Our latest series explores how care providers can build PainChek into everyday practice to deliver measurable outcomes for residents, care teams and providers.
This edition focuses on deterioration, looking at three areas where unrecognised pain can be a hidden driver of decline in care homes: palliative care, malnutrition and infection. These are not always viewed as “pain outcomes” in isolation, yet earlier and more consistent pain recognition helps teams respond before deterioration escalates.
PainChek provides care teams with a consistent, clinically validated and regulatory-cleared medical device for assessing pain, particularly where people cannot reliably self-report. It uses AI-supported facial analysis alongside a structured assessment process, helping care teams detect, score, monitor and evidence pain at the point of care. PainChek assesses pain across six domains and uses facial analysis to identify nine micro-facial expressions indicative of pain.
Based on interviews, care home observations and implementation reviews, this blueprint shows how successful homes embed PainChek into the moments that matter: when someone becomes palliative, before and after meals, when infection is suspected, and when subtle changes may indicate early deterioration.
Practical Blueprint 1: Using PainChek to Support Palliative Care
One major focus of palliative care is pain. When someone is considered palliative, the goal of pain assessment shifts from simply identifying pain to understanding the person more deeply, responding to their changing needs, and helping families feel confident that their loved one is comfortable.
The Care Need
During palliative care, residents may experience pain from multiple causes, including existing long-term conditions, frailty, immobility, infections, falls, or other clinical changes. For people living with dementia or advanced cognitive impairment, self-reporting pain may become unreliable or impossible.
This creates a risk of cracks in the pathway. Pain may be missed, treatment may be delayed or decisions may be based on subjective interpretation rather than consistent evidence. Families may also feel uncertain, especially when their loved one cannot explain what they are feeling.
The PainChek Protocol
The first stage of palliative care focuses on creating a personalised, holistic care plan. Pain monitoring is a core and essential part of this plan, with regular checks needed to ensure comfort and adjust medications if required.
PainChek supports comfort-focused care through regular and consistent pain monitoring, and helps evidence changes in pain and response to interventions where the person may have reduced communication or fluctuating presentation.
In practice, this means PainChek can be used to:
- Establish a clearer baseline of comfort when the person is identified as palliative.
- Monitor changes in pain as the resident’s condition changes.
- Evidence whether interventions are working.
- Support conversations between carers, nurses, GPs, palliative care nurses and families.
- Help ensure treatment is responsive, proportionate and person-centred.
Bringing it to Life
By using PainChek consistently, the care team can evidence that a resident’s pain has increased, act sooner, and review the care plan with the nurse or GP. Where opioid treatment or a syringe driver is being considered, PainChek scores can support clinical decision-making by showing whether comfort is being maintained, whether pain is escalating, and whether the timing of intervention is appropriate.
In a focused study undertaken by Daniel Casson a southeast care home saw a 64% reduction in resident discharges after implementing PainChek.
This is a direct result of better pain management, which improved quality of life and meant that residents could stay in the care home for longer rather than needing to be transferred somewhere else for more intensive care. The care home also noted that the introduction of PainChek and better pain management contributed to an observed reduction in distress, highlighting the importance of the use of PainChek technology during palliative care.
Supporting the Gold Standards Framework
The Gold Standards Framework describes itself as a practical and evidence-based end-of-life care service improvement programme, with an aim to enable “gold standard” care for everyone, with any condition, in any setting, by any care provider.
For providers seeking accreditation or continuous improvement, PainChek can help evidence that comfort is being monitored consistently, that deterioration is being recognised earlier, and that families and clinicians are being supported with clearer information.
Practical Blueprint 2: Using PainChek to Reduce Malnutrition Risk
Malnutrition is often discussed in terms of food, fluid, weight loss and nutritional screening, but one of the less visible barriers to nutrition is pain.
Unmanaged pain can reduce appetite, make meals overwhelming, and contribute to residents missing meals or eating less, which can ultimately lead to malnutrition.
Malnutrition and Unmanaged Pain
Older adults experiencing unmanaged pain may struggle with eating as pain can affect positioning, concentration, appetite, swallowing, chewing, oral care and willingness to engage with meals. Chronic or acute pain can also limit an older person’s ability to chew or swallow due to jaw, neck or dental pain, including pain caused by poorly fitted dentures or tooth decay.
PainChek helps care teams ask an important question: is pain preventing this person from eating?
A Practical Approach
A sensible approach is to complete PainChek twice a day, 15 to 30 minutes before and after main meals, while following the provider’s food, fluid and nutritional policy. This helps identify pain that may be affecting appetite, positioning, swallowing, oral care or willingness to eat.
This creates a practical mealtime workflow:
- Complete a PainChek assessment before the main meal.
- Identify whether pain may be affecting appetite, posture, mouth care, swallowing or engagement.
- Intervene early where appropriate, for example by reviewing positioning, oral discomfort, dentures, pain relief timing or support needs.
- Complete a follow-up assessment after the meal.
- Use the pain trend alongside food and fluid intake, weight, MUST score and care plan reviews.
Real Life Examples
Outcome examples show the potential impact of earlier pain recognition on malnutrition. The Scottish Care Inspectorate independently piloted PainChek for six months and found a 47% increase in resident BMI and subsequent reduction in MUST scores following use of the tool to identify pain earlier. Over six months, 81% of residents at Kirk Lane Nursing Home, part of Randolph Hill, reduced or maintained their MUST scores and 43% achieved an increase in BMI.
