The Bromhead Care Home Service: the impact of a service for care home residents with dementia on hospital admission and dying in preferred place of care

Abstract

People with dementia have worse outcomes associated with hospital admission, are more likely to have interventions and are less likely to be offered palliative care than people without dementia. Advance care planning for care home residents has been shown to reduce hospital admissions without increasing mortality. Studies have shown that staff confidence in managing delirium, a common reason for admission, improves with training. A service combining education for care home staff and advance care planning for care home residents with dementia was introduced to care homes in Boston, UK. There were improvements in staff confidence in recognition, prevention, management and knowledge of factors associated with delirium and dysphagia. 92% of carers rated the service >9/10. Admissions fell by 37% from baseline in the first year and 55% in the second and third years. All but one resident died in the preferred place of care.

Keywords: Care homes; advance care planning; dementia; hospital admission; preferred place of care.

Fig 1.

Percentage of care home staff confident or very confident in the recognition, prevention and management of delirium before and after training.^***p = 0.0001.

Fig 2.

Admissions to hospital from pilot care homes before (2011) and after introduction of the service (2012, 2013 and 2014).

Fig 3.

Cumulative net savings using minimum and maximum NEOLIN admission costs minus cost of service.