Abstract
BackgroundCare home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 (Great Britain.The Care Act 2014. London: The Stationery Office; 2014) requires services to improve ‘well-being’, but many residents cannot self-report and are at risk of exclusion from giving their views. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is currently no equivalent way of measuring aspects of residents’ health-related quality of life. We developed new tools for measuring pain, anxiety and depression using a mixed-methods approach. We also explored the relationship between care home quality, residents’ outcomes, and the skill mix and employment conditions of the workforce who support them.ObjectivesThe objectives were to develop and test measures of pain, anxiety and depression for residents unable to self-report; to assess the extent to which regulator quality ratings reflect residents’ care-related quality of life; and to assess the relationship between aspects of the staffing of care homes and the quality of care homes.DesignThis was a mixed-methods study.SettingThe setting was care homes for older adults in England.ParticipantsCare home residents participated.ResultsThree measures of pain, anxiety and low mood were developed and tested, using a mixed-methods approach, with 182 care home residents in 20 care homes (nursing and residential). Psychometric testing found that the measures had good construct validity. The mixed-methods approach was both feasible and necessary with this population, as the majority of residents could not self-report. Using a combined data set (n = 475 residents in 54 homes) from this study and the Measuring Outcomes in Care Homes study (Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents’ quality of life in England.Health Qual Life Outcomes2019;17:22) we found a significant positive association between residents’ social care-related quality of life and regulator (i.e. Care Quality Commission) quality ratings. Multivariate regression revealed that homes rated ‘good/outstanding’ are associated with a 12% improvement in mean current social care-related quality of life among residents who have higher levels of dependency. Secondary data analysis of a large, national sample of care homes over time assessed the impact of staffing and employment conditions on Care Quality Commission quality ratings. Higher wages and a higher prevalence of training in both dementia and dignity-/person-centred care were positively associated with care quality, whereas high staff turnover and job vacancy rates had a significant negative association. A 10% increase in the average care worker wage increased the likelihood of a ‘good/outstanding’ rating by 7%.LimitationsNo care homes rated as inadequate were recruited to the study.ConclusionsThe most dependent residents gain the most from homes rated ‘good/outstanding’. However, measuring the needs and outcomes of these residents is challenging, as many cannot self-report. A mixed-methods approach can reduce methodological exclusion and an over-reliance on proxies. Improving working conditions and reducing staff turnover may be associated with better outcomes for residents.Future workFurther work is required to explore the relationship between pain, anxiety and low mood and other indicators of care homes quality and to examine the relationship between wages, training and social care outcomes.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 9, No. 19. See the NIHR Journals Library website for further project information.
Highlights
Background and rationale: the importance of measuring the contribution of care homes to the quality-of-life outcomes of older residentsOver 425,000 older people in England live in care homes because they have significant long-term health problems.[1]
Psychometric testing revealed that, the eight items of the Adult Social Care Outcomes Toolkit (ASCOT)-CH4 formed a single unidimensional measurement scale, the three new items did not. This was expected, as the concepts captured by the new items relate to aspects of health-related quality of life, which is distinct from the ASCOT construct of social care-related quality of life’ (SCRQoL)
Analysis revealed that pain did not fit well into a measurement scale alongside low mood and anxiety. These results indicate that the three items are better conceptualised as separate ‘modules’ that relate to the concepts of psychological health and pain, which may be added flexibly alongside ASCOT-CH4, with low mood and anxiety combined and pain standing alone
Summary
Background and rationale: the importance of measuring the contribution of care homes to the quality-of-life outcomes of older residentsOver 425,000 older people in England live in care homes because they have significant long-term health problems.[1]. Care homes collect and use data about the health and care needs of their residents for their own records and regulatory processes, there is no single, agreed, minimum data set in the UK.[5] owing partly to the distinction between health and social care systems in the UK, data about care home residents held by primary and secondary care are not linked with data held by social care providers In such a large and fragmented system, measuring and improving care quality is a challenge. The Adult Social Care Outcomes Toolkit: a method for measuring the social care-related quality of life of service users. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is no single, agreed minimum data set in the UK, making it difficult to measure and monitor the health and social care outcomes of residents as a quality indicator
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
