Care Home Staff Research Articles

102 Online Supportive Conversations & Reflection Sessions [OSCARS] with Care Home Staff Following A Resident’s Death: Improving Coping Mechanisms, Team Cohesion and Communication

IntroductionCOVID-19 Trauma Guidance suggests opportunities for structured, time-limited discussions about challenging experiences should be offered. It is unknown if such discussions can be effectively delivered online by palliative care specialists to support care home (CH) staff in relation to death/dying. Funded by Scotland’s Chief Scientist Office COVID-19 “rapid research” fund, online OSCaRS is being piloted.MethodsFortnightly OSCaRS delivered to small groups of CH staff via a secure online platform in three local CHs over 10 weeks. Sessions are digitally recorded. The shortened version of the Chesney coping self-efficacy questionnaire is completed by all staff pre/post. Additional post-study questions asked of OSCaRS participants and in-depth staff interviews will be undertaken (n = 10). Thematic analysis of the recorded sessions and interviews will be undertaken and related to the staff questionnaire and context of each CH.ResultsNew learning on the feasibility and acceptability of providing OSCaRS to frontline staff. The benefit of OSCaRS to CH staff coping mechanisms, team cohesion and communicaton with relatives during the COVID-19 pandemic will be presented. Initial results show that OSCaRS are feasible, valued by all care home staff and support staff in coping with the challenges of COVID-19/.Key ConclusionsThe analysis will inform future practice, and an Implementation Guide for OSCaRS in CHs will be produced. Key learning on the potential for online support in relation to death/dying during the pandemic and beyond will contribute to future education, training and staff wellbeing resources. It will also inform the role of such sessions in developing individual coping mechanisms and team working alongside communication with relatives during lockdown.

139 What are the Barriers and Facilitators to Effective Advance Care Planning (ACP) in Residential Care Settings for Older People?

Abstract Introduction ACP is recommended for all people approaching the end of life but there is an inequality in access to ACP for care home residents. In North East Essex there has been an Electronic Palliative Care Coordination system (EPaCCS) in place for 6 years, currently without care home staff access capability. The aim of this study was to investigate ACP within care homes within this context. Method A qualitative study, with semi-structured interviews with fourteen senior care home staff from ten care homes across North East Essex. The interview transcripts underwent thematic analysis regarding facilitators and inhibitors to effective ACP. Results Four overarching themes were identified. These were relationships, communication, healthcare systems and attitudes. Care home staff considered ACP to be part of their role but perceived their work in this area to be separate from that performed by other health care professionals. The care home staff awareness of ACP done by other health care professionals was limited. Care home staff were aware of the EPaCCS, but only a minority perceived it to impact on residents care. All interviewees were keen to have access to the EPaCCS. Many of the facilitators and barriers to effective ACP in this locality are consistent with those found in prior literature. Having an EPaCCS within the area did not alleviate a perceived barrier of poor communication. Relationships between staff, residents, families and health care professionals remain the most common facilitators to ACP, with continuity of care from primary care, specialist palliative care and paperwork tools remaining important. Conclusion To overcome the inequity of access to ACP for residents in care homes interventions could be commissioned to address current barriers. These could include communication skills training, aligned primary care and community services as well as technological support for communication with family and access to EPaCCS.

37 Factors Influencing Mealtime Care for People with Dementia Living in Care Homes: An Ethnographic Study

Abstract Introduction More and more people with dementia are living in care homes. Often they depend on care home staff for help with eating and drinking. It is essential that care home staff are able to provide good care at mealtimes. This study used ethnography to identify factors influencing mealtime care for this population. Methods Over twenty-five hours of mealtime observations were conducted in two UK care homes with diverse characteristics. Observations focused on interactions between care home staff and residents living with dementia. Twenty-two semi-structured interviews were carried out with care home staff, family carers, and visiting health and social care professionals, to explore mealtime care from their perspectives. The study used a constant comparison approach, so that data from early observations and interviews were explored in more depth subsequently. Results Five factors were identified which influenced mealtime care for people with dementia living in care homes. These were: environment (such as background music and building layout); kitchen and food (including connectivity between kitchen staff and others); staffing (for example: staff ratios and allocation); knowledge and support (including training, resources and supportive culture); and relationship with wider care team (such as family involvement, and the role of visiting health and social care professionals). Conclusions This study is part of a bigger project which will develop a staff training intervention to improve mealtime care for people with dementia living in care homes. The intervention will be informed by these findings, and by complementary evidence on good practice in mealtime care (from primary and secondary studies). It is anticipated that good mealtime care may improve quality of life for care home residents, and reduce hospital admissions.

