Home Care Research Research Articles

Pandemic impact in care homes: Care homes perspectives

BackgroundCare Homes (CH) are a vital resource in the health and social care system to support elderly people who may be unable to live at home independently. Older adults and carers have been disproportionately affected by coronavirus (COVID‐19). With 410 00 people living in CH, we lack data of how these major changes have impacted CH, and how CH are managing during the pandemic outbreak. We require knowledge, including what policies and procedures CH currently have; how they are mitigating risks; and how current experiences and guidance can improve care of CH residents during the current pandemic and future crises.MethodCH members of the Care Home Research Network (CHRN) were invited to take part on an online anonymous survey. An email invitation was sent to 225 CH, with surveys completed between August to October 2020. The questionnaire comprised of 49 questions, focusing on CH details, their views of the impact on the CH, staff and residents, and questions exploring strategies, ideas, and guidelines that the CH followed.ResultFifty care homes completed the survey. With 60% of the CH having between 10‐40 beds, and 40% between 50 to more than 100 beds. 76% of the respondents felt that their institution had been affected by the pandemic, with 52% having residents dying due to COVID‐19 and 68% had staff absent due to COVID‐19. 94% of respondents felt an increased level of stress in their role due to COVID‐19, with 22% saying that they could not cope with the increase in the workload and 52% hiring staff to cope with the workload. 70% of respondents felt that residents were feeling lonelier and 56% that residents were more depressed.ConclusionCH have been greatly impacted by the Pandemic, with increased anxieties and stress in staff, they lacked the support and resources needed to better overcome the challenges caused by this Pandemic. Moreover, residents were lonelier and more depressed, and their family members were more anxious/worried, requiring more resources from CH to support residents and family members. CH had to adapt, be innovative, find new working ways and using technology to meet residents and family needs.

A data‐driven examination of clustering of apathy and depression symptoms in people with dementia

AbstractBackgroundApathy is one of the most common Neuropsychiatric Symptom (NPS) and is associated with poor clinical outcomes. Apathy remains under‐researched and its medical classification remains unclear, potentially associated with the fact that apathy is commonly a comorbidity with depression. Research that helps define the apathy phenotype is urgently needed, particularly for clinical and biomarker studies.MethodUsing latent class analysis (LCA) we analysed data from the KCL Care Home Research Network study with 349 participants (an observational study of people living with dementia in care homes). The aim was to understand how apathy and depression phenotypes cluster together. Apathy and depression were defined on the basis of item G (Apathy) and D (Depression) of the NPI‐NH scale, combining the 7 apathy subquestions with the 8 depression subquestions, rated as yes or no. Predictors of class membership were then analysed, including other NPS, demographics, medication and Clinical Dementia Rating (CDR).ResultThe LCA analysis showed a 4‐cluster group which was considered the best model: No symptoms, predominantly depression, apathy/depression, and a predominantly apathy group. Those in the apathy/depression class were more likely to experience psychosis symptoms compared to the no symptoms class, whilst those in the predominantly apathy class were more likely to have a higher CDR score compared to the no symptoms class.ConclusionUsing a data driven method, we show distinct clustering of apathy and depression symptoms in this cohort. There was evidence that these clusters have different clinical associations which may help inform diagnostic categories for research studies and clinical practice. Potentially, the four subtypes may be used in future studies to further evaluate their utility in biomarker studies in dementia.

Making progress: but a way to go-the age and ageing care-home collection.

