Approximately 4% of the population aged over 65 years, and 15% of those aged above 85 years, live in care home accommodation. Furthermore, 27% of people living in care homes have diabetes (IDOP, 2014). Many are frail, live with multiple comorbidities and are at high risk for acute health deterioration, unplanned hospital admission and premature mortality. The COVID-19 pandemic also led to a higher prevalence of complications, admission to hospital and increased mortality. Previous national care home audits have identified that there is poor access to diabetes training for care home staff and that standards of diabetes care need to be improved (Gadsby, 2015).
These challenges led to the development by Eden of the CARES Roadshow, a face-to-face diabetes education programme for delivery to care home staff at their place of work. The CARES Roadshow provides an education day focusing on key aspects of diabetes care, and is designed for health and social care staff working in both nursing and residential care home settings.
It is based on the CARES digital education programme, which Eden developed in 2019, and covers a wide range of topics including:
- What is diabetes?
- Foot care.
- Blood glucose monitoring.
- Diabetes medication.
- Low and high glucose levels.
- End-of-life care.
As an established diabetes education programme, CARES has proved successful at enhancing the knowledge and confidence of care staff. This has led to better standards of care for service users with diabetes, a reduced burden of support on community nurses, a reduced risk for hospital admissions, improved medication safety and reduced financial cost to health and social care (internal annual report, 2022–23). More on the CARES digital programme can be found here.
In 2022, the Leicester, Leicestershire and Rutland (LLR) Integrated Care Board (ICB) launched a £2 m fund for grass-root ideas to improve the healthcare and well-being of patients and colleagues in the local area. The fund was available for bright ideas with the potential to make a long-lasting, sustainable impact, and was open to anyone working within the NHS and voluntary sector health organisations in LLR. A funding grant for the Roadshow initiative was applied for, and was successful in securing £10,000; the LLR ICB then made a further investment of £5000.
With funding secured, the care home subgroup (comprising multidisciplinary staff within LLR) and the community lead matron for care homes were liaised with closely. Contact was made with care homes in the area to identify those with the greatest need, based on local data and knowledge. Additionally, a flyer was created to advertise the CARES Roadshows, which was shared on social media platforms, through LLR contacts and via an LLR distribution list.
The CARES Roadshow comprised four elements:
- The who, what and why of diabetes. Screening, risk factors, diagnosis, initial treatment and diabetes complications.
- Who needs finger pricking? Who needs technology? What do the tablets do? Glucose monitoring, continuous glucose monitoring (CGM) and non-insulin glucose-lowering therapies.
- Safety and admission avoidance. Hyper-glycaemia, hypoglycaemia and foot care.
- Things I need to know, but may not have been told. Insulin therapy, end-of-life care, dementia and psychological well-being.
There were options for delivering all four elements as a full day of face-to-face training or for delivering each section once per week over a 4-week period.
To evaluate the education, participants were asked to complete a knowledge and confidence questionnaire after each session. The questions were relevant to the topics taught during the session delivered.
- 53 staff were educated from three care homes.
- 94% of the delegates self-reported having either “good” or “very good” knowledge and confidence gained.
- Topics with the highest reported confidence were:
- Long-term complications of diabetes.
- Blood glucose monitoring.
- Sensor glucose technology (flash and CGM).
All participants who completed the evaluation forms rated the training as excellent or good. Testimonials from the evaluation forms included:
“I have learnt a lot more about diabetes than I knew.”
“I learnt more than I did on my college course.”
“This general update was very much needed.”
“Really good and helpful for my everyday practice.”
Examples of how the participants were going to put the training into practice included: arranging for their care homes to have a “hypo box”; reviewing hypoglycaemia management; and updating diabetes policies and care plans to reflect changes to national guidance and information learnt during the training.
As the funding has now ceased, alternative options to maintain this educational programme were investigated, and a Clinical Research Network bid was secured in August 2023. This will allow work in partnership with community nursing teams within Leicestershire Partnership Trust to deliver a cascade educational model to specifically target care homes within underserved locations with high area-level deprivation. Eden educators will provide the CARES training to community nurses, and support them to disseminate and deliver diabetes education in care homes in identified locations.
Delivering face-to-face diabetes education to staff working in care home settings helps to improve knowledge and confidence. Such education is considered a key intervention strategy, as detailed within the National Advisory Panel on Care Home Diabetes (2022) guidance. Eden has previously demonstrated that increased knowledge and confidence helps to improve the standards of diabetes care for service users living in community care settings.