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Improving Care Home Remote Reviews

29 October 2021

Care reviews are central to NHS-funded Continuing Healthcare (CHC) provision in private care homes. They allow the NHS awareness of the health of the individual and the level and quality of care received.

Prior to the COVID-19 pandemic, in-person, on-site assessments by CHC nurses were the preferred method of review. This would consist of a nurse being shown care records by the care home, followed by conversations with the patients, families and both clinical and care support staff. Since the onset of the pandemic, however, remote care reviews became the norm to reduce the footfall in care homes and the risk of transmission.

This method of review has inadvertently proven to be more productive for NHS nurses and is therefore being considered for implementation beyond COVID-19.

The response from care homes to the new method of assessment has, however, been mixed. This mixed uptake has led to numerous missed reviews, as well as increased effort in trying to speak to the right person at the home.

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Our findings

The adam Provider Insights Team sent a survey regarding remote reviews to care home providers with NHS-funded CHC individuals across 5 UK regions. 175 providers completed the survey, 31 of whom also had a further discussion with a member of the insights team over the phone.

Once this intelligence gathering had taken place, the data was analysed to understand the survey feedback and themes which consistently emerged in providers’ discussions. These themes are summarised in brief below.

Service user involvement and staff training

A central concern of staff who were less positive about remote reviews was the increased difficulty of the service user themselves participating in their reviews. Staff raised that there were individuals who would be able to speak with the nurse assessor in-person but may find the remote review context unusual due to their lack of familiarity with technology. This is a longstanding problem with the introduction of the technology to the care sector - a 2019 study into videoconferencing within care homes found that the most cited reason for concern amongst those who had yet to introduce it was that residents would not feel comfortable participating. Among those spoken to, it was felt that this could be detrimental to the nurse assessor’s understanding of the individual’s condition as well as the individual’s sense of ownership of their care.

There is room for growth in this area, however. Staff stated that a lack of technological literacy and poor Wi-Fi connectivity in the home contributed to diminished engagement with individuals. It is also worth noting that the same 2019 study found largely positive outcomes among care homes who committed to video conferencing - 92% rated it as very good or good.

Process variations

There appear to be significant process variations depending on the assessor carrying out the review. in scheduling, information requested, review medium and review efficiency. Potential areas for improvement here are outlined briefly below:

  • Dedicated points of contact with responsibility for organising all remote reviews.
  • Flexibility over dates and times in arranging reviews and ensuring at least 2 weeks’ notice.
  • Standardising the information requested beforehand around an option that suits care providers (for example pre-existing Care Plans).
  • Stopping variation in medium to alleviate some computer literacy issues.
  • Clarity over whether staff can leave once no longer needed and a defined end-time.

A longer-term consideration could be a change to a system that allows full visibility of reviews for bookings, transfer of notes and notifications. This could be an electronic process to book and submit and see anything due, as well as receive notifications.

Strong chairs

Having a strong ‘chair’ (nurse assessor) and clear structure for the reviews, who avoid duplication with pre-submitted notes in the questions asked, is seen as important and would ease pressures on staff time. The efficiency of reviews and perception of reviews by care home staff is strongly linked to the perceived strength of the chair.

E-Records

With the submission of notes being a significant burden for staff, sharing digital care records (‘E-Records’) was discussed as an alternative. Most care homes who responded now have an e-record system, and most of those who had an e-records system believe using this to share notes with nurses would make reviews easier. Others would be open to sharing this if GDPR-related concerns could be overcome.

One provider was spoken to who had found an efficient and compliant means of sharing e-records with a nurse assessor, and this had reduced the time spent on reviews for 4 Service Users from 3 hours to 1 hour. With NHSX pursuing the digitisation of care records as a top priority , we believe that pursuing this further would have significant impacts on staff time spent on, and the staff perception of, remote care reviews.

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E-Records chart

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