Home Staff Research Articles

Ethical Editing of Oral Histories: The Experience of the Birmingham Children's Homes Project Archivist

This article describes the legal and ethical problems encountered by the Birmingham Children's Homes Project while collecting oral history interviews from former residents and staff of children's homes. The article briefly discusses the background to the project and the wider debate about re-use of data. It then explains the measures considered and undertaken to edit transcripts of the interviews in order to avoid identifying former looked-after children and to remove remarks made by interviewees which could amount to defamation, while retaining enough content and context to make them valuable resources for both general researchers and former residents of children's homes.

An eye opener on living with dementia

An experiential training course is enabling staff in care homes to appreciate how hard it can be to be on the receiving end of care when you have dementia. The course has prompted immediate changes in how staff relate to residents.

Tuberculosis control programme for the elderly with special focus on early detection

1. Epidemiological trend of TB and its diagnosis among the elderly: Masako OHMORI (Research Institute of Tuberculosis, JATA). It is estimated that over 10,000 TB patients will occur among the elderly aged over 75 years of age during 2010 and 2020. Though the new TB patients among the elderly over 65 years of age decreased in number from 1987 to 2001, sputum smear positive patients, which are highly infectious increased by 1.3 times for the same age group, and 2.3 times for that of over 80 years of age. 17.6% of those elderly patients were detected in institutions, either hospitals or nursing homes. These indicate that the elderly will become higher risk of TB for causing early death and infection to others during their admission in the hospitals or nursing homes. 2. Clinical characteristics of TB among the elderly: Nobuhiko NAGATA (Department of Internal Medicine, National Ohmuta Hospital). Analysis of the 93 elderly TB patients shows that TB diagnosis was delayed among the elderly. For TB diagnosis, 43.2% took over 1 month, and 27.3% over 2 months among the patients over 75 years of age, compared to 22.9% and 9.7% respectively for the patients under 65 years. The prognosis was also poor. Of all who died in the hospital during TB treatment, 40.9% (mostly complicated with other diseases) was among the elderly over 75 years, while it was 6.5% among those under 65 years. Complication of dementia delayed the diagnosis. 79.4% of the smear positive patients over 75 years were diagnosed while admitted in a general ward, and 40% had been admitted 2 weeks or more before diagnosis. 3. Use of serological tests for the diagnosis of TB among the elderly: Atsuyuki KURASHIMA (Department of Clinical Research, National Tokyo Hospital). As TB diagnosis is difficult for the elderly due to non-specific appearances of signs/symptoms, X-ray shadows or negative tuberculin reaction, some serological tests, which have been recently developed, can be useful as a supplementary diagnostic tool. One of them is anti-lipoarabinomannan antibody. 74.3% was positive to this among 148 bacteriologically confirmed TB cases; 77.8% for those aged 65 years and above, and 71.1% for those under 65 years. To anti TBGL antibody, 78% of 170 confirmed TB cases were positive; 75% for those aged 65 years and above, 79.8% for those less than 65 years. Multi-lipo antibody developed by Japan BCG Laboratory showed higher sensitivity of 91.5%. GPL-core antibody may increase the sensitivity. 4. Mode of TB detection in nursing homes: Shinji SHISHIDO (Research Institute of Tuberculosis, JATA). 15 elderly TB patients who had been diagnosed in 23 nursing homes in the last 5 years were analyzed. The average age was 80.7 years. 10 were male and 5 were female. 11 were sputum smear positive. The symptoms were fever (8), cough (7), wheezing (2), hemoptysis (1), chest pain (1), body weight loss (1), appetite loss (1). Number of patients by time durations before consulting a doctor of within 2 weeks, 2 weeks to 1 month, 1 to 2 months, 2 to 3 months, 3 to 6 months, and more than 6 months were 6, 1, 1, 3, 2, 2 respectively. The prognosis: 4 died within 10 days after diagnosis, 4 needed examinations for the symptoms but were delayed in diagnosis as they were not admitted due to dementia or disability. The orientation and training to the staff of the nursing homes are needed for early TB diagnosis. 5. Programme for the early detection of TB among the elderly: Tadayuki AHIKO (Murayama Public Health Center, Yamagata Prefecture). Based on the analysis of 138 confirmed TB cases registered in Yamagata Prefecture in 1998, services for early TB detection among the elderly should be 1) periodical chest X-ray examinations by the patients home doctors when underlying high risk diseases such as diabetes or cancer exist, and 2) -sputum examination for the symptomatic patients. A survey to 31 local governments conducting special TB services showed the special screening programme for the bedridden elderly in nursing homes was not so efficient due to low quality of the available X-ray facilities and low case detection rate. But these X-ray films can be utilized for comparison with those when any symptom arises.

