Care Home Managers Research Articles

Involuntary relocation and safe transfer of care home residents: a model of risks and opportunities in residents' experiences

ABSTRACTFew studies explore the application of literature on care home closures in practice or how it can influence residents' experiences. The aim of this study was to investigate from multiple perspectives how a protocol, designed by a local council for the involuntary relocation and safe transfer of older adult residents, was adhered to and the influence that the protocol had on the experiences of residents who relocated from two care homes. Interviews were conducted with 34 stakeholders, including relocated residents (N=11), relatives (N=2), care home staff (N=13), managers (N=6) and advocates (N=2), and analysed using framework analysis. The protocol covered key aspects of guidelines extracted from research evidence grouped into four themes:involvement; staff approaches; preparation; andconsistency and familiarity, with the majority of the guidelines being followed in practice. Two further themes that centred on theprocesses of transitional adjustmentandimpact of relocationwere influenced by the protocol but were also mediated by factors relating to the environment and the resident. Involvement of residents, relatives and advocates, extensive planning and a person-centred approach were of particular importance in improving residents' experiences of relocation. A model that places residents' experiences at the centre of relocations is proposed, which draws on and applies the themes identified in this study and applies them within the context of opportunities and risks.

Access to traumatic spinal cord injury care in Saskatchewan, Canada: A qualitative study on community healthcare provider perspectives

Healthcare provider experiences with access to care for disabled patient populations may inform healthcare system change and improve health outcomes. Persons with spinal cord injury often require access to life-long care. The objective of this study was to explore healthcare provider perspectives on client access to care in traumatic spinal cord injury. We used an interpretive qualitative study with semi-structured interviews and focus groups to explore provider perspectives on five access dimensions: availability, accessibility, affordability, accommodation, and acceptability. Volunteer (n=23) healthcare providers (therapists, physicians, nurses, home care workers and managers) working with traumatic spinal cord injury clients in Saskatchewan participated. Nine healthcare providers serviced rural areas. Healthcare providers felt restricted in their ability to ensure availability of services. In rural areas, therapy and counselling services were often not available. Parking and transportation barriers severely impacted the accessibility of services. Inconsistencies related to the affordability of equipment and accessible housing were expressed. Efforts to accommodate clients to remain in their home communities were apparent. Night time or early morning care seemed impossible to accommodate. Healthcare providers accepted that attitudes and efforts concerning health advocacy among clients, families, and other care providers impacted access. Barriers related to availability, accessibility, and affordability were perceived to affect traumatic spinal cord injury care. Healthcare providers identified the need to accommodate clients’ needs by assuming different healthcare and advocacy roles, especially in the face of service shortages. However, restrictions imposed by administrative guidelines, policies or cost were perceived to limit the ability to fully accommodate client’s needs.

How to … produce an effective press release and handle media attention

NRC's Consultant Editor, Adrian Ashurst provides some ideas to assist care home managers in dealing with the media, including an example of how to write a press release

What to do when you receive an employment tribunal claim

With changes being implemented in the way employees can pursue an employment tribunal claim, Mark Stevens advises care home managers and owners how to deal with any claims that are received

ACTIVITIES OF A MANAGER IN OPTIMIZATION OF A SOCIAL PEDAGOGUE’S WORK IN CHILD CARE HOMES: OPINION OF SOCIAL PEDAGOGUES

The issue of activities of a manager in optimization of work of social pedagogues in child care homes is discussed in the article. A child care home manager is responsible for the children’s welfare, their successful socialization and integration in the society. He seeks for favourable results of this institution by ensuring relationship based on cooperation. He takes care of impromevement of employees, provision of proper working and development conditions, cooperation with other institutions. When resolving these and other issues of children welfare a manager becomes the main person initiating optimization of employees’ activities. The following question arises: what are activities of a manager in optimization of work of a social pedagogue in a child care home? The aim of this article is to disclose possibilities of managers’ activities in optimizations of work of a social pedagogue in child care homes. A research was carried out for achievement of the aim wherein a total of 63 social pedagogues of Klaipėda child care homes participated (a total of 14 institutions). The research disclosed that social pedagogues are not satisfied with the current role of a manager in optimization of activities of a social pedagogue. The optimization of activities of a social pedagogue is manifested at work with learners and their groups when seeking for professional and personal development of a social pedagogue and organization of preventive work. A manager tends to leave optimization of activities of a social pedagogue to the very employees. KEYWORDS: Manager, child care home, social pedagogue, optimization of activities.

