Abstract
To meet a government target (DH 2005a), NHS Primary Care Trusts are required to reduce hospital usage and care home residents have been identified as a group whose admissions may be avoidable. Yet little is known about hospital admissions from care homes as few UK studies have been published. This mixed method study identified factors that led residents to be admitted to hospital as emergencies and unlike previous studies included the perspectives of residents. As the outcome of the research is to inform a local resident-centred hospital admission avoidance strategy their views are important. The research comprised three parts. The first analysed Hospital Episode Statistics data for all admissions from the ten care homes located within a PCT, between 2003 and 2005. This provided an overview and found admissions varied between homes and over time and infections were the most common admission diagnosis. The second part was case studies that examined the 19 admissions from a 35 bed local nursing home during 2006. Most residents had dementia and nine died in hospital and three soon afterwards. The final part comprised semi-structured interviews with 13 residents from four local nursing homes following recent hospital admissions to obtain their views on hospital admission and care. Most considered their admissions unavoidable and most expressed high levels of satisfaction with hospital care, but it is nursing home care they valued most. The four nursing home managers were interviewed about each of these admissions to confirm the details and give their opinion on the appropriateness of the admissions. This study found that GPs appear to be responsible for most admissions and although there is potential to reduce admissions, residents continue to need and benefit from care that is only available in an acute setting. The results indicate that new models of care are needed to reduce avoidable admissions and provide better end of life care in care homes. A ‘Home for Life’ nursing home care model is advocated as a means of achieving both.