Care Home Group Research Articles

An epidemiological investigation of COVID-19 outbreaks in a group of care homes in Wales, UK: a retrospective cohort study.

BackgroundThis study describes the epidemiology of COVID-19 outbreaks in four care homes in terms of spread, severity, presentation and interventions.MethodsParticipants were 100 residents and 102 staff from four co-located care homes in Wales. Data were collected from the homes and Public Health Wales, including demographics, presentations, test status and results, hospital admissions and deaths. Genomic sequencing of confirmed case samples was completed, where possible. Epi-curves, crude attack rates, a Kaplan-Meier survival curve and adjusted hazard ratios were calculated using R.ResultsAbout 14 confirmed and 43 possible resident cases, 23 confirmed and 47 possible staff cases occurred. Crude attack rates of possible and confirmed cases were 57% (residents) and 69% (staff). Genomic sequencing for 10 confirmed case PCR samples identified at least 5 different UK lineages of COVID-19.42 (42%) residents died, 23 (55%) with COVID-19 or suspected COVID-19 recorded on the death certificate. The hazard ratio for death amongst resident possible and confirmed cases compared to null cases, adjusting for age and sex, was 13.26 (95% CI 5.61–31.34).ConclusionsThere were extensive outbreaks of COVID-19 in these homes with high crude attack rates and deaths. Universal testing and early isolation of residents are recommended.

A Study of Universal Severe Acute Respiratory Syndrome Coronavirus 2 RNA Testing Among Residents and Staff in a Large Group of Care Homes in South London.

BackgroundCare homes have experienced a high number of COVID-19 related deaths of residents since the onset of the pandemic. However, up to May 2020, there has been a lack of information about the extent of SARS-CoV-2 infection in residents and staff in care homes and limited testing in this setting.ResultsOverall, the point prevalence of SARS-CoV-2 infection was 6.5% with a higher rate in residents (9.0%) than in staff (4.7%). A key finding was the high proportion of asymptomatic infection detected in staff (69%) and residents (51%) with evidence of under-detection of symptoms by care home staff.ConclusionsThe high proportion of asymptomatic infection combined with under detection of symptoms by care home staff indicates that offering a test to all residents and staff in care homes with rapid reporting of results would assist accurate identification of infected individuals, facilitating prompt infection prevention and control action.MethodsCombined nose and throat swab testing for SARS-CoV-2 RNA was carried out in 2455 residents and staff across 37 care homes in the London Borough of Bromley across a three-week period. Results were reported within 24 hours of sample delivery and data were collected on the presence or absence of symptoms.

Case study: WhatsApp support through the COVID-19 pandemic

As care homes seek innovative ways to support their residents through the lockdown, one care home group has turned to WhatsApp to connect and inspire its staff. Beth Britton reports on the establishment of the group and how the sharing of ideas has benefited both residents and staff

Preparing the Dietetic Workforce of the Future – Developing Innovative Placements in Social Care Settings

Practice placements are key to the training of an allied health professional, supporting the integration of theoretical and practical knowledge, allowing the development of key skills and enculturation to a professional role. Practice placements in dietetic pre-registration training have largely focussed on clinical/health care settings, with the students based in dietetic departments. Current developments in integrated health and social care provision in the United Kingdom mean there is a compelling need to develop a workforce equipped to work across sectors to effectively support people’s nutritional needs. Against this background, a partnership group of healthcare and managerial professionals, representing NHS Education for Scotland (NES), NHS Highland (NHSH), a private care home group based in the North of Scotland and Robert Gordon University worked together to pilot and develop a model for the placement of student dietitians within social care settings (initially care homes). This novel approach embeds students in a social care setting for part of their placement rather than having them based within a dietetic department. The placements were positively evaluated and widely shared via Allied Health Profession (AHP) blogposts and in publications such as the Care Inspectorate newsletter, and other Scottish Health Boards are now developing local models of dietetic social care placements. There is a recognition that practice placement models should prepare the dietitians of the future for working beyond NHS environments, and that alternative models of placement should be explored from the perspective of raising the profile of the profession and ensuring sustainability of placement provision.

Developing a culture of relationship-centred care.

There is a new way of working across a care home group in south east Wales, based on relationship-centred care and an ethos of empowerment for older people in their homes.

Developing a culture of relationship-centred care in a care home group

Developing a culture of relationship-centred care in a care home group

Developing a culture of relationship-centred care in a care home group.

This article outlines the development of a new way of working across a group of care homes in south east Wales, based on a philosophy of relationship-centred care and an ethos of empowerment for older people in the homes. The underpinning aim was to enable residents to have a good quality of life, reflecting recommendations made by the Older People's Commissioner for Wales in a 2014 review into the quality of life and care of older people living in care homes in the country. After the introduction of the new way of working, the care home group were approached by a university to take part in a collaborative project offering nursing students clinical placements in the care homes, mentored by registered nurses employed there. The collaboration between the university and the care homes meant that nursing students became enveloped in the person-centred culture, receiving positive exposure to nursing older people early in their careers. It is hoped that the clinical placements may encourage them to consider careers in the specialty.