Care homes enable people with advanced physical and cognitive impairment to live well with 24-h support from staff. They are a feature of care systems in most countries. They have proved pivotal to the coronavirus disease 2019 (COVID-19) response. We searched Age and Ageing for care-home articles published since 2015. From these we collated 42 into the Age and Ageing care-home collection. This collection draws together important papers that show how Age and Ageing is helping to shape and grow care-home research. The collection outlines the technical issues that researchers face by grouping together important feasibility trials conducted in the sector. It looks at the challenges of measuring quality of life and working with routine data in care homes. It brings together observational studies considering loneliness, functional dependency, stroke outcomes, prescribing and acute deterioration. Health services research in care homes is represented by two studies that demonstrate realist evaluation as a way to make sense of service innovations. Papers are included that consider: non-pharmacological strategies for residents with dementia, end-of-life care, sexuality and intimacy and the care-home workforce. Given the importance of the COVID-19 pandemic in care homes, all of the care home COVID-19 papers published in Age and Ageing to date are included. Finally, a group of papers that present innovative approaches to research in care homes, each of which give voice to residents and/or staff, are collated and presented as a way of moving towards a more resident and care home centred research agenda.

GPs’ involvement to improve care quality in care homes in the UK: a realist review

Background Organising health-care services for residents living in care homes is an important area of development in the UK and elsewhere. Medical care is provided by general practitioners in the UK, and the unique arrangement of the NHS means that general practitioners are also gatekeepers to other health services. Despite recent focus on improving health care for residents, there is a lack of knowledge about the role of general practitioners. Objectives First, to review reports of research and quality improvement (or similar change management) in care homes to explore how general practitioners have been involved. Second, to develop programme theories explaining the role of general practitioners in improvement initiatives and outcomes. Design A realist review was selected to address the complexity of integration of general practice and care homes. Setting Care homes for older people in the UK, including residential and nursing homes. Participants The focus of the literature review was the general practitioner, along with care home staff and other members of multidisciplinary teams. Alongside the literature, we interviewed general practitioners and held consultations with a Context Expert Group, including a care home representative. Interventions The primary search did not specify interventions, but captured the range of interventions reported. Secondary searches focused on medication review and end-of-life care because these interventions have described general practitioner involvement. Outcomes We sought to capture processes or indicators of good-quality care. Data sources Sources were academic databases [including MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), Cumulative Index to Nursing and Allied Health Literature, PsycInfo® (American Psychological Association, Washington, DC, USA), Web of Science™ (Clarivate Analytics, Philadelphia, PA, USA) and Cochrane Collaboration] and grey literature using Google Scholar (Google Inc., Mountain View, CA, USA). Methods Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines were followed, comprising literature scoping, interviews with general practitioners, iterative searches of academic databases and grey literature, and synthesis and development of overarching programme theories. Results Scoping indicated the distinctiveness of the health and care system in UK and, because quality improvement is context dependent, we decided to focus on UK studies because of potential problems in synthesising across diverse systems. Searches identified 73 articles, of which 43 were excluded. To summarise analysis, programme theory 1 was ‘negotiated working with general practitioners’ where other members of the multidisciplinary team led initiatives and general practitioners provided support with the parts of improvement where their skills as primary care doctors were specifically required. Negotiation enabled matching of the diverse ways of working of general practitioners with diverse care home organisations. We found evidence that this could result in improvements in prescribing and end-of-life care for residents. Programme theory 2 included national or regional programmes that included clearly specified roles for general practitioners. This provided clarity of expectation, but the role that general practitioners actually played in delivery was not clear. Limitations One reviewer screened all search results, but two reviewers conducted selection and data extraction steps. Conclusions If local quality improvement initiatives were flexible, then they could be used to negotiate to build a trusting relationship with general practitioners, with evidence from specific examples, and this could improve prescribing and end-of-life care for residents. Larger improvement programmes aimed to define working patterns and build suitable capacity in care homes, but there was little evidence about the extent of local general practitioner involvement. Future work Future work should describe the specific role, capacity and expertise of general practitioners, as well as the diversity of relationships between general practitioners and care homes. Study registration This study is registered as PROSPERO CRD42019137090. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 20. See the NIHR Journals Library website for further project information.

