COMMENT
252
For frail elderly care, there’s no place like home
T
he ever-increasing pressures on accident and emergency (A&E) departments in our NHS hospitals are increasingly in the headlines (‘A&E crisis: hospital casualty units under huge pressure, Jeremy Hunt admits’ (Mason, 2013) is one example). Sixty-five per cent of people admitted to hospital are above 65 years of age. In addition 80% of emergency admissions who have a length of hospital stay greater than 2 weeks are patients in the over-65 age group (Cornwell, 2012). Consequently, we are being urged to seek new models of care that could assist in the avoidance of hospital admissions, particularly in the elderly population. Developing responses that are effective, efficient and deliver change ‘at scale and pace’ (Ham and Walsh, 2013) is challenging. The Florence Nightingale Travel Scholarship (2012-13) supported an observational study in Australia with its model of Geriatric Flying Squads (GFSs). GFSs are rapidresponse teams for elderly people either living in their own homes or in residential/nursing homes. Many of the GFSs were spearheaded by nurse consultants and successfully addressed unplanned, emergency admissions in the over-65s. The domiciliary GFS accepted referrals from anyone who had contact with an elderly person and was concerned about their functional decline at home. The response time to a new referral was 24 hours, Monday to Friday. The initial consultation took the form of a home visit. It was common practice, at this preliminary stage, for this assessment to be undertaken by a nurse consultant or nurse specialist in aged care, and a social worker. Other members of the domiciliary GFS team included a physiotherapist, an occupational therapist, a dietician, a clinical psychologist, a consultant geriatrician and two social workers. If, following the initial consultation, it was felt that a review was needed from the wider multidisciplinary team, their opinions were usually gathered within a week, again in the patient’s own home. Instead of heeding the traditional divide between ‘health’ and ‘social’ fields, the GFS looked to integrate these facets of care for the elderly. Initial comprehensive geriatric assessments were frequently done jointly by the nurse consultant/specialist and a social worker. In addition, if hospital admission was required, the nurses had direct admission rights to the geriatric medical admissions unit and inpatient rehabilitation beds. The overall aim was to provide a ‘one-stop shop’ for elderly people without having to wait many weeks for a professional opinion or support, and to keep them well and at home for as long as possible.
Pivotal to the success of the GFS model was the single point of contact with a nurse consultant or nurse specialist for patients, relatives and carers. As we have seen from the National Voices project (2013), patients emphatically want a healthcare system where, ‘My care is planned with people who work together to understand me and my carer(s), put me in control, coordinate and deliver services to achieve my best outcomes.’ On the other hand, the aged care facilities (residential/nursing homes) GFS provided a response time of 80 minutes to assess patients who were thought to be acutely deteriorating and who, by more traditional pathways, would perhaps have been admitted to hospital. This aged care facilities GFS was led by a consultant geriatrician and a nurse practitioner with advanced skills, and provided cover Monday to Friday, 8am to 9pm. Such a service meant that the majority of patients continued to be cared for and medically treated in their aged care facilities rather than needing hospital admission. All these services had been proven to reduce acute admissions to hospital and/or delay entry into 24-hour care environments for the elderly population. Given the predicted ‘care tsunami’ of burgeoning elderly care, services such as the Australian GFSs need to be considered, and its strengths and innovations translated into practice in the UK. As we move into 2014, in the wake of highly publicised recent reports on the NHS, such as the Francis report (2013) and the Keogh review (2013), such reports can be seized as levers for change by nurses in frail, elderly care, and promote new models of care that bring about real, effective change for BJN their patients. The author would like to thank the Florence Nightingale Foundation and the Royal College of Nursing for their generous sponsorship. Cornwell J (2012) The care of frail older people with complex needs: time for a revolution. Kings Fund, London Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. http://tinyurl.com/bkgyem7 (accessed 27 February 2014) Ham C, Walsh N (2013) Making integrated care happen at scale and pace. King’s Fund, London Keogh B (2013) Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report. http://tinyurl.com/ ph9e267 (accessed 27 February 2014) Mason R (2013) A &E crisis: hospital casualty units under huge pressure, Jeremy Hunt admits. Daily Telegraph online. 15 May 2013. http://tinyurl.com/omxfe5s (accessed 27 February 2014) National Voices (2013) A narrative for person-centred co-ordinated (‘integrated’) care. http://tinyurl.com/ow5g825 (accessed 5 March 2014)
Jacqueline Thompson Advanced Nurse Practitioner, Acute Medicine for Older People, Central Manchester NHS Foundation Trust
© 2014 MA Healthcare Ltd