164 Standardised Anticipatory Care Planning in Care Homes Reduces Unscheduled Hospital Admissions

Abstract Background Anticipatory care planning (ACP) is a proactive person-centred approach for “thinking ahead”, exploring and recording a person’s goals and preferred actions when their health deteriorates. As a key part of Comprehensive Geriatric Assessment of frail patients, care home (CH) residents would benefit from ACP. Introduction West Lothian has 16 care homes with 853 residents. Between Oct—Dec 2017, 5.21% of CH residents were admitted to hospital each month. Some of these admissions could have been avoided had there been robust ACP in place. Methods In 2017 West Lothian Health and Social Care Partnership appointed a GP lead for Care Homes. Through standardising ACP for CH residents, the goal was to improve the pathway for managing medical emergencies and reduce unnecessary unscheduled care calls and admissions. In 2019 this role was taken over by a team of 2WTE Advanced Nurse Practitioners and 1WTE Staff Nurse. Outcome measures include hospital admission rates, number of ACPs in place and uptake of ACP training amongst CH staff. Interventions In collaboration with the Medicine of the Elderly Department at St John’s Hospital, a standardised ACP Summary document was developed for use in all CHs. A medical advice and emergency flowchart was created to reduce unnecessary hospital admissions. An continuous education programme was delivered across all CH staff to facilitate and implement this. Results Medical admission rates from CHs have decreased by 60% from 6 to 2.2 admissions per week. The largest reduction is in CHs with full ACP use. Conclusions Standardised ACP significantly reduces the number of medical admissions. Continuous education and training is crucial in maintaining its implementation, and ensuring its routine use throughout CHs in West Lothian.

Long-term implementation of the Managing Agitation and Raising QUality of lifE intervention in care homes: Aqualitative study.

The dementia care home workforce receives little specific training. There are successful interventions, improving care outcomes, but it is unclear whether or how to sustain these effects. The Managing Agitation and Raising Quality of Life (MARQUE) intervention aimed to train care home staff to reduce resident agitation and improve quality of life. It was designed for sustainability, with implementation plans agreed with managers. MARQUE improves quality of life. In this separate study, we aimed to examine implementation around 2 years later. We explored practice change since the intervention and considered current implementation of home-specific action plans, enablers or barriers, and perceived benefits or harms of implementation using semi-structured interviews with staff working in the trial homes who received the MARQUE intervention. Six out of 10 intervention homes participated. We interviewed 25 staff, 20-30months after the MARQUE study. In all homes, staff reported that at least one MARQUE component was sustained. Three themes emerged about sustained practice change: (i) communication, (ii) respect and understanding of roles, and (iii) ability to try new things. Notable changes included improved team working and feelings of competence, positive attitude to residents rather than blame for agitation and avoidance, and more pleasant activities. Leadership support was important. It is possible to sustain some change over years in care homes. This study indicates factors which help or impede. These factors individually and together could lead to long-term improved quality of life of residents in homes where it is implemented and sustained.

A critical realist evaluation of advance care planning in care homes.

