Care Home Medicine Flashcards
Discharge to assessment beds
Short stay in care home funded by social services following discharge from an acute or community hospital
During stay decisions made for the future care of the patient
Care home demographics
4% of the total population of people in UK aged over 65 live in a care home, rising to 15% (1/7) of those over the age of 85. The equates to approx. 490,000 people who are living in such accommodation in the UK . 40 % of those living in a care home have a diagnosis dementia; this is likely to be an underestimate.
What are the differences between a residential and nursing home?
Residential Homes provide accommodation and personal care such as help with washing and dressing, taking medications and going to the toilet. Some offer activities within and outside of the care home.
Nursing Homes also provide personal care but there will always be 1 or more qualified nurses on duty to provide nursing care . Some nursing homes offer services for people that need more care and support for example some people with severe learning disability , dementia or another mental health diagnosis or a complex medical condition that needs qualified nursing support such as a NG tube .
How are care homes funded?
People either pay for their own care (self-funding), have financial help from the local authority via Adult Social Care or with financial help from family
Self-funding is when you pay for care home fees yourself.
State-funding is when your local authority pays your care home fees for you.
To decide which you are, the local authority will conduct a financial means test.
Why is it important to improve integrated care in care homes?
Care Home residents are heavy users of NHS emergency services both with A and E attendance and emergency admissions and as the UK population is ageing means that there will be increasing numbers of patients with complex multimorbidity living in a care home setting.
Approx. 40% of these admissions are deemed to be potentially avoidable and could be managed, treated or are preventable outside of hospital or are caused by poor care or neglect
Key problem with care home staffing?
Care Home staff who do not have a professional qualification are not well paid which has impacted on care home staffing and impacts on the wider NHS .
Falls risk management in care homes
Many factors can contribute to the heightened risk of falls in a care home, such as physical frailty, physical inactivity, taking multiple medications and the unfamiliarity of new surroundings.
For this reason, NICE recommends that all care homes implement a person-centred process to manage and reduce the risk of falls and fractures.
Multifactorial interventions with an exercise component are recommended for older people in extended care settings who are at risk of falling.
Measure that can be taken:
- Falls risk assement and management plan for each individual service user
- Adapt the physical environment to include hand rails, sensory lighting and bold colours
- Use slip resistance flooring and provide suitable footwear
- Check the positioning of furniture
- Avoid trip hazards
- Keep objects within easy reach
- Label the environment
- Provide multiple and accessible seating areas both inside and out
- Incident reporting following falls with input from management to review care plan and prevent further falls
- Offer daily exercises and physical activities
- Arrange regular visits from opticians, GP’s and chiropodists
- Train staff to manage and reduce the risk of falls
- Adequate supervision of service users as required
- Motion sensors or mat sensors in bedrooms connected to alarm systems in service users who are falls risk
- Provide service users with call bells/buzzers if appropriate
- Regular toileting of service users
How is continence managed in care homes?
encouraging the service user to drink fluids — many people with urinary incontinence will restrict their fluid intake, particularly before bedtime, and this can lead to other problems such as dehydration
discreetly helping the service user to access appropriate toilet facilities
regular scheduled toileting for service users
continence aids such as commodes, bedpans or urine bottles made available to service users who require them
accommodations to maximize the mobility of service users
ensure toilets are acessable and safe
use of incontinence products if appropriate - of varying size and absorbance - may only be required for nightime or used 24/7
input from continence assement teams, GPs, district nurses
consider long term catheterization of residents with long term urinary incontinence or retention if non-invasive management fails
liase with GP re continence changes
utilize PRN laxatives as appropriate
have in place and utilise UTI assement tools within the care home
keeping careful records of fluid intake and frequency of urination
bladder and bowel charts, including level of contience
frequency volume chart may be recorded in service users with new incontience/changes to contience
antibiotics to treat a urinary tract infection
caffeine restriction in troublesome incontience
bladder and bowel training programmes
pelvic floor exercises or other physiotherapy
reviewing existing medication
promote exercise and mobility
staff training
Pressure ulcer management in care homes?
Assess every resident for pressure ulcer risk on admission using the Waterlow Assessment or other tools - re-assess monthly, or more often if condition deteriorates or changes
Body maps should be recorded of new admissions
Reposition residents identified as requiring repositioning
Use of air flow/pressure redistributing mattress as required
Use of pressure relieving aids e.g. boots to offload heel pressure for bedbound service user
Nutrition assessments performed - monthly MUST of service users at medium-high risk and action appropriately
Offer nutritional supplements to adults with a pressure ulcer who have a nutritional deficiency
Ensure adequate hydration of service users
Fluid and food charts
Pressure redistributing cushions for adults who use a wheelchair or sit for prolonged periods and who have a pressure ulcer or are at high risk
Strict documentation of skin damages
Monitoring of any skin damage
Involvement of district nurses in management of pressure injuries
Good skin care, utilize moisturizers/prescribed emollients
Ensure service users are receiving regular washes with adequate drying
Ensure service users requiring it receive personal care and pad changes regularly if incontinent
Use of barrier creams in pressure areas or in areas of early skin breakdown
Reduce amount of time a resident spends sitting in a chair if risk of sacral or pelvic sores is identified,
Resident to be assessed by a qualified nurse, or other appropriate health care professional for detailed assessment and grading of sore/ulcer, identification of wound management and drawing up of wound care plan. Medication and treatment will be discussed with the resident and their next of kin and recorded in their care plan.
