There are an estimated 400,000 residents in care homes across the UK, many of whom have complex healthcare needs, reflecting multiple long term conditions, significant disability and advanced frailty. Care provided to this complex cohort of people is often fragmented and care home residents over 75 are 40-50% more likely to have an emergency hospital admission. Experiences can be exacerbated due to dementia and other age related degenerative disease. Residents are likely to have at least one admission to hospital per year and care for these individuals can be complex. Evidence shows that for every day someone over 65 spends in hospital, their physical deterioration is higher than that experienced in their preferred place of care.
Eastern AHSN worked with a primary care team to introduce remote monitoring into care homes and for high intensity home users. The project centred on supporting high intensity patients to monitor and share their routine observations through a device called CarePortal.
The project, which started slowly, has shown positive improvements in care for patients in their own homes, as well as released time for practice staff, who can remotely monitor their patients, identify and react to early signs of deterioration, preventing perhaps unnecessary ambulance call outs and emergency admissions.
Patient activation has helped sustain the use of remote tracking devices Lessons learnt from the project, as well as implementation documents to aide adoption elsewhere, will be published in June 2018.