Long-stay Hospital Research Articles

Medicare Advantage enrollment and outcomes of post-acute nursing home care among patients with dementia.

Enrollment in Medicare Advantage (MA) has been rapidly growing. We examined whether MA enrollment affects the outcomes of post-acute nursing home care among patients with Alzheimer's disease and related dementias (ADRD). We exploited year-to-year changes in MA penetration rates within counties from 2012 through 2019. After adjusting for patient-level characteristics and county fixed effects, we found that MA enrollment was not associated with days spent at home, nursing home days, likelihood of becoming a long-stay resident, hospital days, hospital readmission, or 1-year mortality. There was a modest increase in successful discharge to the community by 0.73 percentage points (relative increase of 2.4%) associated with a 10-percentage-point increase in MA enrollment. The results are consistent among racial/ethnic subgroups and dual-eligible patients. These findings suggest an imperative need to monitor and improve quality of managed care among enrollees with ADRD.

Stuck in Hospital: how can we make integrated care a reality for people with a learning disability and / or autism who experience long stays in assessment & treatment settings?

Introduction: Integrating care so that people with learning disabilities and/or autistic people can receive support at home rather than in institutional assessment and treatment units is a priority in the UK and many other countries. Despite the recognition of its importance, progress on timely and coordinated discharge has been slow. Surprisingly little previous research has engaged directly with people with learning disabilities and/or autistic people, their families or front-line care staff to understand the issues from their perspectives. This project has sought to address this gap.
 Community of Interest: Professionals, policy makers, researchers, people with a learning disability and / or autism, and family carers connected with this area of integrated care policy and practice.
 Engagement: We worked with a Reference Group of people with learning disabilities and/or autistic people and their families to co-design our approach, sense check findings and support dissemination. Reference Group members were reimbursed for any expenses, paid for their time, and received appropriate support and training for the tasks in which they are involved. The project was also designed and delivered in collaboration with a self-advocacy group.
 Overview: We initially conducted a formal review of the research and grey literature, identifying rates of delayed discharge for people with learning disabilities and/or autistic people in long-stay hospital settings, the methods used to identify such rates and the solutions proposed. 
 Next, we worked with three long-stay hospital sites from across the UK in order to conduct: 
 In-depth work with ten people with learning disabilities and/or autistic people per site, and with a family member, to understand their journey through services over time, their experience of long-stay hospital provision, how care was co-ordinated to meet their aspirations, the kinds of lives they would like to be living, and the barriers that are preventing them from leaving hospital
 Focus groups with front-line staff and interviews with a commissioners for each of the 30 people with learning disabilities and/or autistic people.
 The perspectives of social workers supporting our 30 participants, as well as of advocates and social care providers working with people leaving long-stay hospital settings
 Results: The data from the study is currently being analysed with the final report due by the end of December 2022.
 
 Insights: From our analysis to date, we have identified the following recommendations for policy & practice: see the person behind the labels; don’t make people jump through more hoops than is really needed; help hospital staff know what’s available in the community; give people the chance to try life outside; help people with the trauma they’ve experienced; and. don’t let people fall through the cracks between services.
 Next steps: Alongside completing the report, the research team have a practice guide in publication, a film highlighting main implications, and an accessible practice guide. The team are planning a follow up study with our lived experience reference group which will explore people’s quality of life post-discharge in relation to different approaches to facilitating more co-ordinated and person-centred care.

