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Nearly half of emergency hospital admissions from care homes ‘avoidable’

More than four in 10 of emergency admissions to hospital from care homes could be potentially avoided, analysis published today has revealed.  

Emergency hospital admissions of care home residents were for ‘potentially avoidable’ conditions such as chest infections, pressure sores and urinary tract infections in 41% of cases, according to a report from NHS England and the Health Foundation.

It comes as the NHS rolls out the Enhanced Health in Care Homes (EHCH) framework – a nationwide scheme for care homes to improve residents’ health, step up care provision and reduce avoidable hospital admissions. 

The new analysis detailed four care home sites where local NHS initiatives using elements from the EHCH model were found to have reduced emergency hospital admissions by around a quarter. 

There were 23% fewer emergency admissions at a site in Rushcliffe than a comparison group, while care homes in Nottingham City and Wakefield saw 27% fewer potentially avoidable admissions. Results from a care home in Sutton were inconclusive.  

Meanwhile, the report suggested that residential care homes, where care is provided by non-clinical staff, were most likely to benefit from EHCH:  there were approximately 32% more A&E visits and 22% more emergency admissions of residents from residential care homes than nursing homes

As outlined in the NHS Long Term Plan, EHCH will upskill care home staff, alongside giving residents improved support primary care services and GPs, and more visits from specialists like dieticians and clinical pharmacists.  

Care home residents were shown to account for nearly one in 12 emergency admissions to hospital for people aged 65 or older, an estimated 192,000 emergency admissions each year.  

The report said: ‘This shows that reducing emergency admissions from care homes has the potential to reduce pressure on hospitals.’ 

Responding to the research, Wendy Preston, head of nursing practice for the Royal College of Nursing, warned that further support for nursing staff was needed in order to reduce hospital admissions.   

She said: ‘Nursing staff in care homes want more than anyone to try and prevent the residents they care for from being admitted to hospital as emergencies. But, at present, if a care home resident has a fall or develops a urinary tract infection (UTI), particularly out of hours, staff have very few options and are often advised to call an ambulance by NHS 111 or managers.  

‘What is needed are dedicated primary care teams including advanced practice nurses who can promptly assess and treat residents who fall ill or injure themselves - a few areas currently have such teams, but we need them to be rolled out nationwide. Hospital is not the best place for most frail elderly people and nurses are often the solution to this problem despite services not always receiving the correct funding.’ 

Adam Steventon, director of data analytics at the Health Foundation, said: ‘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.’