Abstract

Objective: The heterogeneity of the care home market and localised approaches to the provision of primary and community care means it is unlikely that one model of service delivery will be suitable for all settings. The aim of this study was to understand what supports effective working within and across different models of health care provision to care homes.

Method and Results: Using realist methodology we completed an evidence synthesis to determine what, within different models of care might determine success and failure in care home settings in relation to five outcomes: residents’ medication use, use of out of hours’ services, hospital admissions and length of hospital stay, costs and user satisfaction. The synthesis findings of what works when and in what circumstances were tested in three sites with different approaches for health care delivery to care homes. Residents’ care in 12 care homes (n=242) were tracked for 12 months with resident, relatives and visiting and care home staff interviews (n=130). Findings identified key mechanisms within different service models that were likely to increase (or reduce) staff and resident satisfaction and use of NHS services. Financial incentives for GPs and investment in dedicated services were an important resource but were not of themselves sufficient to change working relationships and behaviours.

Policy implications: Models of service delivery to care homes are many and ill-defined. An understanding of the likely mechanisms that generate conditions for effective working between primary/community health and residential care is key for planning future health care provision to care homes.