Home In England Research Articles

Re-Designing Secure Children’s Homes Through a Child-First Lens

This article explores existing learning gaps concerning optimal ways to support children within and beyond secure care in England and Wales, with a specific focus on Secure Children’s Homes (SCHs). Insights from key stakeholders working in SCHs are often omitted from research despite being fundamental to understanding both challenges and best-practice initiatives. The Children’s Residential Care Research Network, which is a collaboration between the authors, aims to develop novel research with stakeholders working across the secure children’s estate and expand the extant literature to inform the design and build of future Secure Children’s Homes (SCH) through a Child-First lens. The research presented here involves a mixed-methods approach gathering rich qualitative data from participants across the sector. Fifty-three participants engaged in participatory methodologies, focus groups, and interviews, which led to a large data set. Thematic analysis identified three key themes to inform the design and build of new SCHs. SCHs should (i) be close to home to enable family involvement and continuity of care, (ii) feel like a home, and (iii) be flexible and adaptive to changing needs. These findings are feeding into the design of two new homes in England as well as the refurbishment of existing provision and can also influence future expansion of the secure estate. The research also contributes to knowledge about how the Child-First tenets can be engaged to improve outcomes for children deprived of their liberty, both in and outside the youth justice system.

The Role of Adult Social Care in Supporting People with Learning Disabilities Who Rent Their Own Homes in England

The Role of Adult Social Care in Supporting People with Learning Disabilities Who Rent Their Own Homes in England

Social workers' consideration of dental support for people living with dementia: Findings from interviews and care assessment documentation.

Social work assessments underpin support plans for many people living with dementia in their own homes in England, but it is unclear how they acknowledge that dementia places people at greater risk of mouth and dental problems affecting their wellbeing. We explored if and how dental needs are addressed during care assessments and social workers' perceptions of this aspect of personal care. This study analysed (a) semi-structured interviews with 14 social workers providing support to people living with dementia in their own homes, (b) data from 39 care assessments and support plans from two English local authorities. Interviews were recorded online, transcribed, and thematically analysed. Documents were analysed descriptively and presented visually. Participants acknowledged that oral care may be overlooked during assessments and reflected on various reasons, including assumptions of responsibility and role restrictions, limited training, and poor links with dental services. This was further evident in the analysis of assessment documentation. Participants identified potential strategies and practice changes to better integrate oral care in social work practice. These included increased awareness and more discussions around dental needs, skills training and streamlining of support. The findings have implications for social workers, educators, and commissioners or funders engaging with people affected by dementia in social work and beyond.

Prevalence of strong anticholinergic use in residents with and without cognitive impairment and frailty: Analysis from 106 nursing homes in 12 Asia-Pacific and European countries

PurposeThere is a need to balance the benefits and risks associated with strong anticholinergic medications in older adults, particularly among those with frailty and cognitive impairment. This study explored the international prevalence of strong anticholinergic medication use in residents of nursing homes with and without cognitive impairment and frailty. MethodsSecondary, cross-sectional analyses of data from 5,800 residents of 106 nursing homes in Australia, China, Czech Republic, England, Finland, France, Germany, Israel, Italy, Japan, Netherlands, and Spain were conducted. Strong anticholinergic medications were defined as medications with a score of 2 or 3 on the Anticholinergic Cognitive Burden scale. Dementia or cognitive impairment was defined as a documented diagnosis or using a validated scale. Frailty was defined using the FRAIL-NH scale as 0–2 (non-frail), 3–6 (frail) and 7–14 (most-frail). Data were analyzed using descriptive statistics. ResultsOverall, 17.4 % (n = 1010) residents used ≥1 strong anticholinergic medication, ranging from 1.3 % (n = 2) in China to 27.1 % (n = 147) in Italy. The most prevalent strong anticholinergics were quetiapine (n = 290, 5.0 % of all residents), olanzapine (132, 2.3 %), carbamazepine (102, 1.8 %), paroxetine (88, 1.5 %) and amitriptyline (87, 1.5 %). Prevalence was higher among residents with cognitive impairment (n = 602, 17.9 %) compared to those without (n = 408, 16.8 %), and among residents who were most frail (n = 553, 17.9 %) compared to those who were frail (n = 286, 16.5 %) or non-frail (n = 171, 17.5 %). ConclusionsOne in six residents who were most frail and living with cognitive impairment used a strong anticholinergic. However, there was a 20-fold variation in prevalence across the 12 countries. Targeted deprescribing interventions may reduce potentially avoidable medication-harm.