Empirical Project: Investigating the onset and trajectory of Alzheimer’s disease in Down syndrome

Three decades of data, collected at a community learning disability service in a region of the UK, are reported on. Participants included 579 people with Down syndrome (DS), who were followed up from baseline to the point of a dementia diagnosis, and in some cases until death. Since most people with DS develop Alzheimer’s disease (AD), the aim was to see whether certain neuropsychological measures were changing in the prodromal stages of AD, above that of normal ageing, to support timely diagnoses. Variables associated with earlier age at dementia onset and subsequent survival times were also assessed. Generalised linear mixed models in R were used to compute prodromal changes for 204 of the sample, who had more than two complete assessments. Regression and hazard regression models in SPSS were used for onset (n= 279) and survival times (n= 185), respectively. Results suggest that difficulties with lexical-retrieval and visual memory may be early indicators of later AD. Awareness of the level of intellectual disability appears essential, since profound disability produced ‘floor’ effects, which impacted on the possibility for later declines. Earlier age at first assessment and living with family were predictive of an earlier age at diagnosis, which then led to longer duration of life, post-diagnosis. Both earlyand late-onset epilepsy, and living in a long-stay hospital were associated with earlier mortality. Implications for clinical practice and research are discussed.

Cross-sectional study on anxiety in confinement due to covid-19 in a sub-acute and long-stay mental health unit

IntroductionChronic psychiatric patients admitted to subacute and long-stay hospital units are especially vulnerable to the situation of confinement due to the pandemic. Throughout 2020 and 2021 they have suffered the consequences of multiple strict confinements given the differences in isolation protocols in hospitalized patients compared to the general population. This has repercussions on the increase in anxious symptomatology, which influences a more torpid and prolonged evolution of mental disorders in this subpopulation.ObjectivesThe objective of this study is to study the anxiety levels of patients admitted to a sub-acute and long-stay mental health unit in a situation of confinement due to covid-19.MethodsWe have carried out a cross-sectional descriptive observational study in 25 patients admitted to the subacute and long-stay unit of the Barcelona Forum Center between December 8 and 23, 2021 in the context of confinement due to a covid-19 outbreak. Sociodemographic and clinical variables are collected. We have used the self-administered STAI scale to assess clinical anxiety.ResultsThe mean age is 47.7 years; women 60%. 80% with single marital status. 90% of the patients presented active tobacco consumption, with an average of 21.2 cigarettes/day. The mean score on the STAI scale was 58.8 for state anxiety and 46.7 for trait anxiety, both levels above the 75th percentile for adults, both men (state anxiety 28, trait anxiety 25) and women (state anxiety 31, trait anxiety 32).ConclusionsThe state and trait anxiety scores of the STAI scale of hospitalized patients are higher than the average of the general population, which could be due to the situation of confinement due to the covid pandemic.Disclosure of InterestNone Declared

Оn the issue of diagnosis of Norwegian scabies on the example of a clinical case

Norwegian scabies is a rare form of a fairly common contagious skin disease. It is characterized by difficulties in diagnosis due to the absence of a typical clinical picture and characteristic complaints of the patient. Also, the diagnosis of Norwegian scabies is often complicated by the presence of concomitant diseases, such as ichthyosis and mental retardation. As a result of impaired cognitive functions in patients, it is quite problematic to collect complaints and anamnesis. An incorrect diagnosis leads to the appointment of ineffective therapy and, as a result, to further progression of the disease, accompanied by the addition of secondary infection and deterioration of the general condition of the patients body.
 Training of doctors of various specialties (dermatovenerologists, therapists and general practitioners) in the skills of differential diagnosis of Norwegian scabies is relevant due to the increase in cases of this disease in various groups of people, mainly related to boarding houses and long-stay hospitals.
 In this article, the authors provide an overview of the etiology, pathogenesis, and clinical manifestations of a rare form of scabies ― Norwegian scabies, and highlight the difficulties of differential diagnosis of this dermatosis. A clinical case of Norwegian scabies in a 52-year-old woman suffering from ichthyosis and mental retardation on the background of Down syndrome is described.

'Why are we stuck in hospital?' Understanding delayed hospital discharges for people with learning disabilities and/or autistic people in long-stay hospitals in the UK.