To evaluate care planning in advance of end-of-life care in care homes. A qualitative study. Qualitative data were collected from January 2018-July 2019 (using focus groups and semi-structured interviews) from three care homes in the South West of England. The data were analysed using thematic analysis followed by Critical Realist Evaluation. Participants comprised of registered nurses (N=4), care assistants (N=8), bereaved relatives (N=7), and domiciliary staff (N=3). Although the importance of advance care planning was well recognized, the emotional labour of frequently engaging in discussions about death and dying was highlighted as a problem by some care home staff. It was evident that in some cases care home staff's unmet emotional needs led them to rushing and avoiding discussions about death and dying with residents and relatives. A sparsity of mechanisms to support care home staff's emotional needs was noted across all three care homes. Furthermore, a lack of training and knowledge appeared to inhibit care home staff's ability to engage in meaningful care planning conversations with specific groups of residents such as those living with dementia. The lack of training was principally evident amongst non-registered care home staff and those with non-formal caring roles such as housekeeping. There is a need for more focused education to support registered and non-registered care home staff to effectively engage in sensitive discussions about death and dying with residents. Furthermore, greater emotional support is necessary to help build workforce resilience and sustain change. Knowledge generated from this study can be used to inform the design and development of future advance care planning interventions capable of supporting the delivery of high-quality end-of-life care in care homes.

The Impact of Prioritisation and Dosing Intervals on the Effects of COVID-19 Vaccination in Europe: An Agent-Based Cohort Model

Background: Different strategies are being explored to maximise the effect of COVID-19 vaccination in Europe. We studied the impact of different population prioritisation and dose intervals on infections, hospitalisations, mortality, and public health restrictions.Method: An agent-based model was built to quantify the impact of different vaccination strategies over 6 months. Input parameters were derived from recent phase 3 trials and official European figures. We explored the prioritisation of vulnerable people, care-home staff and residents, and contagious groups and dose intervals from 3 to 12 weeks.Findings: Prioritising vulnerable people, rather than the most contagious groups, led to higher COVID-19 prevalence, but clear reductions in mortality, hospital admissions, and restrictions. At a realistic vaccination speed of ≤0·1% population/day, separating doses by 12 (instead of 3) weeks reduced hospitalisations, mortality, and restrictions for vaccines with similar first- and second-dose efficacy (e.g., the Oxford-AstraZeneca and Moderna vaccines), but not for those with lower first-dose efficacy (e.g., the Pfizer/BioNTech vaccine).Interpretation: Mass vaccination should dramatically reduce the effect of COVID-19 on Europe’s health and economy. Early vaccination of vulnerable populations will reduce mortality, hospitalisations, and public health restrictions compared to prioritisation of the most contagious groups. The choice of interval between doses should be based on expected vaccine availability and first-dose efficacy, with 12-week intervals preferred over shorter intervals in most realistic scenarios.Funding Statement: The research was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC). DPA is funded through a NIHR Senior Research Fellowship (Grant number SRF-2018-11-ST2-004). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the department of Health. CP research is partially funded by Ministerio de Ciencia e Innovación, Gobierno de España through the grant PGC2018-095456-B-I00. MC is funded by La Caixa Foundation (ID 100010434), under agreement LCF/PR/GN17/50300003.Declaration of Interests: Dr. Prats reports grants from Ministerio de Ciencia e Innovación, Gobierno de España (PGC2018-095456-B-I00), during the conduct of the study; other from European Commission, DG-CONNECT (CNECT/LUX/2020/LVP/0085, LC-01591965), outside the submitted work. Dr. Prieto-Alhambra reports grants and other from AMGEN, grants, non-financial support and other from UCB Biopharma, grants from Les Laboratoires Servier, outside the submitted work; and HTA Funding Committee membership. Janssen, on behalf of IMI-funded EHDEN and EMIF consortiums, and Synapse Management Partners have supported training programmes organised by DPA's department and open for external participants. Dr. CATALÀ reports grants from Ministerio de Ciencia e Innovación, Gobierno de España (PGC2018-095456-B- I00), grants from La Caixa Foundation (ID 100010434), under agreement LCF/PR/GN17/50300003, during the conduct of the study; other from European Commission, DG-CONNECT (CNECT/LUX/2020/LVP/0085, LC-01591965), outside the submitted work. Ms. Li has nothing to disclose.Ethics Approval Statement: Only public aggregated data was used for this study. The use of such data does not require ethics approval.