Dovehaven Care Homes saw a transformation in pain management following PainChek implementation, including a 40% reduction in PRN benzodiazepine use, according to Jo Hadfield-Cubbin, Head of Clinical Governance at Dovehaven Care Homes. Residents taking benzodiazepines may experience a loss in appetite or struggle with eating due to sedation and so are more likely to experience malnutrition. Reduction in the use of PRN benzodiazepines can often result in a subsequent reduction in malnutrition cases.
By identifying pain earlier, care teams can support better nutrition, reduce unnecessary escalation, and strengthen the resident’s ability to remain well within the home.
Practical Blueprint 3: Using PainChek to Reduce Infection-related Deterioration
Infections such as UTIs, respiratory infections and wound infections are a major driver of deterioration in care homes. They can lead to distress, reduced mobility, dehydration, hospital transfer and increased workload for care teams.
Many infections start with localised pain before obvious symptoms appear, including pain or discomfort linked to UTIs, skin infections and influenza-like infections.
Infection Prevention
For residents unable to reliably verbalise pain, infection may first appear through behavioural or functional changes. A resident may become more unsettled, resist care, eat less, sleep poorly, breathe differently, or show discomfort before clinical observations clearly deteriorate.
Infection prevention starts before a thermometer beeps or a wound becomes red. For many people living with dementia, cognitive impairment, learning disabilities or advanced frailty, pain may be the earliest and sometimes only sign that an infection is developing.
This is a critical point for deterioration pathways. NEWS2 remains an important escalation tool, but pain can sometimes become visible before NEWS2 reflects physiological change. PainChek gives staff an earlier signal that something may need checking.
An Escalation Pathway
A practical approach is to complete an at-rest PainChek assessment to rule out moderate to severe pain. If PainChek indicates moderate or severe pain, teams should undertake NEWS2 and follow the provider’s policy for identifying and managing deteriorating residents.
This creates a clear escalation pathway:
- A change is noticed, such as discomfort, agitation, reduced intake, unsettled behaviour or altered presentation.
- Complete a PainChek assessment at rest.
- If moderate or severe pain is identified, undertake NEWS2.
- Follow the provider’s deteriorating resident policy.
- Use the PainChek score as evidence when escalating to nurses, GPs, urgent care teams or other clinicians.
The Impact of PainChek
At Azalea Court, one resident showed increased PainChek scores indicating pain and discomfort, particularly in the chest area, before significant changes were noted in vital signs. Observations later detected a rising NEWS2 score, confirming physiological deterioration, and early antibiotic and supportive care prevented hospital admission.
In another example, PainChek identified increased pain behaviours in a resident unable to communicate UTI symptoms. Subtle changes in temperature and pulse raised staff suspicion of infection, leading to prompt clinical assessment and treatment.
Elsyng House Care Home reported a 72% reduction in hospital admissions following daily PainChek use, driven by earlier recognition of pain-related issues including infections and falls. Ryeview Manor used PainChek for more than 2,300 assessments and saw measurable decreases in incidents that typically lead to hospital admissions.
Suzanne Mumford, Head of Nursing and Dementia at Care UK, has explained that PainChek has helped with earlier identification of infections and issues that may cause a person to go into hospital, including UTIs and respiratory infections.
For care homes, this is the practical value: PainChek helps teams move from waiting for deterioration to become obvious, to recognising discomfort early enough to act.
From Clinical Improvement to Financial Resilience
Deterioration has a human cost first. It affects comfort, dignity, nutrition, recovery, independence and quality of life. But it also has an operational and financial impact for care providers.
When deterioration is not recognised early, care homes may experience more ambulance call-outs, hospital admissions, safeguarding concerns, staff pressure, family anxiety and resident discharges due to unmet care needs. Daniel Casson’s report, The Immediate Financial Impact of Using PainChek, found that consistent use of PainChek can support care quality and financial resilience through better outcomes. Reported findings included up to 48% fewer falls, 50% fewer hospital admissions, 59% fewer ambulance call-outs and 64% fewer resident discharges due to unmet care needs.
Daniel Casson’s findings also link better pain identification to occupancy stability, noting a potential turnover uplift of up to 2% through fewer avoidable discharges and more proactive care.
For providers, the message is clear: preventing deterioration is not only a clinical priority. It is directly connected to resilience, workforce pressure, family confidence, avoidable transfers and the ability to keep residents safely supported within the home.
Building More Proactive Deterioration pathways
The most successful care homes are not using PainChek as a standalone assessment. They are embedding it into practical workflows linked to their existing policies, including palliative care plans, nutrition and hydration policies, deteriorating resident protocols and escalation pathways.
Ultimately, deterioration is rarely caused by one factor. Pain, infection, reduced intake, frailty, medication, distress and mobility often interact. PainChek helps care teams identify one of the most overlooked drivers in that chain and act before the resident declines further.
PainChek gives a voice to people who cannot always explain their pain. In palliative care, malnutrition and infection prevention, that voice can be the difference between reacting to deterioration and preventing it.
Discover the findings from Daniel Casson’s report, The Immediate Financial Impact of Using PainChek, and learn how PainChek can support the prevention of deterioration and build stronger financial resilience.