Mentoring undergraduate nursing students in palliative home care research

BackgroundEngaging nursing students in research is essential to enhance evidence-based practice in nursing. PurposeThis paper outlines undergraduate students' research experiences with palliative care research team at a School of Nursing in rural Appalachia through the Research Apprenticeship Program (RAP). Students engage in research endeavors at the early stage of their education. MethodsEach principal investigator (PI) provided a synopsis of the research project through RAP. RAP staff reviewed all students' applications and notified the PI mentor based on students' research interests. Once students and PIs agree to work together, specific trainings are initiated, including enrolling students in an introductory research course. FindingsStudents were engaged in a variety of research related activities. Disruption on research activities during COVID-19 pandemic was also reported and addressed. DiscussionStudents shared the benefits and research challenges they experienced. Lessons learned can be adapted to mentoring plans for students in the future.

COVID, Communication and Care Homes: A Staffs’ Perspective of Supporting the Emotional Needs of Families

An important part of care home life is the support given to older residents by their families/friends through regular visiting. Social visits to residents by their families ceased in response to the COVID-19 pandemic and residents were confined to their rooms. This paper reports on how care home staff improvised to address this situation during the first wave of the pandemic. It focuses on steps taken to maintain communication between residents and families to support emotional well-being. We undertook in-depth café-style interviews with twenty-one staff to explore creative practices that they introduced. It was part of a wider Scottish study examining the effect of lockdown on families whose relative was living/dying in a care home (May–October, 2020). Findings reveal the enormous effort by care staff to maintain family connections and the rapid acclimatisation involved working with a number of different on-line platforms, the pulling together of staff from across the care home, and, the attention to emotional well-being of residents living and dying in the care home. Findings highlight the professionalism and commitment of the leadership and staff involved. Whilst some of the staff accounts need no further comment, we draw on some themes from the care home research literature to make sense of the findings in terms of what we might learn going forward. This in-depth qualitative study emphasises the importance of recognising, fostering and nurturing relational compassionate care within long-term care. There is however little evidence whether health and social care policies recognise the importance of this on-going relationship.

Patient and public involvement in care home research: Reflections on the how and why of involving patient and public involvement partners in qualitative data analysis and interpretation.

BackgroundThere is limited evidence for the impact of involving patients and the public (PPI) in health research. Descriptions of the PPI process are seldom included in publications, particularly data analysis, yet an understanding of processes and impacts of PPI is essential if its contribution to research is to be evaluated.ObjectiveTo describe the ‘how’ of PPI in qualitative data analysis and critically reflect on potential impact.MethodsWe focus on the development and critical reflection of our step‐by‐step approach to collaborative qualitative data analysis (through a series of analysis workshops) in a specific care home study, and our long‐term engagement model with patients and the public (termed PPI partners).ResultsAn open access PPI group, with multiple events over time, sustained broad interest in care home research. Recordings of interview clips, role‐play of interview excerpts and written theme summaries were used in workshops to facilitate PPI partner engagement with data analysis in a specific study. PPI resulted in changes to data interpretation and was perceived to make the research process accessible. We reflect on the challenge of judging the benefits of PPI and presenting PPI in research publications for critical commentary.ConclusionsPatient and public involvement partners who are actively engaged with data analysis can positively influence research studies. However, guidance for researchers is needed on approaches to PPI, including appropriate levels and methods for evaluation. Without more systematic approaches, we argue that it is impossible to know whether PPI represents good use of resources and is generating a real impact.

101 Avoiding Burnout of the Care Home Workforce During the COVID-19 Pandemic and Beyond: Sharing National Learning and Local Initiatives

