The British Geriatrics Society have launched Right time, right place: Urgent community-based care for older people. This new publication aims to help health professionals to navigate the options for providing urgent care to older people which can be delivered at home, avoiding unnecessary emergency hospital admissions.
The provision of healthcare for older people in England is changing as Integrated Care Systems (ICSs) gradually get underway in the wake of the devastating COVID pandemic, and the priorities of the NHS Long Term Plan, such as the Ageing Well programme, are implemented. This BGS document reflects the evolving situation, where various approaches to delivering urgent care closer to home are currently in progress. As this new publication highlights, although these may be configured and described differently, they share a common aim of providing emergency care to older people in their own home or other community setting that avoids the need for hospital admission.
The document explains that there are times when hospital is the right place for treatment. However, for many older people living with frailty and complex long-term conditions, a spell in hospital can result in worsening frailty, delirium and deconditioning, particularly if discharge is delayed. Once they return home, they are likely to require rehabilitation and other support to help them recover. Right time, right place sets out an alternative to this scenario: a rapid response to the initial crisis delivered in someone’s home by a multidisciplinary team, providing timely assessment, diagnosis and treatment. The community team is then well-placed to link up with other local services to ensure follow-up support is provided and patient information shared with relevant health care, social care and voluntary sector agencies.
While such provision may come in different forms, from Hospital@Home teams through to virtual wards, this document sets out underlying principles of high-quality, person-centred care. It also identifies some enablers that need to be in place for urgent care to connect up with other parts of the healthcare system. Tips are offered for those planning to set up such services, even in environments where there are resource and capacity shortages.
Right time, right place shows some of the emerging ways in which community teams are able to deliver care quickly, safely and effectively to older people living at home or in care homes. The BGS believes that developing a consistent, coordinated approach to such delivery across the country will bring benefits in terms of older people’s wellbeing and health outcomes, and in the longer term reduce the costs of acute care by minimising avoidable hospital admissions.
Shelagh O’Riordan, Chair of the BGS Community Geriatrics Special Interest Group, says:
In my work as a community geriatrician I see many people with frailty and multi-morbidity who benefit from prompt person-centred care when they have a crisis, without having to go to hospital. Right time, right place sets out how community teams across the country can make that a reality in their location. There is so much potential for us to change how we deliver urgent care for older people and this document demonstrates some practical ways forward.”