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Care home offers a step between hospital and home for patients


New initiative sees independent care homes working with hospitals to provide a place for people to recuperate and alleviate pressures on acute care

A stroll up to the door of Harrogate Lodge care home in the Leeds suburb Chapel Allerton is leaf-lined and heralded with birdsong. It’s a far cry from the hospital corridor 90-year-old temporary resident Mavis found herself sleeping in a couple of weeks ago, after she had a fall at home.

Mavis has been in Harrogate Lodge for a week while she recovers from a urine infection and is well enough to go back to her home on the other side of the city. “It’s certainly quieter here,” she laughs, “and the food is lovely.”

Mavis is here as part of a new joint initiative, which sees independent care homes working with hospitals to alleviate delayed transfers of care. In a survey of 50 heads of NHS trusts by the Guardian in 2015, at least 10% of beds were occupied by patients who were ready to be discharged. The survey also reported the case of a patient in Cambridge who had remained in hospital 72 days after being declared ready for discharge. According to Monitor and the Trust Development Authority, these delays cost UK hospital trusts £270m a year. Lord Carter’s 2015 review of efficacy in hospitals suggested that hospitals should be working more closely with neighbouring NHS trusts to save money.

Harrogate Lodge has been involved in the scheme since November 2015, starting with four beds and expanding by four additional beds each week. This has increased workload, says manager Sue Green, but, she says, “We recruited six extra carers and a unit manager with experience in intermediate care.”

The average stay time for intermediate care residents at Harrogate Lodge is six weeks. Green explains that length of stay does vary from case to case, “We have had a few less than that but some others for longer, for various reasons. The main thing is to get them back to the most appropriate place for them, whether that’s their own home or a different care home.”

Paul Hayes, national director, commissioning and commercial operations at Four Seasons, says, “The scheme is in its early days but where it’s being actively used it’s regarded as a success by the hospitals and patients.” Part of this, claims Green, is simply the setting: “It’s rehab in a home environment rather than a busy hospital ward. The bedrooms are like a bedroom at home, there’s furniture around and there’s open visiting. The residents also stay in the same room for the entire period.”

Four Seasons’ head of business development Richard Hardman agrees, “The acute nature of a hospital dictates the clinical relationship. Here, the care is much more holistic and the resident feels they are on a step home. A lot of people have lost confidence and have fears about going home. Here, there’s time to sit and talk to them and reassure them.” People get depressed being in hospital for such a long time, he says, and this itself has an impact on care needs.

Hardman works nationally to support the care homes in working with commissioners. He says one of the biggest issues, as with many projects like this, is the availability of nurses: “You don’t want to create a new service run on agency staff. You want continuity of care and you want the staff to buy into the culture.” But for the teams in place it’s a great opportunity, as Hardman explains, “It’s exciting for the teams to be able to see some short-term outcomes and it means nurses can focus on skilled work rather than doing things like medication, which is a bit more routinised.”

Another fly in the ointment is the lack of joined up services. “If someone needs a lot of equipment the community teams won’t come in and assess,” says Green, “they’ll only assess when they’re at home.” But, she says, “It’s early days in this model and we’re learning all the time.”

Mavis is off to hospital to get (she hopes) the all-clear. “When I get home there will be temporary help,” she says, “they’ll want to see how well I can make a cup of tea, that sort of thing. They won’t be there long, I can tell you …”


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