1. Supporting Care Homes in East Kent
Dr Joe Chaudhuri EK Care Home Working Group Chair  
and SKC CH Clinical Lead
Ann Judges, EK Frailty Coordinator
3 October 2018

2. Workshop Format
11.30am – 11.50am : EK CCG Care Home Update Presentation and Q&A 11.50am – 12.25pm: Table Top Discussions 12.25pm – 12.30pm: Sum up and close

3. Wider context - Frailty in East Kent
Frailty key priority for all East Kent commissioners and providers
East Kent Frailty Steering Group :
Brings clinical and managerial leaders together from all partner agencies;
Provide whole system leadership and oversight and assurance to develop clinical model for frailty;
Identifies areas of key impact and developing clinical solutions to support them;
Task and finish groups with clinical, operational, and wider stakeholder input support priority areas.
Priorities focus areas
Care Homes Support
Community rapid response services
Rapid access to frailty services in hospital

4. Why focus on care homes?

5. Why focus on care homes?
Across East Kent we have 324 homes, comprising 6,496 beds
Pressure on acute hospitals – should people really be going to hospital?
Unscheduled attendances
Unscheduled admissions
Delayed discharges – people are in hospital too long
Lack of Care Plans for all residents – impacting on quality and outcomes
Care homes have told us more support is needed to help to make sure that people can stay at home.

6. Activity from Care Homes
The CCGs regularly look at A&E attendances and NEL admissions from care homes to identify themes or outliers
Attendances and admissions are looked at in terms of rate per bed, as this is fairer for larger homes, who will clearly have higher levels of activity than smaller homes.
For April to July an average of 425 A&E attendances and 321 NEL admissions occurred each month from East Kent Care Homes (this will climb in the winter months)
Around 3 in 4 resulted in a NEL admission with 40% of stays being 0-1 day in duration

7. Challenges
Increasing complexity of patients living in residential care homes
Variety of homes (different specialisms, sizes, procedures)
Variety of funding sources and commissioners
Require out of hours support for physical and mental health needs
Community workforce challenges
Funding and governance arrangements
Is access to mental health support for residents improving? What do you do in a crisis? How do you rate the support?
Do can we get better alignment of Care Home policies?

8. Care Home Support – the EK Frailty Programme
Two key functions:
East Kent level advice and guidance service accessible to care homes, warm transfer to clinical support when unable to access local or primary care services. Also signposting care homes and system wide providers to the local care support or other services available in the relevant area.
Pilot use of additional care home clinical support/ care home treatment service in Herne Bay, with anticipated roll out across Canterbury in the first phase with rollout across East Kent proposed.

9. Advice and guidance Line
To signpost to and access core local care teams if these exist and have capacity
To signpost to other local or East Kent wide services (e.g. KMPT dementia support services)
To support the consistent compliance with advanced or anticipatory care plans, for example if a care plan is in place but the care home requires support to implement this or discuss with family members. This was a direct request from care home managers via the local forums.
To support clinical decision making as part of the team around a care home resident at that time (e.g. care home staff, Secamb responder) regarding conveyance to hospital
To provide a clear evidence base of the cohort of care home patients being referred to the service. This may identify where services are not working optimally, where there are service gaps and where there are particular pressures within the system.

10. Advice and Guidance Line
Available to all EK care homes
Hours of operation 8am – 10pm initially
Safety net response/ not to replace current primary or community care responses
Co-ordinated via the LRU with ‘warm transfer’ to Rapid Response teams in the local areas.
Rapid Response would provide advice and where needed a face to face response.
Co-ordinated with Local Care Hubs

11. Clinical Support Service - Pilot
Based on evidence from local and National service examples,
Test feasibility of implementation rather than pilot of clinical model
Appropriate clinical staff resource integrated into local care teams to support care homes
Pilot in Herne Bay - area with high care home population 6 identified homes all residents received care plan
Primary care led with support from community frailty team

12. Outcome of Pilot
Initial analysis of the newly published Care Home dashboard would suggest that unplanned admission and AE attendance for the for the pilot homes had reduced by over half compared to the same period last year, with those homes no included in the pilot in Canterbury & Coastal showing a reduction of 8%. (only one months data)
Feedback from Care Homes
The staff really felt that the sessions and plans were of great help and look forward to the reviews continuing (projects like this have been started and stopped before).
The facility felt more supported and really engaged with the planning sessions.
The visits have been great support and that has helped staff feel included.
Keen to start to use the referrals into the Local Care Hub
Following creation of care plan EOL resident had various medications reviewed/stopped, and the resident died in the hospice in her place of choice
Ensure the agreed care plan template is set up and correctly coded on EMIS with access to a laptop to complete the care plan remotely – completed care plan to be returned within 2 weeks.
Dedicated primary care admin support to update care plans and document alerts and actions and co-ordinate rota.
Care Homes would benefit from a care home pack; this to be co-ordinated per Local Care Hub. Pack to include Care Home admission form, CQC myth busters
Follow up “home“rounds were identified as useful within the pilot review and were planned for one month after the care planning had been completed. The purpose of these follow up sessions was :

13. Additional Resources available
East Kent wide rolling Education programme, delivered locally in Ashford, Canterbury, South Kent Coast and Thanet. Topics include: Medicines Management, Wound Care, Supporting the resident with challenging behaviour, continence management, Sage and Thyme – These sessions are delivered by a variety of providers (EKHUFT, KCHFT, Pharma, local Hospice and others).
Recognising the Acutely ill patient in the community – 2 day course delivered by EKHUFT (4 courses each year)
Verification of Death Training – delivered by Hospice and IC24 jointly
Advanced Care Planning Link Worker Training – delivered by Hospice

14. Additional Resources Cont’d
Web based Resource Tool available for homes in Ashford, C&C and SKC (National and local information uploaded by each CCG area for their locality – these are separate tools).
Stop, Look Care booklet (hard copies and flip booklet on resource page) – Ashford, C&C and SKC – app in development
Quarterly Managers Forums/workshops (delivered locally)
Bid submitted for Pharmacist and Technician dedicated support for Care Homes (Ashford, C&C and SKC)

15. General Resource
East Kent Health Ageing -Your Local Guide – how to stay well and spot signs of a common illness’ at an early stage.

16. Next steps for care home support in EK
EK opportunities – we are now scoping what else can be done at an EK level that offer added value. This is likely to include:
Roll out of Red Bag Scheme in EK (planned before year end);
Sharing care home training;
Medicines management optimisation in care homes;
Advanced care planning in care homes – identify champions and share best practice;
Promulgate care home training support across EK – learning from local implementation;
Embedding links to local care models – patient identification and referral to MDTs via care home nurse specialists.

17. Questions?

18. Table Top Session - 35 Mins
What would good care and support look like from a care homes perspective?
How do we engage with the care homes sector to develop an EK Care Home Strategy?
Do staff experience difficulties utilising advanced care plans/anticipatory care plans? Are care home staff involved in the planning process?
What difficulties do care homes experience when patients are discharged from hospital?
Is access to mental health support for residents improving? What do you do in a crisis? How do you rate the support?
Do can we get better alignment of Care Home policies?

19. Table Top Session Notes
Each table to debate two of the discussion questions, as set out.
Use the Record Sheet on the table to capture your discussion.
Please focus on the following:
What works well now?
What can be improved?
What are your priorities?