Health Inequalities / discharge and care

Question 1

List some examples of category 1 hazards, as outlined by the Decent Home Standard

Answer 1

• Fire risk / accidents
• Insecure property e.g. faulty locks
• Damp / mould
• Excess heat / cold
• Dangerous substances e.g. asbestos or carbon monoxide
• Overcrowding
• Risk of infection e.g. insects
• Too much noise / poor lighting

Question 2

List 4 types of homelessness

Answer 2

1. At risk of homelessness
2. Hidden homelessness e.g. sofa surfing, hotels etc.
3. Statutory homelessness
4. Rough sleeping (on the streets)

Question 3

Describe what is meant by ‘NHS continuing healthcare’

Answer 3

Certain patients with long-term complex health needs qualify for free health and social care arranged / funded solely by the NHS
Package reviewed on a 3-monthly basis

Eligability assessed by the integrated care board (ICB)

Question 4

When is a ‘discharge to assess (D2A)’ process used

Answer 4

Once a patient is medically fit to leave hospital, but have not yet sorted their care needs

Discharged to a care home for a period of 28 days of assessment - by PT, OT and social workers

Question 5

List some potential discharge locations for a patient in hospital

Answer 5

• Patient’s own home (family home) +/- POC
• Assisted living facility
• Care home
• Nursing home
• Community hospital
• Discharge to assess pathway

Question 6

What is meant by rehabilitation following on from hospital discharge

Answer 6

• Usually takes place in the person’s home or in a short-term community setting
• Holistic approach including cognitive and psychological screening, medication review, review of physical functionality and communication needs
• Create an individual rehabilitation plan designed to support the person throughout their intermediate care journey

Question 6

State what is meant by nursing care home

Answer 6

1 or more qualified nurses on duty to provide nursing care

Also provides accommodation and personal care e.g. washing, dressing etc.

Question 7

State what is meant by residental (care) home

Answer 7

Residence providing accommodation and personal care e.g.
- washing
- dressing
- taking medicines
- going to the toilet

Question 8

State what is meant by intermediate care

Answer 8

• Free short term service which provide supports to help patient recovery, run by an MDT
• Patient can remain at home, in a care home or hospital

Question 9

List some conditions commonly seen in care homes

Answer 9

Dementia
Frailty
Post-stroke
Slow growing cancers
Heart failure
COPD
OA
Osteoporosis
Chronic pain

Question 10

Outline how care homes are funded

Answer 10

Means tested currently
< £14,250 = fully funded by local authority
Between £14,250 and £23,250 = partially funded
> £23,250 = fully funded by self

Lifetime cap on fees currently at £86,000 (only covers care aspect, not included daily living cost)

Question 11

State the average life expectancy of those entering a care home
- Nursing home
- Residental home

Answer 11

Nursing home = 12 months (1 year)
Residental home = 24 months (2 years)

But obviously also highly variable

Question 13

State some causes of malnutrition

Answer 13

• Reduced dietary intake e.g. N&V
• Malabsorption conditions e.g. Coeliac disease
• Increased loss
• Increased requirements

Question 14

List some consequences of malnutrition

Answer 14

• Weight loss / pressure ulcers
• Reduced muscle mass and strength / increased falls risk
• Fractures and osteoporosis
• Poor healing or recovery
• Immunodeficinecy
• Gingivitis
• Deficiencies e.g. anaemia, B12/folate definiciency
• Anxiety / depression / cognitive impairment

Question 15

Describe the 4 stages of wound healing

Answer 15

1. Haemostasis = vasoconstriction and clot formation to reduce blood flow
2. Inflammation (4 days) = invasion of white cells and removal of debris
3. Proliferation (2 weeks) = active reconstruction of damaged tissue, fibroblast activity and neovascularisation
4. Remodelling (3 weeks to 1 year) = refinement and strengthening of the newly formed tissue, reorganisation of collagen

Question 16

List 3 medications that can reduce wound healing rates

Answer 16

• NSIADs
• Steroids
• Chemotherapy
  (temporary during treatment)

Question 17

Outline the pathophysiology of pressure ulcers

Answer 17

• Develop when a pressure is applied to an area of skin
• Disrupts blood flow through the skin (particuarly capillaries)
• Affected skin becomes ischaemic and necrotic, leading to ulcer formation

Question 18

List some common sites of pressure ulcer formation

Answer 18

• Back of the head
• Ears
• Buttocks
• Sacrum
• Heels

Question 19

List some screening tools used to assess pressure ulcers

Answer 19

1. Waterlow Scale (high score is worse)
2. Braden scale (low score is worse)
3. Norton Scale

Question 20

If unable to obtain height measurement from patient, how else can height be calculated?

Answer 20

Ulnar length

Measure between the olecranon of elbow to ulnar prominence at the wrist - use chart to calculate height from this ulnar measurement

Question 21

If unable to obtain BMI calculation from patient, how else can height be calculated?

Answer 21

Measure upper arm circumference (mid humerus) and calculate approximate BMI from this