The care-home classification: part one

Care homes, you gotta love them.

Where else can you go to find a collection of like-minded people, sitting about doing the same thing, watching other people, and there be qualified ushers there to move along the stragglers. A football match maybe?

I remember when training, one of my more illustrious trainers code-named Dr Legend compared care homes to the football league. You would have your amazing premiership club home, with textured wallpaper covered in memorabilia of a bygone era, fancy hoists and stair-lifts with a lift that could recognise you by your posture; food the likes that Heston Blumenthal would wish he could serve, and most importantly, with staff so in-tune that they know the what you need before you even have asked for it.

This is in comparison to the conference league home with gormless zombies as residents, staff who you may easily confuse with the patients and where you hold your breath walking in, praying you don’t need to stay longer than the 3 minutes and 36 seconds it takes before you pass out from lack of oxygen to your now addled brain.

Hopefully now you are chuckling as you read this amusing take on the state of care our elderly patrons reside in. Unfortunately it is not such a hilarious situation as most will be aware. A recent Panorama investigation highlighted issues in care in a learning disability care home. The resulting fallout sparked mass outrage, civil outcries and even legal action.

Scary huh.

There are many types of care homes. I use the term care homes, as nursing homes form a particular section in the group term that I feel care homes encompass.

First up is the ever popular warden based accommodation. Simplest in terms of care, in that the patient lives independently, but has a warden that is (or should be) on site to deal with any issues that may arise, and can alert the relevant services if need be. They also check in on the more fragile residents on a routine basis. These may be grouped houses/bungalows or more commonly now aggregated flats with a warden office. 

Next is your residential home. These are where people go to retire as such (from work or life depending on your pleasure), or are placed by the choice, be it the patient’s, carer’s, family or state. Care is given in terms of assisted living with meals, and room care, but no real nursing care or help with daily tasks apart from basic levels in some places. There maybe carers working in these establishments but more commonly they are standard non-medical employees. That is unless you count the years of experience in working in care environment which may be a good or bad thing depending on the person.

Next step up is a standard care home. Here the main difference is that most or at least a higher proportion of the staff will have some medical training. This is the kicker, because it is normally this ratio that above all governs in my experience how good a nursing home truly is. Here patients, and let’s be honest that is what they are when they are in a nursing home, need some form of help in daily tasks . Be it feeding, sanitation, or general health, they need a more medical environment that a residential home can not supply, to the completely bed bound patient. They also tend to be the favourite dumping ground of geriatric wards when patients have no relatives (or none able/willing to care for them).

A new breed is coming up now, and they are the next step up in care. These are the dementia nursing homes. I am sure someone out there will be able to tell me what the proper term for these homes is, but in reality, they are homes designed to care for patients with dementia. These from what I understand are more supportive environments with appropriately trained nursing staff who work to understand the patients rather than just manage them, so they can offer holistic care (notice a few of the GMCisms there?)

Learning disability care homes are abundant. Some are truly excellent in the care they deliver, some, well lets be honest less so. However here generally live the younger patients, but those with such difficulties that make managing them in a home environment truly challenging, and where constant monitoring and guidance is required, in addition to care. I can not emphasize that last one, these places need to deliver care.

The last port in our care home bay is the EMA nursing homes. I will be honest, I can’t for the life of me remember what exactly EMA stands for (please feel free to point this elusive fact out for me – education maintenance allowance is not acceptable). I consider it to mean elderly medical asylum, well for lack of a true definition, I challenge anyone to come up with a better definition. Here patients at the more severe end of the dementia scale live. The patients need significant care, aid, and it is common for a 2:1 or even 1:1 nurse to patient ratio to exist. These homes also tend to hold some of the most unwell medical patients in addition to the psychological states.

The confusing issue when performing visits to these institutions of care, is when they are in one place. Yep, just to make life easier (or harder depending on your viewpoint, particularly a financial one) such institutions are combined. What is really…..interesting is if you confuse the two. I challenge any reading this to visit a dual institution i.e. residential and nursing home, and ask a carer at the residential home to take a set of obs on a patient, or better yet, attempt a fluid diary, watch the confusion/offense/impossibility of such a request build.

However from a primary care POV (point of view), I think care homes give great opportunity to do what we should do, but better. What i mean by this, is giving continuity of care in a holistic environment, whilst practising with autonomy for the patients, working with their own health beliefs and  in their best interests.  Sounds like a lot of GMCisms in there, but to be honest, I belive it.

So this belief, and the start of our classification of the various types of care homes has begun. Next week I plan on elaborating these principles, but in the meantime, I invite others to make comments on the above, and let the fun begin…….

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