Editorial Board David Aldulaimi, Consultant Physician, Gastroenterologist, Worcestershire Acute Hospitals NHS Trust Palo Almond, Academic and Research Consultant, Anglia Ruskin University Irene Anderson, Prinicipal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Residential Nurse Dimitri Beeckman, Lecturer and Researcher, Florence Nightingale School of Nursing & Midwifery, King’s College London Lizzy Bernthal, Research Fellow and Lead Nursing Lecturer, Medical Directorate, Birmingham Martyn Bradbury, Clinical Skills Network Lead, University of Plymouth Emma Collins, Senior Sister, Practice Development Lead, Brighton and Sussex University Hospitals NHS Trust Alison Coull, Lecturer, Department of Nursing and Midwifery, University of Stirling, Scotland David Delaney, Charge Nurse, Clinical Research, Alder Hey Children’s Hospital Jane Fox, Independent Consultant, Derbyshire Alan Glasper, Professor of Child Health Nursing, University of Southampton Angela Grainger, Assistant Director of Nursing, King’s College Hospital NHS Trust, London Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Joanne McPeake, Acute Specialist Nurse/Senior Staff Nurse in Critical Care; Honourary Lecturer/Practitioner in Critical Care, University of Glasgow Andrew McVicar, Reader, Dept of Mental Health & Learning Disabilities, Anglia Ruskin University Danny Meetoo, Lecturer in Adult Nursing, University of Salford Mervyn Morris, Director, Centre for Mental Health Policy, Birmingham City University Aru Narayanasamy, Associate Professor, University of Nottingham Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser Joy Notter, Professor, Birmingham City University & Saxion University of Applied Science, Netherlands Anne-Maria Olphert, Chief Nurse, Director of Quality, Erewash CCG, Derbyshire Hilary Paniagua, Senior Lecturer, School of Nursing & Midwifery, University of Wolverhampton Ian Peate, Director of Studies, Head of School, Gibraltar Health Authority Bernadette Porter, Nurse Consultant, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust Angela Robinson-Jones, Consultant Nurse, Gynaecology, Liverpool Women’s Hospital John Tingle, HRS Reader in Health Law, Nottingham Law School, Nottingham Trent University Geoffrey Walker, Matron for Medicine, Cardiology and Specialist Nursing Services Poole Hospital NHS Foundation Trust Catherine Whitmore, Research Nurse, Diabetes and Endocrinology, University of Liverpool Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Lecturer, Bournemouth University, PhD student at London School of Hygiene and Tropical Medicine Sue Woodward, Lecturer, Specialist and Palliative Care, Florence Nightingale School of Nursing and Midwifery, King’s College London
British Journal of Nursing, 2014, Vol 23, No 5
British Journal of Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 2, 2015. For personal use only. No other uses without permission. . All rights reserved.
252
For frail elderly care, there’s no place like home
T
he ever-increasing pressures on accident and emergency (A&E) departments in our NHS hospitals are increasingly in the headlines (‘A&E crisis: hospital casualty units under huge pressure, Jeremy Hunt admits’ (Mason, 2013) is one example). Sixty-five per cent of people admitted to hospital are above 65 years of age. In addition 80% of emergency admissions who have a length of hospital stay greater than 2 weeks are patients in the over-65 age group (Cornwell, 2012). Consequently, we are being urged to seek new models of care that could assist in the avoidance of hospital admissions, particularly in the elderly population. Developing responses that are effective, efficient and deliver change ‘at scale and pace’ (Ham and Walsh, 2013) is challenging. The Florence Nightingale Travel Scholarship (2012-13) supported an observational study in Australia with its model of Geriatric Flying Squads (GFSs). GFSs are rapidresponse teams for elderly people either living in their own homes or in residential/nursing homes. Many of the GFSs were spearheaded by nurse consultants and successfully addressed unplanned, emergency admissions in the over-65s. The domiciliary GFS accepted referrals from anyone who had contact with an elderly person and was concerned about their functional decline at home. The response time to a new referral was 24 hours, Monday to Friday. The initial consultation took the form of a home visit. It was common practice, at this preliminary stage, for this assessment to be undertaken by a nurse consultant or nurse specialist in aged care, and a social worker. Other members of the domiciliary GFS team included a physiotherapist, an occupational therapist, a dietician, a clinical psychologist, a consultant geriatrician and two social workers. If, following the initial consultation, it was felt that a review was needed from the wider multidisciplinary team, their opinions were usually gathered within a week, again in the patient’s own home. Instead of heeding the traditional divide between ‘health’ and ‘social’ fields, the GFS looked to integrate these facets of care for the elderly. Initial comprehensive geriatric assessments were frequently done jointly by the nurse consultant/specialist and a social worker. In addition, if hospital admission was required, the nurses had direct admission rights to the geriatric medical admissions unit and inpatient rehabilitation beds. The overall aim was to provide a ‘one-stop shop’ for elderly people without having to wait many weeks for a professional opinion or support, and to keep them well and at home for as long as possible.