‘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.

Decisions about transferring nursing home residents to hospital: highlighting the roles of advance care planning and support from local hospital and community health services

To explore current practice and opportunities to improve practice in decision-making about transfer of nursing home residents to hospital. Nursing home staff are often faced with the decision of whether to send a resident to hospital for medical treatment. While many residents will benefit from going to hospital, there are also several risks associated with this. This study sought to add to the existing body of research on this issue by seeking the views of nursing home managers, who are the persons most frequently involved in making these decisions. Qualitative design using purposive, quota sampling. Qualitative interviews with 41 nursing home managers from south-western Sydney, Australia. Factors affecting the decision to transfer a resident to hospital include acuteness of their condition; level and style of medical care available; role of family members; numbers, qualifications and skills mix of staff; and concern about criticism for not transferring to hospital. Two factors that have not featured as strongly in previous research are the roles of advance care planning and support from local hospital and community health services. While transferring a nursing home resident to hospital is often necessary, there are many situations where they could be cared for in the nursing home; therefore, avoid complications associated with being in hospital. Apart from a range of factors already identified in the literature, this study has highlighted the important role that advance care planning and support from local health services can play in reducing unnecessary transfers to hospital. There are several strategies that nursing homes and local health authorities can adopt to promote advance care planning and build better support systems between the two sectors, thereby reducing the numbers of residents who need to be transferred to hospital for their health care.

Researching young people’s outcomes in children’s services: Findings from a longitudinal study

• Summary: This article reports findings from a longitudinal study of outcomes for a sample of children who had become, or who were considered at risk of becoming looked after. Using a multi-case study design, two stages of the project are reported here. In Stage One, information was gathered from and relating to 21 young people. In Stage Two, semi-structured interviews were undertaken with 32 social workers, and 31 parents and carers regarding 52 children. Eleven of these young people also volunteered to be interviewed. Standardized measures were utilized including the Strengths and Difficulties Questionnaire, Adolescent Well-Being Scale, and Rosenberg Self-Esteem and Self-Efficacy scale. • Findings: The study highlights the need for preventive multi-agency work with families with multiple risk factors and the importance of education and children’s social care working co-operatively together on behalf of children in need. The study demonstrates the ongoing challenges in providing low level emotional therapeutic work, building on young people’s prosocial relationships with peers, and finding effective ways of improving children’s self esteem and self efficacy. In this local authority children did not feel routinely involved in decision-making. Placement stability, meeting the short and longer-term needs of all placed children, and addressing the needs of foster carers and residential children’s home staff, also presented challenges. • Application: The study highlights the importance of the organizational context when meeting young people’s needs, including strong leadership, quality assurance, ongoing assessment and focused interventions.

Psychosocial interventions through memory clinics

Memory Clinics are associated with early diagnosis and treatment of dementia. Esme Moniz-Cook considers how these might support staff in care homes to assist residents to ‘live well with dementia’.

The day the wild west came to town.

CARE HOME residents and staff dressed as cowboys and Native Americans enjoyed a western-themed fun day recently.

Use of Mental Health Services by Nursing Home Residents After Hurricanes

A growing body of research supports the value of mental health intervention to treat people affected by disasters. This study used a mixed-methods approach to evaluate pre- and posthurricane mental health service use in Florida nursing homes. A questionnaire was administered to 258 directors of nursing, administrators, and owners of nursing homes, representing two-thirds of Florida's counties, to identify residents' mental health needs and service use. In four subsequent focus group meetings with 22 nursing home administrators, underlying factors influencing residents' use of services were evaluated. Although most nursing homes provided some type of mental health care during normal operations, disaster-related mental health services were not routinely provided to residents. Receiving facilities were more likely than evacuating facilities to provide treatment to evacuated residents. Nursing home staff should be trained to deliver disaster-related mental health intervention and in procedures for making referrals for follow-up evaluation and formal intervention.

