Long stay care and the NHS: discontinuities between policy and practice

Summary points The independent sector now provides most long stay care for elderly people The ageing population in homes will result in greater demands for NHS support Failure to maintain best nursing practices and lack of specialist knowledge in many homes places special demands on the NHS Experts in health care for older people have been largely ineffective in establishing standards and good practice in long stay care homes Data on older people in homes are few and of poor quality, and there is no understanding of what people in these homes think or wantM The independent sector and the NHS must ensure that interventions reflect best practice and the efficient use of resources The growing importance of long stay care provided by the independent sector has been partly attributed to a lack of commitment by the medical profession to preserving long stay NHS care. 3 The drive to give priority to acute medical care and a decline in rehabilitative geriatric medicine 4 have meant that hospital care for frail older people has become focused on acute management and speedy discharge. 5 NHS doctors who previously cared for long stay older inpatients are becoming deskilled, and there are claims that the speciality of geriatric medicine is losing its identity. 4 Who cares for whom?