Restraints and Restrictive Interventions during Essential Personal Care in Elderly People Living with Dementia in Care Homes

Care home staff are frequently required to provide invasive personal care for their residents, and on occasions need to use restraint and restrictive practices with people with dementia. This often occurs in situations where the residents no longer have the insight that they require help and may misperceive the personal assistance as an assault. On a practical level, a significant number of people with dementia are currently being admitted to inpatient units due to their level of resistance around essential personal care. Often these same people are settled at all other times. This paper provides practical advice on how to support residents and their caregivers, and gives clinical, legal and ethical guidance. Previous work undertaken by the present authors have shown that care staff require supervision and coaching on this topic.
 The paper includes training materials used by the authors. This includes a composite, fictitious case example that illustrates approaches that are compliant with UK guidelines. It addresses the training of staff working in care homes.
 As such this paper provides a review and practical example of the appropriate use of restraint for residents unable to consent to the ‘intimate’ care they are receiving. It describes a method delivered in a person-centred manner and within a legal framework. Having read this paper, care home staff should feel more confident, competent and secure in the assistance they are providing in this contentious area.

A scoping review of education and training resources supporting care home staff in facilitating residents' sexuality, intimacy and relational needs.

BackgroundHaving positive intimate, sexual and relational experiences is an important issue for older adults in care settings, yet little is known on the extent to which nursing staff and care workers have received education or training in addressing and meeting these needs among older residents. This scoping review aimed to identify and examine what education and training resources exist to assist nursing staff and care workers to meet their residents’ needs in this area.Methods and analysisUsing the Arksey and O’Malley framework, we systematically searched papers and grey literature to identify education interventions and resources that aimed to facilitate care home staff to meet their residents’ sexuality, intimacy and relational needs.ResultsEleven studies (one dissertation) and three education resources met the inclusion criteria; most were conducted in the USA and Australia. Across the studies and resources identified, the education content was mixed and the methodology, presentation, design and duration varied widely. The focus of the education interventions and resources was to increase knowledge and improve and/or change attitudes towards the: (i) sexual expression of older people living in residential aged care, (ii) sexuality and ageing and (iii) expression of sexuality in people with dementia.ConclusionFew education interventions and training resources were identified. The findings suggest that education interventions can improve knowledge and/or change care staff attitudes, in the short-term, towards older people’s sexuality, intimacy and relational needs in care home settings, which can lead to facilitating staff to enhance person-centred care in this area of need.

Staff's perspectives on the organization of homecare services to people with dementia-A qualitative study.

AimsThe aim of the study was to explore the experiences of homecare staff about the impact of the organization of homecare services for people with dementia.DesignThis study has a qualitative, exploratory design based on a phenomenological‐hermeneutic approach, using individual in‐depth interviews with homecare staff to collect data.MethodsA convenience sample of 14 homecare staff from five municipalities participated in the study. Main topics introduced: (a) how homecare services for people with dementia are organized and (b) challenges in respondents' everyday practice of caring for people with dementia. Interviews were conducted from October to December 2017.ResultsThree main themes were identified from the interviews. (a) Complexity and need for individualized facilitated homecare services; homecare services were described as complex in regard to both the patient and the service. The complexity of the service made it challenging to tailor the service to the individual patient. (b) The importance of trust and relationships; establishing trust in the relationship between the patient and the staff resulted in better‐quality care. This was crucial for identifying the patient's need for help. (c) Organizational challenges; homecare services could be vulnerable to changes in the organization. Practical tasks and following the daily scheduled task list were often prioritized at the expense of an individually tailored service.

Mass testing after a single suspected or confirmed case of COVID-19 in London care homes, April-May 2020: implications for policy and practice.

