My Health, My Care, My Home - healthcare framework for adults living in care homes: summary

3. Prevention

Preventing deterioration in health and wellbeing through good nutrition, hydration, continence, movement and activity, cognitive stimulation and social connections

Prevention can stop the onset of illness through early positive interventions. It can also reverse, stop or delay the progression and impact of a pre-existing condition. Put simply, it involves proactively keeping people well, and maximising their independence to thrive in the most appropriate care setting for their needs. This involves an asset based approach, focusing on what a person can and likes to do, rather than where their difficulties are.

People living in care homes must be supported to access any relevant age-specific public health programmes, for example, screening for bowel cancer or immunisations against flu, COVID-19, pneumococcal and shingles infections. They should have the opportunity to make an informed decision about whether to take part in these programmes with appropriate information that is tailored to their needs.

Preventing the spread of infections has always been important within care homes, and has been even more apparent during the COVID-19 pandemic. Care homes are not and should not become sterile 'clinical' settings, but they must remain safe environments for people to live in.

The Healthcare Improvement Scotland (HIS) Infection Prevention and Control (IPC) standards are a requisite for safe, high-quality care in all settings. They must be supported by access to relevant IPC guidance, advice, education/training and guidance.

People living in care homes have increasingly complex needs, so preventing deterioration in health through good nutrition, hydration, continence, movement and activity, cognitive stimulation and social connections is imperative. A key aspect for a person with multiple needs (physical, mental health and other social needs) is a personal plan detailing how care and support will be provided.

Effective prevention of deterioration or of harm must also include proactive management of all long-term health conditions as well as regular, structured pharmacist led polypharmacy reviews. Moreover, prevention places importance on a number of other issues including: oral health, hearing and eye care, nutrition and hydration, continence promotion and bowel care, tissue viability and wound care, mobility and meaningful activity, and psychological wellbeing and spiritual support.

Recommendations

3.1 People living in care homes must be supported to access any relevant age-specific public health programmes with appropriate information to allow an informed decision.

3.2 Application of IPC standards in care homes should be supported by access to relevant IPC advice, education and guidance.

3.3 Everyone living in a care home will have a regularly reviewed personal plan.

3.4 Ensure there are effective systems in place to deliver a consistent approach to the development and implementation of proactive, personal plans.

3.5 A person centred medication review, using the 7-step approach should be initiated by a pharmacist when someone first moves into a care home, and then at least annually thereafter. Certain high risk drugs, such as antipsychotics, will require more frequent monitoring and review.

3.6 Routine dental, sight, and hearing reviews should continue to be part of an individual's personal care plan when they move to live in a care home.

3.7 There should be a named dentist / dental practitioner for each care home and contracts with local optometry and hearing services.

3.8 There should be a proactive approach to hydration, nutrition, continence promotion, meaningful activity and mobility using appropriate resources and should be considered with the same degree of importance as reactive healthcare.

3.9 Religious and philosophical beliefs in relation to food and diet should be enquired about and catered for.

3.10 Psychological and spiritual aspects of healthcare should be assessed and regularly reviewed within care plans.

3.11 Individuals should be supported to maintain links in their local community which enables cognitive stimulation, mobility, independence and communication.