Health and Social Care
Care homes: why ‘My Health My Care My Home’ matters
The development of a healthcare framework for adults living in care homes by Dr Paul Baughan, GP and Professional Adviser to CMO on Ageing and Health
25 years of General Practice, visiting and consulting people living in care homes, has given me an understanding of how important and valuable care homes are. However, I gained a new level of respect for the people living and working in care homes in the Spring of 2020.
During the first wave of the pandemic, I left my GP practice to help support the establishment of a multi professional and multiagency ‘Care Home Assessment Team’, based in Stirling. During that period we visited and assessed over 200 people living in the 66 care homes within Forth Valley who were unwell. It was a period of intense pressure for everyone, and a time when people living in care homes experienced distress through the effects of the infection and the restrictions that were placed on normal activities and visiting. Despite these pressures there was a determination to do the right thing for the person living in the care home, evidenced by some excellent joint working between health and social care professionals and the wider care home sector.
So I was delighted to be asked to co-chair a reference group tasked with developing a new framework that would examine how healthcare should be provided for people living in care homes across Scotland. We started by asking those living and working in care homes for their views, and were overwhelmed by the response. Over 500 people replied to our online survey and 674 people were invited to attend our 29 engagement events. People living in care homes and their families were open and honest about the things that they required to help their health and wellbeing. They wanted to be listened to, involved and engaged in decisions about their health, with a focus on prevention, forward planning and person-centred care.
The framework was published on 29th June 2022 and has a clear and appropriate focus on the homely and nurturing environment of the care home. Health and wellbeing is much more than medicines and clinical diagnoses, and the provision of a safe and stimulating environment with meaningful activities and social connections are fundamental components of good healthcare. The important role of our skilled care home staff in enabling this is highlighted and emphasised throughout the document.
A key recommendation within ‘My Health My Care My Home’ is the need for effective multidisciplinary team working. There are many examples across Scotland where close and effective relationships exist between GP practices, primary care teams, specialist services and individual care homes.
My own GP practice participates in regular ‘TEAMS’ meetings with one of the care homes in our local community. It required an initial leap of faith to block off an hour each fortnight for a GP to attend these meetings, given the current pressure for appointments within the practice. However the benefits have been significant, and we have found this a good use of our time. Our typical virtual MDT meetings involve 2 or 3 people from the care home team, a specialist nurse, a hospital specialist, myself and occasionally a social worker. We have plans to include a pharmacist when pharmacotherapy services are developed further within our locality.
Everyone attending the MDT meeting has the opportunity to highlight something or someone that they would like to discuss, and there is an emphasis on proactive and preventative care. For example, we might discuss someone whose anticipatory care plan is requiring review, or whether a recent medication change has been successful, or strategies for managing distress associated with dementia. At the end of each meeting we decide who is the most appropriate person to see or review the resident, and how best to involve family members or any welfare power of attorney. This means that most care home visits that I undertake are planned and scheduled for a time when I have the capacity to do them.
Within the new healthcare framework, it is strongly recommended that GP practices and individual care homes develop similar close links, with regular planned multidisciplinary team meetings taking place between the key people involved in providing care. How this happens will depend upon local factors, which will include geographical location, size of care home and workforce. There may also be the need for some admin support to co-ordinate meetings. However the benefits to people living in care homes from this way of working are considerable.
In total there are 78 recommendations within ‘My Health My Care My Home’ spanning prevention, anticipatory care, supporting self-management, urgent and emergency care and palliative and end of life care. Some of these can start now, but others will require more time, investment or planning. We have acknowledged the need for a sustainable and skilled workforce across health and social care to enable the full implementation of the framework and there is a specific and detailed section describing the reasons for this.
As we move forward, we have a duty to ensure that we look after people living in care homes in a holistic and person-centred way, involving and engaging with families and those that are close to them. People living in care homes must be right at the centre of what we do, and this framework sets out how this should happen. After all, it is their health, their care, and their home.
My Health, My Care My Home: A healthcare framework for adults living in care homes is published here: