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New Care Home Charter could ‘transform care’ for people in care homes

The Patients Association has today launched its Care Home Charter to improve medication practices for people living in care homes across the UK. Developed in collaboration with care home residents and their families, experts in health and social care and endorsed by the National Institute for Health and Care Excellence (NICE) among other organisations, the Charter aims to help support residents living in care homes to be actively involved in decisions about their care. It also provides a guideline for care home staff to follow in order to improve medication practices.

It is estimated that there are around 410,000 residents in care homes in the UK1. Many have complex needs including significant frailty, dementia and disability2. Research shows that care home residents are prescribed an average of 7.2 medications and seven out of 10 residents were found to have been exposed to at least one medication error3.
The Charter consists of a nine-point guideline for care home residents and their families, and is designed to promote and advance shared decision-making and improve patient safety. It emphases the importance of residents being involved in regular monitoring and review of medications, and states that medicines should only be given with a resident’s consent, unless they lack the capacity to provide it. In addition, the Charter also provides a nine-point guideline for care home staff to follow, stating that medicines should not be hidden by staff in food or drink, unless it is in a resident’s best interests and all legal requirements have been met. Other key points include that staff should ensure that an advance care home plan is in place for the resident, and that optimal oral and dental care is provided.

Piloted in 22 care homes across England, Wales and Northern Ireland, the Charter received positive feedback from care home residents and staff. Initial feedback was requested on the implementation of the Charter, and on perceived outcomes six months post-implementation. A total of 16 (88.9%) out of 18 respondents from nine homes reported a positive response to the charter, with care home managers
describing it as ‘useful’ and saying that it ensured ‘safe administration of medication to
people with swallowing difficulties’. In a survey of 39 care home staff following the Charter’s implementation during the pilot period, the Charter was found to have improved staff confidence in several areas including knowledge of how to identify
swallowing problems, use of advanced care plans, administration of medicine, covert administration, and the laws underpinning these areas. Most respondents believed that the charter would increase involvement of residents in decision making, improving oral health, enhancing identification of swallowing problems, and improving the administration of medicine.

The Charter is the culmination of a number of years of work by the Patients Association.
In 2015, after a caller to the Patients Association helpline reported the difficulties a care home resident with dysphagia (swallowing difficulties) was enduring with their medication, the charity conducted a survey to investigate how widespread the problem was. Publishing the findings in a report that year, the Association found that in some cases, and against medical practice, medicines were being crushed for care home residents with dysphagia to swallow. Worryingly, we also found that some care home staff weren’t trained to spot the signs of a person with swallowing difficulties.
The Charter was developed by an expert panel including a mix of clinicians, patient representatives and an expert in healthcare law. Nurses, pharmacists, care home managers and speech and language therapists contributed to the document, with valuable input also received from representatives from national bodies including NHS England and the Care Quality Commission.

Rachel Power, Chief Executive of the Patients Association, said: “We’re delighted to launch our Care Home Charter, which is the culmination of years of work in this area by an array of experts across multiple disciplines in health and social care. The feedback from our pilot of the Charter in care homes across the UK demonstrates the great potential it has to transform care for residents, with an emphasis on establishing a two- way relationship between those receiving care and those providing it.

“The Government predicts that by 2025 there will be two million people aged over 85
living in care homes, so it’s vitally important that medication practices are improved for both existing and future residents. We hope this Charter will go some way to helping people in care homes and hope that the document is disseminated widely among healthcare professionals and care homes so it can benefit as many people as possible.”
Nicola Bent, Director of the System Engagement Programme at NICE, said: “People living in care homes have the same right to be involved in decisions about their care and treatment as anyone else and it’s important that they’re supported to do this. We’re therefore pleased to endorse the Patient Association’s Care Home Charter which will support health professionals in implementing our guidance on managing medicines in care homes.”

Professor Tahir Masud, President of the British Geriatrics Society, said: “This Care Home Charter for Medicines provides valuable advice, for both staff and residents, on how they can work together to improve care for older people living in care homes.

Experience tells us that people in residential care are sometimes taking inappropriate medications and the Charter will help raise awareness of this critical issue. Encouraging patients to make shared decisions about medication, as well as highlighting the importance of safe swallowing and optimal oral and dental care, will also help to
improve quality of life for care home residents. Professionals working in care homes provide an invaluable service and this Charter will help them continue to deliver the best possible care. The Patients Association is to be congratulated on producing this excellent document.”

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