Developing a care plan which includes health and well-being in care home residents

The Proactive Healthcare for Older People in Care Homes (PEACH) study considered how to deliver high quality care to older people living in UK Care homes.  Here Neil Chadborn, Claire Goodman and Adam Gordon discuss the findings of a realist synthesis on how Comprehensive Geriatric Assessment works in care homes.  This is the second of three blog posts on the subject, completing the description of how Comprehensive Geriatric Assessment works in this setting.

Neil Chadborn is a Research Fellow in the Faculty of Medicine & Health Sciences at University of Nottingham; he tweets as @nchadborn

Component 2 – Developing a Care Plan

Where Comprehensive Geriatric Assessment improved outcomes for residents, it did so by drawing together assessments covering multiple aspects of health and well-being.  The most common way for this to happen was by multidisciplinary meetings.  The group which seemed least able to attend these were General Practitioners.  There was evidence, though, that GPs were more likely to engage over time if they knew that their observations were a key part of care planning, and where they recognised improvements in care as a consequence of their input.

The voice of residents and relatives was surprisingly absent from multidisciplinary meetings in many of the research articles we reviewed.  This jars with currently accepted gold-standard care, where shared decision-making plays a central role.  It is clear that research and development work is required to bring families into these discussions.

A common understanding of the multiple needs of a resident means that care plans can be prioritised around their individual goals, supporting person-centred care.

We recommend the following:

  • Teams need to plan ahead how to come together for care planning at times which are mutually convenient.
  • Teams need to work to ensure that individual contributors know their input is valued and is changing care for residents.
  • Further research and practice development are needed by all involved in healthcare in care homes, to find ways of giving more voice to residents and their relatives within care planning.

In our next post we’ll be discussing Component 3: Working Towards the Delivery of Patient-Centred Goals.

More about the PEACH study and see the realist synthesis in greater detail at: https://bmjopen.bmj.com/content/9/4/e026921.info

To hear more about the project, please do come to our 2019 annual lecture where Adam Gordon will be presenting the findings.