Summary
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This Guidance explains why people living with diabetes in UK care homes can be particularly vulnerable and dependent. It provides a series of indicators that can help inspectors to assess whether a service is meeting the particular needs of people with diabetes; has an assessment and support framework that is thorough and safe; and protects their dignity and rights.
Diabetes Mellitus is the most common metabolic problem in our ageing society. It affects up to one in four residents of care homes, both with and without nursing. People living with diabetes are vulnerable to chest and urine infections, are often frail, and have high rates of admission to hospital when their health deteriorates.
Research has shown that diabetes is often poorly understood and managed in care homes. People living with diabetes often don’t have access to specialist diabetes services; these include retinopathy screening, foot care services, and diabetes treatment reviews. A recent audit showed that screening for diabetes on admission is rare, and that the national care home workforce is not well trained in diabetes care.
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Guidance
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1. Is diabetes a particular problem in care homes?
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Yes it is – diabetes affects around 25% of residents in care homes (residential and nursing) and 15% or more in mental health care facilities. A large proportion of these residents are very frail. They can have vascular complications that can lead to blindness and foot disease. Many are nearing the end of their lives.
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2. Are there any national standards for the care of diabetes in care homes?
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Diabetes UK produced national guidance in 2010. The guidance includes information to help with treatment decisions, a tool for recording important information about diabetes care, and support for the development of a diabetes care policy.
Two sets of international diabetes guidelines have also been published that provide information and advice on supporting residents with diabetes in care homes (see appendix 1).
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3. Has diabetes care in UK care homes ever been audited?
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Yes. In 2013 the Institute of Diabetes for Older People and the Association of British Clinical Diabetologists undertook a collaborative national audit of diabetes care in care homes and received responses from more than 2,000 care homes (see Appendix 1).
The audit found few diabetes screening policies; low levels of awareness and knowledge about diabetes; and inadequate training and education for care home staff.
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4. What health and wellbeing problems were found by audit, research and guidance development work?
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People living with diabetes often have other health problems at the same time, both acute and longer term. They are particularly susceptible to infection and diabetic foot disease, and are often admitted to hospital because their diabetes is not managed well. This is usually due to avoidable ‘hypoglycaemia’ (very low levels of blood sugar).
Research has found similar levels of diabetes in all types of care home, including those specialising in mental health care. Levels of prevalence range from 15-25%.
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5. What gaps in diabetes care processes were identified by audit, research and guideline development work?
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Most diabetes-related problems in care homes are linked to failure to follow a structured approach to recognising and managing the condition;
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6. What medical care services are available for people living with diabetes in care homes?
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Most GPs provide ‘reactive’ care to residents on request by care home staff; audits and research have found little evidence of routine, proactive diabetes care being offered.
Community-based teams sometimes include a ‘DSN’ (Diabetes Specialist Nurse) or dietician, where these are available care homes can ask them for specialist advice and support.
Podiatry services are often available, but not always for diabetes-specific foot care.
Specialist diabetes care consultants and nurse-consultants are sometimes available, but appointments can be hard to arrange.
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7. What are the elements of good diabetes care?
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Good diabetes care begins with a diabetes policy. A good diabetes policy describes and requires the four elements set out below.
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