There’s no place like home when it comes to care for older people

It is estimated that of the 327,000 people living in the Wigan borough, more than 52,000 are aged 65 and over.

Poor weather combined with chronic and seasonal health conditions can make winter extremely challenging for older people and greater numbers are admitted to hospital as a result.

Nurse Consultant Marie Hart Here Marie Hart, Nurse Consultant for Older Adults at Bridgewater Community Healthcare NHS Foundation Trust, explains how the Healthier Wigan Partnership is working to help older adults stay well through winter and ensure more people benefit from coordinated care at home.

Older people are often living with multiple complex health conditions such as respiratory and heart disease, diabetes, dementia and may be suffering from the effects of loss of appetite and an age-related decline in their immune system.

In addition many older people face the further challenge of social isolation and loneliness.

All of this puts them at greater risk of suffering a sudden deterioration in their condition, an ambulance being called and time spent in Accident and Emergency (A&E) or on a hospital ward.

All this can happen during the winter months when A&E and other hospital services are already under pressure from increased demand.

There is national evidence to suggest that people, particularly those aged 80 and over, can suffer adverse effects as a result of hospitalisation and often spend longer in hospital unnecessarily.

These effects include a loss of muscle mass from prolonged bed rest and for some there is risk of hospital acquired infection.

However, when cared for in their own home, there is increased satisfaction of both the older people and their carers and older people are more likely to maintain their independent lifestyle as a result.

Supporting the health of older people is a key priority for the borough.

The Wigan Locality Plan for Health and Care Reform identified the need to focus on helping people over the age of 65 years to age well and enjoy quality of life and independence for many more years.

As a Nurse Consultant for Older People I am in an ideal position to see how community services are working together with hospital, social care and voluntary sector services to make a real difference.

As part of the continued development of the Healthier Wigan Partnership we have been working with Dr Micky Malhotra Consultant Physician in Elderly Care at Wrightington, Wigan and Leigh NHS Foundation Trust (pictured).

He is also the medical lead for community services and together we are using the latest evidence and research to develop new pathways.

These are centered on providing support at the right time in the right place, to keep people well at home, avoid unnecessary hospital admissions and to reduce the longer term impact of illness on individuals.

This year we have made significant progress in avoiding unnecessary hospital admissions by looking outside traditional care settings and also in reducing the length of time older people spend in hospital.

We have developed new frailty assessments and are working to increase awareness amongst our staff to make frailty everyone’s priority.

These assessments are carried out both in and out of hospital to ensure that when people are medically fit to return home we can provide ongoing input to support their discharge and help them in their recovery.

They also help us to inform how we can prevent ill health and keep people well for longer.

We also launched a number of new pathways in advance of the winter season.

These include teams of community medics, nurses, physiotherapists, occupational therapists and social care professionals all working together to provide joined-up care packages and accessing other specialist services such as heart failure and falls prevention, where necessary.

Collectively this team is called the Community Response Team (CRT).

For over a year the CRT has been working closely with GPs and since August 2018 has been taking calls from North West Ambulance Service.

Together the teams jointly assess and treat patients in their own homes.

Since August the service, which is staffed by highly experienced health and social care professionals, has helped to avoid more than 1,000 ambulance transfers to hospital.

We recently supported a 101 year-old patient to remain at home to receive treatment.

We have also launched what we call a ‘step up care’ facility which provides a bed within a care home for a short period.

This facility allows for closer observation and treatment from the CRT team as an alternative to a hospital admission.

Here people identified as needing urgent treatment receive care and support from a team of nursing, therapy and social care professionals for up to 72 hours and from then on care will be continued in the patient’s home.

Since July this year we have provided care for over 50 people through this facility including those with water infections, suffering falls and where existing care arrangements are no longer sufficient.

These new approaches are working to provide safe care for vulnerable people in our community and keeping more people out of hospital this winter.

Given the positive outcomes we have seen, we are intending to continue to integrate our community health and social care services and will this year be working much more closely with GP, hospital and mental health colleagues to support more people to receive care and treatment in their own homes and to improve the working environment for our staff.

This is not only good for the borough’s residents but will help to keep our hospital services available for those people with the most urgent and serious medical needs.

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