• The provision of diabetes care in nursing homes in Galway city and county: a survey of nursing homes

      Hurley, Lorna; Dinneen, Sean; Galway Primary Community & Continuing Care & the Diabetes and Endocrinology Service, University Hospital Galway (Galway Primary Community & Continuing Care & the Diabetes and Endocrinology Service, University Hospital Galway, 2014-03)
      In addition to the increasing prevalence of diabetes, our population is growing older and living longer. This survey aimed to determine the care provided to residents with diabetes in Nursing Homes. All 44 Nursing Homes in County Galway were sent postal surveys and 75% (n=33) responded. Of these, 18% (n=6) were Health Service Executive (HSE) Nursing Homes and 82% (n=27) were private Nursing Homes. Nursing Homes had an average of 38.2 residents, 5.2 of whom had diabetes. This equates to a prevalence of 14%. 42% of Nursing Homes had a policy on diabetes management, 56% had access to diabetes care guidelines and 97% had diabetes care plans. Retinal screening, dietetic and chiropody/podiatry services were accessed by 70%, 89% and 97% respectively. A third of residents with diabetes were managed on insulin. Titration of insulin was performed in collaboration with the diabetes specialist (60%) and/or the GP (60%) while 20% report titration of insulin in-house without additional support. One third of Nursing Homes do not keep a record of the residents’ blood test results. These are held by the GP. Management of hypoglycaemia was reported to be a frequent or very frequent occurrence in 19% of homes. One third of residents with diabetes attend the diabetes outpatient clinic and the rate was highest in private Nursing Homes (p=0.01). 36% of Nursing Homes had staff with diabetes training. Access to education was the most cited opportunity for improving diabetes care (88%), followed by access to services (67%). A focus group and interviews were carried out with Nursing Home managers to further explore the data and issues arising. Findings from this qualitative research highlight variations in the level and standard of diabetes care provided in nursing homes. Level of support from general practice varies depending on the GP. Ancillary services provided in-house are usually from private sources with transport being identified as a barrier to accessing public ancillary services. Although education and training is provided in-house by a variety of sources preferences for education by practicing specialists and tailored to the people with diabetes in specific homes were expressed. This is the first report on the status of diabetes care in Nursing Homes in an Irish setting and may help inform policy.