title: The Bromhead Care Home Service: the impact of a service for care home residents with dementia on hospital admission and dying in preferred place of care.
abstract: People with dementia have worse outcomes associated with hospital admission, are more likely to have interventions and are less likely to be offered palliative care than people without dementia. Advance care planning for care home residents has been shown to reduce hospital admissions without increasing mortality. Studies have shown that staff confidence in managing delirium, a common reason for admission, improves with training. A service combining education for care home staff and advance care planning for care home residents with dementia was introduced to care homes in Boston, UK. There were improvements in staff confidence in recognition, prevention, management and knowledge of factors associated with delirium and dysphagia. 92% of carers rated the service >9/10. Admissions fell by 37% from baseline in the first year and 55% in the second and third years. All but one resident died in the preferred place of care.
authors.affiliation: United Lincolnshire Hospitals NHS Trust, Pilgrim Hospital, Boston, UK gill.garden@stbarnabashospice.co.uk.
authors.forename: Gill
authors.initials: G
authors.lastname: Garden
authors.affiliation: Care Home Liaison Service, United Lincolnshire Hospitals NHS Trust, Pilgrim Hospital, Boston, UK.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Green
authors.affiliation: Care Home Liaison Service, United Lincolnshire Hospitals NHS Trust, Pilgrim Hospital, Boston, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Pieniak
authors.affiliation: CLAHRC East Midlands 'Caring for Older People and Stroke Survivors' theme lead, East Midlands AHSN Frail Older People Programme lead, Queens Medical Centre, Nottingham, UK; deceased 20 June 2014.
authors.forename: John
authors.initials: J
authors.lastname: Gladman
mesh_terms: D032722:Advance Care Planning; D000369:Aged, 80 and over; D017028:Caregivers / Q000193:education / Q000523:psychology / Q000706:statistics & numerical data; D003693:Delirium / Q000517:prevention & control / Q000628:therapy; D003704:Dementia / Q000628:therapy*; D004501:Education, Medical; D005260:Female; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006113:United Kingdom
keywords: Care homes; advance care planning; dementia; hospital admission; preferred place of care