Older people’s transition between different care settings

Moves between care settings or services like home care, care homes or extra care housing are challenging for older people, and the family and friends who support them. In this section you can find out about the experiences of older people, their family carers, as well as social care practitioners, by seeing and hearing them share their stories and viewpoints.

We established a co-production group, including older people and family carers, social care practitioners and managers working in different adult social care organisations, and social care researchers. Working together, we co-produced these move-related resources for social care staff, managers and others. The aim of this resource is to inform and support older people’s moves into and between social care settings. These resources are grounded in real-life experience and evidence from our co-production work, the literature review and interviews around care moves and how to improve practice.

Julia Greig, a practitioner researcher in the Better Care Moves co-production team, talks about why it is important to improve move-related practice.

Who supports older people’s care moves? Social care practitioners have a significant role in supporting older people and their families with transitions. Social care practitioners are a diverse and somewhat fragmented group. It may include social workers, support workers, care coordinators, nurses, occupational therapists, care managers and other professionals, and we all work in different care settings, such as in hospitals, in the community, and in care accommodation provider settings. How do social care practitioners support care moves? The roles we play in relation to older peoples moves are also many. They can include: identifying and highlighting the need for an older person to move, providing advice and guidance, signposting to other services, undertaking assessment, identifying suitable placements, securing funding, and review following a move. Each of these can provide their own challenges in the context of competing demands, expectations and resources. And these challenges have been further exacerbated in recent years by the covid pandemic. What challenges do social care practitioners face in supporting care moves? All social care practitioners want transitions for older people to be successful and positive experiences. However, given the range of roles we assume and the fact that older people’s experiences of moves are very context and person specific and therefore unique, this gives rise to a number of challenges for social practitioners who are attempting to navigate the most effective approach and provide the right level of support and guidance. Social care practitioners may lack understanding of the needs of older people and their carers at these times, as well as the confidence, guidance or resources, particularly in cases which are complex or unanticipated. What is missing for social care practitioners who support care moves? As social care practitioners, we have raised the need for a better and more consistent approach to preparing, communicating with and supporting older people and their families. Although local authorities, care providers and practitioners all recognise the importance of supporting people through transitions, there is a lack of evidence-based guidance around this, and the current approach relies on the personal and professional judgements and skills of the individual practitioners and their managers. How can we use these resources to inform move-related practice? The Better Care Moves project has enabled the co-production of practice-based guidance, based on research evidence, on how best to support older people and their families through transitions both between and into social care settings. This work and these resources will assist in building a better understanding between frontline practice and social care research, and also for social care practitioners and their managers in practice. Please take the time to explore our website, where we will provide you with tools and resources to help you to support older people with their moves.
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Helen, Janet, Karin and Kate, who are part of the Better Care Moves co-production team, have experienced care moves or have supported care moves themselves. Here they share their stories and how services can be improved:

In this video, people who have experienced care moves talk about how services can be improved. My experience of care moves Karin I'm a former carer for my mum who had vascular dementia as the result of a hemorrhagic stroke, and I cared for her for four years, until she fell and broke her hip and then had to go into hospital. I then spent four months battling with the health and social care system, trying to get her released back. Janet I live in an independent living with extra care scheme for seven years. And many elderly and vulnerable residents have been moved into this scheme as a quick option, not a long term solution the way it should be. Helen I have had plenty of experience with both my parents, individually, in moving them from one care setting to another. My mother had vascular dementia, and I was involved in choosing suitable respite care locations, and later, choosing a full time nursing home for her. Kate I'd had tremendous challenges finding a care home for my father who had early stage dementia. He was self-funding, moving counties to be near where I lived at that time. Then coincidentally during the project, I became directly involved in a “Discharge to Assess” for a close friend who suffered a severe stroke and being discharged from hospital through this temporary discharge process into a care home. Why is it important? Janet I witnessed on a daily basis how an incorrect move can have a devastating impact on a person's life, the outcome of which many are moved on again, some unfortunately, finishing in hospital, waiting until a suitable place becomes available. Helen I recall the practical and emotional implications when moving someone from one care setting to another and how important it is to get these moves right, not just for the patient, but for their friends and their families' peace of mind as well. And needless to say, a dementia patient taken out of their care home to go into another setting, for example, a hospital, they find these changes particularly confusing and distressing, as I found out with my own mother. Kate We had a lack of knowledge of the care home sector, not knowing where to go, which organisations to contact, who to contact and when to contact them, and not having sufficient information about the person's health and care needs. Karin When mum had to move into a specialist dementia care home, even though she was mainly social services funded, it was again me who sourced a suitable nearby home where I could visit mom daily. My mom luckily had me to fight for her needs, but so many people have no family to do so for them. And it is why I feel so passionately that this study is of value. No one should have to endure what my mom and I went through. Kate It is about a management of change. These are significant life change events for both the individual, the close family and friends. How can move-related practice be improved? Janet From participating in this research, I have realised that there is currently a lack of communication between all the facilitators and a misunderstanding of what schemes really do offer. I hope that from the result of this research, a more holistic approach will be taken with more questions and answers between all the stakeholders. Therefore, when someone unfortunately must move, it is just the once to the place that is suitable for their needs. Kate There's a need for professionals to understand other people may not know or understand the processes, the procedures, each organisation's responsibilities and boundaries, and also the handovers, actually what it means. People may not know who to contact, and be nervous about when to contact them, timescales and what expectations should they have? Helen Professional bodies in the care sector need to listen to people like us, real carers, as to what is needed in order for social care to be more effective. Better communication between social workers, and the family and the doctor surgery. Regular contact would have helped us a lot more after mom got her diagnosis. Had the social worker been more proactive and efficient with her communication. Karin Patients and family carers need to be respected and kept informed when somebody needs to be either moved back home from a prolonged hospital stay or when a person may have to transition into a care home. The system is broken, and everybody knows this. It needs fixing with better communication between professionals, by keeping families involved, by greater financial investment, and all done by retaining empathy for the people being supported. Without empathy and kindness, nothing will progress. Kate Information is key. But so is someone to help you interpret it for your circumstances, someone to reassure you and to guide you through. And as with any change, it's about Communicate, Communicate, Communicate. Key messages:
  • It is important to get care transitions right, not only for the older person but also for their friends and families.
  • Older people and their carers might lack knowledge about the care home sector and the options available. Social care practitioners need to understand the different types of care provisions that are available, including the purpose and eligibility criteria of those provisions to ensure appropriate placements are made.
  • Practitioners should be aware that older people and their families may not be familiar with processes, procedures and responsibilities.
  • It is important to realise and be aware of the distress and confusion faced by older people with dementia during care setting changes, and respond in a way that supports them through that change.
  • Transitions are periods of change and uncertainty. Make time to keep the older person and their family informed and updated, as this helps people feel in control of the process and offers opportunities to discuss concerns and provide reassurance.
  • Communication is vital and needs to be effective - timely, clear and in a format that the older person and their family can understand.
 
