New care home admission after hospitalisation - understanding trajectories and predictors using linked health and social care data

Introduction: When used appropriately, admission to a care-home makes a positive contribution to the care landscape, offering best care to individuals who require this level of support and reducing demand on healthcare systems (Bockerman et al., 2012; Spiers et al., 2018). However, use of care varies eight-fold across England and Wales (Audit Commission, 2011).

Underpinning this is significant variation in the percentage of older adults admitted to hospital from home who are discharged to a care-home – ranging from 0.14% of admissions to 4.61% (Audit Commission, 2011). The reasons for these variations have not been explored but suggest potential for improvement.

NICE guidance states: “ensure that people do not have to make decisions about long-term residential or nursing care while they are in a crisis” (National Institute for Health and Care Excellence, 2015).

Data linkage offers the potential to enhance the information available in single data sources and explore complexity in everyday practice (Steventon and Roberts, 2012).

Unlinked analysis of the Scottish Care-Home Census (SCHC) provides new insights into this difficult-to-research population and demonstrates the feasibility of using this data source (Burton et al., 2019).

Aims: To describe the characteristics, outcomes and costs of moving into a care-home from hospital, compared with from the community and to characterise the variation between regions in proportions moving into care-homes from hospital and from the community Methods: The SCHC contains national data, submitted by care-homes summarising activity over the preceding year and individual level data on long-stay residents (Information Services Division Scotland and NHS National Services Scotland, 2016).

There are no comparable national social-care datasets available in England (NHS Digital, 2019).

We have created an anonymised linked dataset, based on the SCHC, allowing descriptive epidemiology on those moving into care-homes from hospital, compared with those moving in from home.

This dataset includes hospital admissions and secondary care use, long-term conditions and psychoactive medication use for three years prior to moving to the care-home.

It will be used to identify predictors of admission; outcomes after admission, calculate costs and identify geographical variations in practice.

Importance: This project will provide an exemplar of the potential of linked health and social-care data in exploring real-world practice, develop analytical understanding and insights into the organisation of health and social-care.

Its results will help to inform future mixed-methods research around pathways into care-homes and how best to support older people as care needs increase.