While Covid-19 has thrown much of society into disarray and caused monumental damage to hospitals, healthcare workers and their patients – in healthcare, there have been some positive changes. One of these is in the altered attitudes toward hospitals and home-based care. Another is in the rapid rollout of crucial services that ease pressure on hospitals and make for better patient experiences. At HomeLink Healthcare, we believe it is essential that these changes remain – pandemic or not.
Attitudes towards hospitals have been shifting for some time. Historically, both doctors and patients operated under the belief that the patient was best cared for in the hospital. This led to extended stays; the remedy for any illness, a hospital visit; prolonged periods in the ward even after a patient was fit to return home.
Covid-19 was the catalyst of a new way of thinking: avoiding hospital admissions in the first place where possible; getting people home faster in every other case.
For patients, in the heightened context of the pandemic, fear and avoidance of hospitals has become widespread. Numerous statistics underpin this. For overstretched and overburdened healthcare workers, the ability to relieve beds for urgent patients is critical.
The UK government has also taken note. In 2020, Discharge to Assess (D2A) was launched in hospitals across the country. The aim? To discharge all patients who no longer met ‘acute criteria’ as soon as clinically safe to do so, and where possible, to avoid hospital admission to begin with. Assessments take place at home, rather than at hospital. It has been found to not only be possible, but beneficial.
We were pleased to partner with The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust (QEHKL) to create a harmonious D2A service to improve patient flow in their wards and reduce capacity challenges. Being a small and agile company brings a number of advantages to our partnerships. We are able to set up and deploy supporting services rapidly: our D2A with QEHKL was one of the quickest services we’ve ever delivered, with just a four week mobilisation period until it was fully up and running, using the NHS SBS Patient Discharge Services framework for procurement and contracting was essential to achieve the tight timescales.
For patients, that meant we could get many of them back home for Christmas. Since then, we have rapidly ramped up the service, and it continues to go from strength to strength. We were one of the first homecare providers to flex our services to accept Covid-positive patients. A core element of how we work is as a bridge organisation: not replacing existing systems or provisions but complementing and enhancing the care provided. That means all our services are bespoke, moulded to the needs of the particular hospital. Whether we’re providing increased capacity or improving the efficiency of processes, we align ourselves with existing hospital and community practices as much as possible. And as a small company, we can do that efficiently, cost-effectively and most importantly; safely.
Key to this is open, transparent and supportive communication. At QEHKL, this meant visiting the wards or speaking with the therapists, building rapport with the therapy-leads, frequent team and stakeholder meetings, and giving constructive feedback on how patients were progressing and any issues encountered.
Similarly, we ensured we made positive connections with the community therapy teams; reiterating that we exist to fill the gaps, not replace their services. We recognise the strain they are under and their huge waiting lists – so how could we best complement that service and really place patients at the centre? Now, if the community team has patients that need to be urgently seen and they are unable to support, they send them to us, knowing we can assess them in 24 hour and feedback any recommendations or provide the input required.
In the words of Tim Rees, Professional Lead Occupational Therapist at The Queen Elizabeth:
“HomeLink has been a marvellous asset to our service at the hospital. Their therapy team has worked seamlessly with our therapy teams in the development of the Discharge to Assess model. The communication, expertise and support they have brought to the project has been invaluable. The feedback has always been positive and non-judgemental which has fostered team spirit rather than creating an atmosphere of them and us.”
So how does it work?
The Queen Elizabeth community response team identifies medically optimised patients and flags them to our service. We then contact the ward, discuss the discharge plan for the patient and the D2A process is commenced. Our home assessments are undertaken by either a registered nurse or one of our expert physiotherapists.
Our holistic home-based assessments encompass examining the health, wellbeing and social care needs of each individual. From there, we determine what package of care prescription they need – whether it is once, twice, three or four times a day – and then our specialist team delivers that personalised wrap-around care.
Our approach is one of enablement: we work alongside the individual to help them manage their daily personal care. The care we provide varies. It might be washing and dressing, meal preparations, supermarket shopping, medication prompts or provisions. We help them to complete their domestic tasks: supporting our patients to clean their property, look after their pets. The therapy element focuses on reablement and rehab: progressing their mobility, increasing their confidence, and modifying walking aids and equipment. During our assessment, we undertake a rapid review of what existing equipment is in the home and what additional equipment we could put in place – perching stools, kitchen trolleys – to enhance independence and reduce the required package of care.
In one case, an elderly gentleman was referred to our service for therapy only. On post- discharge assessment, we realised he needed a package of care, not just therapy. We initiated morning visits: helping him with his washing, providing physiotherapy, and communicating with the community response team so that they were then able to source a care team to take over his needs.
For patients, one of the consequences of Covid-19 is that they now receive far less rehabilitation on the ward. With the workforce redeployed to focus on acute patients, there is a significant gap in patient therapy provisions. We are seeing more people leaving hospital weaker and more deconditioned – not having received the therapy they would normally have received before the pandemic. This risks serious long-term effects on an individual’s confidence and independence.
In some estimates, for every 24 hours a patient stays in bed they lose 1% of muscle mass.
In others, 10 days of bed rest was found to lead to a 14% reduction in leg and hip muscle strength.
12% reduction in aerobic capacity: equivalent to 10 years of life.
Even with rehabilitation in place, prolonged hospital stays incur damage to patients, particularly the elderly.
We work to bridge that gap and get patients home faster: helping them reach a point where they are safe, independent and at ease – until a community therapist can take over.
There are a number of reasons why we believe the Discharge to Assess service is so important – and why discharges should continue to be done in this way post-pandemic. In terms of a hospital’s operational flow, bed flow through the trusts can be reduced and capacity dramatically eased by utilising out of hospital services like ours. This frees up beds to provide space for new acutely unwell patients, it enables hospitals to recommence elective activity, and in using the service for admission avoidance, reduces the burden on the front door. Financially, it’s cost-effective – home services are cheaper to run than an equivalent hospital bed.
Ultimately, and most importantly, is the patient’s care: we believe in putting patients first, always, and to do this, we believe the best place for them to recover is in the comfort of their own home.
As April Thompson, HomeLink’s Head of Therapies, who leads the QEHKL D2A service, says:
“One of the positive things to come out of the pandemic is how services have adapted (at pace) to meet the changes and demands of patients needs. It has strengthened relationships and fostered new ways of working. The pandemic has enabled clinicians to think differently about how to provide care and what can be delivered in the community setting. It comes down to patient care and putting them first. Everybody knows the best place for them to be is in their own home.”
To speak to a member of our team about our Hospital at Home services, call us on (020) 3137 5370 or contact us. You can tell us about your situation, and we can tell you more about our experience and how we might be able to help you.
“I am so grateful to have been referred to HomeLink Healthcare, they have really helped me get back on my feet. If I had stayed in the hospital I would not have achieved everything I have done”
“The visiting therapist took her time with me, was always providing encouragement and without that I wouldn’t be at the point I am today.”
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A recent feasibility assessment concluded that implementing Hospital at Home services would free up significant numbers of inpatient beds.Read more
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Patients are assessed by a HomeLink Healthcare physiotherapist in the care home within 72 hours of admission and start receiving physiotherapy and re-ablement immediately.Read more
Intensive physiotherapy at home can dramatically improve patient outcomes, shorten waiting lists and reduce care costs by over 65%.Read more