Let’s be comfortable with the clinical role in our care homes

If you’re not up to speed, there are some people, for understandable reasons perhaps, who are uncomfortable with the word ‘clinical’ being used to describe care being given in care homes and the interventions from health care professionals. During the COVID-19 pandemic, nurse directors have been given an oversight and scrutiny role for care in care homes, particularly infection prevention and control. 

The RCN campaigned for clinical care needs in care homes to be recognised in the Health and Care (Staffing) (Scotland) Act which passed into law just over a year ago. We weren’t successful at that time and it has taken the COVID-19 crisis for there to be, in our view, a proper recognition of the increasing complexity of clinical care required in care homes. 

But this is not a takeover. The concept of ‘care being provided in a homely setting’ is not alien to health care professionals. 

Obviously, ‘clinical’ is associated with hospital care and we would all agree hospitals are not intended to be homely environments. For me, the word ‘clinical’ also describes the health interventions that require to be delivered by health care professionals to meet the needs of people in their homes, whether that’s their own home or their care home.  

Providing clinical care in the community whether that be nursing, physiotherapy, occupational therapy, for example, is integral to enabling people to stay in their own homes and not be admitted to hospital. This can range from caring for a ventilated child at home, to renal dialysis, supporting people with chronic pulmonary obstructive disease (COPD), intravenous antibiotics or end of life palliative care.  

So, if this works for people in their own homes - and I have seen health care professionals working alongside social care colleagues enabling people to stay  in a homely setting - why is the word clinical causing concern for some in the care home sector?  

Despite integration of health and social care there remains, for some, a division around what we understand by social care and health and social care. Of course, if the word ‘clinical’ is used to apply hospital-based policies in a care home setting, this is clearly not the right approach. But to me, it is about ways of working and how teams respect and value each other’s contribution.  

Does bringing in clinical interventions act as a barrier to a homely setting? Or is it about that adaptation that many people take in their stride so they have a choice in where they receive their care? There is much too understand about why some perceive this as a barrier and can perhaps reflect more on professional conflicts and differing use of language.  

I doubt for the person or their family this is something that concerns them. Like the amazing lady I visited in her home with the COPD nursing team. Her siting room and bedroom had all the required clinical equipment and she made a joke about it all. When I asked her what she most wanted to achieve she answered, ‘no admissions to the big hospital’. The year before she had 15 admissions and by, the time of my visit the following spring, she’d had none. She had social care support from her team, who she described as ‘gems’, and health care support from a specialist nurse and physiotherapist. I enquired after her later and heard that she achieved her goal and died at home as she wished.  

So while professionals argue over who owns the concept of what is homely and how care is delivered, perhaps, as some studies have shown, we should just ask the person at the centre of it all. 

[This blog was first published in a shorter version in the Herald newspaper on 3 July 2020.]