Care homes often do not meet national standards of diabetes care

Diabetes care in nursing homes still remains “fragmented” and urgent steps need to be taken to restore the “health and dignity” of older people, leading experts have said.

A review of multiple studies carried out across 25 years involving service users with diabetes has slammed care home provision saying that care homes “often do not meet national standards” of diabetes care and staff training is “patchy”.

Lead author Professor Alan Sinclair, from the Foundation for Diabetes Research in Older People and University of Aston, said: “Our findings show the level of diabetes care remains fragmented which is quite worrying because figures suggest over a quarter of care home residents are believed to have the condition. Without proper management, it can lead to frailty, dependency, disability and reduced life expectancy.

“There is also the added strain on the NHS as frequent hospital admissions to treat diabetes-related complications are costly, not to mention unsettling for the patient.”

Declining diabetes health

Alongside Professor Sinclair, Professor Roger Gadsby, of Warwick Medical School, Dr Ahmed Abdelhafiz, from Rotherham General Hospital and Dr Mark Kennedy, from Corio Medical Clinic in Australia wanted to investigate what interventions had been introduced in a bd to improve care and what needed to be done to address the declining diabetes health of this vulnerable sector of people.

The findings also suggested that care homes often lack HbA1c monitoring, diabetes self-management programmes, regular exercise activities and most staff have very little knowledge of hypoglycaemia treatment.

Jenny Hirst, the co-chair of the Independent Diabetes Trust (IDDT), said: “It is thought around 27 per cent of residents in care homes have diabetes. With a growing number of older people developing the condition, the need is ever more pressing to ensure there is a good standard of care for this group of vulnerable people who have complex needs.

“Older people, particularly those with diabetes, are more likely to be admitted to hospital when they are unwell. This is because diabetes can have an additional effect on the illness and the illness can impact on their diabetes.

There is a need for much better training and support so that care homes are able to support people living with diabetes

Professor Martin Green OBE, chief executive of Care England

“However, this can be often be avoided if care home staff are trained properly in how to treat diabetes, checking blood sugar levels, identifying when a person is suffering from high or low blood sugar levels and taking the necessary action, quickly and also encouraging light exercise activities.”

To help counteract these problems, the researchers have made a series of recommendations for care home staff, health professionals, diabetes organisations and policy makers to undertake constituting a ‘Call for Action’.

Professor Martin Green OBE, chief executive of Care England, said: “There is a need for much better training and support so that care homes are able to support people living with diabetes. There needs to be a training programme put in place by Health Education England, much better access to primary care services and regular and proactive monitoring of residents so that they are able to live well with their condition.

“Currently, the NHS is poor at supporting care homes and we need them to understand the residents of care homes are part of the community and should be enabled to have all the resources that would be available to people living in their own homes.”

Professor Sinclair said: “We want to see older people with diabetes who are in care home settings being given greater prominence by healthcare professionals. In addition to this, we want more focus to be given to defending the rights, health and dignity of care home residents with diabetes.

“More training for staff, introducing better interventions and encouraging a change in attitude is all going to contribute towards improved health outcomes for those with diabetes.

“Furthermore, we want international health organisations to include diabetes in care homes within their policies and guidelines. This will ensure global collaboration at a high level of influence and pave the way for an International Best Practice statement in this area.”


This review of multiple studies carried out across 25 years involving service users with diabetes highlights the continual decline in provision to address the growing problem of service users with diabetes in care homes. A solution to the problem of diabetes will not be solved by care homes alone. They will need the support of NHS and Health Education England to ensure sufficient resources are made available and staff are properly trained.

The findings of the review, entitled Failing to meet the needs of generations of care home residents with diabetes: a review of the literature and a call for action, has been published recently in the Diabetic Medicine journal.

Albert Cook Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy


A new guide for care home staff- Is my resident well?

Care home staff are being encouraged to think ‘Is my resident well?’ as part of  a new training programme to help spot the early warning signs of those they care for becoming unwell.

Most of us know that there are simple things we do everyday to look after ourselves; making sure we eat, drink plenty of fluids and taking care of our physical needs. When something isn’t quite right, we take steps to prevent it getting worse or seek medical advice.

