Abstract
The integrated care home service was designed in a post pandemic era to bolster resilient communities by developing new alliances. Between 25-70% of care home residents have had swallowing difficulties, 41% have malnutrition and over 20% suffer from dehydration (1-3). Residents who need Dietetics, Speech and Language Therapy and Pharmacy input needed to be in three separate waiting lists with risk of protracted service delivery resulting from disjointed care.
The project involved co-developing an integrated pathway with care home staff, residents and their family and health clinicians. Training was delivered to include clinical and technical skills to safety conduct a remote joint session using telehealth. The six-month pilot was conducted with three care homes. To assess its effectiveness, Malnutrition Universal Screening Tool (MUST) audits were conducted. Evaluations were used with care home staff to understand if training had a significant impact on practice, change management and use of telehealth. Quality Of Life (QOL) data were gathered using Therapy Outcome Measures (TOMs). Staff and patient interviews were conducted to gain staff wellbeing and patient feedback.
Over 260 residents had access to the service and more than 20 staff competed training. It was found that waiting times for the residents were reduced by 75%. The new streamlined pathway also improving clinical capacity from community teams by 10%. Cost avoidance of over £8.5k were found from reduction of travel costs, hospital prevention and effective use of clinician’s time. Staff interview showed improved staff wellbeing, and significant increase in clinical and technical confidence. There has been a significant improvement with QoL outcomes for residents’ activity, participation and wellbeing.
The novel model of service showed how multidisciplinary teams were able to work collaboratively and cohesively with the resident and the care home staff to improve clinical outcomes. The improved confidence of staff highlighted the need for in-depth training to support innovative changes in health and social care. The findings demonstrated that inclusion of key stakeholders reduced the overall quality of the pathway, highlighting better equity of care for the residents and reducing the incidence of further decline.
Digital services complimented by an integrated care team, has ensured that the resident is kept at the centre of equitable care, providing a more efficient approach to a care home-based resident. These results were achieved without the need to allocate additional resource, and without additional time allocated for the resident by the care home staff, all whilst improving the wellbeing and confidence of the care home staff as well as improving the QoL of the residents.
1.Welsh Government. A Healthier Wales: our plan for health and social care. 2021
2.Stoumpos A, Kitsios F, Talis M, et al. Digital Transformation in Healthcare: Technology Acceptance and Its Applications. PMC. 2023 Feb 15;20(4):3407.
3.Fong R, Tsai K, Tong M, et al. Management of Dysphagia in Nursing Homes During the COVID-19 Pandemic: Strategies and Experiences. PMC. 2020 Aug;2(9):1361–5.