Despite longstanding efforts at de-institutionalisation, around 2000 people with learning disabilities and/or autistic people in England currently live in hospital settings, amidst reports of protracted stays, limited progress towards living more ordinary lives and scandals of abuse and poor care. Yet, there is relatively little research on why people with learning disabilities and/or autistic people are delayed in hospitals, and what exists has significant limitations. In particular, previous studies have rarely talked directly to people with learning disabilities and/or autistic people, their families and frontline staff about their experiences of living or working in such settings, the barriers to discharge and what would help more people to lead chosen lifestyles. This paper presents the findings of a structured literature review conducted between January and March 2021 on delayed discharges of people with learning disabilities in long-stay hospital settings. It investigated: the proportion of people with learning disabilities delayed in long-stay hospital settings, the suggested reasons for these delays and the proposed solutions. The literature reported delays for 11%-80% of inpatients in different settings. The reasons reported are related either to particular characteristics of the person (which we find problematic) or limitations of the system supporting them. However, delays were defined and reported inconsistently, reasons usually lacked depth and detail, and the majority of included studies did not engage directly with the people living in long-stay settings, their families or frontline staff. Without listening to these voices, genuine solutions will be difficult to find.

Recent findings on subjective well-being and physical, psychiatric, and social comorbidities in individuals with schizophrenia: A literature review.

Care for people with schizophrenia is shifting the locus from long-stay mental hospitals to nonspecialized community-based settings. Knowledge on the care is not a sole property of psychiatric specialists. Community healthcare workers who do not specialize in psychiatry are recommended to learn more about schizophrenia. This review aimed to summarize recent findings on subjective well-being and physical, psychiatric, and social comorbidities in individuals with schizophrenia. A literature review was conducted. We retrieved findings from existing systematic reviews and meta-analyses as our preferred method. When data were not available, we referred to other types of studies. As per our review, individuals with schizophrenia demonstrated poor subjective well-being, happiness, and life satisfaction despite individual differences. Pharmacotherapy caused weight gain and constipation, whereas race and hospitalization might affect weight reduction. Individuals with schizophrenia demonstrated poor oral health, a high prevalence of noncommunicable diseases, and unique eating behaviors. Depression, sleep disorders, smoking, and alcohol and drug consumption were frequently found in the individuals. Research findings regarding problematic internet and smartphone use and stress perception were limited. Low health literacy and neglect of preventable behaviors were frequently seen in individuals with schizophrenia. They tended to be less educated, poor, unemployed, unmarried/unattached, and had poor social cognition, resulting in little social support and a small social network. Retrieving recent data, we confirmed that individuals with schizophrenia had poor subjective well-being and suffer from various physical, psychiatric, and social comorbidities.

Implementing Dysphagia Screening and Assessment in an Intermediate and Long-Stay Hospital: A Hospital-Based Quality Improvement Project

Dysphagia can occur due to a wide range of medical conditions including acute or progressive neurological disorders, trauma or surgery, with secondary effects such as dehydration and malnutrition causing an increase in morbidity and mortality rates. Dysphagia screening and assessment of swallowing function by a multidisciplinary care team is essential to identify, diagnose and manage patients with dysphagia. A cross-sectional study of dysphagia screening and assessment was performed from the 1st to the 15th of April 2022 on patients hospitalised in an intermediate and long-stay hospital in Cartagena in the southeast of Spain. The Eating Assessment Tool-10 (EAT-10) questionnaire was used as a direct-scoring screening test for dysphagia together with the standardised Volume-Viscosity Swallow Test (V-VST) in all patients with an EAT-10 score ≥ 3 points. After confirming dysphagia, different dietary and pharmaceutical interventions were performed. The following data were collected from the medical record program EKON®: age, gender, primary diagnosis, diet and texture and the use of thickener for liquids. A total of 86 patients were included in the study with a mean age of 80.0 ± 12.0 years. The mean EAT-10 score was 2.5 ± 1.7 points with 36 patients (43.9%) testing positive for being at risk of presenting dysphagia. Of these patients at risk, the V-VST detected dysphagia and the necessity of a nectar consistency in 24 patients, a honey consistency in 3 patients and a pudding consistency in 2 patients. Only 10 of the patients with dysphagia were using thickener prior to the screening and the assessment. Dietary and pharmaceutical interventions were made in the other 19 patients with dysphagia. Dysphagia screening in intermediate and long-stay hospitals is not common practice even though there is a high prevalence and important clinical repercussions. Implementing dysphagia screening and assessment protocols will improve quality of care in these patients.

