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Managing deterioration in Care Homes

Why change was needed

Care home residents frequently find themselves in hospital because of health issues that could have been avoided with timely recognition of deterioration and an appropriate community-based response. Furthermore, once an issue has been identified, there is often not the necessary response from health services required to treat the patient effectively.

We want our aging population to stay healthy in care homes as unnecessary hospital stays can have detrimental effects such as loss of mobility and muscle strength. Up to 60% of older patients experience functional decline after hospitalisation, which has a significant impact on their day-to-day needs. It can also have a negative mental impact in patients with dementia due to the confusing change in environments and routines. 

 

What we did

It was recognised that a collaborative approach was needed to ensure consistent and appropriate training was offered to care home staff to enable them to identify and respond to signs of deterioration at the earliest possible opportunity. Furthermore, the support from other health services offered to care homes needed to be improved to get patients the treatment they need as quickly as possible.

The West Midlands Academic Health Science Network (WMAHSN) launched the Managing Deterioration Safety Improvement Programme in early 2022-23 with a focus on minimising harm associated with deterioration by enhancing prevention, identification, escalation, and response to physical deterioration. This initiative aims to create a smoother, more reliable pathway of care through better coordination. 

The Coventry and Warwickshire Deteriorating Residents project group was established in February 2022, which includes representatives from various stakeholders, such as South Warwickshire NHS Foundation Trust, Coventry and Warwickshire Partnership Trust, Warwickshire County Council, Coventry City Council, Coventry and Warwickshire Integrated Care Board, and care homes in our system. The group were initially working towards implementing deterioration management tools in at least 85% of care homes by the end of March 2023. 

To support the project a series of communications were established. Key messages were delivered via newsletters to encourage care homes to adopt deterioration tools. The group also developed an information pack on managing deterioration, covering Urgent Community Response services, common health conditions, mental health, palliative care, and end-of-life support. Care homes received hard copies and digital versions, with links to deterioration tools which gained positive feedback.

Building on this work, the project group shared messages highlighting the pack's content and guiding care homes to relevant training. Deterioration tools have been integrated into work to ensure quality across our system, providing crucial support to care homes in elevating their standard of care and therefore helping us achieve our aim as an ICB to improve outcomes in population health and health care.

For care homes using Docobo, a 'my resident is unwell' feature has been built into the digital tool to bolster its existing functionality and support this workstream. WMAHSN actively monitored tool adoption with an initial survey and initiated follow-up contact where necessary to ensure care homes were appropriately supported.

The group recognises education of care home staff is key as they are naturally the most well connected with residents, so they organised a series of webinars focused on recognising and managing deterioration in those they look after. Tailored webinars for Learning Disability (LD) homes were run as part of the inclusive approach, with care homes in Coventry and Warwickshire encouraged to attend.

 

What’s next?

The project was successful in its aim and surpassed the target it set itself, with 90.5% of care homes having implemented deterioration management tools by March 23, with 44% showing sustained use for 12 months or more. 

WMAHSN were nominated for ‘Provider Collaboration of the Year’ at the 2023 HSJ Awards for the implementation of this project across the region. They were awarded ‘Highly Commended’ in their category, which is testament to the work done on the project. You can see some pictures from the awards ceremony in the photo gallery below.

Locally, there is an ongoing focus on managing deterioration and embedding the use of deterioration tools is part of the Enhanced Health in Care Homes (EHCH) workplan for 23/24 and the impact of the project on care home admissions will continue to be monitored.

There is consideration being given to whether the information pack could be adapted for use in other settings such as supported housing and other social care providers.