IntroductionCOVID-19 in care homes has heightened the risk of staff burnout, undermining already problematic staff retention and low morale. There has been an associated proliferation of resources and online initiatives to support frontline workers, however, few of these are directly targeted at the care home workforce. Care home workers are highly skilled in caring for people with complex needs, but have very variable levels of formal training, and just over half of care homes in Scotland include registered nurses. This project will rapidly collate existing resources and identify, direct from care home workers, their best practice, initiatives, and resources used to support resilience and retention during this pandemic and moving forward.Methods1) Rapid review of care home specific evidence and resources (including published research and social media); 2) Online survey of Enabling Research in Care Homes (ENRICH) members across Scotland (n = 55); 3) Case studies within six care homes to identify what is working well and what is not in terms of promoting resilience and emotional support.ResultsThe rapid review has identified a wide range of resources directed at supporting staff working in care homes; the survey and case studies will provide data on the key learning and resources that have supported staff, and outline the challenges identified. There are many resources available but staff do not access these. The role of the care home manager is key.Key conclusionsThis comprehensive review of resources and initiatives will make a valuable contribution to policy and practice designed to reduce burnout and foster retention not just in care homes but more widely across health and social care.

Embedding Music and Music Therapy in Care Pathways for People with Dementia in the 21st Century—a position paper

Unique music therapy interventions are discussed from a clinical educational and research perspective, demonstrating a current position on music therapy for people living with dementia and their carers. The position paper, adapted from the keynote lecture given at the workshop “Music Selves and Societies” at Cambridge University in 2018, outlines current research and practice across music and music therapy fields, focussing upon embedding music in daily life and care for people living with dementia. Worldwide, around 50m people have dementia; this is estimated to increase to 75.6m in 2030 and 135.5m in 2050. This results in increased demand for long-term care and a need for heightened awareness and capacity for home care in local settings. Distinctions between interventions delivered by music therapists (direct music therapy) and interventions delivered by musicians or carers arising from training from music therapists (indirect music therapy) are discussed. Political and strategic developments for music and dementia are summarized, highlighting the need for increased training in the field and access to music at all stages of dementia. Case study examples are presented to highlight emerging practices and research; for example, couples attending music therapy groups in a rural community setting (Together in Sound) improved relationships and attitudes for people living with dementia. An international trial investigating reading and music interventions for people living with dementia and their homebased family carers (Homeside) is introduced, alongside practice and research in care homes where music therapy had been found to reduce agitation and improve carers’ well-being. Research shows music therapy interventions address personalized needs linked to daily lived experiences. However, indirect music therapy is needed to reach all who can benefit from music and are living with dementia. It is concluded that high quality, accessible music interventions should be embedded in care, and further research is needed to ascertain best practice.

Building relational research capacity in care homes in the COVID-19 era: applying recognition theory to the research agenda

Purpose Research can be an influential driver in raising care home standards and the well-being and human rights of residents. This paper aims to present a case for how a relational research capacity building programme could advance this agenda. Design/methodology/approach This study uses Axel Honneth’s Recognition Theory as a lens through which to explore organisational and institutional factors (such as research capacity and investment) that can either enable or limit “recognition” in the context of research in care homes. This paper draws on recent evidence from the COVID-19 pandemic in the UK and worldwide, to argue that such a relational capacity building agenda is even more pressing in the current context, and that it resonates with evidence from existing relational capacity building initiatives. Findings A lack of relevant research arguably contributed to the crisis experienced by the care home sector early in the pandemic, and there are only tentative signs that residents, care home providers and staff are now informing the COVID-19 research agenda. Evidence from pre COVID-19 and insights from Honneth’s Recognition Theory suggest that relational approaches to building research capacity within the care home sector can better generate evidence to inform practice. Originality/value This is a novel application of recognition theory to research in the care home sector. Drawing on theory, as well as evidence, has enabled the authors to provide a rationale as to why relationship-based research capacity building in care homes warrants further investment.