What does 'feeling at home' mean for adults with intellectual disabilities living in group homes in England?

Shared housing for adults with intellectual disabilities with staff support, is a common housing model internationally. We explored an overlooked aspect of group homes, namely the extent to which they enable a sense of 'feeling at home' for residents. A diverse group of 19 housemates participated in a photovoice study. Participants took photos in their homes and discussed them in individual interviews and in groups. Data was analysed using reflexive thematic analysis. Residents' experience of home was multi-dimensional. 'Feeling at home' related to home as a site of identity cultivation (personal home); physical comfort or 'misfitting' (physical home) and home as the locus of key relationships (social home). Achieving a sense of 'feeling at home' requires engagement in practices of home-making. Many of our participants required support from staff to engage in these practices. For some housemates their experience of home was conditional and precarious.

How do care workers learn to care for people with dementia living in care homes? A model of informal learning

PurposeThis paper describes a model of “Learning to care” derived from a study exploring how care workers in care homes learn to care for people living with dementia. The “Learning to care” model is primarily informal in nature in which influences such as formalised training and organisational culture impact care outcomes indirectly rather than directly.Design/methodology/approachThis study used a focused, critical ethnographic approach in two care homes in England resulting in 63 h of observation of care of people living with advanced dementia, 15 semi-structured interviews and 90 in-situ ethnographic interviews with care staff.FindingsThe findings reveal a three-level model of learning to care. At the level of day-to-day interactions is a mechanism for learning that is wholly informal and follows the maxim “What Works is What Matters”. Workers draw on resources and information within this process derived from their personal experiences, resident influences and care home cultural knowledge. Cultural knowledge is created through a worker’s interactions with colleagues and the training they receive, meaning that these organisational level influences affect care practice only indirectly via the “What Works is What Matters” mechanism.Originality/valueThis study makes an original contribution by explaining the nature of day-to-day informal learning processes as experienced by care workers and those living with dementia in care homes. In particular, it illuminates the specific mechanisms by which organisational culture has an effect on care practice and the limitations of formal training in influencing such practice.

Does outsourcing enable the survival of good care homes? A longitudinal analysis of all care homes in England, 2011–2023

BackgroundIt is unclear whether outsourcing has enabled the growth and survival of the best care homes, as intended. We aimed to test whether ownership (for-profit, public and third sector (non-profit))...

Looters to collectors

Abstract During the plunder of the Summer Palace in Beijing (commonly ‘Pekin’ in English until the 1890s) by the Anglo-French army in 1860, soldiers of the British forces acquired imperial objects. They repurposed these at home in Britain as commodities, trophies and decorative art. This essay takes a critical look at their activities as collecting – the purposeful selection and assembly of objects – and considers the tastes and priorities that were factors in the selection of treasures from the imperial estate; it then examines how, in the hands of soldiers, dealers and collectors, new meanings accrued to objects that were economic, political and aesthetic. This collecting history is told through case studies involving exhibitions, designed interiors and auctions at which objects from the Summer Palace figured, and situates these within the wider collecting and exhibition cultures of the later nineteenth century. The facts show that soldiers’ collections of Summer Palace material not only fed the art market, but also had a formative impact on the understanding and valuation of the objects in the marketplace.

“In the wilderness…dealing with difficult situations”: Knowledge exchange with care home staff in England on managing seizures and epilepsy – An initial exploration

PurposeWith epilepsy increasingly affecting older adults, seizure-related care needs arise in new settings. Persons in these settings must receive optimal support and challenges identified for remediation. This may entail the epilepsy community researching in unfamiliar environments. One setting is care homes. Seizure-related ambulance incidents in them are common. We conducted the first qualitative study with care home staff to explore their experiences and challenges in managing suspected seizures. MethodsThree online focus groups were organised for January 2024 to explore ambulance calls, post-incident procedures, and challenges faced by care home staff when managing seizures. Persons were eligible to participate if they worked as a care assistant, nurse or manager in a care home in North-West England. Different recruitment pathways were employed including direct approach, a managers’ network, social media and a register of research interested homes. Focus group audio recordings were transcribed and analysed using Hamilton’s Rapid Analysis. ResultsRecruitment was difficult; 13 care home staff from 12 different homes were ultimately recruited. Despite data saturation not being achieved, insights were gained regarding ambulance call decisions, paperwork navigation, and follow-up care challenges. Patients not having meaningful seizure action plans in place and regulatory restrictions were identified as factors that contributed to potentially avoidable calls for ambulance help being made. ConclusionThis study highlights systemic issues in care homes’ seizure care, emphasizing the need for further research. The epilepsy community may need to innovate to better research within this increasingly important setting. This study offers insights into the effectiveness of different recruitment strategies.

