Case Study: The North Manchester Care Home Project

Introduction

The Care Act advocates the need to safeguard people from harm with a key focus on achieving better outcomes for people who have care and support needs.

Most people are reluctant to be admitted to hospital, more so if the admission results in distress, confusion and anxiety, particularly if they have dementia. There is evidence to suggest that many older people are unnecessarily admitted to hospital, which not only has cost implications for the NHS, but also has an impact on ambulance services who already have limited resources.

However, most importantly, it is about ensuring that care home residents are supported to achieve better outcomes if uninjured following a fall, without resorting to hospital admission. There are many joint initiatives being undertaken by NHS Trusts and CCGs to reduce the number of ambulance call outs to care homes to enable residents to have better outcomes and to safeguards them from unnecessary hospital admissions.
This case study examines how North Manchester CCG identified ways in which they could achieve better outcomes for residents who may have had a fall in their care homes. This was achieved by introducing more dignified falls equipment, to aid care home staff in moving uninjured residents, thus reducing the need to call an ambulance for assistance.

The reduction in ambulance calls has implications for NHS Ambulance Trusts and Clinical Commissioning Groups, in that millions of pounds could be saved every year if the CCGs could support care homes to have the Mangar falls equipment to aid in the moving and handling of residents following a fall.

The Care Quality Commission is examining best practice in falls retrieval for an innovation report to be published later this year.

The ELK And Camel Moving And Handling Equipment

The benefits of using the Camel and ELK:
• Reduce the risk of musculoskeletal (MSK) disorders
• Protect staff from injury
• Reduce costs associates with staff injury
• Maintain patient dignity
Hazardous manual lifting techniques, associated with moving and handling, can not only be distressing and undignified for the person who has fallen but can also increase the risk of injury to workers.
The Mangar ELK and Camel lifting cushions are practical, efficient manual handling products that are used across the world.
Inflated using an Airflo 24 Compressor, a fallen person can be lifted in minutes. Their innovative design and portability means the lifting cushions can be used anywhere, inside or out.
Easy to use
No additional accessories are required to complete a lift – one size fits all. Very little staff training is required.
Easy to clean
Lifting cushions are made with a durable Riverseal® material with an anti-microbial coating.
Easy to transport
Lifting cushions are battery powered, lightweight and portable.

Inappropriate Callouts Cost The NHS £50 Million Annually

Objectives
The objectives of the project are;
• To focus on enabling residents to have a better outcome, whilst at the same time reducing the cost implications and the number of callouts to the ambulance service by care homes to move uninjured residents.
• To empower care home staff to move residents safely following the Post Fall Assessment Pathway and ISTUMBLE guidelines advocated by the West Ambulance Service to ensure that only uninjured residents are moved.
• To promote moving and handling aids that enable care home staff to achieve an outcome, which promotes a more dignified approach to moving residents following a fall.

Background

Today, 1,000 people living in a care home will fall

Research shows that every day 1,000 residents living in care homes in the UK will fall and more than 45% are uninjured and do not require transportation onto hospital. (Cardiff University, 2006).

The NHS Ambulance Trusts are charged with reaching high priority calls within 8 minutes and are often put in the unfortunate position of needing to classify uninjured residents who have had a fall in care homes as low priority. This means residents are regularly left on the floor for up to 4 hours or more.
In North Manchester there has been instances of a 4-6 hour wait before an ambulance has been able to attend an uninjured resident. Leaving a resident on the floor for more than an hour can have implications both physically, socially, physiologically and psychologically. Some of the complications cited associated with lying on a hard service for long periods of time are hyperthermia, pressure sores, kidney failure or renal failure. (ROSPA 2017).

In addition to this, being left on the floor in a communal area has implications on the resident’s dignity, and often can be very distressing for both the resident involved and the other residents around them.
Promoting dignity and safeguarding residents from harm should be a priority for all CCGs and Local Authorities.

Better outcomes and health benefits are ensured when moving a resident who has had a fall within an hour. CCGs and Local Authorities are constantly identifying ways in which ambulance calls out to care homes can be reduced. They will regularly review this as part of their compliance quality and monitoring processes and falls and ambulance calls out are often some of the key areas explored.

Avoiding Hospital Stays and the Associated Costs
The Think Tank, Nuffield Trust reports avoidable stays in hospital costs the NHS £330m a year, with an average of £135,000 a day. At least 45% of ambulance call outs to care homes are to uninjured residents, equating to 450 people a day. With an overnight stay in hospital costing an average of £400, that’s a potential £180,000 of avoidable cost…every day.
Paramedics do not know the medical history of the resident they are moving and may decide to transfer onto hospital if health checks are not in line with the expected standard measures. Care home staff are in a much better position to assess their residents’ health and make decisions regarding hospitalisation based on the individual’s normal level of health.

