Community institutional care for frail elderly peopleBMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7133.780a (Published 07 March 1998) Cite this as: BMJ 1998;316:780
“Unitary care” homes might be the answer
- William R Primrose, Consultant physician
- Department of Medicine for the Elderly, Woodend Hospital, Aberdeen AB15 6LS
- St Margaret's Hospital, Swindon SN3 4QP
EDITOR—Black and Bowman rightly emphasise the importance of preadmission assessment and ongoing medical supervision in caring for frail elderly people.1 Current practice in many areas does not provide for formal specialist input at the time of admission and undoubtedly some older people are moving into homes prematurely. The pressure to clear beds leads to inadequate opportunities for rehabilitation and the possibility of missing remediable disease. Furthermore, the balance of local provision between residential and nursing homes may encourage misplacement in both directions. A recent survey of new admissions to nursing homes noted that 23% of residents funded by the local authority, when independently assessed, were not dependent on nursing.2 These people seemed more suited to a residential environment, and some could possibly have stayed in their own homes given sufficient time, rehabilitation, and community support.
A more radical suggestion about the overlapping nature of residential and nursing institutional provision would be to move towards a “unitary …