When less is more: deprescription in a long-stay hospital. A case report

IntroductionWe present the case of a 54-year-old man diagnosed with mixed histrionic / obssesive personality disorder admitted in a long-stay hospital. Symptoms began at 40 years of age, predominantly anxiety and agoraphobia alongside somatic complaints. During his admission, the symptoms markedly fluctuated. The patient alternated periods in which he presented confusion with others of irritability, disinhibition, and stereotyped movements. Moreover the patient spent long periods of time in bed with little or no communication with other patients or staff.The different pharmacological approaches which were carried out and their consequences are analyzed.ObjectivesIt is a common practice to increase the number of prescribed drugs or their doses when symptoms worsen. The result is polymedication and higher doses above maximum levels in the technical sheet. Reducing medication is rarely considered as a strategy.MethodsA case report is presented alongside a review of the relevant literature regarding different long-term pharmacological treatments and their side effects.ResultsThe suspension of the antipsychotic treatment which had been administered for years represented a significant improvement. Withdrawal of Olanzapine resulted in a significant improvement.ConclusionsIt is important to review the prescription of each medication in time, as well as to consider their possible side effects.DisclosureNo significant relationships.

Primum non nocere: psychosurgery in a case of severe anorexia nervosa. A case report

IntroductionBilateral cingulotomy and anterior capsulotomy are two neurosurgical procedures which are reserved as a last resort for cases of severe OCD in Spain; these procedures are not approved in cases of AN.ObjectivesWe present the case of a 29-year-old female patient who was diagnosed with anorexia nervosa (AN) when she was 15 (2006). Due to the severity of the case the patient needed to be hospitalized for many months due to excessive weight loss. She was also treated in an out-patient department and started several intensive psychotherapeutic procedures. In 2015 the patient’s family took her to a private clinic where she was diagnosed with Obsessive-compulsive disorder (OCD) and had a bilateral cingulotomy and anterior capsulotomy.MethodsA case report where the ethical implications of the case are weighed alongside a review of the relevant literature regarding neurosurgical treatments of AN.ResultsThere were no significant short or long term improvements in terms of Body Mass Index or reduction of symptoms, the patient’s cognitive functions showed a decline in neuropsychological tests. Contrary to that the patient has needed hospitalizations for at least 9 months per year since the surgery and has needed admission in the Intensive Care Unit at least 3 times because of extreme malnutrition. Due to her need for chronic hospitalization was institutionalized in a long-stay psychiatric hospital.ConclusionsPsychosurgery is a controversial therapy which has limited evidence in cases of AN. Our case shows the way in which neurosurgical procedures can do more harm than good and worsen the prognosis of patients.DisclosureNo significant relationships.

Respects of human rights and perception of quality of care, the users’ point of view comparing mental health and other health facilities in a region of Italy

This work is part of a research project that aims to measure organisational well-being, human rights respect and quality of care in mental health services in Sardinia, Italy, country that has replaced long-stay psychiatric hospitals with community mental health services. Previous contributions have seen Italian health professionals and users as the most satisfied and optimistic about the quality of the mental health care provided and the respect they offer for service users’ rights. Our aim is to confirm these findings by comparing experiences of users of mental health services with those of other care services in the same region. Our findings indicate that mental health services users show higher level of satisfaction for care and higher perception of users’ human rights respect compared to non-mental health facilities users. They also have greater satisfaction with organisational aspects of services and they are more convinced that the health professionals rights are respected. In contrast, they are less satisfied with the resources available for care centres than other users and require more professional psychosocial support. We want to allow future comparisons to other regions on quality assessment through the perception of users and worker on respect for standards and human rights.