'I wasn't on the front line per se, but I was part of health care': Contributions and experiences of ancillary staff in care homes in England during the COVID-19 pandemic.

Ancillary staff - cleaning, catering, housekeeping and laundry workers - play a crucial role in care homes, by promoting infection control, food preparation and hygiene, and contributing to the care home environment. This study sought to understand the experiences of ancillary staff working in English care homes during the COVID-19 pandemic. The results will inform policy makers, employers, care home managers and others, both in England and overseas, as how to best support the ancillary workforce. Between March and August 2021, video and telephone interviews were conducted with those working or living in care homes in England. Participants comprised ancillary staff (n = 38), care home managers (n = 8), care home residents' family members and friends (n = 7), human resource managers (n = 5) and care home residents (n = 5). Ancillary staff often had increased responsibilities and contributed to pandemic efforts by changing working practices, routines and job roles with the aim of supporting residents and other staff. Teamwork, underpinned by strong leadership, helped ancillary staff feel supported. Ancillary staff should be better recognised as being central to care home care. They are essential workers helping to keep residents safe and well.

Anticipatory prescribing of injectable controlled drugs (ICDs) in care homes: a qualitative observational study of staff role, uncertain dying and hospital transfer at the end-of-life

BackgroundThe anticipatory prescribing of injectable controlled drugs (ICDs) by general practitioners (GPs) to care home residents is common practice and is believed to reduce emergency hospital transfers at the end-of-life. However, evidence about the process of ICD prescribing and how it affects residents’ hospital transfer is limited. The study examined how care home nurses and senior carers (senior staff) describe their role in ICDs prescribing and identify that role to affect residents’ hospital transfers at the end-of-life.Methods1,440 h of participant observation in five care homes in England between May 2019 and March 2020. Semi-structured interviews with a range of staff. Interviews (n = 25) and fieldnotes (2,761 handwritten A5 pages) were analysed thematically.ResultsSenior staff request GPs to prescribe ICDs ahead of residents’ expected death and review prescribed ICDs for as long as residents survive. Senior staff use this mechanism to ascertain the clinical appropriateness of withholding potentially life-extending emergency care (which usually led to hospital transfer) and demonstrate safe care provision to GPs certifying the medical cause of death. This enables senior staff to facilitate a care home death for residents experiencing uncertain dying trajectories.ConclusionSenior staff use GPs’ prescriptions and reviews of ICDs to pre-empt hospital transfers at the end-of-life. Policy should indicate a clear timeframe for ICD review to make hospital transfer avoidance less reliant on trust between senior staff and GPs. The timeframe should match the period before death allowing GPs to certify death without triggering a Coroner’s referral.

1982 A new way of involving experts by experience in social care research

Abstract Introduction Meaningful involvement of experts by experience in the design of health and care research is now well-established as good practice (Staniszewska, 2018). For example, it is essential that the voices of residents and staff are properly heard in care homes research, since they provide important perspectives not necessarily shared by the wider multidisciplinary team (Shepherd et al. 2017). Nevertheless, there are concerns that involvement can be tokenistic, or vulnerable to power imbalances (Baines & de Bere, 2017; Jennings et al., 2018). Methods A care home in northeast England is working with researchers to pioneer a new approach to involvement, with residents and staff at the centre. The care home has helped to shape a number of research projects, for example a feasibility study of mealtime care training. In this study, an advisory group was set up initially within the care home itself, comprising residents, staff and family carers. Subsequently the group was joined by people from other care homes in the area, with support from the local authority. In parallel to this, health and social care professionals have contributed to the advisory group through one-to-one meetings with the researcher. Results Advisory group meetings in the care home have provided an inclusive and equitable platform for residents and staff to share their views on the research topic and design. Other stakeholders have been able to input into the project, but separately and in a way that has left room for key voices to be properly heard. Contributors have felt valued and are keen to continue in the process. Conclusion This study offers an alternative and authentic model for the involvement of experts by experience in social care research, inverting the more typical approach so that residents and staff are at the centre not the periphery.

