Repeat visits to A&E should trigger automatic home checks

• The charity warns that some older and vulnerable people face an ‘endless cycle of avoidable hospital readmissions’ – going in and out of hospital multiple times in a single year without support
• British Red Cross frontline staff and volunteers are concerned that vulnerable patients are being sent home from hospital without the right support, or to unsuitable or even unsafe conditions at home
• Automatic home assessments could reduce repeat visits to hospital and pressure on our health and social care system, says charity CEO

In and Out of Hospital, a report published today by the British Red Cross, warns of an ‘endless cycle of avoidable hospital readmissions,’ in which some frail, older or vulnerable people are sent home from hospital, without the right care in place, only to go straight back to emergency departments.

The charity says that many of the older or vulnerable people it supports don’t feel safe in their own homes and fears they may be returning from hospital to unsuitable conditions.

Latest figures show that emergency hospital readmissions have risen by 22.8% in the last five years (1), with the number of people being readmitted within 48 hours now accounting for 1 in 5 of all emergency readmissions (2) .

This new report, based on the first-hand accounts of frontline health and care workers, British Red Cross staff and volunteers, as well as vulnerable people supported by the charity recommends automatic home checks to prevent a person’s condition deteriorating further and help put a stop to repeated visits to hospital.

The charity argues that while a patient might appear to be medically fit enough for discharge, repeated visits to hospital signal that something might be amiss in their home environment.

The British Red Cross highlights that there is no agreed, consistent approach to flagging repeat admissions and attendances. Often it takes a person falling into crisis before any kind of support package is put in place, by which time their needs have spiralled and become increasingly complex.

The charity argues that a series of simple interventions between hospital and home, including home checks, could prevent this cycle of re-admissions and discharge much earlier.

The British Red Cross supports around 300,000 people every year with support-at-home services, transport for patients to and from hospital, ambulance support and mobility aid loans. It has run a series of successful pilots aimed at better supporting frequent attenders to hospital, in order to reduce preventable readmissions.

Mike Adamson, chief executive of the British Red Cross said: 

“The NHS is rightly a source of national pride, but despite the best efforts of hardworking doctors and nurses we know that many of our hospitals remain under serious pressure this winter.  When the system is strained, all too often it is frail, older people who live alone that are falling into crisis in the gap between home and hospital.

“We believe that routine home inspections, when someone vulnerable is discharged from hospital, could flag basic steps that would prevent dangerous falls and repeat admittance to hospital. This could dramatically ease the flow of patients in and out of hospitals, helping to free up critical bed space. 

“British Red Cross staff and volunteers are working with hospitals across the country, to help patients get home safe and quickly. This includes transporting people home, checking their house for hazards and making sure there is a stocked fridge. Our experience proves that relatively low-cost measures save a significant number of bed days in hospital.”

Frail, older and vulnerable people don’t feel safe in their own homes

“And people we see have just come into hospital because they've had a fall and broken their hip, and then we turn up after they've been discharged… there's no gas, there's no electric, they're living in a messy house; they've not really been coping getting their food, they've just been getting by.” 

British Red Cross volunteer, Leeds

The British Red Cross argues that checking for falls hazards and making sure people can move around their home, would make older and vulnerable people feel safer.

In and Out of Hospital is based on the insights of frontline volunteers, staff and health and care professionals. The British Red Cross conducted a series of interviews and a survey with people accessing Red Cross support at home services as well as focus groups with Red Cross staff and volunteers and health and social care professionals from across the sector. 

It revealed that many frail, older and vulnerable people do not feel safe in their own homes because of the fear of falling. The top six everyday basic tasks that people struggled with were: 

• Taking a shower
• Getting dressed 
• Walking 100 yards
• Climbing a flight of stairs 
• Shopping for food
• Doing odd jobs in the house or garden 

It also found a troubling difference between the number of those that live alone accessing both formal and informal support, compared to those that live with others. Those living alone seem less likely to have accessed support to cope with everyday tasks and activities.  With more older people living alone – in the last 20 years the number of people aged over 75 living alone has increased by 27% (3) - support at home is vital to prevent this cycle of hospital admission. 