Incidence of falls in long-stay hospitals: risk factors and strategies for prevention

IntroductionFalls are a major health problem in elderly institutionalised patients, due to the associated high morbidity and mortality rates and the impact on future quality of life. ObjectiveTo analyse the incidence and patient profile for falls, and to identify potential causes and effects. We also assess the efficacy of intervention in selected patients in preventing further falls. MethodsWe performed a prospective study at a long-term care centre for 12 months. Data were collected via fall reports. The falls committee drafted a monthly data collection form. ResultsA total of 155 falls were recorded in 80 patients, with 40% presenting more than one fall. Patients aged over 70 years accounted for 84.5% of falls; 42.7% of patients are able to walk independently; 55.5% of falls occurred in the bedroom; 74.8% of patients had been prescribed sedatives or psychoactive, or antihypertensive drugs; 27.7% of falls were due to loss of balance and 22.5% were due to patients performing an activity for which they did not have the capacity. Fractures occurred in 1.9% of patients. ConclusionsPatients aged over 70 years, walking independently, receiving sedatives or psychoactive or antihypertensive drugs, and with history of falls were at greatest risk. The majority of falls occurred in the bedroom. Physiotherapy interventions were highly effective in cases selected by the falls committee.

Perceived versus objective sleep quality in long-stay hospitalised older adults-a mixed methods study.

Hospital inpatients experience substantial sleep problems that have been linked with worse health outcomes, poor quality of life and the post-hospital syndrome. However, little is known about assessing sleep issues in older hospitalised patients. To conduct an in-depth investigation on hospitalised older adults' sleep challenges and methods of sleep assessment. Cross-sectional observational study. Public hospital inpatient unit. Long-stay hospitalised older adults. Data were collected using validated sleep questionnaires, actigraphy devices and qualitative interviews. Quantitative data were analysed with descriptive statistics, multiple logistic regression and Cohen's Kappa. Qualitative data were analysed with qualitative content analysis; findings compared to the quantitative assessments. We collected data on 33 older long-stay hospital inpatients, who were mean (SD) 80.2(7.4) years old, 57.6% female and were hospitalised following stroke, medical illness and orthopaedic fracture. Mean (SD) total sleep time and actigraphic sleep efficiency were 480.6(73.6) minutes and 81.5(11.2)%, respectively. About, 57.6% were poor sleepers (Pittsburgh Sleep Quality Index [PSQI]) and 30.8% had indicators of clinical depression/low quality of life (WHO-5 well-being index). Three main themes were identified: "sleep assessment"; "factors that affect sleep"; "expectations of sleep". Bad sleepers were more likely to feel a lack of control over their sleep, while good sleepers spoke about the ability to adjust and accept their circumstances. We found high levels of sleep problems and identified substantial discrepancies between the validated sleep questionnaire and qualitative response data. Our findings indicate that standard assessment tools, such as PSQI, may not be suitable to assess sleep in hospitalised older adults and call for further investigations to build more appropriate methods. Further exploring psychological factors and expectations could potentially lead to novel interventions to improve sleep in this setting.

Conflicts in the end-of-life care: Interviews with care staff by Buddhist priests and researchers

