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Introduction: Older care home residents are a particularly vulnerable population as they have multiple and complex needs, but frequently lack access to specialist support. The importance of determining how best to address these residents' physical healthcare needs, and prevent unnecessary hospital admissions, cannot be underestimated. The aim of this study was to explore services designed to tackle this challenge.

Methods: A national survey of specialist healthcare support services for care homes was undertaken with British Geriatrics Society (BGS) consultant members and a snowball sample of service representatives. Obtained data were used to develop a typology of care models, and these were examined through in-depth focus groups and interviews with service staff.

Results: In total, 438 (35%) BGS consultant members and 54 (57%) further providers responded to the survey. Of these, 82 respondents described 64 separate specialist services. The services were delivered by lone healthcare providers, single- or multi-disciplinary teams and could be categorised into five distinct models of care based on whether they had dedicated input from a medical consultant, and whether assessment and management of residents were provided. Nine exemplar services were recruited from six sites. Discussions with staff highlighted the evolving nature of these services, the need for effective liaison with other providers and the benefits of working in partnership with GPs. Difficulties forming relationships with care homes had been overcome by passionate and committed staff offering support and sharing their expertise.

Conclusions: This comprehensive study of specialist healthcare support for care homes has captured the range of services operating within the UK and identified their key characteristics. A new typology of services has been developed and each model illustrated with in-depth case studies. This study provides a strong evidence base, which can inform service commissioning and from which further experimental research can be designed.

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