Producing ‘Top Tips’ for Care Home Staff During the COVID-19 Pandemic in England: Rapid Reviews Inform Evidence-Based Practice but Reveal Major Gaps

<strong>Context:</strong> The work presented in this paper was undertaken during the first three months of the COVID-19 crisis in the UK. <strong>Objectives:</strong> The project is aimed to respond to questions and concerns raised by front-line care staff during this time, by producing research-based ‘Top Tips’ to complement emerging COVID-19 policy and practice guidelines. <strong>Methods:</strong> Eight rapid, expert reviews of published, multidisciplinary research evidence were conducted to help answer care home workers’ questions about ‘how’ to support residents, family members and each other at a time of unprecedented pressure and grief and adhere to guidance on self-distancing and isolation. A review of the emerging policy guidelines published up to the end of April 2020 was also undertaken. <strong>Findings:</strong> The rapid reviews revealed gaps in research evidence, with research having a lot to say about what care homes should do and far less about how they should do it. The policy review highlighted the expectations and demands placed on managers and direct care workers as the pandemic spread across the UK. <strong>Implications:</strong> This paper highlights the value of working with the sector to co-design and co-produce research and pathways to knowledge with those who live, work and care in care homes. To have a real impact on care practice, research in care homes needs to go beyond telling homes ‘what’ to do by working with them to find out ‘how’.

Studying about the family's role in taking care of the elderly in Vietnam today - Through the research in elderly care homes in Ho Chi Minh city

Population aging is the most important trend of the 21st century in the world. Vietnam has officially entered the period of population aging since 2014 with the fastest aging rate. “Population aging” is a noticeable topic in Vietnam today. And in fact, according to many researchers, the number, especially the number of in-depth researches and applicable researches are still limited. Based on the inheriting of precedence researches and the result of my fieldwork study conducted in nursing homes in Ho Chi Minh city, from a new viewpoint, the paper aims to explore the traditional role of elderly care of the family in relationship with using nursing home today. Until now, the traditional family has played the main role in elderly care in Vietnam. In the context of changing society under the impact of urbanization and industrialization today, studying about the traditional role of elderly care of family, the relationship between family and the trend of &amp;quot;socialization&amp;quot; of elderly care, the changes and predicted future trend when compared with Japan, etc. would be necessary. The research result shows that the Vietnamese still have a strong negative attitude toward elderly care homes, and the traditional role of the family of elderly care is still deeply maintained. But at the same time, some basic changes have also confirmed, such as the change in traditional filial piety, the strengthening of the role of social services such as elderly care homes, etc. It can be said that this is the outstanding characteristic of the status of elderly care in Vietnam today. And based on comparing with other countries, the study also shows that in order to find an effective elderly care model in Vietnam, it is necessary to pay much attention to the relationship with the family.

Studying about the family's role in taking care of the elderly in Vietnam today - Through the research in elderly care homes in Ho Chi Minh city

Population aging is the most important trend of the 21st century in the world. Vietnam has officially entered the period of population aging since 2014 with the fastest aging rate. “Population aging” is a noticeable topic in Vietnam today. And in fact, according to many researchers, the number, especially the number of in-depth researches and applicable researches are still limited. Based on the inheriting of precedence researches and the result of my fieldwork study conducted in nursing homes in Ho Chi Minh city, from a new viewpoint, the paper aims to explore the traditional role of elderly care of the family in relationship with using nursing home today. Until now, the traditional family has played the main role in elderly care in Vietnam. In the context of changing society under the impact of urbanization and industrialization today, studying about the traditional role of elderly care of family, the relationship between family and the trend of "socialization" of elderly care, the changes and predicted future trend when compared with Japan, etc. would be necessary. The research result shows that the Vietnamese still have a strong negative attitude toward elderly care homes, and the traditional role of the family of elderly care is still deeply maintained. But at the same time, some basic changes have also confirmed, such as the change in traditional filial piety, the strengthening of the role of social services such as elderly care homes, etc. It can be said that this is the outstanding characteristic of the status of elderly care in Vietnam today. And based on comparing with other countries, the study also shows that in order to find an effective elderly care model in Vietnam, it is necessary to pay much attention to the relationship with the family.

SettleIN: Using a Manualised Intervention to Facilitate the Adjustment of Older Adults with Dementia Following Placement into Residential Care.

