ABSTRACT
In the wake of the 1990 National Health Service (NHS) reforms the continuing care provision for elderly people has changed beyond recognition. Institutional care in the community is now provided by many independent or corporate residential and nursing homes. Infection control is of great importance in hospitals where multiple resistant organisms pose major clinical risks. Patients need to have their medical state and their present and future care needs identified and defined. Processes that seem to require medical involvement include: initial assessment, care planning, systematized care, routine surveillance, risk management and quality assurance. The physical environment of institutional care in the community has improved as a result of good inspection mechanisms for residential care homes by the local authority and for nursing homes by the health authority. Annual influenza immunization is an important component of risk management and should be planned for all elderly in institutional care.
