Vera was taken to A&E by ambulance from her care home with suspected pneumonia. She remained on a trolley in the open assessment area for more than nine hours. Her daughter Janet describes their experience:
“I assumed that after all this time, as all the relevant tests having been done, she would be taken to a ward straight away. We asked staff a couple of times how much longer we would have to wait, but no one could give us a proper answer.
“Mum was in pain, very uncomfortable and needed the toilet. A nurse helped us to the bathroom and I told her it was terrible that a 100-year old woman should be on a trolley for this long. The nurse seemed shocked at her age, like she hadn’t realised how old and frail she was. It wasn't long after that we were told that she was moved to a ward.
“She was given anti-biotics and finally put into a bed at 11.45pm, 13 hours after arriving at the hospital. She was exhausted and confused and I hated having to leave her in unfamiliar surroundings with people she didn’t know.”
Enhanced support to care homes
GPs in Rushcliffe have been working with care home staff, community nurses and therapists to deliver and enhanced model of support to nursing and residential homes in the area. Analysis from the Health Foundation shows that, since the initiative launched, residents in care homes are 23 per cent less likely to be taken to hospital by ambulance and 29 per cent less likely to attend A&E when compared with other, similar areas of the country. One care home manager describes how the new enhanced care model is improving the quality and efficiency of care:
“We now have a designated GP surgery for the home and have encouraged our residents to register to receive care from this practice. A GP from the surgery and a member of the community nursing team visit weekly or fortnightly to see the residents and review medication. This has helped us build relationships with the GPs who regularly visit and improved communication between the care home staff and NHS nursing teams.
“New residents have a visit from the health team within five days of them moving to the care home and a comprehensive geriatric health assessment within two weeks. If one of our residents has spent time in hospital, the community team follows up on their care within 48 hours of discharge. We are better informed about the support that person needs to recover properly which helps them avoid readmission to hospital.
“We also now have better information about the urgent care services we can access as an alternative to calling an ambulance. Plus the GPs and community nurses know our residents well through regular visits and can spot any problems sooner before their health seriously deteriorates.
“Another aspect of the enhanced support has seen a significant increase understanding and recording people’s preferences for their end of life care. Residents and their families are now proactively involved in discussions with NHS and care home staff about how they want to be cared for at end of life. We know that many people would prefer to die in the place they call home rather than in the hospital - by having these conversations we can make sure their wishes are known and supported where possible.”