Pivotal to the success of the GFS model was the single point of contact with a nurse consultant or nurse specialist for patients, relatives and carers. As we have seen from the National Voices project (2013), patients emphatically want a healthcare system where, ‘My care is planned with people who work together to understand me and my carer(s), put me in control, coordinate and deliver services to achieve my best outcomes.’ On the other hand, the aged care facilities (residential/nursing homes) GFS provided a response time of 80 minutes to assess patients who were thought to be acutely deteriorating and who, by more traditional pathways, would perhaps have been admitted to hospital. This aged care facilities GFS was led by a consultant geriatrician and a nurse practitioner with advanced skills, and provided cover Monday to Friday, 8am to 9pm. Such a service meant that the majority of patients continued to be cared for and medically treated in their aged care facilities rather than needing hospital admission. All these services had been proven to reduce acute admissions to hospital and/or delay entry into 24-hour care environments for the elderly population. Given the predicted ‘care tsunami’ of burgeoning elderly care, services such as the Australian GFSs need to be considered, and its strengths and innovations translated into practice in the UK. As we move into 2014, in the wake of highly publicised recent reports on the NHS, such as the Francis report (2013) and the Keogh review (2013), such reports can be seized as levers for change by nurses in frail, elderly care, and promote new models of care that bring about real, effective change for BJN their patients. The author would like to thank the Florence Nightingale Foundation and the Royal College of Nursing for their generous sponsorship. Cornwell J (2012) The care of frail older people with complex needs: time for a revolution. Kings Fund, London Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. http://tinyurl.com/bkgyem7 (accessed 27 February 2014) Ham C, Walsh N (2013) Making integrated care happen at scale and pace. King’s Fund, London Keogh B (2013) Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report. http://tinyurl.com/ ph9e267 (accessed 27 February 2014) Mason R (2013) A &E crisis: hospital casualty units under huge pressure, Jeremy Hunt admits. Daily Telegraph online. 15 May 2013. http://tinyurl.com/omxfe5s (accessed 27 February 2014) National Voices (2013) A narrative for person-centred co-ordinated (‘integrated’) care. http://tinyurl.com/ow5g825 (accessed 5 March 2014)
Jacqueline Thompson Advanced Nurse Practitioner, Acute Medicine for Older People, Central Manchester NHS Foundation Trust
© 2014 MA Healthcare Ltd
Editorial Board David Aldulaimi, Consultant Physician, Gastroenterologist, Worcestershire Acute Hospitals NHS Trust Palo Almond, Academic and Research Consultant, Anglia Ruskin University Irene Anderson, Prinicipal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Residential Nurse Dimitri Beeckman, Lecturer and Researcher, Florence Nightingale School of Nursing & Midwifery, King’s College London Lizzy Bernthal, Research Fellow and Lead Nursing Lecturer, Medical Directorate, Birmingham Martyn Bradbury, Clinical Skills Network Lead, University of Plymouth Emma Collins, Senior Sister, Practice Development Lead, Brighton and Sussex University Hospitals NHS Trust Alison Coull, Lecturer, Department of Nursing and Midwifery, University of Stirling, Scotland David Delaney, Charge Nurse, Clinical Research, Alder Hey Children’s Hospital Jane Fox, Independent Consultant, Derbyshire Alan Glasper, Professor of Child Health Nursing, University of Southampton Angela Grainger, Assistant Director of Nursing, King’s College Hospital NHS Trust, London Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Joanne McPeake, Acute Specialist Nurse/Senior Staff Nurse in Critical Care; Honourary Lecturer/Practitioner in Critical Care, University of Glasgow Andrew McVicar, Reader, Dept of Mental Health & Learning Disabilities, Anglia Ruskin University Danny Meetoo, Lecturer in Adult Nursing, University of Salford Mervyn Morris, Director, Centre for Mental Health Policy, Birmingham City University Aru Narayanasamy, Associate Professor, University of Nottingham Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser Joy Notter, Professor, Birmingham City University & Saxion University of Applied Science, Netherlands Anne-Maria Olphert, Chief Nurse, Director of Quality, Erewash CCG, Derbyshire Hilary Paniagua, Senior Lecturer, School of Nursing & Midwifery, University of Wolverhampton Ian Peate, Director of Studies, Head of School, Gibraltar Health Authority Bernadette Porter, Nurse Consultant, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust Angela Robinson-Jones, Consultant Nurse, Gynaecology, Liverpool Women’s Hospital John Tingle, HRS Reader in Health Law, Nottingham Law School, Nottingham Trent University Geoffrey Walker, Matron for Medicine, Cardiology and Specialist Nursing Services Poole Hospital NHS Foundation Trust Catherine Whitmore, Research Nurse, Diabetes and Endocrinology, University of Liverpool Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Lecturer, Bournemouth University, PhD student at London School of Hygiene and Tropical Medicine Sue Woodward, Lecturer, Specialist and Palliative Care, Florence Nightingale School of Nursing and Midwifery, King’s College London
British Journal of Nursing, 2014, Vol 23, No 5
British Journal of Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 2, 2015. For personal use only. No other uses without permission. . All rights reserved.
