Background Developing ACPs requires timely and skilful communication and if done badly can risk discrimination in a frail population.¹ Our report aims to demonstrate the impact of a Frailty Collaborative Initiative to support ACP for care home residents in Shropshire which was accelerated during the Covid-19 crisis.

Methods Care homes were identified by high rates of non-elective admissions (NELs). Two doctors experienced in ACP visited the residents, reviewed their care plans and talked with carers and relatives. ReSPECT forms and symptom-specific ACPs were written. NELs, average length of hospital stay (LOS), A&E and Inpatient cost data were compared between care homes which had received ACP intervention (Scheme homes) and those that had not (Non-scheme homes).

Results 20 care homes were visited between 1st April and 1st July 2020. 385/585 residents (66%) required a ReSPECT form. 59 (15%) had a further anticipatory care plan for specific symptoms. 353 (92%) were not for resuscitation and 206 (54%) were not for escalation of care to hospital. Scheme homes saw a 56% reduction in emergency spells, 59% reduction in A&E costs and 52% reduction in inpatient costs cf. 44%, 3% and 9% reductions respectively in Non-scheme homes. Scheme homes showed a 29% decrease in average LOS compared to a 20% increase in Non-scheme homes.

Conclusion Timely ACP can have a significant impact in a frail population. Most residents were not for resuscitation but were still for active treatment, highlighting the fact that careful ACP does not deny medical care in this population. There was a high level of engagement with residents, carers and relatives together with a reduction in length of hospital stays and a cost benefit to the admitting hospital trust.

Reference

1. https://spcare.bmj.com/content/early/2020/08/20/bmjspcare-2020-002612