows them to develop experience and expertise working with social care. Ongoing investment in resources and services dedicated to care homes, as well as forging links with different services locally, would provide a way of working that can accommodate the different priorities of health and social care staff.
There is no one-size-fits-all answer for the NHS when it comes to working with care homes. The diversity of care homes in terms of size, approach, staff experience, proximity to other services and funding means it will always be context specific. But this is not an excuse for ad hoc and unequal healthcare provision.
To date, most of the research for answers has been driven by a healthcare agenda. This is not the starting point for residents and their families, who are interested in quality of life and quality of care. Our study demonstrates the benefits of finding common ground but more work is needed to ensure care homes have an equal say on what matters for the health of their residents.
When NHS commissioners and healthcare professionals see care homes as an integral part of the health and social care system, and take the time to learn how to work together, there is a marked improvement in appropriate access to, and use of, healthcare. It is time, in short, for the NHS to see care homes as partners, not problems.
Claire Goodman is professor of healthcare research at the Centre for Research in Primary and Community Care at the University of Hertfordshire