Integrated care results in fewer elderly people dying in hospitalBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e4731 (Published 16 July 2012) Cite this as: BMJ 2012;345:e4731
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Dear Sir/ Madam,
I read with interest the letters from Dr Cohen and McCarthy. Similar results to theirs have been reported from proactive work by primary care doctors and nurses in Sheffield, Leeds, Newcastle, Manchester and London, with or without geriatrician support. However, such care is not uniform throughout the country and in many areas care home residents continue to be admitted to hospital when there is little prospect of real benefit to them.
The British Geriatric Society (BGS) has recently published the results of a joint working party inquiry into NHS services for care home residents, drawing attention to the inadequate support that many areas of the NHS offers to this group of most frail people, who often live with a number of long term conditions.
The BGS is producing guidance for commissioners indicating the growing body of evidence that proactive for care home residents provides outcomes for residents and is associated with a reduction in hospital admissions and in prescribing costs.
Good end of life care is critically important for care residents; as a group they have limited life expectancy and death is often preceded by a clearly identifiable period of decline. As Drs Cohen and McCarthy illustrate in their letter, end of life care planning can be highly effective in this environment. The recently published “Voices” survey of bereaved relatives indicated that the view of informal carers of deceased patients was that care in care homes exceeded that in acute hospitals, in terms of respect for privacy and dignity and in provision of care.
All commissioners of services for older people need to ensure that care for care home residents is pivotal in their planning, and that in accord with the End of Life Strategy (www.endoflifecareforadults.nhs.uk), that end of life care is an integral part of this work.
Competing interests: No competing interests