Nursing homes: a suitable alternative to hospital care for older people inthe UK?

Over the past two decades nursing homes have become the major supplier of l ong-stay care for frail older people in the UK. Demographic projections ind icate that die volume of nursing home places will continue to increase to k eep pace with demand and that the population of homes will become steadily more dependent. Little systematic research exists to indicate how nursing h ome care compares with hospital care; the evidence that does exists tends t o be restricted to local studies and thus is not generalizable. Local studi es indicate that in both care settings there are,shortfalls in terms of mee ting basic quality of care standards. Despite this, there is obvious potent ial for nursing homes to act as an alternative to hospitalization, provided that there is suitable access for residents to specialist care and, for ex ample, appropriate administration of medicines. Proposed changes in governm ent policy will introduce more uniform standards in nursing homes and assoc iated inspection structures and procedures. However, further research is ne eded to ascertain the clinical and consumer value of different intervention s in nursing homes, and the cost-benefit of enhancing provision available i n terms of preventing or forestalling demand on hospitals or reducing hospi tal length of stay. In the light of the commitment to develop evidence base d practice, it is important that such research is urgently advanced to elim inate poor practice. In our rights conscious society, future generations of older people are unlikely to be as tolerant of substandard care.