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Care home offers a step between hospital and home for patients

A stroll up to the door of Harrogate Lodge Care Home in Leeds is leaf-lined and heralded with birdsong. It’s a far cry from the hospital corridor 90-year-old temporary resident Mavis found herself sleeping in after she had a fall at home back in March.

Mavis was in Harrogate Lodge for a week while she recovered from a urine infection and is well enough to go back to her home on the other side of the city. “It’s certainly quieter here,” she laughs, “and the food is lovely.”

Mavis went to Harrogate Lodge as part of a new joint initiative, which sees independent care homes working with hospitals to alleviate delayed transfers of care. In a survey of 50 heads of NHS trusts by the Guardian in 2015, at least 10% of beds were occupied by patients who were ready to be discharged. The survey also reported the case of a patient in Cambridge who had remained in hospital 72 days after being declared ready for discharge. According to Monitor and the Trust Development Authority, these delays cost UK hospital trusts £270m a year. Lord Carter’s 2015 review of efficacy in hospitals suggested that hospitals should be working more closely with neighbouring NHS trusts to save money.

Four Seasons Healthcare, has been running a successful pilot scheme moving high-quality care from acute to community settings, shifting sub-acute community assessment and rehabilitation beds out of hospital.

Harrogate Lodge has been involved in the scheme since November 2015, starting with four beds and expanding by four additional beds each week. “This has increased workload”, says Home Manager Sue Green, “but, we’ve recruited six extra carers and a unit manager with experience in intermediate care.”

The average stay time for intermediate care residents at Harrogate Lodge is six weeks. Sue Green explains that the length of stay does vary from case to case, “We have had a few less than that but some others for longer, for various reasons. The main thing is to get them back to the most appropriate place for them, whether that’s their own home or a different care home.”

Paul Hayes, National director, Commissioning and Commercial Operations, says, “The scheme is in its early days but where it’s being actively used it’s regarded as a success by the hospitals and patients.”

“It’s rehab in a home environment rather than a busy hospital ward. The bedrooms are like a bedroom at home, there’s furniture around and there’s open visiting. The residents also stay in the same room for the entire period.”

Head of business development Richard Hardman agrees, “The acute nature of a hospital dictates the clinical relationship. Here, the care is much more holistic and the resident feels they are on a step home. A lot of people have lost confidence and have fears about going home. Here, there’s time to sit and talk to them and reassure them.”

Richard Hardman works nationally to support the care homes in working with commissioners. He says one of the biggest issues, as with many projects like this, is the availability of nurses: “You don’t want to create a new service run on agency staff. You want continuity of care and you want the staff to buy into the culture.”

“It’s exciting for the teams to be able to see some short-term outcomes and it means nurses can focus on skilled work rather than doing things like medication, which is a bit more routinised.”

Date published: 15 September 2017

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