Abstract
Background: Integrated Care Systems (ICSs) in England bring together health, social and community care, and public health. Initiatives such as Enhanced Health in Care Homes and National Health Service (NHS) policies emphasise the need for integration to support an ageing population. Care home and health services staff need to work together to support physically deteriorating residents. Recently, innovative approaches such as “hospital-at-home” (HAH) are being introduced to reduce hospitalisation for older adults.
Approach: This mixed methods study used an online survey and semi-structured interviews with care home staff to explore their use and experiences of health services, care pathways and strategies to support their residents. The survey and interview guide were developed with input from five care home staff. Survey participants were recruited via email, post and a network of research ready care homes, and interview participants, via the survey. The survey data were analysed descriptively and the interview data, thematically.
Results: To date, 48 care home staff participated in the survey and 19 in an interview (data collection will finish in December 2024). The preliminary analysis identified two main findings:
1.Lack of consistent care pathways for physically deteriorating residents
Care home staff used different types of health services (e.g. general practitioners (GPs), 999 emergency calls, or community-based services including HAH) to support residents. Decisions about which service to contact were based on staff experience or easy accessibility. Formal integrated care pathways were lacking and care homes frequently developed their own pathways to support their residents. This meant that unwell care home residents experienced inconsistent care pathways.
2.Challenges and opportunities for integrated care
Most participants identified challenges that affected integration and collaborative working such as negative attitudes and poor communication; a lack of prioritisation when requesting help from urgent and emergency services; and limited understanding of the practice and policy challenges faced by care homes. The challenges were often perceived as unwillingness of healthcare staff to help their residents; leading to tensions between care homes and health services.
Nevertheless, some participants gave examples of successful joint working. Primary Care was the most frequently used service and some care home staff described good relationships with their care home GP. They valued regular GP visits, which they felt reduced the need for additional health and social care services. If HAH services were used, care home staff felt there was good collaboration and knowledge-sharing opportunities. Most survey respondents (66%) stated they would prefer HAH to hospitalisation for their care home residents.
Implications: Supporting physically unwell residents’ health requires integration of social and health services. The challenges experienced by staff and the lack of consistent formal pathways indicate that effective integration of services for physically unwell residents is yet to be realised. In our study, positive examples of joined-up working between care home staff and NHS services were scarce despite ICSs and policies in England specifically advocating integration. This study highlights the need for improved collaboration and clearer pathways, as well as learning for improving integration and residents’ healthcare.