Admiral Nurse Case Management within Enhanced Health in Care Homes

Abstract

The United Kingdom’s (UK) older population is higher than the global average. Over the next 20 years, England will see an increase in the number of older people who have higher levels of dependency, dementia, and comorbidity many of whom may require 24-hour care. Currently it is estimated that 70% of residents in nursing and residential care homes either have dementia on admission or develop it whilst residing in the care home. The provision of high-quality care for this population is a challenge with a lack of consistency in the provision of primary care and specialist services and a known gap in knowledge and skills. The NHS Long Term Plan aims to move care closer to home and improve out of hospital care which includes people who live in care homes by introducing Enhanced Health in Care Homes (EHCH). However, such services need to be equipped with the correct skill mix to meet the needs of the care home population. Admiral Nurses are specialists in dementia care and are well placed to support the delivery of EHCH and improve access to specialist support to care home residents, their families, care home staff and the wider health and social care system. This paper discusses current gaps in service provision and how both the EHCH framework, and the inclusion of Admiral Nurses, might redress these and improve outcomes.

Exploring access to community care and emergency department use among people with dementia: A qualitative interview study with people with dementia, and current and bereaved caregivers

“…Furthermore, as we have shown that caregiver voice is not always heard, there may be a role for independent advocacy. This may be afforded by Admiral Nurses whose triadic relationship‐centred approach facilitates shared decision‐making between the person with dementia, their family caregivers, and staff 33 …”

“…This may be afforded by Admiral Nurses whose triadic relationshipcentred approach facilitates shared decision-making between the person with dementia, their family caregivers, and staff. 33 Participants described an absence of follow-up care and single point of contact, as well as limited financial and social support. While observed in other studies, 8,21 our analyses offer new insights by suggesting this is driven by a systemic lack of parity of esteem between dementia and other life-limiting illnesses.…”

Hard to Reach and Hidden: Improving the Identification of Young Dementia Carers

“…Additionally, evidence of the cost-saving implications of an Admiral Nurse model is also starting to emerge. For example, a small pilot study [40] found that the Norfolk Admiral Nurse service meant a saving to the health and social care economy of GBP 426,601, hence demonstrating that it is possible to deliver gold-standard clinical care with no financial risk to the taxpayer. However, despite dementia being the leading cause of death among people in the UK, there are currently only 376 Admiral Nurses and only a very small proportion of these are available as formal support for families affected by YOD, which are more likely to have younger members [41].…”