The authors examined the feasibility of delivering an adapted version of SettleIN, a manualised staff-led programme designed to facilitate adjustment to care for new residents with dementia. The effects of SettleIN on resident adjustment, mood and quality of life were also investigated. A pilot randomised controlled trial was conducted. Nineteen new residents with dementia and 21 staff participants were recruited. Residents were randomly assigned to receive the SettleIN programme or residential care as usual. Resident quality of life, mood and overall adjustment were measured at baseline and post-intervention, in week seven. Interviews were conducted with staff in week seven to explore intervention feasibility. Despite medium to large effect sizes, there was no significant difference in mean change scores between the two conditions, with regards to quality of life, psychological wellbeing or overall adjustment outcomes. Qualitative feedback indicated that SettleIN was not feasible across all areas, with problems around recruitment and practicality. However, SettleIN was deemed feasible in terms of retention and acceptability among staff. The majority of staff felt that SettleIN was beneficial for residents but that organisational and programme factors impacted upon intervention feasibility. Further exploration of organisational barriers is needed in order to reduce the impact of such factors on care home research.

A posture and mobility training package for care home staff: results of a cluster randomised controlled feasibility trial (the PATCH trial).

Backgroundprovision of care for care home residents with complex needs is challenging. Physiotherapy and activity interventions can improve well-being but are often time-limited and resource intensive. A sustainable approach is to enhance the confidence and skills of staff who provide care. This trial assessed the feasibility of undertaking a definitive evaluation of a posture and mobility training programme for care staff.Design and settinga cluster randomised controlled feasibility trial with embedded process evaluation. Ten care homes in Yorkshire, United Kingdom, were randomised (1:1) to the skilful care training package (SCTP) or usual care (UC).Participantsresidents who were not independently mobile.InterventionSCTP—delivered by physiotherapists to care staff.Objectives and measurementskey objectives informed progression to a definitive trial. Recruitment, retention and intervention uptake were monitored. Data, collected by a blinded researcher, included pain, posture, mobility, hospitalisations and falls. This informed data collection feasibility and participant safety.Resultsa total of 348 residents were screened; 146 were registered (71 UC, 75 SCTP). Forty two were lost by 6 months, largely due to deaths. While data collection from proxy informants was good (>95% expected data), attrition meant that data completion rates did not meet target. Data collection from residents was poor due to high levels of dementia. Intervention uptake was variable—staff attendance at all sessions ranged from 12.5 to 65.8%. There were no safety concerns.Conclusioncare home and resident recruitment are feasible, but refinement of data collection approaches and intervention delivery are needed for this trial and care home research more widely.

Exploring a Common Data Element for International Research in Long-Term Care Homes: A Measure for Evaluating Nursing Supervisor Effectiveness.

The aim of this study is to recommend a common data element (CDE) to measure supervisory effectiveness of staff working in LTC homes that can be used in international research. Supervisory effectiveness can serve as a CDE in an effort to establish an international, person-centered LTC research infrastructure in accordance with the aims of the WE-THRIVE group (Worldwide Elements to Harmonize Research in Long Term Care Living Environments). A literature review was completed and then a panel of experts independently reviewed and prioritized appropriateness of the measures with mindfulness of their potential applications to international LTC settings. The selection of a recommended CDE measure was guided by the WE-THRIVE group’s focus on capacity rather than deficits, the expected availability of internationally comparable data and the goal to provide a short, ecologically viable measurement, specifically for low- and middle-income countries. Two measures were considered as the CDE for supervisory effectiveness, Benjamin Rose Relationship Scale and the Supervisory Support Scale; however, given that the latter measure has been translated in Spanish and Chinese and has been tested with nursing assistants in both of these countries with good psychometric properties, our group recommends it as the CDE going forward.

A Practical Methodology for Improving the Aging-Friendliness of Communities: Case Studies from Three U.S. Communities.