Some people however, rely on others to ensure their basic needs are looked after and may themselves not always notice the small warning signs that they may becoming unwell.

This can often be the case for care home residents, who need extra help and support to stay well and recognise when things are not right. Within adult social care, this role is largely carried out by medically untrained care workers.

A new guide called ‘Is my resident well?’ and associated training programme is being rolled out to care homes across North West London to support these care workers.

Content of the guide

The guide contains 10 questions for carers to think about whilst providing every day care, like washing and dressing.

The 10 questions go through simple steps to check;

  • Breathing
  • Bowel habits
  • Hydration
  • Pain
  • Confusion
  • Wellbeing
  • Skin health (specifically looking out for the early signs of pressure sores).

In addition, care staff are asked to consider other things including:

  • Sepsis (infection of the blood)
  • Falls
  • Care Plans
  • Last year of life

The guide trains staff to use a simple traffic light system Red, amber and green to help staff to identify any concerns they may have and what they should do if they are concerned.

Dr Asha Katwa GP and clinical lead for the guide and training, explained: “This pocket guide is designed to provide a simple method for care workers to assess their residents.

By repeating the 10 questions during everyday interactions with the people they care for, it is hoped that care workers will be more confident in recognising some early warning signs of deterioration and be empowered to know what to do, and to get the right help when needed.”

The guide provides practical advice on what to do if someone shows signs of being unwell or deterioration and how to escalate to get the right help. It includes guidance on what to do if resident falls or is suspected of having sepsis (serious infection).

The guide also provides practical information about how to prepare to call an NHS service when requesting medical help.

“This may sound simple,” said Dr Katwa, “But, in order to get the best help and advice when calling a GP, 111 or 999, care workers need to provide as much information about the resident as possible. Their role is vital in helping health care professionals provide the right support and advice so that decisions for their residents are made in accordance with any known wishes and care plans. In doing so, this training aims to encourage care workers to act as advocates for the residents they care for, particularly if the resident cannot communicate their needs”.

Across NW London 40 clinical staff are being trained during June on how to use the guide and provided with a training programme to go on and train care home staff and carers. The aim is to have 40 percent of care homes in NW London using the guide by the end of 2018/19.


I was impressed by the simplicity of the Is my resident well guide. It is colorful, practical and easy to follow. Given the workload of staff in adult social care services time for staff training is at a premium. It would seem because of the simplicity of the guide that it would not take a great deal of training time.

The guide would provide considerable benefits to staff, carers and service users. It would encourage staff to become more aware of the health and wellbeing of service users and alert staff to the changing needs of people in their care.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

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Extending the range of social activities in care homes

Although older people in care homes are offered opportunities during their day to participate in meaningful activity that promotes their health and mental wellbeing, staff are always on the lookout for new and interesting activities to engage service users. This week’s blog article brings together two new activities which readers may find of interest.

It has long been known that activity helps to sustain both physical and mental health, so it is important that older people living in care homes are able to maintain interests and have opportunities to develop new ones.

The challenges of providing good care for older people with complex needs in care home settings, as well as the culture of the care home, can result in staff prioritising practical tasks above supporting people to take part in meaningful activities. Risk management can also be an issue, with staff not feeling empowered to support people if there is an element of risk involved in activities.

Even when taking these important issues into consideration care homes can still greatly improve levels of activity for the people living there by ensuring that they have opportunities throughout the day to take part in the daily life of the home. To achieve this, staff need to know that engaging with people living in the home and encouraging activity is central to their caring role. SCIE’s film Excellence in residential settings – older people demonstrates the success of this approach in a care home. Meaningful activity can include routine personal care tasks, such as getting dressed and brushing teeth. If older people are encouraged to carry out these tasks for themselves, rather than have others do them on their behalf, it will contribute to their sense of wellbeing.

Pen pal scheme

A new initiative aiming to be the UK’s biggest pen pal scheme is to partner nursery and primary school children with care home service users of the same name.

The initiative, dubbed ‘Letters from a Namesake’, aims to bring together two different generations to share experiences and life stories.

