The Sub-Committee will receive a presentation on how Care Homes manage and monitor the admission and discharge of residents from hospitals.
Minutes:
Following a request from members about the admissions and discharges from Care Homes, officers provided a presentation on the processes in place.
The Sub-Committee were informed that there were 17 Nursing Care Homes with 964 beds, 22 Residential Care Homes with 643 beds and 20 Learning Disability Homes with 130 beds. There were two types of admission to hospital, the first was planned admission which was for an operation or tests under sedation, these would either be accompanied by a family member, carer or the home would provide sufficient information to the hospital about the individual’s needs. The second would be unplanned admission these could be in the form of an urgent (via 999) sudden collapse, a serious fall, injury or at the request of the GP.
All care homes are now aligned with a GP surgery. The GP visited at least once a week. This enables the GP to get to know the residents, to understand the medications of the patient, can spot early issue and provide early intervention, offer out of hours support and can prescribe and refer to other specialists if necessary.
There are 20 Learning Disability homes in Havering who have 130 residents. Each resident is issued with a hospital passport which gives all their details together with their needs. In the event of an emergency an escort would accompany the resident. The hospital was aware of the passport however it does not always come back to the home with the resident.
Members felt that given recent technology the data could be uploaded onto a bracelet that could be worn by resident, which could be scanned at the hospital and prevent the need for paper copies which could get lost. It was through this would be useful for older people in care homes. Officers felt that this was a good suggestion.
End of Life Care was for the final 48 hours of an individual’s life. This was very limited and ensured that the individual was comfortable, hydrated and their care wishes were in place. Whilst this was for the last 48 hours of their life, it was important that this was put in place at an earlier stage so that their preferences and choices can be made.
When an individual is discharged back to the care home from hospital this is planned. The relatives are the first to be informed as they would generally be the next of kin. The care home is contacted if there is a change to medication or mobility. If there is a change the care home would arrange for an assessment to be carried out on the hospital ward before the resident is sent back to the care home. Transport can also be arranged by the care home as this is often quicker than waiting for an ambulance.
Discharges of a new resident from hospital are often for “step-down” beds. This could be in the form of respite care due to hydration, nourishment or because they have a broken limb and have a co-dependent who they cannot care for. A social worker would carry out an assessment and a detailed support plan would be written for the needs of the resident. These plan are often shared with the individuals family.
Members raised concerns about hospitals discharging residents too early without mediation in place. Officers stated that there were improvement and this was now rare, however if it did happened there care homes could refer the inappropriate discharge form back to the hospital. The Quality and Suspension Team meet every three weeks to discuss these issues and investigate if necessary.
The Sub-Committee thanked the officers for an informative presentation.