H2CH Research
Welcome to the Hospitals to Care Homes (H2CH) Research project website, which has been created to summarise my PhD work. My PhD thesis is entitled "New care home admission following acute hospitalisation: A mixed methods approach". The final version is freely available to download from the link below
Being admitted to a care home is an important and life-changing decision for any individual and their family. However, it can be an important and necessary way to provide care and support when a person’s needs cannot be met in their own home. Every year, there are around 13,000 admissions to over 1,200 Scottish care homes, of whom ~8,000 are admitted from hospital. UK health policy documents argue that we should avoid care home admission from the acute hospital. Despite this, little research has been done to guide doctors, nurses, social workers and individuals and their families in this area.
My thesis has explored a pragmatic topic by taking a range of approaches. These included: reviewing published research; surveying practitioners; studying individuals using their hospital case notes; interviewing patients, families and staff and; using data collected routinely by the NHS and care homes.
Reviewing published research found 53 studies in 16 countries which considered predictors of care home admission from hospital. The main factors linked to this were increasing age, being female, having dementia and being limited in daily activities. Other factors, which may be important to older people and their families, were not considered. Care-home services are organised differently across the world and most studies did not describe the care provided. The survey found that many different terms (including ‘Nursing Home’ and ‘Long-term Care) are used to describe care homes, making it difficult for researchers to find relevant studies.
The clinical case-note review found differences among the in-hospital experiences and assessments of those discharged to a care home from hospital. The patient’s own views were seldom recorded in their hospital notes. In the interviews, however, the opinions of the patients, their families and the staff caring for them were heard, offering insights into how the decisions are made and how best to support those involved.
Identifying who lives in a care home using data is challenging. Comparing different methods, including postcode matching and hospital coding, found these do not always agree. It is important that researchers and those using data to compare hospitals, are aware of the limitations of each method. The Scottish Care Home Census (2013-2016) includes 21,368 admissions to care homes: 56.7% from hospital. These data showed variations in the care needs, funding patterns and the number and proportion of individuals moving from hospital.
The work described in my thesis has provided the first description and quantification of the challenges of identifying care home residents using routinely-collected health & social care data in Scotland. It has also allowed the first national description of those admitted to care homes in Scotland – from hospital and from home. It has enabled the views of patients, their families and those involved in their hospital care to be expressed and will help to inform guidance to support practice.
Future research should involve exploring and improving the available data and using them to direct more specific work with all those involved in decisions about long-term care. The ultimate aim is to use data and research to inform health and care policy and practice in Scotland, to support older people needing long-term care.
The six component projects of my PhD used different research methods to help to improve our understanding of the predictors, processes and patterns of care home admission from hospital. These are summarised separately, using the links on the left of the page. The information is intended to raise interest and awareness of the subject and to promote discussion.
If you are interested in the work, please feel free to Tweet me @JenniKBurton or complete the which will open in a new browser window.
ABOUT ME
Jenni Burton is a NES/CSO Postdoctoral Clinical Lecturer at the School of Cardiovascular and Metabolic Health at the University of Glasgow. She undertook her PhD at the University of Edinburgh which was generously funded by the Alzheimer Scotland Dementia Research Centre and the Centre for Cognitive Ageing & Cognitive Epidemiology (CCACE). She is a trainee geriatrician, whose long-term personal and research goal is to improve understanding of the needs of those living in care homes and the staff who support them.
