Enhancing health in care homes

Project partners: East and North Hertfordshire Clinical Commissioning Group (CCG), Hertfordshire County Council and Hertfordshire Care Home Providers Association (HCPA), which acts as an impartial body for all adult social care providers within Hertfordshire.


The vanguard’s main aim is to help health and social care providers work together to provide greater levels of support for care home residents and avoid unnecessary trips to hospital.


The HCPA has been delivering chair-based exercises in residential care homes since 2014 to help residents build their strength and reduce their risk of falls. The exercise classes are led by a specialist health and wellbeing team who have historically carried out falls risk assessments by hand. They were interested to find out if there was a way to use technology to carry out this assessment.

HCPA made contact with an Irish technology start-up and, after initial testing, purchased two Quantitative Timed Up and Go (QTUG) devices to use in residential homes. The first pilot of the QTUG device began in 2015. HCPA ran a weekly class (involving a maximum of 10 residents) at 19 homes over six months. The classes always start off in week one with a TUG walking assessment; on assessment days, two class tutors are present.

The QTUG package is made up of a Samsung tablet installed with QTUG software and attached to two medical-grade sensors (about the size of iPod nanos) which are strapped just below the knees during a walking assessment. The sensors measure criteria such as gait and stride length in order to calculate a person’s falls risk. With the sensors strapped around their legs, the care home resident starts off in a seated position, stands up, walks three metres, turns around, walks back, and sits back down again. 

Data collected from the sensors is transmitted via Bluetooth to the tablet. It is compared to similar data in the general population of the same height and weight to calculate falls risk. The data can be saved to a unique client ID number to keep track of an individual’s results and can be transferred to other computers via USB cable or wifi. The results can be saved as a PDF and automatically backed up to the cloud, allowing them to be accessed from any computer with the appropriate log-in details.

HCPA ran a second pilot across 10 residential homes in 2016 to address some of the issues encountered in the first pilot. For example, they had found that a significant number of residents had been unable to do the chair based exercises because they were unable to do a walking assessment. HCPA decided to tackle this by using additional technology such as Fitbits looking at what they could monitor instead, such as changes in heart rate during the period of the class.

In addition to these devices, HCPA is using other measures to analyse a resident’s risk of falling. For example, they are asking people how likely they think they are to fall while getting dressed. This allows the care home staff to build a more rounded picture of each person and their specific needs.
Alongside the pilots, the vanguard team have been working to get the email, diary and directory system into all the elderly residential homes in North Hertfordshire. The aims are to ensure that information is sent securely, rather than relying on paper and fax machines, and enable more efficient communication between services, helping residents receive the most appropriate care more quickly.


Data from the project suggests that the use of the QTUG device has resulted in a reduction in falls risk in 15 of the 19 nursing homes for residents who attended more than 50% of exercise classes. There was no change for those who attended less than 50%, demonstrating the importance of regular exercise, supported by professionals.

There have also been unexpected mental health benefits for residents. Their confidence and wellbeing levels, measured using self-reported scales, increased over the course of the pilot, with residents reporting feeling happier as a result of social interaction at exercise classes. The class tutors also report increased levels of satisfaction from being able to spend more time focusing on the exercise classes and the residents doing them, rather than carrying out the risk assessment.


As care home residents are likely to be unable to attend regular exercise classes, HCPA intend to upskill existing staff so that they can provide one-to-one exercise support to care home residents and reduce their reliance on bringing in external trainers. HCPA are also working to ensure that the most appropriate residents are identified for the classes by clearly defining the eligibility criteria.

HCPA doesn’t currently have an electronic system to capture qualitative comments from residents, which can offer a different degree of understanding about a person’s fall risk. They have been using a basic online form builder which is downloaded onto spreadsheets and analysed but plan to explore opportunities to develop an app or software that can capture this type of information so that it can more easily be used in tandem with the QTUG generated data.

The Hertfordshire partnership has identified the potential the technology also offers to community- based prevention work. Thanks to the success of the care home pilot, and additional funding from NHS England, the team have been able to roll out the technology and exercise classes into community settings. They have been running the classes in the community with Support at Home providers who have had flexicare sites since April 2017. This programme will run until March 2018, by when the team hope that 100 people will have completed the 20-week exercise programme. So far, the impact in the community is mirroring that in residential homes, with falls risk decreasing for class participants.


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