Interprofessional communication and collaboration is essential for a better end-of-life and death, where individual dying people are respected and their satisfaction is the goal. The aim of this study is to explore 1) ethical conflicts viewed by care staff of geriatric institutions, 2) their views about geriatric medicine, and 3) their views about religion in the context of institutional end-of-life care. Semi-structured interviews were conducted by Buddhist priests and researchers with nine care workers who worked in nursing homes or long-stay geriatric hospitals. This interview was conducted as part of a research project that investigated the feasibility of the engagement of religious workers in the geriatric care setting. Regarding ethical conflicts, six themes were merged: difficulty in knowing the will of the person being cared for, dissonance with the family, older person's wish to die, losing the purpose for living, staff not being used to death, and families not being used to death. Regarding geriatric medicine, eight themes were merged: gratitude for cooperation, persuasive explanation, not accepting death, not allowing patients to share a peer's death, cold attitude, being drug therapy centered, not being person-centered, and heavy burden for patients. Regarding religion, five themes were merged: expectation for salvation, barrier to hospitals, already involved in nursing homes, explicit religious traits are acceptable, and favorable character of religious workers in institutions. Communication between geriatric physicians, care staff, and mainstream religious workers, with the aim of providing a better quality of end-of-life and death, is beneficial in a super-aged society.

Prevalencia de infección por coronavirus SARS-CoV-2 en pacientes y profesionales de un hospital de media y larga estancia en España

Background and goalsThe aim of the study is to know the prevalence of SARS-CoV-2 infection in patients and professional staff of a medium or long-stay hospital during the peak period of the pandemic in Spain, spring 2020. Material and methodsAt the end of February 2020, we developed at the hospital a strategy to diagnose the SARS-CoV-2 infection consisting of complementing the realization of PCR tests at real time with a quick technique of lateral flow immunochromatography to detect IgG and IgM antibodies against the virus. We also developed a protocol to realize those diagnostic tests and considered an infection (current or past) a positive result in any of the above tests.We included 524 participants in the study (230 patients and 294 hospital staff), and divided them into hospital patients and Hemodialysis outpatients. Furthermore, we divided the hospital staff into healthcare and non-healthcare staff. The documented period was from March, 20th to April, 21st, 2020. Results26 out of 230 patients tested positive in any of the diagnostic techniques (PCR, antibodies IgG, IgM) with a 11.30% prevalence. According to patients groups, we got a 14.38% prevalence in hospital patients vs. 5.95% in outpatients, with a significantly higher risk in admitted patients after adjustment for age and gender (OR=3,309, 95%CI: 1,154-9,495).24 out of 294 hospital staff tested positive in any of the diagnostic techniques, with a 8.16% prevalence. According to the groups, we got a 8.91% prevalence in healthcare staff vs. 4.26% in non-healthcare staff. Thus, we do not see any statistically significant differences between hospital staff and patients as far as prevalence is concerned (P=0,391), (OR=2,200, 95%CI: 0,500-9,689). ConclusionsThe result of the study was a quite low prevalence rate of SARS-CoV-2 infection, in both patients and hospital staff, being the hospital patients’ prevalence rate higher than the outpatients’, and the healthcare staff higher than the non-healthcare's. Combining PCR tests (gold standard) with antibodies tests proved useful as a diagnostic strategy.

Non-Pharmacological Interventions towards Preventing the Triad Osteoporosis-Falls Risk-Hip Fracture, in Population Older than 65. Scoping Review.

Osteoporosis leads to increased risk of falls, and thus an increase in fractures, highlighting here hip fractures, that result in high mortality, functional disability, and high medical expenditure. The aim is to summarise the available evidence on effective non-pharmacological interventions to prevent the triad osteoporosis/falls risk/hip fracture. A scoping review was conducted consulting the Scientific Electronic Library Online (Scielo), National Institute for Health and Care Excellence (NICE), Cumulative Index to Nursing & Allied Health Literature (CINAHL) y PubMed.databases. Inclusion criteria were articles published between 2013 and 2019, in Spanish or English. In addition, publications on a population over 65 years of age covering non-pharmacological interventions aimed at hip fracture prevention for both institutionalised patients in long-stay health centres or hospitals, and patients cared for at home, both dependent and non-dependent, were included. Sixty-six articles were selected and 13 non-pharmacological interventions were identified according to the Nursing Interventions Classification taxonomy, aimed at preventing osteoporosis, falls, and hip fracture. The figures regarding the affected population according to the studies are alarming, reflecting the importance of preventing the triad osteoporosis, falls risk, and hip fracture among the population over 65 years of age. The most effective interventions were focused on increasing Bone Mineral Density through diet, exercise, and falls prevention. As a conclusion, primary prevention should be applied to the entire adult population, with special emphasis on people with osteoporosis.