Introduction: Previous investigations have identified high rates of SARS-CoV-2 infection among residents and staff in care homes reporting an outbreak of COVID-19. We investigated care homes reporting a single suspected or confirmed case to assess whether early mass testing might reduce risk of transmission during the peak of the pandemic in London.Methods: Between 18–27 April 2020, residents and staff in care homes reporting a single case of COVID-19 to Public Health England had a nasal swab to test for SARS-CoV-2 infection by RT-PCR and subsequent whole genome sequencing. Residents and staff in two care homes were re-tested eight days later.Results: Four care homes were investigated. SARS-CoV-2 positivity was 20% (65/333) overall, ranging between 3–59%. Among residents, positivity ranged between 3–76% compared to 3–40% in staff. Half of the SARS-CoV-2 positive residents (23/46, 50%) and 63% of staff (12/19) reported symptoms within 14 days before or after testing. Repeat testing 8 days later in two care homes with the highest infection rates identified only two new cases. Genomic analysis demonstrated a small number of introductions of the virus into care homes, and distinct clusters within three of the care homes.Conclusions: We found extensive but variable rates of SARS-CoV-2 infection among residents and staff in care homes reporting a single case of COVID-19. While routine whole home testing has now been adopted into practice, care homes must remain vigilant and should be encouraged to report a single suspected case, which should trigger appropriate outbreak control measures.

Is it possible to influence ability, willingness and understanding among nursing home care staff to implement nutritional guidelines? A comparison of a facilitated and an educational strategy.

Translating nutrition knowledge into care practice is challenging since multiple factors can affect the implementation process. This study examined the impact of two implementation strategies, that is external facilitation (EF) and educational outreach visits (EOVs), on the organisational context and individual factors when implementing nutritional guidelines in a nursing home (NH) setting. The EF strategy was a one-year, multifaceted (including support, guidance, a practice audit and feedback) intervention given to four NH units. The EOV strategy was a three-hour lecture about the nutritional guidelines given to four other NH units. Both strategies were directed at selected NH teams, consisting of a unit manager, a nurse and 5-10 care staff. A questionnaire was distributed, before and after the interventions, to evaluate the prerequisites for the staff to use the guidelines. Three conditions were used to examine the organisational context and the individual factors: the staff's ability and willingness to implement the nutritional guidelines and their understanding of them. Confirmatory factor analysis and structural equation models were used for the data analysis. The results indicated that on average, there was a significant increase in the staff's ability to implement the nutritional guidelines in the EF group. The staff exposed to the EF strategy experienced better resources to implement the guidelines in terms of time, tools and support from leadership and a clearer assignment of responsibility regarding nutrition procedures. There was no change in staff's willingness and understanding of the guidelines in the EF group. On average, no significant changes were observed for the staff's ability, willingness or understanding in the EOV group. A long-term, active and flexible implementation strategy (i.e. EF) affected the care staff's ability to implement the nutritional guidelines in an NH setting. No such impact was observed for the more passive, educational approach (i.e. EOV).

How quality improvement collaboratives work to improve healthcare in care homes: a realist evaluation.

BackgroundQuality improvement collaboratives (QICs) bring together multidisciplinary teams in a structured process to improve care quality. How QICs can be used to support healthcare improvement in care homes is not fully understood.MethodsA realist evaluation to develop and test a programme theory of how QICs work to improve healthcare in care homes. A multiple case study design considered implementation across 4 sites and 29 care homes. Observations, interviews and focus groups captured contexts and mechanisms operating within QICs. Data analysis classified emerging themes using context-mechanism-outcome configurations to explain how NHS and care home staff work together to design and implement improvement.ResultsQICs will be able to implement and iterate improvements in care homes where they have a broad and easily understandable remit; recruit staff with established partnership working between the NHS and care homes; use strategies to build relationships and minimise hierarchy; protect and pay for staff time; enable staff to implement improvements aligned with existing work; help members develop plans in manageable chunks through QI coaching; encourage QIC members to recruit multidisciplinary support through existing networks; facilitate meetings in care homes and use shared learning events to build multidisciplinary interventions stepwise. Teams did not use measurement for change, citing difficulties integrating this into pre-existing and QI-related workload.ConclusionsThese findings outline what needs to be in place for health and social care staff to work together to effect change. Further research needs to consider ways to work alongside staff to incorporate measurement for change into QI.