How to … manage time and resources more effectively

Today the demands on a care home manager's precious time and resources need to be prioritised, Nursing & Residential Care's Consultant Editor, Adrian Ashurst, shares his top tips to improve the manager's role

Psycho-educational Approaches in Long-term Care Homes: Direct Care Workers and Managers’ Perspectives

The majority of the Direct Care Workers (DCWs) in long-term care (LTC) facilities have no formal qualifications or training on dementia and experience high levels of stress and burnout as a result of dementia-related symptoms and behaviours. Psycho- educational (PE) approaches can be effective in supporting DCWs, yet, they are underdeveloped within the context of formal care. Therefore, this study aimed to explore the expectations and concerns of care home managers (service managers and top- level managers) and DCWs about PE interventions. A qualitative, cross-sectional study was conducted. Individual interviews with 8 managers (75% female; mean age 45.5 ± 10.26) and 8 focus-group interviews with a total of 58 DCWs (female; mean age of 44.72 ± 9.06) of 4 LTC facilities were performed. All interviews were recorded, transcribed and analysed through thematic analysis by 2 independent judges. Managers’ main expectations were related to the opportunity to improve DCWs’: understanding and attitudes towards dementia; ability to interact with residents; motivation and job satisfaction. DCWs expected to: acquire knowledge and practical skills to deal with dementia; develop their knowledge about resident's biography; enhance their ability to deal with job strain; share experiences and improve group cohesion. Lack of time and support to translate learning into practice and sustain potential benefits over time were anticipated as the main barriers by both elements. There were coincident expectations and concerns among both managers and DCWs. Findings underscore the importance of targeting both DCWs-level and manager-levels perspectives to the planning of a sustainable PE intervention for DCWs.

Enabling research in care homes: an evaluation of a national network of research ready care homes

BackgroundIn the UK care homes are one of the main providers of long term care for older people with dementia. Despite the recent increase in care home research, residents with dementia are often excluded from studies. Care home research networks have been recommended by the Ministerial Advisory Group on Dementia Research (MAGDR) as a way of increasing research opportunities for residents with dementia. This paper reports on an evaluation of the feasibility and early impact of an initiative to increase care home participation in research.MethodsA two phase, mixed methods approach was used; phase 1 established a baseline of current and recent studies including the National Institute for Health Research portfolio. To explore the experiences of recruiting care homes and research participation, interviews were conducted with researchers working for the Dementia and Neurodegenerative Diseases Research Network (DeNDRoN) and care home managers. In phase 2, four DeNDRoN area offices recruited care homes to a care home network for their region. The care home networks were separate from the DeNDRoN research network. Diaries were used to document and cost recruitment; DeNDRoN staff were interviewed to understand the barriers, facilitators and impact of the care home networks.ResultsThirty three current or recent studies were identified as involving care homes as care home specific studies or those which included residents. Further details of care home recruitment were obtained on 20 studies by contacting study teams. Care home managers were keen to be involved in research that provided staff support, benefits for residents and with minimal disruption. In phase 2, 141 care homes were recruited to the care home research networks, through corporate engagement and individual invitation. Pre-existing relationships with care homes facilitated recruitment. Sites with minimal experience of working with care homes identified the need for care home training for researchers.ConclusionsPhase 1 review revealed a small but increasing number of studies involving care homes. Phase 2 demonstrated the feasibility of care home research networks, their potential to increase recruitment to research and develop partnerships between health services and care homes, but highlighted the need for care home training for researchers.

Perceptions Of Clinical Leadership In An Aged Care Residential Facility In Perth, Western Australia

Objective: To investigate the perceptions and approaches to leadership and leadership development of senior nurses and care home managers in an aged care residential facility. Method: A descriptive phenomenological research approach was employed to support purposive sampling. A questionnaire (n=10) was used, followed by interviews (n=8). Analysis employed an SPSS and NVivo 0.6 computer programs, with manual data configuration as required. Results: Participants saw a distinction between their role as leaders and managers and that their more clinically focused responsibilities favoured a greater affinity with clinical leadership. In addition, the attributes and characteristics of clinical leaders identified by participants were approachability, clinical skills, clinical knowledge, honesty, integrity, support for others and visibility in the clinical area. Conclusion: The development and deployment of clinical leadership attributes are vital so that senior nurses and care home managers can play a more effective part in care provision and service improvement in the residential care environment.

