Setting the scene...
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There are 40+ care homes (encompassing Nursing, Dementia & Residential Care) in the area that the department operates in, of which half are served by the NHS on a regular basis. Currently the team visiting these comprises of three podiatrists, who have up to 8 clinical session between them each week dedicated for care homes.
Due to the high demand, and limited resources, these homes are visited on a rotational basis for routine podiatry. However, at the same time we also undertake visits for 'urgent' requests and monitoring patients who have previously ulcerated, and remain at an increased or high risk of ulceration, as deemed clinically appropriate.
We ensure we have an updated list of residents (new, moved, deceased etc) prior to visiting so that all the appropriate paperwork can be made up for their records, and also requesting medication lists for new patients. All this is done about a week in advance, providing the home with sufficient notice, with a courtesy call on the morning we visit. As most homes are unable to accommodate us before 10:00/10:30 due to breakfast and medication rounds, we usually deal with and urgent requests for visits or reviewing high risk patients.
We then normally visit in pairs, usually met with a look of huge disappointment and inconvenience by the care staff, and told that they "Don't do feet!" but i digress.
The issues we face are as below:
1] The interval between routine visits is long (and gradually beginning to increase)
2] There is a lack of carers willing to provide simple foot care for low risk residents
3] There seems to be a fundamental breakdown in cooperation with ourselves in a majority of the homes. We are seen as a nuisance and have less importance than the hair dresser (I've witnessed first hand how the same carers be helpful and use their initiative)
There are a few homes, with challenging patients, that demonstrate the system we operate has the potential to be successful. This i belive is only possible because the staff are extremely organised, accommodating and helpful. Usually one joint session is sufficient to have seen all the residents.
What I am hoping for is for you lovely people of PA to share your local practices so that we can model/pilot an improved service where we are able to provide more regular/equal care for the residents in a care setting.
We have considered offering foot care training to carers to manage low risk patients, but there is little interest and a huge turnover of staff in many of the homes.
I should also note that the area in question is in the top ten for socioeconomic deprivation. Very few have the means to, or wish to pay for private podiatry. In addition to this the are nearly tops the tables for almost every risk status.
- What are your local practices?
- What works for you?
- What approach have you tried that wasn't successful?
- What advice would you give to our team - where are we going wrong?
Often the answers are out there, but much to my annoyance it seems the NHS is set on re-inventing the wheel at all times. The lack of information sharing is diabolical.
Your help, advice, insights, well whatever you can offer really will be much appreciated.
I look forward to you responses, thanks in advance.
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