Launched by the nations’ biggest supplier of name tags and labels for schools and care homes, My Nametags, the educational scheme aims to help develop children’s letter writing skills, while tackling loneliness among care home residents.

My Nametags are appealing for care homes in all parts of the UK to come forward and sign up if they are interested in taking part.

Lars B Andersen, Managing Director at My Nametags, said: “The way the scheme will work is we will match people and children with the same names.

“For example, a ‘Mary’ from a local nursery will be given the opportunity to write to ‘Mary’ in a residential care home and vice versa.

“No personal details will be shared as all the letters, pictures and drawings will be sent to us and passed on directly. We’re excited to be launching the scheme, and hope that it will help the local community enormously by bringing these two very different generations together.”

Care homes wishing to take part can register their interest by contacting or calling 01993 823 011.

Tailoring social activities to people’s choice and preferences

Organised activities contribute to the sense of community in a care home, but they aren’t for everyone. Some people prefer activities that they can pursue on their own, such as reading or listening to the radio. Other people prefer group activities, but a group activity that is enjoyable and meaningful to one person may be of no interest to another. People need a range of activities to choose from and support to maintain existing interests. The College of Occupational Therapy’s Living well through activity in care homes toolkit has plenty of ideas for building meaningful activity into the daily life of a care home and Staying involved and active from the Alzheimer’s Society provides tips on how to involve people with dementia in activities.


The importance of social activities to service users in care homes as a means of sustaining physical and mental health is well documented. Staff are always searching for new social activities. SCIE’s film Excellence in residential settings – older people, the My Nametags, educational pen pal scheme and The College of Occupational Therapy’s Living well through activity in care homes toolkit may well help to extend the range of social activities available in care homes. It must always be remembered that service user choice and preference are strong motivators towards engaging service users in social activities.

Albert Cook BA, MA & Fellow Charted Quality Institute
Managing Director
Bettal Quality Consultancy

The CQC has called for an overhaul of health and social care funding, commissioning and regulation

A recent article published in Care Home professional draws attention to The Beyond Barriers report. This follows the completion of 20 local authority area reviews exploring how older people move between health and social care services in England.

Sir David Behan, Chief Executive of CQC, said: “Our findings show the urgent necessity for real change. A system designed in 1948 can no longer effectively meet the complex needs of increasing numbers of older people in 2018. People’s conditions have evolved – and that means the way the system works together has got to change too.”

The report makes a number of recommendations including long-term funding reform in order to help social care and NHS commissioners pool their resources to meet the needs of their local populations.

Care Minister Caroline Dinenage said: “This report confirms what we already know – the provision of NHS services and social care are two sides of the same coin and it is not possible to have a plan for the NHS without having a plan for social care.

“There are good examples of progress in integrating health and care, including through the Better Care Fund and ongoing joint health and social care assessments pilots, but we know we need to do more. That’s why we will publish a Green Paper in the autumn on social care around the same time as the government’s long term plan for the NHS.”

The report’s findings were welcomed by social care leaders.

Vic Rayner, Executive Director of NCF, said: “The report highlights the real impact of the current shortfalls in integrated practice on people. By exploring the failings of the current system through the lens of people’s journeys, it makes it crystal clear why the need to change is imperative and through the exemplification of good practice – what real impact different approaches can have.”

Professor Martin Green OBE, Chief Executive of Care England, added: “This new approach is to be welcomed particularly the recommendation for better oversight of local systems and commissioning.  New regulation we hope will allow CQC to regulate not just individual organisations, but the quality of service for people across systems.

“Improving regulation is a huge part of the jigsaw, but will not be complete without commensurate funding to plug the shortfall in adult social care.”

In conclusion, key professionals in the regulation of care services including the Chief Executive of CQC are calling for urgent change in an antiquated system designed 70 years ago.

The government may wish to regulate further in the improvement of services which has been welcomed, but providers are strongly urging greater levels of funding to plug the shortfall in adult social care.

There is no short term fix to this issue, the government need to develop a long term care funding reform strategy to help better allocate resources to social and health care service.

The Care Quality Commission are hoping that new regulation will allow CQC to regulate not just individual organizations, but the quality of service for people across systems.

Stuart Cook
Bettal Quality Consultancy