Study shows medical care neglected in some districts with patients waiting for up to 18 weeks for health checks
The healthcare needs of older care home residents are being neglected in some areas of the country, according to a review published by the British Geriatrics Society and the Care Quality Commission.
Most primary care trusts plan healthcare for their local population by assessing the needs of people who live in their own homes – so elderly people living in care homes may be out of sight and out of mind. The BGS says PCTs "do not accord sufficient priority" to their health needs.
There are 376,250 older people living in 10,331 care homes in England and many are frail and vulnerable, with more health needs than most of the population. Around 40% have dementia, many are on cocktails of medication, and the average lifespan when they get to a care home is one to two years.
"The NHS disengaged from care homes when they became private sector nursing homes," said Prof Finbarr Martin, BGS president and co-author of the report, Quest for Quality. "The NHS disengaged except for the statutory responsibility to provide GPs.
"Care home residents have potentially become disenfranchised from a lot of community health services they would expect to get if they were in their own homes. There is an assumption that they are taken care of. The NHS, if it is about patient-centred care and equitable access, has to look at care home residents and meet their needs."
If the health needs of this vulnerable elderly population are not properly met, they end up in hospital instead, he said.
Data on the healthcare provided to residents was collected by the CQC, which has the job of monitoring standards in care homes, but analysed by doctors from the BGS. They found that the amount of NHS care offered to people varied widely.
Elderly residents had access to a geriatrician who could take an overview of their complex age-related health problems in only 60% of PCTs, the analysis shows.
The residents needed a whole range of medical services, including mental health teams, dietetics, occupational therapy, physiotherapy, podiatry, continence, falls and tissue viability (dealing with wounds, pressure sores and ulcers). Only 43% of PCTs made all of these available to care home residents. Where the services were available, it could take a long time for an elderly person to be seen – sometimes as long as 18 weeks, which could lead to a deterioration in health.
"The fault in many cases is not with care homes but with those responsible for ensuring that the NHS plays its part in ensuring that healthcare needs of residents are met," says the BGS.
It wants local health service commissioners to agree clear service specifications with hospitals and other providers.
"It is evident that while there are pockets of excellent NHS care, such as in Sheffield, Leeds or south Manchester, there are striking geographical differences," said Martin.
"It is unacceptable to leave people waiting for over three months to receive treatment that could significantly improve their quality of life, especially when you consider that the average life expectancy of an older person entering a care home is between one and two years.
"It is time that commissioners and health service planners matched their obligations to ensure that the healthcare needs of this vulnerable group are adequately met."
The CQC also looked at how staff in a small sample of care homes dealt with the health needs of residents. They found good practice in most cases in identifying residents' medical needs and planning, but there were also problems.
Thirty-five per cent of homes said they "sometimes" had difficulties getting medicines to residents on time, and only 38% of care homes said GPs made routine visits, while 10% paid the GP surgeries to visit.
Under the health changes, the CQC no longer has responsibility for monitoring the work of commissioners. The British Geriatric Society says it is concerned to know "who is looking out for the needs of this very vulnerable group of older people. The Guardian
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