Background and ObjectivesIn this paper, we present a series of three case studies to illustrate an innovative and practical approach to improving the aging-friendliness of communities. These three communities used the AdvantAge Initiative to “listen” to the voices of older adults in their communities and to identify and prioritize aging-related issues. This approach was developed by the Center for Home Care Policy and Research at the Visiting Nurse Service of New York (VNSNY), the largest not-for-profit home health care organization in the United States, and has been implemented in over 60 communities throughout the United States. The methodology involves tools such as conceptual frameworks, survey questionnaires, focus groups, and technical assistance to help stakeholders interpret data and find solutions to identified issues.Research Design and MethodsWe interviewed VNSNY program staff and community partners involved in three AdvantAge Initiative projects that commenced at varying time points: Memphis and Shelby County, Tennessee (2012); New York City’s Chinatown neighborhood (2006); and the state of Indiana (2008). We also collected and reviewed secondary materials associated with these projects (e.g., meeting notes from community planning meetings, annual reports from grant recipients, press coverage).ResultsIn this case study, we begin by providing an overview of the AdvantAge Initiative framework and the AdvantAge Initiative key indicators. We then present a more in-depth look at the three communities and how they approached and implemented the AdvantAge Initiative.Discussion and ImplicationsThese case studies demonstrate that this methodology may be implemented in diverse communities and geographic locations. By looking at the longer-term outcomes and by comparing the strategies employed by each community, we see that communities, regardless of size, can bring stakeholders together to promote health and implement meaningful changes that make the community a better place to live for older adults and their families.

Cervical Cancer Screening in Postmenopausal Women Referring to Hamadan Comprehensive Health Centers

1- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran 2- Assistant Professor, Maternal and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran , aghababaii@yahoo.com 3- Associate Professor, Department of Biostatistics, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran 4- School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran

USING INTERNATIONAL COLLABORATIONS TO SHAPE RESEARCH AND INNOVATION INTO CARE HOMES IN BRAZIL: A WHITE PAPER

The Brazilian care home sector is underdeveloped, and the limited available evidence suggests that care quality falls below international standards. Development of the Brazilian care home sector could be associated with better outcomes for those receiving care, and more efficient use of resources across health and social care. Research has an important role to play. This article summarises research priorities for Brazilian long-term care homes developed as part of an international workshop held in Brazil and the UK, and attended by 71 clinicians and researchers from 6 Brazilian Universities, supported by an international faculty of 8 Brazilian, 8 British, 2 Dutch and 1 Austrian academics. The research priorities identified were: understanding and supporting multidisciplinary working in care homes, with emphasis on describing availability of multidisciplinary teams and how they operate; dignity and sensitivity to cultural needs, with emphasis on collating accounts from Brazilian stakeholders about dignity in care and how it can be delivered; enriching the care home environment with art, music and gardens, with a focus on developing arts in the care home space in a way that is sensitive to Brazilian cultural identity; and benchmarking quality of care, with emphasis on exploring how international quality benchmarking tools can be adapted for use in Brazilian care homes, taking account of new initiatives to include person-centred outcomes as part of benchmarking. Instrumental to research in these priority areas will be establishing care home research capacity in Brazil.

“We should see her like part of the team”: an investigation into care home staff’s experiences of being part of an RCT of a complex psychosocial intervention

Objectives: To contribute to improvements in the design and delivery of intervention research in care homes by adopting a collaborative approach that listens to the experiences of care home staff who had participated in a clinical trial aimed at optimising and evaluating a psychosocial intervention package for people with dementia.Methods: Qualitative study involving focus group discussions (FGDs) involving 41 staff across 6 care homes with the UK. Inductive thematic analysis was used to identify themes and interpret the data.Results: Three overarching themes emerged as influential: Recognising preparedness; working together and learning more than expected. The findings highlighted the need to be attentive in addressing staff expectations, the value of sustained relationships and recognition of good practice. The FGDs also identified areas of unanticipated learning that staff and managers adopted.Conclusions: The FGDs showed the importance of considering the overall experience of care home staff who are involved in research and the importance of valuing the skills and experience they hold through positive affirmation. There are often unanticipated consequences of research involvement both on staff practice and on relationships which if promoted could help sustain effective ways of working together.