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A world without care homes

What would happen if there were no care homes?
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LINDSAY DINGWALL: Care homes provide the long-term care that used to be supplied by the health service, but they’re not always valued. And yet the half a million people living in care homes are some of the most vulnerable in our society. Many of them are dependent on 24-hour nursing care to live well. But care homes are losing staff to the NHS, which has more than 40,000 nursing vacancies. And so nursing homes are closing. Imagine if suddenly the place you call home is no longer there for you. It has gone. What would that be like? For older people, their cognition, communication, and social engagement can become worse. Rates of falls, depression, pleasure source, an antipsychotic drug use can rise.
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Unnecessary admissions to hospital rise and so do the number of people who die. NHS hospitals are already under great strain. Without care homes, the one in five emergency and avoidable admissions to hospital would increase. Without care homes, someone who cannot be discharged safely must stay in an NHS bed. Without care homes, someone who is ill or waiting for an operation cannot access an acute hospital bed. Imagine if that were you. Without care homes, the NHS will need 3 billion pounds per year to support frail and older people who do not belong in hospital.
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Without care homes, vulnerable people could be discharged to their own home, some to wait for care, some to wait for company, some to wait until they become ill again and go back into hospital as an emergency. And so the cycle starts over. Without care homes, social care can’t cope. Without care homes, the NHS is on its knees. Without care homes, some people won’t survive.
In the UK the term “care home” commonly refers both to residential care homes and nursing homes.
While nursing homes employ registered nurses, care homes now increasingly care for older people with highly complex needs and significant physical dependence, disability, or cognitive impairment.
The Institute of Public Care in 2017 found that the average size of newly opened care homes (37 places) was greater than in those that closed (29), so the overall number of places for older residents increased by 4%, from 387 485 to 404 163.
Yet potential demand has outstripped this expansion, as the number of citizens aged over 85 increased by 16%
On average, registered nurses in nursing homes for older people have a turnover rate of 32.7%
Compared to social workers and occupational therapists the turnover of registered nurses in adult social care is higher. The risk is increased that care homes de-register from nursing homes to residential care homes because they cannot recruit and retain nurses.
Care homes form a sector at the heart of the health and social care system and yet report after report suggests that without investment, there will be a projected loss of 37,000 beds over the next three to five years. Part of this investment should be in attracting registered nurses into care homes.
Looking to the future, the sector will continue to grow. There is a need for a whole system approach, to promote partnership working between providers from health, social care and other third sector organisations (e.g. Alzheimer’s Society, MIND and Age UK) to understand the full patient journey, including the nurses’ contribution to living well in care homes.
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Care Home Nursing: Changing Perceptions

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