Geriatricians and care homes: perspectives from geriatric medicine departments and primary care trusts

Abstract

Older people in care homes are clinically complex and particularly vulnerable to the effects of poor care and poor medicine. They are also a group to whom the NHS seems least committed. Geriatricians have become disengaged over the past two decades, as a result of social policies rather than clinical judgements. In 2000, the Royal College of Physicians, with the Royal College of Nursing and the British Geriatrics Society, issued guidance and recommendations for improving clinical practice. This paper reports progress since then based on results of national surveys of geriatric medicine departments and primary care trusts in England. The results show that important deficiencies persist, though most respondents were in favour of greater specialist involvement. Some suggestions are made for ways to improve the shared care of residents in care homes.

Fig 1.

Geriatric medicine departments: how important is it that geriatricians are involved in care homes?

Fig 2.

Primary care trusts: how important is it that geriatricians are involved in care homes?

Fig 3.

Primary care trust survey: who must assess a person before they are admitted to a care home? GP = general practitioner

Fig 4.

Geriatric medicine department survey: are geriatricians involved in the admission assessment to care homes in your area?

Fig 5.

What were the primary aims of your initiative in care homes? GM = general medicine; PCT = primary care trust.

Fig 6.

Which of these professionals are involved in your initiative to support care in care homes? CPN = community psychiatric nurse; GP = general practitioner; GPwSI = GP with special interests; OT = occupational therapist; PCT = primary care trust; PT = physiotherapist, SALT = speech and language therapist.

Fig 7.

Do care home residents have equitable access to the following services? CPN = community psychiatric nurse, ng/peg nurse = nasogastric/percutaneous gastrostomy feeding nurse.