‘Am I supposed to be in a prison or a mental hospital?’ The nature and purpose of secure children's homes

AbstractSecure children's homes are locked institutions that deprive children of their liberty. The government are investing significantly in these homes, yet there remains a lack of clarity about their nature and purpose. Drawing on data generated through a substantial ethnography in one secure children's home in England, this paper uses Goffman's (1961) theorising as a conceptual lens to view the institution. It concludes that ambiguity and confusion about what these institutions are, and what they seek to achieve, impacts negatively on the experience of everyday life within. Clarity is needed urgently to improve experiences and to enable the assessment of outcomes.

A Multiple Case Study Exploring Person‐Centred Care in Care Homes

Background: There are 14,228 care homes in England with a population of approximately 372,035 residents, many of whom are living with frailty or multiple and complex comorbidities. Policy and international literature advocate that care homes provide high‐quality person‐centred care that meets each person’s specific needs. This study aims to provide an exploration of person‐centred care in care homes in the South West of England from the perspective of all those involved.Methods: A qualitative multiple case study design was used across seven care homes in a region of South West England. Semistructured interviews were conducted with 61 participants (residents, family and health and care professionals). Nonparticipant observations were undertaken in communal areas to understand the practices and cultures of the care homes. All data were analysed using reflexive thematic analysis.Findings: The findings are presented as six themes, they are adjusting to the transition into a care home; people at the centre of care; the place we call home with the people we call family; working across the boundaries of care; supporting, valuing and empowering care home teams; and managing complex and challenging moments of care.Conclusion: This study demonstrates a whole system understanding of person‐centred care across seven care homes. The main components of person‐centred care appear to be relational. These relationships take place in cultures and systems that are complex and challenging with care boundaries that need to be navigated. Navigating these care boundaries requires a people‐centred care approach built on partnerships and mutual respect.

Testing reflective tools to support care home residents living with dementia with their spiritual needs

AbstractThe needs of older people with a ‘diverse’ cultural or faith background are not well represented in social care research in general, and particularly of those living in care homes where an estimated 70% of residents are living with dementia. Additionally, the spiritual needs of care home residents are often overlooked or misunderstood by care workers, resulting in a double lack of recognition. It is common for care workers to relate spirituality primarily to religion. This can be the case, but spirituality mainly reflects (the need for) a purpose and meaning in life. Evidence demonstrates that spirituality and religion can help reduce or stabilise cognitive disorders or enable people to develop coping strategies to help accept a cognitive disorder, maintain relationships, hope, and find meaning in their lives, thus improving their sense of wellbeing. Recent studies have highlighted the importance of creating dementia‐specific spiritual assessment tools and stakeholder training. This proposed study helps fill that gap.Pre‐liminary findings will be presented on a Reflective Spirituality Tool (RST) that is tested in care homes in England. Through interviews with care home residents living with dementia, their relatives/friends, care home staff, managers, and faith leaders, the RST will be re‐developed to ensure it reflects the diversity of people living in residential care. Furthermore, care home residents were asked to bring an artefact to their interview that represented a sense of peace, safety, or wellbeing to them. The artefacts were then photographed and collected in a ‘Gallery of Spiritualities’. These two tools aim to inform people involved in dementia care and reflect upon the diverse spiritual needs that care home residents have. Furthermore, the tools help inform care home managements, care home staff, nursing students and policy makers on how to improve spiritual care for people living with dementia in residential care.

A deathly silence: why has the number of people found decomposed in England and Wales been rising?

