In a British Town, a New Way of Caring for Older People Is Bringing Hope

An “integrated care center” brings doctors, physiotherapists, social workers and pharmacists under one roof. It won’t solve Britain’s underlying social care crisis — but it could help.

A nurse in uniform takes the pulse of an older woman sitting in an armchair at home. A framed picture on the wall shows family and a cup of tea sits on a table nearby.
Vanessa Joyce, 67, had her blood pressure taken and her heart rate checked at her home by an advanced community nurse practitioner, Samantha Hines, from the Jean Bishop Integrated Care Centre, in Hull, in June.Credit…Mary Turner for The New York Times
Megan Specia

By Megan Specia

For 12 years after her husband died, Norma Fitzgerald tried to maintain her independence, living alone in an apartment on the outskirts of Hull, in northern England, despite her mobility worsening as she reached her mid-80s.

Then one day in the spring of 2022, she suddenly grew dizzy. Her legs gave out, and she collapsed on her apartment floor, unable to find the strength to get up.

She lay there for two days.

Eventually, a neighbor realized she hadn’t seen her for some time and called an ambulance.

“They had to force the door open,” Ms. Fitzgerald, who is now 87, recalled. She was severely dehydrated and spent the next five days in a hospital.

As Britain’s population ages, with almost 19 percent of the population over 65, according to the 2021 census, up from 16 percent a decade before, the needs of an increasingly frail older population are weighing on the country’s health care system.

Along with the National Health Service, or N.H.S., many older people also rely on what is known as social care, a mosaic of private and public support that is plagued by chronic staffing shortages, a lack of nursing home beds and slashed local budgets.

Norma Fitzgerald steps into an ambulance parked outside a modern low-rise brick building. An ambulance worker in a green uniform helps her.
Norma Fitzgerald was helped into an ambulance at the Jean Bishop Integrated Care Center.Credit…Mary Turner for The New York Times

The lack of easily accessible social care, which encompasses everything from home health aides who help with washing and dressing to full-time residential care, means that falls or treatable health conditions can lead to extended hospital stays. That is piling pressure on the N.H.S., when earlier intervention or home support would have been more appropriate.

But what happened to Ms. Fitzgerald after she was discharged from the hospital is an example of an approach that could transform the way that older adults living with complex health conditions are cared for, experts say.

In the past, she would likely have been sent home with little continuing care aside from her family doctor. Or she might have had to move into full-time residential care, losing her independence.

Instead, she was referred to the Jean Bishop Integrated Care Center in Hull, a facility that opened five years ago as a one-stop shop for frail older people. The first of its kind in Britain, it brings together doctors, physical therapists, social workers and other professionals under one roof. In the course of a few hours, a patient can see a number of clinicians and have diagnostic tests if needed, including X-rays and blood tests, and receive a personalized care plan — all free of charge.

On a sunny morning in June, Ms. Fitzgerald sat knitting a red-and-gray blanket in the center’s bright and cheerful waiting room. She had been brought by ambulance — all patients are offered transportation if needed — from her assisted-living apartment, to see a doctor specializing in geriatric care, a pharmacist, an occupational therapist and a social worker.

Members of staff, some in clinical uniform, stand chatting in a communal area with a fridge, sink and table and chairs nearby.
Staff members discussed patient care at a work station in the Jean Bishop Integrated Care Center.Credit…Mary Turner for The New York Times

Many geriatric health experts believe this kind of “integrated care,” with a multidisciplinary team addressing all the issues that can impact well-being, from loneliness to immobility, is the future for older people with complex health needs in Britain.

Dr. Dan Harman, a geriatrician and one of the center’s clinical leads, sees his job as trying to prevent crisis rather than simply reacting to it, as in Ms. Fitzgerald’s case. The center contributed to a 13.6 percent reduction in emergency room visits and hospital admissions among people over 80 and a 17.6 percent drop in E.R. visits by patients in care homes in the area between 2019 and 2022, according to N.H.S. data.

In the long run that could lead to substantial savings for the health service and local government, while allowing patients more control over their care.

“Older people were sort of lodged in the wrong places in the health and care system, particularly in emergency departments,” Dr. Harman said. “A lot of people are getting stuck there unnecessarily because we weren’t providing the support in the community.”

Linda Ryan standing at an ironing board in a bedroom, running an electric iron over a floral top.
A home care worker, Linda Ryan, from Age UK, visited the home of Mavis Ireland, 84, to help out with tasks such as ironing and making the bed, which Mavis finds difficult.Credit…Mary Turner for The New York Times

Integrated services like this are still rare in Britain, where the social care system is under extraordinary strain. After the 2008 financial crisis, the Conservative-led government oversaw a period of prolonged austerity in which local governments cut spending on social care sharply, leading to a rise in hospital admissions of people over 65. The pandemic, and recent high inflation, intensified the pressure.

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