Existing data shows that falls at home are a large cause of emergency hospital admissions - over 255,000 people aged over 65 attend hospital because of a fall in England each year (4).  Thirty percent of people aged 65 and over will fall at least once a year. For those aged 80 and over it is 50 per cent . Something as simple as addressing falls hazards in the home could potentially save the NHS England £435m (4).

In and Out of Hospital identifies too many missed opportunities to help prevent people from falling into crisis. It recommends simple interventions that could be adopted at each stage of a patient’s journey, ensuring they are sent home from hospital appropriately with full support and prevented from re-admission.

ENDS

For further information: 

Penny Sims psims@redcross.org.uk
020 7877 7044 / out of hours 07719 391703

Interviews available on request.

Notes to editors

“In and Out of Hospitals” - our recommendations: 

i) Avoiding unnecessary hospital admission

• Invest in non-clinical personnel in A&Es to help people who just need support home before they are admitted. Non-clinical personnel have the time to provide the flexible, person-centred support others in busy accident and emergency departments often do not have time for. Importantly, they are able to take people home safely who might need a little bit of support but do not need to be in hospital. 
• Ensure there are more multidisciplinary teams who work with people at risk of being admitted into hospital. These teams should be located in the same offices, have regular meetings and shared access to care records. Voluntary and community sector representatives should be fully involved in these teams.

ii) Helping people home from hospital 

• All discharge ‘checklists’ must include an assessment of equipment and medication needs, from wheelchair to blister packs. These should be arranged before leaving hospital.
• At a minimum, transport home from hospital should be offered to all those who live alone, who are leaving hospital alone and have poor mobility. Anybody transported home should be assisted inside. Assisting patients inside their home provides an opportunity to check their home environment.
• Frail patients whose transfer back to the community has been delayed should be encouraged and assisted to get dressed and walk around every day they are in hospital so that their condition does not deteriorate (5). 

iii) Helping people feel safe at home

• The Government should consider seed-funding proactive falls prevention schemes, ensuring people can access the simple home adaptations and mobility aids they need to live independently at home. 
• People who live alone, have poor mobility and have been in and out of hospital due to falls, should automatically have their home assessed for falls hazards before they are discharged.
• Automatic home assessments should be triggered for people who have come in and out of hospital several times within a few months. We encounter people who have come in and out of hospital with nobody questioning why their needs have spiralled into something much more complex. While people might appear to be medically fit enough for discharge, a regular cycle of readmission so often signals that something is amiss at home.

How the British Red Cross helps get people home from hospital in 10 simple steps

1. The patient is signposted to our services by hospital staff
2. We ensure the person has suitable clothes to wear to keep warm
3. We check they have their medication and know how and when to take it
4. We transport a person home, either via assisted public transport or car/ambulance 
5. We ensure a person has their keys and can get into their home OK
6. We check whether people can move around their homes OK, do they need a mobility aid like a wheelchair, walking frame or commode. And whether the home is habitable, are there trip hazards or any other safety concerns
7. We check that the power is working, is the heating on, can you boil a kettle, and is the home warm and comfortable
8. We ensure there are enough supplies, is there food in the fridge to eat
9. We check that their pets are OK - this is a huge source of comfort and support to people
10. Next steps – continue to check in with people, is there a family, a friend, carer or neighbour nearby, connect them with local services, accompany them on shopping trips or appointments and help build confidence and recovery  

The British Red Cross helps people in crisis, whoever and wherever they are. We are part of a global voluntary network, responding to conflicts, natural disasters and individual emergencies. We enable vulnerable people in the UK and abroad to prepare for and withstand emergencies in their own communities. And when the crisis is over, we help them to recover and move on with their lives. 

www.redcross.org.uk

 

1. Compared to a 9.3% rise in overall admissions to hospitals during the same period, Healthwatch, October 2017
2. Healthwatch, October 2017
3. ONS
4. Public Health England
5. Older people are estimated to lose 5 per cent of muscle strength per day in hospital, ultimately reducing their ability to live independently rel="noopener noreferrer" at home once discharged. National Audit Office Discharging older patients from hospital, (May 2016)