Nursing staff and home managers are responsible for documenting the condition of a pressure ulcer to include; size (measurements), description, presence or absence of sings of infection (and whether a wound swab has been taken) and photographic record
Nursing staff are responsible for the reporting of pressure ulcers stage II-IV (EPUAP)
Nursing staff are responsible for coordinating and liaising with other agencies in the plans for pressure ulcer prevention and management, including seeking advice from NHS Tissue Viability Specialist Nurses for the management of complicated or non-healing wounds
Why might a care home refuse a new admission?
Inability to meet a person’s needs
If a resident if they pose a risk to existing residents in the home
Inadequate staffing
Inadequate bed capacity
N.B. under the Equality Act 2010 you could not refuse an admission on the basis of a prospective resident’s protected characteristics
End of life management in care home setting?
Anticipatory medications prescribed and available in advance
Increased flexibility of family visits
Close liaison with GP - ensure GP has reviewed service user recently
Close liaison with family
Increased staff supervision of service user
Cessation of regular medications under direction of GP - established and doccumented ceiling of care
Mouth care and repositioning
Visits from district nurses to give end of life medications/manage syringe drivers
Make sure any advanced care decisions are known and documented
Make sure a ReSPECT form is in place and status of this is known to care home staff
Have a record of the service user’s (if possible) or family wishes re death: funeral arrangements, post mortem care requests
Care home staff will usually perform post mortem care following death certification
Documented policies on death notification
Practitioner’s to attend home to certify death: GP, out of hours GP, DNs with appropriate competnancies
End of life management in care home setting?
Anticipatory medications prescribed and available in advance
Increased flexibility of family visits
Close liaison with GP - ensure GP has reviewed service user recently
Close liaison with family
Increased staff supervision of service user
Cessation of regular medications under direction of GP - established and doccumented ceiling of care
Mouth care and repositioning
Visits from district nurses to give end of life medications/manage syringe drivers
Make sure any advanced care decisions are known and documented
Make sure a ReSPECT form is in place and status of this is known to care home staff
Have a record of the service user’s (if possible) or family wishes re death: funeral arrangements, post mortem care requests
Care home staff will usually perform post mortem care following death certification
Documented policies on death notification
Practitioners to attend home to certify death: GP, out of hours GP, DNs with appropriate competencies
Care home - admissions and referral
In accordance with the Care Act, local authorities in England have an obligation to assess everybody.
A care needs assessment will identify a person’s care needs - what kind of care is required and how much support is needed.
A social worker, occupational therapist, nurse or someone else working on the local authority’s behalf will carry out the assessment.
An application for a care needs assessment can be made directly to the local social services department or through a person’s GP or health consultant. A carer, friend or relative can also ask for an assessment on behalf of someone.
To meet national eligibility criteria for care in England, individuals are assessed on whether their needs meet the following conditions:
1. The person’s needs arise from or are linked to a physical or mental impairment or illness
2. Their needs make you unable to do two or more criteria specified (management and maintaining nutrition, maintaining personal hygiene, managing toilet needs, dressing, safe mobilizing, keeping a home clean and safe, developing/maintaining social relationships, carrying out care responsibilities, accessing and engaging in work/volunteering/education, safely using facilities or services in the local community)
3. Whether there is likely to be a significant impact on a person’s wellbeing, because they cannot meet the criteria.
The local authority will draw up a care and support plan that outlines the help a person can receive and set out the services which are to be provided and what will be achieved by providing them. This may include residential care.
If a person has been assessed as requiring a care home place, they will need to have a financial assessment to ascertain whether or not you are entitled to financial assistance towards your care home fees from the local authority.
Care home places will either be self-funded or funded by the local authority (this is means tested)
Prior to admission, a full assessment of needs is completed to ensure the service user’s needs can be met by the care home and the home can complete a fully comprehensive person-centered care plan.
The care home manager or the person responsible for a resident’s transfer into a care home should coordinate the accurate listing of all the resident’s medicines (medicines reconciliation) as part of a full needs assessment and care plan.
On admission service users will undergo various risk assessments (falls, nutrition, etc) and will have baseline measurements recorded (weight, body map).
What is the national eligibility criteria assessed in England as part of the care needs assesment?
Managing and maintaining nutrition e.g. Are you able to access and prepare and consume food and drink?
Maintain personal hygiene, e.g. can you wash yourself and your clothes?
Managing toilet needs
Dressing appropriately e.g. do you need anyone to help you dress?
Moving around the home safely
Keeping the home clean and safe
Developing and maintaining family or other personal relationships
Accessing and engaging in work, training, education or volunteering
Safely using facilities or services in the local community
Carrying out any caring responsibilities e.g. for a child.
What is meant by BPSD?
Behavioral and psychological symptoms of dementia
The most common BPSD symptoms include apathy and agitation, irritability, sleep and appetite disorders, and mood disorders