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Terms used in this resource:

For additional information on any of these or other terms, please visit our resources page, which provides links to more comprehensive and in-depth discussions.

Care home – a care home is an establishment that provides accommodation together with nursing or personal care. In general use, a care home (or a residential care home) refers to a care home registered to provide personal care only. Care homes must also provide information about the needs of people who will be accommodated, e.g. dementia or mental health issues. People may live in a care home for a short or long period. For many people, it is their sole place of residence and so it becomes their home, although they do not legally own or rent it. Both the care that people receive and the premises are regulated by the CQC.

Care Quality Commission (CQC) – the independent regulator of health and social care in England. The CQC registers providers of health and social care.

Discharge to assess – this is where people in hospital are well enough to no longer need care in an acute hospital bed, but may still require care services, and are provided with short term, funded support to be discharged to their own home (where appropriate) or another community setting, such as a care home. Assessment for longer-term care and support is undertaken following discharge from hospital. People who have been discharged to a community setting for assessment usually then move back to their own home or to another community setting that has been deemed suitable to meet their needs.

Extra care housing/schemes – the most widely-used term in the UK for housing with care, previously known as very sheltered housing or assisted living. Extra care housing takes a variety of forms, but its main features are self-contained living accommodation, the availability of 24-hour care, and communal facilities and services. Residents have security of tenure through renting or purchasing their living accommodation, and care and assistance is provided by on-site staff according to individual needs, although night-time staff may be on call. Most extra care housing schemes have eligibility criteria, such as a lower age-limit (e.g. 55 or over) and a certain level of care needs. Local authorities support people in extra care housing, according to care needs eligibility criteria. Care services in extra care housing are regulated by the CQC.

Home care – also known as domiciliary care, is care delivered to a person in their own home. The needs of people using the services may vary greatly, but packages of care are designed to meet individual circumstances. The person is visited at various times of the day or, in some cases, care is provided over a full 24-hour period. Where care is provided intermittently throughout the day, the person may live independently of any continuous support or care between the visits.

Integrated Retirement Communities (IRCs) – this term is being used increasingly for all forms of specialised housing, including extra care housing, retirement housing and retirement villages. Specialised housing developments often provide outreach services, sharing their facilities with the wider community.

Nursing home – this is the former term for care homes registered to provide nursing care, and in general use still refers to care homes providing nursing care. Nursing care must be provided by qualified nurses.

Publicly-funded – this is where social care is funded fully or partially by the local authority. People with capital below a certain amount may have to make a contribution towards the cost of their care, which is calculated by the local authority following a financial assessment of their weekly income.

Retirement villages – typically with more than 100 apartments, provide more social and leisure activities than smaller extra care schemes, but also offer care and support, and some are designated as extra care villages.

Retirement homes – known as sheltered housing by social housing providers (local authorities and housing associations), are purpose-built developments for people who wish, and are able to live independently with minimal or no support. This can be an attractive option for those who wish to live in a smaller home that is easier to manage. Retirement housing is usually only available to people over 55 years of age. Whilst features can vary from scheme to scheme, they often include a 24-hour emergency help alarm system, communal areas and gardens, and social activities. Retirement housing is housing provision and care services are not provided. Where residents require home care they use local domiciliary care services.

Respite – respite care provides family and friend carers with a break from their caring role. Whilst respite care can be provided in many ways it is usually provided via a temporary stay in care or nursing home. Respite care can also be provided in the person’s own home via home care, this is usually to enable shorter breaks.

Self funding – this is when someone pays the full cost of the social care services they receive. If a person living in England has capital of more than £23,250, excluding the value of the house they are living in, they will usually be required to pay for the full cost of their social care.