Current and Future Care of Older People with Diabetes in UK Nursing & Residential Care Homes

In April 2024 I was in London attending the Diabetes UK Professional Care Conference as a #dedoc° voice. Being a 74-year-old diagnosed with type 1 diabetes in September 1954 I was proud to be able to represent the older person with diabetes at this conference.

During the #DUKPC2024 conference I spent most of my time networking and speaking to Health Care Professionals about this sadly neglected area.(1)   Hopefully from these conversations and those that have taken place since things will start to change. For change is needed now, but there is no doubt that it will take time as social care is the poor relation of the NHS. Neglected for decades by government's who have promised reform but they have consistently failed to implement the changes required.

The next decade will be a challenging time as people with diabetes are living longer due to improved diabetes care and technology. So, the prevalence of diabetes over the age of 65 will increase. Some of these older people with diabetes may require care in the community or maybe in nursing or residential care facilities due to the problems of ageing, dementia, frailty, etc.

Is the government, primary care in the NHS, private and public nursing, and residential care homes ready for the onslaught of older people with diabetes that will happen over the decades? 

I suggest that they are not.

Many of the issues revolving around the lack of care and understanding of diabetes were uncovered by the first and last 'England wide IDOP Care Home Diabetes Audit' (2012/13).(2)

Here are a few results from the care homes:

• 52.81% were aware of the Diabetes UK Guidelines of 'Good Practice for Residents with Diabetes in Care Homes.'
• 36.75 % had a member of staff who had designated responsibility for diabetes management
• 63.28% had a written hypoglycaemia policy.

A more recent local audit was published in 'Diabetic Medicine' in 2023. Titled 'First diabetes survey in Surrey Downs Care Homes, 10 years after the UK National Diabetes Audit: What has changed?'(3)

Well since the first national audit in care homes, negligible progress has been made.

For comparison:

• 83.6% were aware the Diabetes UK Guidelines of 'Good Practice for Residents with Diabetes in Care Homes.'
• 52.5% had a key worker (Diabetes Champion) responsible for the management of residents with diabetes and the supervision of staff.
• 67.2% had a written policy to manage hypoglycaemia. 

Improvement is still needed as this is not good enough. 100% is required. 

To quote from this audit "Hypoglycaemia was confirmed to be an undervalued event."  Dr. Giuseppe Maltese continued "Our audit highlights that in the last 10 years, since the first national audit in care homes, negligible progress has been made in optimising the quality of diabetes care in long-term facilities. There is much hope that the new care home diabetes guidelines launched by the NAPCHD in 2022 will be implemented at national level, but there is also legitimate doubt as to whether this will happen on a large scale in the United Kingdom."

Locally it is going to happen. I quote "Following our audit in Surrey Downs, we have initiated a structured phase of improvement in diabetes care in care homes including the promotion of an accredited online training programme for staff and the delivery of education events organised by the community diabetes specialist service. We are also planning to pilot the implementation of the NAPCHD recommendations in the care homes of one of the six primary care networks in Surrey Downs." 

'Oak trees from little acorns grow' if is starting in Surrey Downs it can happen in your area.

Over the past year or so I have learnt a lot about what is required in the care home sector to enable safe quality diabetes care for those older residents in care homes now and in the future. That information is from various best practice publications including 'Diabetes - Good Practice Guide published by British Geriatrics Society (2009) (4) and the Diabetes UK 'Good Clinical Practice for Care Home Residents with Diabetes' (2010)(5) guidelines. Plus, a recent important publication regarding care home diabetes guidelines as mentioned in the paragraph above. Published by The National Advisory Panel on Care Home Diabetes (NAPCHD) it is the 'Strategic Document of Diabetes Care for Care Homes' and its appendices (2022).(6)

As a person with type 1 diabetes, I am pleased that in November 2023 the NAPCHD 'Position Statement on Type 1 Diabetes Mellitus in Care Homes' consultative document was issued. I have had sight of this document; it is impressive containing a framework for the enhanced care of type 1 diabetes in care homes with minimum standards of care for older people with type 1 diabetes.

Staff training must be prioritised for the future care of those older people with diabetes. As in Surrey Downs these 'Diabetes Champions' are paramount. Staff who could be either a nurse or a non-clinical carer would be responsible for the management of residents with diabetes and the supervision and training of other staff looking after them.

I am looking forward to the future publication of this document and its full implementation nationwide. I believe these beneficial changes contained in all of these documents must become the 'Standard of Care' for all care homes in the UK.

At present 'Eden Sanofi Cares' (7) provides free places for care home staff via online learning. So, if one staff member takes this course, then these 'diabetes champions' could pass on this knowledge to thier colleagues. Thereby improving the care of their residents. So, I implore all care homes to take up this training for the health and safety of your residents.

Recently, I was asked to address an online meeting of care home managers during 'Insulin Safety Week'. I asked the question "How many of you have read these the NAPCHD documents?" But I was dismayed at the response. Not one of these managers had read them, not one!

So, to all of you stakeholders involved with caring for the older person with diabetes in care homes, including care home owners and managers, community health, adult social services, and diabetes specialist teams etc; please read these documents and appendices. Then contact others in your area to put into practice those recommendations contained within.

This is a problem that is not going away and will only increase over the coming years. Action is needed now so that their and our future care needs will be catered for safely, adequately and consistently. As stated in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12 – Safe Care and Treatment.(8) It is your responsibility to make sure that staff have the qualifications, competence, skills and experience to keep people safe. The CQC Single Assessment Framework (9) which started in 2023 has five key questions. Does your care home environment conform for those under your care who have diabetes? Is it safe, effective, caring, responsive and well-led?

Because today statistically it most likely that staff qualifications, competence, skills and experience is lacking for them to enable safe quality care to older people with diabetes.

So, let's begin, it all starts with the correct knowledge. That is obtained with the training of staff. Please act now.

DISCLOSURES

#dedoc° run by Dedoc Labs a profit for impact company paid for my hotel costs plus granted me complimentary registration to the conference as a member of 'press'. In return #dedoc° voices agree to #tpayitforward to their communities in various ways. This blog is my way of paying it forward.

REFERENCES

• 1.  Failing to meet the needs of generations of care home residents with diabetes: a review of the literature and a call for action - Sinclair - 2018 - Diabetic Medicine - Wiley Online Library
• 2.  England-wide-Care-Home-Diabetes-Audit.pdf (diabetesfrail.org)
• 3.  Surrey Downs Audit https://pubmed.ncbi.nlm.nih.gov/37690128/
• 4. Diabetes - Good Practice Guide    https://www.bgs.org.uk/resources/diabetes
  
• 5. Good Clinical Practice for Care Home Residents with Diabetes https://www.diabetes.org.uk/resources-s3/2017-09/Care-homes-0110_0.pdf?
• 6. Strategic Document of Diabetes Care for Care Homes' and its appendices  NAPCHD – fDROP
• 7. SANOFI CARES — EDEN (edendiabetes.com)
• 8. Regulation 12: Safe care and treatment - Care Quality Commission (cqc.org.uk)
• 9. Our new single assessment framework - Care Quality Commission (cqc.org.uk)