A simple guide to setting up an online shopping account

In this article, Adrian Ashurst discusses the benefits of online shopping for managers of care homes and how it can benefit the organisation through value for money, convenience, and providing quality products and excellent customer service

Assessment of the implementation of the National Cold Weather Plan for England

BackgroundTo address the large wintertime health burden in England, the Department of Health introduced a Cold Weather Plan (CWP) in 2011, which provides advice to relevant organisations and the general public on actions that should be taken to protect vulnerable individuals during cold weather. The Department of Health commissioned the Policy Innovation Research Unit at the London School of Hygiene and Tropical Medicine to undertake an assessment of the implementation of the CWP over winter 2012–13 and to begin to assess its potential health benefits and costs. MethodsThe research consisted of time-series regression and episode analysis of historic records of daily mortality, 1993–2006 (from the Office for National Statistics) and emergency hospital admissions and accident and emergency department visits, 1997–2010 (both from the Health and Social Care Information Centre), linked to weather data for each region of England. Models were adjusted for seasonal factors unrelated to temperature and possible day-of-week effects. Semistructured telephone interviews (n=52) with staff involved in the implementation of the CWP were done in ten local authorities selected from within regions of the country with different winter weather patterns to provide a spread of urban versus rural areas and levels of socioeconomic deprivation. Interviews focused on the operational policy changes and health-care or social-care services' response to the introduction of the CWP for comparison with the expectations contained in the plan. 25 local authority managers, 13 National Health Service (NHS) commissioners, four NHS acute or community trust managers, two NHS ambulance trust managers, six care home managers, one family doctor, and one voluntary sector manager were interviewed, dependent on the local allocation of responsibility for CWP implementation between agencies. Analysis of CWP-related plans and related documents in the ten local authority areas was done. A national survey was undertaken of 8500 community nurse members of the Royal College of Nursing, of whom 437 (5%) responded. Semi-structured telephone interviews (n=35) with individuals at high risk from cold weather exposure living in their own homes in two local authorities were also done. People were interviewed shortly after a level 3 cold weather alert had been issued, which is issued when severe winter weather is occurring. FindingsCold-related effects were noted for both mortality and hospital use but the biggest cold burdens occurred at temperatures outside the alert thresholds used in the CWP. Effects could be delayed by up to 4 weeks after initial exposure. The CWP and the cold weather alerts were viewed as a helpful exposition of good practice by local health-care and social-care managers. The CWP formalised existing activity and helped to coordinate the actions of a wide range of staff in different agencies. There were examples of innovations that local staff attributed directly to the CWP (eg, a push to raise influenza immunisation levels of front-line staff). Analysis of the interviews with people living in the community suggested that interventions aimed at people who are vulnerable to cold should focus on people who live in cold homes and are socially isolated. InterpretationThe CWP is broadly welcomed and has the potential to reduce cold-related public health effects and health services usage, but the alerts may need revision. The present study is limited by the fact that the most robust quantitative evidence on the effectiveness of the CWP will only come once there are sufficient years after intervention to assess any changes in weather–health relations. FundingDepartment of Health Policy Research Programme.

Maintaining dignity for residents of care homes: A qualitative study of the views of care home staff, community nurses, residents and their families

This study uses the Framework approach to qualitative analysis to explore and compare the views of residents in care homes for older people, their families and care providers on maintaining dignity. We interviewed 33 care home managers, 29 care assistants, 18 care home nurses, 10 community nurses, 16 residents and 15 members of residents' families. The most prevalent themes were: “independence,” and “privacy”; followed by “comfort and care,” “individuality,” “respect,” “communication,” “physical appearance” and “being seen as human.” Residents and their families sometimes described incidents where a resident's dignity had been compromised. How to help residents maintain dignity and focusing on fostering dignity, can be a starting point for improving the quality of care and quality of life of residents. It is, however, important to remove the gap between the rhetoric of dignity conserving care and the reality experienced by residents in these and other care settings.

P1 Improving End of Life Care (EoLC) in care homes: An action learning and education development programme for care home leaders

In the last decade there has been considerable investment in end of life teaching to the care home sector with particular reference to the Gold Standards Framework and Six Steps...

