The needs of service users can be complex and unpredictable as their medical status frequently changes. This may happen suddenly and without warning, leading to urgent or emergency situations arising. Higher rates of functional impairment, multimorbidities with consequent disability and medical complexity, as well as a higher prevalence of dementia/cognitive impairment, incontinence, poor mobility, circulatory problems and angina contribute to the ongoing daily clinical challenges care homes face.

The NHS 10-year Long Term Plan (2019) states there are 185,000 emergency admissions each year and 1.46 million emergency bed days, with 35–40% of emergency admissions deemed potentially avoidable. Evidence suggests service users in care homes may not be adequately having their needs assessed and addressed as well as they could be, often resulting in unnecessary, unplanned and avoidable admissions to hospital and sub-optimal medication regime. Care home staff and managers are well aware of the pressures they face, and this acknowledgement is a step in the right direction.

Decreasing emergency service use not only has the potential to reduce pressure on hospitals but may also prevent exposure of vulnerable service users to potential infections, increased stress and loss of independence. There is evidence that service users in care homes preference is to mainly be treated in the care home and that hospital admission has an impact on diminishing their health and wellbeing after discharge.

At times, of course urgent treatment, assessment in A&E or hospital admission may be required, or a review and adjustment of service users individual care plan, treatment or the level of support service users require.

The emergence of a new strain of coronavirus (COVID-19) was declared a pandemic by the World Health Organization in March 2020 and has resulted in an unprecedented situation globally. COVID-19 poses specific challenges for care home service users, their families and staff. Reports of outbreaks in care homes have had devastating results and service users who contract the infection can deteriorate very quickly.

This situation is evolving, and information changes daily so care home managers should keep abreast of this through the Public Health England (PHE) website.

If a situation arises where there is any doubt of the best course of action or if staff feel they do not have the relevant skills or expertise to deal with a specific situation, then they should obtain urgent advice or dial 999.

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