Structural discrimination and abuse: COVID-19 and people in care homes in England and Wales

PurposeThe purpose of this paper is to explore the significant and high death toll of COVID-19 on care home residents and social care staff in England and Wales. These mortality figures, alongside differential treatment of residents and staff during the pandemic, are conceptualized as a form of structural abuse. Arguments are made for the inclusion of structural abuse as a separate category of elder abuse.Design/methodology/approachThis paper is predominantly conceptual but it also draws on available secondary data, such as mortality statistics, media reports and developing research.FindingsThe lack of appropriate personal protective equipment, paucity of guidance and high mortality rate among care home staff and residents during the pandemic is indicative of social discourses that, when underpinned by ageism, reflect structural elder abuse.Research limitations/implicationsThe research is limited by its focus on a specific time period and its recency. It is also limited in not being based on primary empirical research but it remains exploratory and conceptual and provides a base for ongoing research in this area.Social implicationsIf structural elder abuse was to be included in classifications, it demands a rethink of social and health-care services and the policies and practices associated with them and reinforces the government message that safeguarding is everyone’s business.Originality/valueResearch concerning the effects and impact of COVID-19 are still in their early stages. However, the central element of originality in the paper concerns the linking of practices, policies and underlying social assumptions and structural, or societally ingrained, elder abuse.

Admiral Nurse Case Management within Enhanced Health in Care Homes

The United Kingdom’s (UK) older population is higher than the global average. Over the next 20 years, England will see an increase in the number of older people who have higher levels of dependency, dementia, and comorbidity many of whom may require 24-hour care. Currently it is estimated that 70% of residents in nursing and residential care homes either have dementia on admission or develop it whilst residing in the care home. The provision of high-quality care for this population is a challenge with a lack of consistency in the provision of primary care and specialist services and a known gap in knowledge and skills. The NHS Long Term Plan aims to move care closer to home and improve out of hospital care which includes people who live in care homes by introducing Enhanced Health in Care Homes (EHCH). However, such services need to be equipped with the correct skill mix to meet the needs of the care home population. Admiral Nurses are specialists in dementia care and are well placed to support the delivery of EHCH and improve access to specialist support to care home residents, their families, care home staff and the wider health and social care system. This paper discusses current gaps in service provision and how both the EHCH framework, and the inclusion of Admiral Nurses, might redress these and improve outcomes.

Staff experiences of implementing Dementia Care Mapping to improve the quality of dementia care in care homes: a qualitative process evaluation

BackgroundDementia Care Mapping™ (DCM) is a widely used, staff-led, psychosocial intervention to support the implementation of person-centred care. Efficacy evaluations in care homes have produced mixed outcomes, with implementation problems identified. Understanding the experiences of staff trained to lead DCM implementation is crucial to understanding implementation challenges, yet this has rarely been formally explored. This study aimed to examine the experiences of care home staff trained to lead DCM implementation, within a large cluster randomised controlled trial.MethodsProcess evaluation including, semi-structured interviews with 27 trained mappers from 16 intervention allocated care homes. Data were analysed using template variant of thematic analysis.ResultsThree main themes were identified 1) Preparedness to lead - While mappers overwhelmingly enjoyed DCM training, many did not have the personal attributes required to lead practice change and felt DCM training did not adequately equip them to implement it in practice. For many their expectations of the mapper role at recruitment contrasted with the reality once they began to attempt implementation; 2) Transferring knowledge into practice – Due to the complex nature of DCM, developing mastery required regular practice of DCM skills, which was difficult to achieve within available time and resources. Gaining engagement of and transferring learning to the wider staff team was challenging, with benefits of DCM largely limited to the mappers themselves, rather than realised at a care home level; and 3) Sustaining DCM - This required a perception of DCM as beneficial, allocation of adequate resources and support for the process which was often not able to be provided, for the mapper role to fit with the staff member’s usual duties and for DCM to fit with the home’s ethos and future plans for care.ConclusionsMany care homes may not have staff with the requisite skills to lead practice change using DCM, or the requisite staffing, resources or leadership support required for sustainable implementation. Adaptations to the DCM tool, process and training may be required to reduce its complexity and burden and increase chances of implementation success. Alternatively, models of implementation not reliant on care home staff may be required.