Behavioural and psychological symptoms of dementia and their management in care homes within the East of England: a postal survey

Objectives: To determine the prevalence of antipsychotic use in care homes. To explore which behaviours care home staff can find difficult to manage and which non-pharmacological interventions are currently used within care homes to help cope with behavioural and psychological symptoms of dementia.Method: A postal survey sent to all care homes registered as specialising in the care of older people or/and older people with dementia within four counties in the East of England (n = 747).Results: Questionnaires were returned from 299 care home managers (40%). The vast majority (n = 200, 73%) reported having at least one resident with an antipsychotic prescription in their home. Twelve percent (n = 1027) of care home residents were reported to be prescribed antipsychotic medications. Aggression was most frequently reported, by 37% (n = 109) of care home managers, as a difficult behaviour to manage. Non-pharmacological interventions were reported to be used in 87% (n = 253) of care homes. The interventions most commonly used in care homes to manage difficult behaviours were reminiscence (75%, n = 219) and music therapy (73%, n = 213).Conclusion: This survey was a first attempt to estimate the use of antipsychotics in care homes. Despite measures to reduce antipsychotic use for all people with dementia in England, we found that 12% of care home residents were still prescribed antipsychotic medication. Around half of all care home managers reported they had experienced behaviours they found difficult. Antipsychotic medications and a variety of non-pharmacological interventions appear to be used concurrently in many care homes.

Putting patients first

Care home manager Geraldine Browne has improved the quality of care for her patients and reduced the number of hospital admissions. The changes, enthusiastically implemented by staff, have won her the RCN Northern Ireland nurse of the year award.

Explaining the barriers to and tensions in delivering effective healthcare in UK care homes: a qualitative study

ObjectiveTo explain the current delivery of healthcare to residents living in UK care homes.DesignQualitative interview study using a grounded theory approach.Setting6 UK care homes and primary care professionals serving the...

Practice Learning in Private Care Homes for Older People—A Two-Way Resource

This paper reports on three evaluated projects of social work placements in private care homes for older people in Scotland. This was a new situation for each of the care homes. They were uncertain about the student role and this was initially challenging for the students. Reported outcomes of these placements include deep learning for the students who developed core social work skills and an understanding of ageism within a relationship-based model of social work. The care homes reported considerable benefit from the presence of the student in terms of raising overall standards of practice and enhancing the opportunities which they could offer to residents. An increase in inter-professional understanding was reported by all respondents and this had been a major factor in the motivation of care home managers in agreeing to participate in the projects. Planning, preparation and communication were cited as challenges in some of the studies. Because they are new and different in the UK, such developments must be supported and nurtured, and considering groups of such placements as projects to be managed holistically would work to the advantage of all stakeholders, especially the care home residents who gained so much from these projects.

The many faces of the job: boss, manager, friend

Judy addison and Christine Bunce discuss how their experience as managers of care homes has highlighted certain strengths in their attitude and capability of the job at hand

Quality of Life Versus Quality of Care: Elderly People and Their Experience of Care in South Australian Residential Facilities

Residential aged care facilities provide care to elderly people but do they provide quality of life? Current issues such as the growth of the elderly population, increasing longevity and resulting complex health problems, financial demands, and policy inadequacies highlight the need for investigation into the aged care sector. In particular, residential care is seen as requiring analysis, due to the highly vulnerable nature of recipients. While nursing homes often profess to provide ‘holistic’ or ‘person-centred’ care to their residents, the evidence suggests that institutional goals will take precedence. Thus the research question for this study is ‘Does residential care in South Australia enable recipients to live to their full potential?’ The research method for this project will utilise in-depth, semi-structured interviews with a sample of 10 residents from two residential facilities. Findings reveal that while participants of the study are reasonably satisfied with the quality of care they receive, they are not able to live to their full potential. This has implications in many industrial and post industrial nations with ageing populations, for care home management and social work practice with older people living in residential care settings.

Limits of Mental Capacity Act training for residential care homes

PurposeThe Mental Capacity Act (MCA) was implemented in 2007 as a piece of legislation to empower and protect adults who require support making decisions. Many older adults in residential care homes will be in this position due to developmental disabilities associated with functional impairments of the mind and brain. This paper aims to evaluate the impact of MCA training within older persons' care homes within an East‐Midlands local authority.Design/methodology/approachSemi structured interviews were conducted with key informants who had strategic responsibility for implementation of MCA training as well as a focus group conducted with managers/deputy managers of care homes within the local authority.FindingsWith a primary focus on training, data revealed issues surrounding the delivery and content of training, and the organisational factors relating to both training and the subsequent implementation of the knowledge learned.Research limitations/implicationsThe key informants for this paper are limited to management perspectives. Interviews and a focus group were conducted with stakeholders who either had direct responsibility for service delivery or managerial oversight for training and development.Practical implicationsThe paper suggests methods of delivery with the Mental Capacity Act which offer a tailored, engaging and cost effective alternative to conventional “away day” training sessions.Originality/valueThe paper challenges and critiques conventional approaches to training the social care workforce.