New ways of working across a care home group

New ways of working across a care home group

That's why I take my ONS. Means-end chain as a novel approach to elucidate the personally relevant factors driving ONS consumption in nutritionally frail elderly users

Oral nutritional supplements (ONS) are a recommended form of nutritional intervention for older malnourished persons when a ‘food first’ approach and/or food fortification prove ineffective. The efficacy of ONS will depend on, amongst other factors, whether persons do, or do not, consume their prescribed amount. Factors influencing ONS consumption can be product, context, or person related. Whereas product and context have received some attention, little is known about the person factors driving ONS consumption. In addition, the relative importance of the product, context, and person factors to ONS consumption is not known. Using the means-end chain (MEC) method, the current study elucidated personally relevant factors (product, context, and person factors) related to ONS consumption in two groups of older nutritionally frail ONS users: community-dwelling persons and care home residents with mainly somatic disorders. To our knowledge, the current work is the first to apply the MEC method to study older nutritionally frail ONS users. Forty ONS users (n = 20 per group) were recruited via healthcare professionals. The level of frailty was assessed using the FRAIL scale. Both groups were interviewed for 30 to 45 minutes using the soft laddering technique. The laddering data were analysed using LadderUX software™. The MEC method appeared to work well in both groups. The majority of the participants took ONS on their doctor's or dietician's prescription as they trusted their advice. The community-dwelling group took ONS to prolong their independence, whereas the care home group reported values that related more to small improvements in quality of life. In addition, care home residents perceived themselves as dependent on their caregiver for their ONS arrangements, whereas this dependence was not reported by community-dwelling persons. Key insights from this work will enable doctors and dieticians to customize their nutritional interventions to ONS users' personal needs and thus positively impact health outcomes.

Supervision and appraisal: how to support staff performance

Rob Mackenzie is active in the fields of clinical audit, staff training, policy and procedure creation and review, as well as managerial assistance. In this article, he describes the process of an audit of a group of care homes in Scotland

Loneliness in Care Homes: A Neglected Area of Research?

Approximately 5% of older people, those aged 65 years and over, in developed countries live in care homes and these represent the frailest and most vulnerable members of this population group. Levels of morbidity, especially dementia and cognitive impairment, are high, making it challenging to conduct research with these population groups. Loneliness is a debilitating condition with important negative outcomes in terms of both quality of life and wider health outcomes. The prevalence of severe loneliness among older people living in care homes is at least double that of community-dwelling populations: 22–42% for the care population compared with 10% for the community population. However, the evidence-base for the care home group is tentative as it is based upon a very limited empirical base of only five studies. This review failed to identify compelling evidence for the effectiveness of interventions to remediate loneliness in care home populations.

How education can improve care for residents with dementia

Meeting the needs of people with dementia is topical in health and social care. However, the care of older people, including those with dementia, has received much negative media coverage over the past few years. Colten Care, a care home group in the south of England, asked staff from the School of Health and Social Care at Bournemouth University to develop and deliver an educational programme to 20 staff working at three of the group's care homes. The programme adopted a person-centred approach to residents and staff and focused on empowering staff to influence practice in the homes where they worked. This article explores the content of the programme and how aspects of it were incorporated in participants' care homes. The programme was positively evaluated and formed the basis for the development of Colten Care's inhouse two-and-a-half day education programme.

Sustaining improved end of life care in care homes

BackgroundUK policy calls for care homes to provide reliably good palliative and end of life (EOL) care (Care Commission, Better Care Every Step of the Way, 2009). Consequently an intervention...

‘Early days’: Knowledge and use of the Mental Capacity Act 2005 by care home managers and staff

The Mental Capacity Act (MCA) was fully implemented in England and Wales in October 2007 and has relevance for the care home sector through its focus on decision-specific assessments of capacity. This article reports on research that forms part of a five year programme exploring evidence-based interventions in dementia and this article draws on part of the research that was designed to identify issues relating to implementation of the Act. Specific research questions for this study pertain to staff abilities to incorporate a new legal framework addressing mental capacity into care of people with dementia. Qualitative interviews with 32 staff in one group of care homes in Southern England demonstrated that, regardless of knowledge of MCA, the daily working ethos of staff appeared to be within the remit of Act. Training could therefore continue to build on these principles. However, considerable variation in understanding of terms and principles of the MCA was found. Few participants were aware of specific legislative points and offered ‘common sense’ explanations for their actions and decision-making. This level of knowledge may not meet regulators’ requirements or the needs of residents.

Factors associated with ADL dependence: A comparative study of residential care home and community‐dwelling elderly in Japan

Background: Since the start of Long Term Nursing Insurance in Japan in April 2000, there has been much discussion about and emphasis on leading healthy and active twilight years, without ever being bedridden if possible. In an attempt to address some of these concerns, this comparative study examines the factors associated with dependence in the activities of daily living (ADL) in two samples of elderly people living in two different environments.Methods: In this cross‐sectional, self‐reported study, 262 and 968 elderly people from a residential care home and Yogo town completed a 65‐item questionnaire. Questions pertaining to ADL, medical and social history, quality of life (QOL) and the 15‐item Geriatric Depression Scale were included in the questionnaire. Using logistic regression model, factors associated with ADL dependence were determined.Results: In the residential care home group, age, female gender, instrumental ADL, communication‐related ability, history of falls, stroke, and osteoarthropathy, depressive tendency and low satisfaction with life emerged as the factors associated with ADL dependence, after multivariate logistic regression. The corresponding factors in the community‐dwelling elderly group were age, depressive tendency, history of osteoarthropathy, and low sense of health.Conclusion: Age and female gender were the two non‐modifiable risk factors associated with ADL dependence. Stroke, followed by osteoarthropathy and falls were the main medical conditions predisposing to functional dependence. Dependence in instrumental ADL, independence in communication‐related ADL, depressive tendency and components of QOL were factors associated with ADL dependence. Awareness of these factors not only helps to identify at‐risk patients, to initiate preventive measures and to promote disability‐delaying activities, but also helps in the holistic management of geriatric patients.