However, this will depend on the care staff’s knowledge and skills in achieving this. In response to assisting care homes staff to ensure that they only call an ambulance when necessary the West Midlands Ambulance Service introduced the Post Fall Assessment pathway and ISTUMBLE guidelines. This pathway and guidelines enable care home staff to make an assessment, which will enable them to determine if the resident has been injured or has suffered more serious illness or disorders that have led to the fall.
North Manchester CCG
Sophie Wallington, an Advanced Physiotherapist Practitioner from an acute hospital provider in North Manchester, managed the project from the beginning in August 2016.
After an initial meeting with Mangar Health, a group of occupational therapists and physiotherapists assessed the Camel and ELK inflatable lifting cushions against the criteria required to provide suitable falls equipment in care homes.
They found the ELK suitable for their care home population for a number of reasons, including:
• It can be used in confined spaces where a full body hoists are not always accessible
• It can be used inside and outdoors
• The ELK is fully portable and isn’t constrained by needing to be near an electric socket.
North Manchester selected the Mangar ELK as their moving and handling cushion of choice within a care home setting.

Methodology:
Selecting care homes for the trial: The next step was to trial the ELK moving and handling cushion in selected care homes in the North Manchester area. The care homes selected were chosen because of their high propensity for calling an ambulance when a resident falls, whether they are injured or not.
North West Ambulance Trust provided data which identified the top 10 care homes in the area who had called an ambulance to move uninjured residents from the floor. These residents needed no medical intervention or hospitalisation.
Each of the 10 care homes were given a Mangar ELK to trial from August 2016.
Training: All care homes were given training on how to use the ELK to move residents who had had a fall. Although easy to use, an initial concern was how care staff determined whether it is safe to move the resident. The West Midlands Ambulance Service Post Fall Assessment pathway, ISTUMBLE was identified as a key resource in addressing this concern to ensure that there are safeguards in place to only move residents who are uninjured or have not had a fall as a result of a more serious illness or disorder.
When to move a resident following a fall: Sophie Wallington issued all care homes with guidance on when it is safe to move residents who had had a fall, as follows:
• ISTUMBLE guidelines, first issued by West Midlands Ambulance Service for assessing fallen patients, should be referred to in the first instance
• If in doubt, call the local primary care provider by calling 111. Depending on the area, this will either be crisis response, the GP service, the local nursing home team or the local project nurse.
Care Home Project Feedback

‘‘This equipment is an absolute godsend. We’ve used it 20 times at least, preventing 999 on every occasion. Residents are happier, families are much happier and the staff find it easy and safe to use.”
Daniel Kelly, Manager at Chestnut House Care Home

“We really like it, staff like it and the ambulance was not called out to support us on any occasion. Really good piece of equipment and we are pleased we are able to use it. Simple to use and feels really safe to use with our residents.”
Hannah Jackson, Manager at Lightbowne Hall Care Home
“We are using the ELK between 2-3 times per week. Staff love it, it’s very easy to use and more dignified for residents, especially in communal areas. The unit has never failed, no problems. “
Jacqueline Van Zandt, Manager at Wellington Lodge
Next Steps
The trial continues with a further 11 care homes taking part in the project across Manchester and with the first year’s full data to be released later this year.
The Care Home and CCG project continues with more trials to be identified and planned regionally and nationally to ensure that more robust data relating to the outcome of uninjured residents following a fall are obtained, as well as the cost implications associated with the reduction of unnecessary ambulance call out.
Reference
Rospa.com. (2017). Older People Safety -RoSPA 
Cardiff University (2006)
Sophie Wallington, an Advanced Physiotherapist Practitioner, North Manchester
Participating Care Homes
With special thanks to Acacia Lodge, Alexian Brothers Care Home, Blackely Premier Care, Chestnut House, Eachstep, Israel Sieff, Lightbowne Hall, Oakbank, Veiw Park and Wellington Lodge for participating in the study.
Supporting Information
Wales Ambulance Service recently trialed a similar project in Bridgend, South Wales.
Anecdotally, initial findings suggest a 55% reduction in ambulance calls outs to uninjured residents in the trial care homes. Further research will be completed later this year.
FINANCIAL CONCLUSIONS
During the trial period, based on published falls data, the expected ambulance costs for picking up uninjured residents in the 10 trial North Manchester care homes would be:
The combined resident numbers in the care homes trialed 427
Average falls per year* 213
Uninjured fallers (213 x 45%) 95
Ambulance cost to pick up uninjured fallers (£300 x 95) per annum £28,700
The following are the actual cost savings during the trial period
Recorded use of ELK instead of calling an ambulance over 5 months 123
Pro rota to 12 months (123/5×12) 295
Ambulance Cost would have been (295 x £300) £88,560
COST SAVINGS
Ambulance call out costs avoided £88,560
ELK cost (£1K x 10 care homes) £10,000 NHS Saving over a year £78,560
*Based on 50% of over 80s falling at least once a year (often higher in care homes) – (Ref HSE)

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