The Contribution of Pharmacists and Pharmacy Technicians to Person-Centred Care within a Medicine’s Optimisation in Care Homes Service: A Qualitative Evaluation

Pharmacists and pharmacy technicians seek to improve person-centred care. Improvements to systems for care homes seeks to reduce medicines waste and inefficiency, particularly through supporting care home staff, to enhance safer administration of medicines. A complex evaluation used qualitative design and utilised narrative enquiry, and team members and key stakeholders were interviewed. Framework analysis was used, aligning findings to a person-centred care framework for older people. The Medicines Optimisation in Care Homes (MOCH) team brokered improvement practices across care homes to enhance person-centred care. The framework analysis confirms that the team used ‘authentic attention’ in relation to the residents’ experiences and flexibility in relation to negotiating medication. The importance of transparency of processes and systems in medicines management is highlighted, alongside requirements for person-centred care to make explicit the reason for taking a medication, and the continuous discussion with a range of stakeholders about the continuing need for particular medications. The outcome of the evaluation includes insights into a new area of pharmacy practice in community, based on the skills, knowledge, and experience of pharmacists and pharmacy technicians working in the care home sector. Further study is needed into the efficacy and outcomes of medicines management interventions.

Care homes, their communities, and resilience in the face of the COVID-19 pandemic: interim findings from a qualitative study

BackgroundFrom late February 2020, English care homes rapidly adapted their practices in response to the COVID-19 pandemic. In addition to accommodating new guidelines and policies, staff had to adjust to rapid reconfiguration of services external to the home that they would normally depend upon for support. This study examined the complex interdependencies of support as staff responded to COVID-19. The aim was to inform more effective responses to the ongoing pandemic, and to improve understanding of how to work with care home staff and organisations after the pandemic has passed.MethodsTen managers of registered care homes in the East Midlands of England were interviewed by videoconference or phone about their experiences of the crisis from a structured organisational perspective. Analysis used an adapted organisational framework analysis approach with a focus on social ties and interdependencies between organisations and individuals.ResultsThree key groups of interdependencies were identified: care processes and practice; resources; and governance. Care home staff had to deliver care in innovative ways, making high stakes decisions in circumstances defined by: fluid ties to organisations outside the care home; multiple, sometimes conflicting, sources of expertise and information; and a sense of deprioritisation by authorities. Organisational responses to the pandemic by central government resulted in resource constraints and additional work, and sometimes impaired the ability of staff and managers to make decisions. Local communities, including businesses, third-sector organisations and individuals, were key in helping care homes overcome challenges. Care homes, rather than competing, were found to work together to provide mutual support. Resilience in the system was a consequence of dedicated and resourceful staff using existing local networks, or forging new ones, to overcome barriers to care.ConclusionsThis study identified how interdependency between care home organisations, the surrounding community, and key statutory and non-statutory organisations beyond their locality, shaped decision making and care delivery during the pandemic. Recognising these interdependencies, and the expertise shown by care home managers and staff as they navigate them, is key to providing effective healthcare in care homes as the pandemic progresses, and as the sector recovers afterwards.

Buddying up: implementing a personal protective equipment buddy system in a care home environment

With the third wave of COVID-19 once again gripping the country, care home staff are under increasing pressure. Karen Hayes and Gail Beckett outline the introduction of a personal protective equipment buddy system that was well received by those working in a care home environment in their locality.

Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK

IntroductionPalliative and end-of-life care in care homes is often inadequate, despite high morbidity and mortality. Residents can experience uncontrolled symptoms, poor quality deaths and avoidable hospitalisations. Care home staff can...