We operate a joint health-housing case management initiative to reduce high numbers of A&E admissions from Bennett House. We do this by upskilling our care staff and proactively managing residents’ health needs. Bennett House is an Accord Group care home for 45 older people in the West Midlands with dementia.
This project was initiated following an analysis of data collated by West Midland Ambulance Service. Ambulance requests and A&E admissions were nearly 50% higher for Bennett House compared to other similar care homes due to their acceptance of customers from hospitals with very complex needs, at high risk of falls, and some being discharged at earlier stages in their recovery than usual.
We aimed to reduce the number of ambulance attendances and the number of in-patient bed days experienced by our residents.
The initiative involved providing the Home with access to NHS Telford & Wrekin Case Managers and a Clinical Nurse Advisor who could:
- Provide expertise to advise how to proactively manage Bennett House residents’ medical and nursing needs
- Train and empower carers in the provision of high quality care for residents with long term conditions or acute illnesses.
The training included recognising early signs of illnesses, indications of when residents need medical intervention, how to provide quality end of life care, as well as practical skills in areas such as blood pressure monitoring and urinalysis.
Our initiative demonstrably benefited the residents of Bennett House, the Primary Care Trust, the acute Trust, and West Midlands Ambulance Service (WMAS). Pre- and post-intervention data was collected from WMAS, Case Managers, Bennett House, GP Practices, and Telford & Wrekin Primary Care Trust.
We have seen reductions in:
- emergency hospital admissions
- ambulance attendances
- accident and emergency attendances
- hospital bed days
- number of GP visits/contacts (reduced by 32%)
We have seen increases in:
- quality of care
- quality of life and wellbeing
- empowerment of carers
- the ability of the care home to continue to look after people to end of life
- understanding of where resources are needed
- evidence showing benefits of health and housing joint-working.
The reductions in A&E attendances and hospital admissions alone equated to cost savings of £67,332 during the three month initial evaluation period (December 2010 – February 2011).
Our multi-disciplinary team addressed the identified issue of high numbers of ambulance call outs. Our approach provided opportunities to draw on resources from health partners. After analysing data collated by West Midland Ambulance Service (WMAS), and investigating possible causes, discussions took place with Bennett House, Accord Group staff, GP practices, District Nurses, commissioners, and providers in NHS Telford & Wrekin. An agreement was reached to run a Case Management pilot.
Our proactive Case Management solution capitalised on the opportunities afforded by having a group of residents living together in one building, Bennett House.
Accord Group staff are skilled at building strong working relationships with local health partners; this as an essential aspect of being able to provide quality care for residents.
The success of the initiative was due to our ability to enhance the health-related knowledge, skills and confidence of our home care staff team. They are on-site 24 hours a day, and therefore are able to contribute effectively to the identification, support and management of residents’ health needs.
Our contribution to improving health
Our initiative has resulted in:
- better and more appropriate health care provision and management
- enhanced quality of life of people with care and support needs including long-term conditions
- being able to delay or reduce the need for care and support
- people feeling more supported with their long term-conditions
- people having a more positive experience of care and support, health care, integrated care, and end of life care
- reductions in hospital admissions and time spent in hospital
- better safeguarding and protection from harm for people whose circumstances make them vulnerable
- increased empowerment for carers.