The number of deaths occurring in private homes in England and Wales had been rising for years, increasingly rapidly from 2020. Media stories and research linked decomposing bodies found in private homes with pandemic-related social isolation. We aim to explore whether these incidents are one-offs or part of a wider trend. Descriptive analysis of publicly available Office for National Statistics (ONS) data. England and Wales. All residents of England and Wales, 1979 to 2020. Using data from the Office for National Statistics, we calculate European Age Standardised Rates for deaths coded as R98 ('unattended death') and R99 ('other ill-defined and unknown causes of mortality') in the 10th version of the International Classification of Diseases (ICD-10), and the corresponding codes in ICD-9, by sex and age group from 1979 (when ICD-9 began) to 2020. These are proxy markers for deaths where decomposition precludes attribution of a specific cause at postmortem. While mortality from all other causes decreased from 1979 to 2020, the opposite was seen for deaths from R98 and R99 (or 'undefined deaths'), with men more affected than women. There was a sharp rise in these deaths in both sexes but in men particularly in the 1990s and 2000s, coinciding with a time when overall mortality was rapidly improving. The increase in people found dead from unknown causes suggests wider societal breakdowns of both formal and informal social support networks. They are concerning and warrant urgent further investigation. We call on national and international authorities to consider measures that would make it possible to identify these deaths more easily in routine data.

Data Collection in Care Homes for Older Adults: A National Survey in England

Context: In many countries, there is a specification for information that should be collected by care homes. So-called ‘minimum data-sets’ (MDS) are often lengthy, and report on resident health and wellbeing, staff, and facilities. In the UK, the absence of any easily accessible data on the care home population was highlighted at the start of the COVID-19 pandemic. Care homes faced multiple requests for data from external agencies who had little knowledge of what care homes were already collecting. Objective: This study aimed to identify the range (and method) of data collected by care home organisations, in a country without a mandated MDS. Methods: Online survey of care homes (with/without nursing) in England. Care homes recruited via research and care home networks, social media. Questions covered data content, storage, and views on data sharing, analysed with descriptive statistics. Findings: 273 responses were received, representing over 5,000 care homes. Care homes reported extensive data on the health, care and support needs of individual residents, their preferences, and activities. Clinical measures and tools adopted from health were commonly used, but few collected information on quality-of-life. Care homes reported uses of these data that included monitoring care quality, medication use, staff training needs, budgeting, and marketing. Concerns over privacy and data protection regulations are potential barriers to data sharing. Implications: These findings challenge the notion that incentives or mandates are required to stimulate data collection in care homes. Care home organisations are collecting an extensive range of resident-level information for their own uses. Countries considering introducing social care records or an MDS could start by working with care home organisations to review existing data collection and evaluate the implications of collecting and sharing data. A critical approach to the appropriateness of health-related tools in this setting is overdue.

Caring for the dead at home: an exploratory study of home deathcare in England

ABSTRACT At a time when the natural death and home deathcare movements are gaining traction both in the UK and elsewhere, this article details an exploratory project on the barriers to and potential for caring for deceased people at home in England. A two-phase study, the paper uses data from a discourse analysis and interviews with deathcare professionals to show that there is limited information online on keeping the deceased person at home, and that participants felt that a lack of awareness was a significant barrier to families being able to make an informed choices about home deathcare. Including poor information provision, the paper identifies five reasons as to why there is a low uptake of home deathcare in England and makes recommendations for how each of these barriers may be overcome.

Shaping care home COVID-19 testing policy: a protocol for a pragmatic cluster randomised controlled trial of asymptomatic testing compared with standard care in care home staff (VIVALDI-CT)

IntroductionCare home residents have experienced significant morbidity, mortality and disruption following outbreaks of SARS-CoV-2. Regular SARS-CoV-2 testing of care home staff was introduced to reduce transmission of infection, but it...

Harnessing mobility data to capture changing work from home behaviours between censuses

AbstractThis paper provides an analysis of working from home patterns in England using data from the 2021 Census to understand (1) how patterns of working from home (WFH) in England have shifted since the COVID‐19 pandemic and (2) whether human mobility indicators, specifically Google Community Mobility Reports, provide a reliable proxy for WFH patterns recorded by the 2021 Census, providing a formal evaluation of the reliability of such datasets, whose applications have grown exponentially over the COVID‐19 pandemic. We find that WFH patterns recorded by the 2021 Census were unique compared with previous UK censuses, reflecting an unprecedented increase likely caused by persistent changes to employment during the COVID‐19 pandemic, with a clear social gradient emerging across the country. We also find that Google mobility in ‘Residential’ and ‘Workplace’ settings provides a reliable measurement of the distribution of WFH populations across Local Authorities, with varying uncertainties for mobility indicators collected in different settings. These findings provide insights into the utility of such datasets to support population research in intercensal periods, where shifts may be occurring, but can be difficult to quantify empirically.