Management of health crisis in nursing homes by adapting hospital-at-home integrated care programs: a local experience from Catalonia

Abstract

Introduction: It is essential to find new models of care adapted to older residents in social institutions, due to the increasing health complexity of users of these long term care settings. If hospital staff could be effective in managing health crisis in nursing homes, in a more integrated approach, it is unclear. Description of practice: New integrated care units were created in Catalonia, using Intermediate Care resources, in order to manage health crisis of older patients without using conventional hospitalization. A key supportive point of this project for the future is developing hospital-at-home interventions in older patients in the community, including nursing home. Interventions could be run after: a. direct assessment at nursing home or an Emergency Department visit (Admission Avoidance strategy); b. a short hospital stay (Early Discharge strategy). At nursing home, an individualized care plan was defined for each suitable case (medical stability with no severity criteria), sharing objectives with the staff of the setting, in order to stabilize health status and improve conditions associated with acute illness (as functional decline, delirium or nutritional risk). Targeted population and stakeholders: It was developed to attend nursing home residents of the urban area of Badalona, North of Barcelona. A previous analysis found that they have high risk baseline characteristics as old age and multiple chronic conditions related with morbidity and disability. More than a half of the users have low to severe grade of dementia.