The Effects of ARBs, ACEis, and Statins on Clinical Outcomes of COVID-19 Infection Among Nursing Home Residents

ObjectivesAngiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), and HMG-CoA reductase inhibitors (“statins”) have been hypothesized to affect COVID-19 severity. However, up to now, no studies investigating this association have been conducted in the most vulnerable and affected population groups (ie, older adults residing in nursing homes). The objective of this study was to explore the association of ACEi/ARB and/or statins with clinical manifestations in COVID-19–infected older adults residing in nursing homes. DesignWe undertook a retrospective multicenter cohort study to analyze the association between ACEi/ARB and/or statin use with clinical outcome of COVID-19. The outcomes were (1) serious COVID-19 defined as long-stay hospital admission or death within 14 days of disease onset, and (2) asymptomatic (ie, no disease symptoms in the whole study period while still being diagnosed by polymerase chain reaction). Setting and participantsA total of 154 COVID-19–positive subjects were identified, residing in 1 of 2 Belgian nursing homes that experienced similar COVID-19 outbreaks. MeasuresLogistic regression models were applied with age, sex, functional status, diabetes, and hypertension as covariates. ResultsWe found a statistically significant association between statin intake and the absence of symptoms during COVID-19 (odds ratio [OR] 2.91; confidence interval [CI] 1.27–6.71), which remained statistically significant after adjusting for covariates (OR 2.65; CI 1.13–6.68). Although the effects of statin intake on serious clinical outcome were in the same beneficial direction, these were not statistically significant (OR 0.75; CI 0.24–1.87). There was also no statistically significant association between ACEi/ARB and asymptomatic status (OR 2.72; CI 0.59–25.1) or serious clinical outcome (OR 0.48; CI 0.10–1.97). Conclusions and ImplicationsOur data indicate that statin intake in older, frail adults could be associated with a considerable beneficial effect on COVID-19 clinical symptoms. The role of statins and renin-angiotensin system drugs needs to be further explored in larger observational studies as well as randomized clinical trials.

Transforming Care: supporting people with learning disabilities, autism and mental health issues to move out of long-stay hospitals

The Transforming Care programme was devised by NHS England in 2015 with the aim of supporting people with a learning disability and/or autism who exhibit behaviour that challenges, including those with a mental health condition, to move out of long-stay hospitals and live in the community. The driving factor behind the programme was abuse and neglect experienced by people in long-stay settings, including those living at Winterbourne View, a private hospital near Bristol that was closed in 2011 after revelations that patients had been ill-treated. By March 2019, when the programme ended, the target to reduce inpatient bed capacity by 50% had not been met.This article discusses the author’s experience as a dual-qualified social worker and mental health nurse employed by a Transforming Care Partnership. In this role, the author coordinated the discharge process for five people with learning disabilities and/or autism, often with co-morbid mental health issues, who had lived in hospital for 7-21 years. The complex multiagency work that enabled these successful discharges is explored and the article considers how this work can be built on in future to ensure more people with learning disabilities are able to live in their own homes.

Perceived versus objective quality and duration of sleep in long-stay hospital inpatients: mixed methods study

Perceived versus objective quality and duration of sleep in long-stay hospital inpatients: mixed methods study

MON-PO427: Functional and Nutritional Status of the Patients with Subacute Stroke at Admission and at Discharge from the Brain Injury Unit of La Pedrera Long-Stay Hospital (HLP)

MON-PO427: Functional and Nutritional Status of the Patients with Subacute Stroke at Admission and at Discharge from the Brain Injury Unit of La Pedrera Long-Stay Hospital (HLP)