Support to Care Homes using Physician Associates
‘People living in care homes should expect the same level of support as if they were living in their own home. This can only be achieved through collaborative working between health, social care, Voluntary, Community, and Social Enterprise (VCSE) sector and care home partners.’[i]
All too often, residents in care homes experience difficulties accessing timely care. Improving the clinical input into a home and tailoring care around the diverse needs of individual residents can improve the quality of both care for people and reduce unnecessary hospital admissions.
With multiple co-morbidities and multiple medication use, residents in care homes are often the most medically complex people in the community. According to figures from the British Geriatrics Society, 68% of care home residents have no regular medical review, 44% have no regular review of medications and just 3% have occupational therapy. To this end, residents need structured and pro-active approaches to their care, with coordinated teams working together to deliver:
- A reduction in ambulance call-outs.
- A reduction in hospital attendance and subsequent admission.
- Improved experience for both patients and family/carers.
- Improved capacity of care home staff to manage day to day needs.
- Co-production of care.
Whilst this brief emphasises the role of Physicians Associate, the approach is co-productive and relies on inputs from the wider primary care team e.g., a nominated GP, Clinical Pharmacists and crucially, the care home staff as well as seeking inputs from Social Services, Community and Palliative Care nursing teams
The benefits of this type of service are:
- continuity of care
- enhanced patient safety through delivery of better clinical outcomes
- increased satisfaction of residents and their carers
- a reduction in wasted/overprescribed medicines
- better trained and empowered staff in care homes.
The overall philosophy of the service will be that the Physicians associate will work pro-actively in the home to review and improve the residents’ health and medication and spot early-warning signs that might otherwise have led to a deterioration in their health. This will ensure that they can be treated and cared for within the home thus avoiding unnecessary ambulance call outs or hospital admissions. The enhanced involvement of practice staff within the care will facilitate the development of a stronger relationship between the home and the surgery.
The programme of support would have the following broad objectives:
Establishing baseline and risk stratification (PA & Care Home Staff)
Experience shows that one of the main reasons that care home residents are admitted to hospital is because staff feel unable to cope or do not have access to advice that would dissuade them from calling an ambulance. To combat this, the PA has a vital role to play in building the confidence of care home staff to manage their charges through helping them to understand when deterioration is of serious concern and when a simple intervention will do. To support this approach, it is vital that the PA establishes a baseline of all residents in terms of their normal health profile. This can be done through history taking, a review of notes and by recording baseline data such as NEWS 2, basic nutrition, hydration and capabilities. Once established these can be observed and recorded by the care home staff within their care plans and a score applied that would indicate improvement or deterioration. Training of care home staff will help them understand trigger points that would necessitate a call to the surgery/PA, involvement of other primary care teams or the need to call an ambulance.
Medicines management (in conjunction with Clinical Pharmacist)
- Medication reviews of all the care home residents on a regular basis improving patient safety and ensuring cost-saving prescribing.
- A review of the use of antipsychotic drugs.
- Improved management of care home residents’ medicines by the use of NICE medicine’s management checklist tool https://www.nice.org.uk/guidance/sc1/resources
- Review of patients’ medications on admission and discharge from hospital.
- The introduction of calcium and vitamin D supplements for residents, where clinically appropriate.
- The provision of a Flu & Covid vaccination services within the care home.
Improved oral health, hydration and nutrition
- All care home residents will be reviewed using the Malnutrition Universal Screening Tool. https://www.bapen.org.uk/pdfs/must/must_full.pdf
- Training for care home staff in the use of urinalysis tools to detect dehydration particularly for those most prone, such as Dementia patients.
- Ensuring all patients have access to oral hygiene products to maintain good dental hygiene.
- Facilitating access to appropriate dental treatment.
End of Life Care – close working with local hospice palliative care team
- Close working with the local hospice Palliative Care team to support improved end of life care,
- Support for care home staff in discussions with residents regarding Advanced Care Planning and review of Do No Attempt resuscitation directives.
- Provision of timely prescribing of anticipatory drugs.
- Provision of Verification of Expected Adult Death service as required.
Promoting mental health and well-being
Physical activity and access to essential healthcare services are very important in the support of people’s mental wellbeing. Empowering older people in care homes to be involved in all decisions about their lifestyle and care is fundamental to their mental wellbeing.
The PA can assist in this through considering what can be put in place to support their resident’s mental health and wellbeing and, by the use of tools to identify deterioration in wellbeing and mental state.
This service outline is specifically designed to meet all of the aims of a successful enhanced health in care home model as identified in the NHS Framework for enhanced health in care homes (March 2020) which are:
The EHCH model has three principal aims:
a. delivering high-quality personalised care within care homes;
b. providing, wherever possible, for individuals who (temporarily or permanently), live in a care home access to the right care and the right health services in the place of their choosing; and
c. enabling effective use of resources by reducing unnecessary conveyances to hospitals, hospital admissions, and bed days whilst ensuring the best care for people living in care homes.
For further details and help around service design contact Stephen Kemp at firstname.lastname@example.org or McCartneyhealth