Care homes’ use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people

Introduction:Care home residents are at particular risk from medication errors, and our objective was to determine the prevalence and potential harm of prescribing, monitoring, dispensing and administration errors in UK...

Managing fire safety in care homes

Fire safety regulations can sometimes appear confusing, with responsibilities unclear. Richard Griffiths explains the current fire regulations and the role of care home proprietors, managers and staff in ensuring fire safety.

Assessment staff in home and community care services: issues of learning and professional identity in Australia

Home and Community Care (HACC) is a funding programme of the Commonwealth and State governments of Australia which supports the vast majority of community care services. Gaining access to basic community care services is via an assessment process undertaken by workers in roles that may be comprised partially or solely of assessment and care planning tasks. Arguably, the role of assessor in the HACC programme has become increasingly professionalised in recent years, and the complexity and demands of the role have increased. However, to date, little information has been available about the composition of this workforce, making initiatives to improve practice difficult to plan and implement. This paper reports findings of research from Victoria in which interviews were conducted with a range of key informants, and staff employed in client assessment roles. Results indicate considerable diversity on issues such as: the professional backgrounds of HACC assessment staff; the education, training and support they receive; how they learn their role; and what they draw upon to assist decision-making. A significant theme to emerge is that the nature of their practice derives substantially from the local contexts in which they work. In the absence of a single profession or narrative that guides their practice, they draw from a diverse range of knowledge sources. The significance of the workplace as a site of professional learning, which may provide the basis for the development of a new qualification for this workforce, is highlighted, as is the need for a professional body for this group of workers.

Kitchen staff found to hold outdated views on diabetes care.

Diabetes is common in the older population and the prevalence in residential care can be as high as 25 per cent. Management of type 2 diabetes is complicated by the fact that it may have no visible symptoms so can be regarded as not serious. It is important that assessment includes the health beliefs of patients and those who are caring for them. Kitchen staff in residential care homes were found to hold old-fashioned views; they thought that a diabetic diet meant that the patient should have no sugar and that diabetic products could be eaten in unlimited quantities.

The impact of the integrated services to home care personnel's job, job satisfaction and quality of services: an intervention study

Introduction: Health and social care services are undergoing integration worldwide. The reform has changed home care work considerably. According to previous studies, home care work has become more versatile and home care workers’ responsibility for home-dwelling elderly who are more fragile has increased. Organisational interventions can strengthen home care work, staff resources and staff well-being. Only a few studies have studied the restructuring from a home care staff point of view. Aim: The aim was to examine the impacts of a work reorganisation intervention on home care personnel’s job, job satisfaction and the quality of services. This work forms part of a larger Finnish project entitled PALKO (Integrated Services in the Practice of Discharge and Home Care). Method: The design involved 11 municipalities randomised to the intervention municipalities and the other half to the controls. The data from home care personnel were gathered via a questionnaire in spring 2001 (ns1183) and in autumn 2003 after the intervention (ns1291). The response rate was 63 per cent in both cases. Results: Nearly all respondents were women and two-thirds were home aids and home help workers. The mean age was 46 years in the intervention group and 44 years in the control group (p-0.001). Otherwise the groups did not differ statistically in background variables. The information flow between home care and hospitals improved in the intervention group compared to the controls. The work load was not reduced. Skill discretion scores did not change in the intervention group between baseline and follow-up. Interestingly, decision authority scores had reduced in the intervention group compared to the control group. There were no statistically significant changes in the job satisfaction scores in either group. The quality of services was rated as better in the intervention group at the follow-up compared to the baseline. Conclusions: There were favourable changes in the home care personnel’s job control and the quality of services in the intervention group compared to the control group. However, outcome measures and possible effects of socially complex interventions need to be discussed more.

The evidence-base for stroke education in care homes

1. What are registered care home nurses' educational priorities regarding stroke care? 2. What are senior care home assistants' educational priorities regarding stroke care? 3. How do care home nurses conceive stroke care will be delivered in 2010? This was a 2-year study using focus groups, stroke guidelines, professional recommendations and stroke literature for the development of a questionnaire survey for data collection. Workshops provided study feedback to participants. Data were collected in 2005-2006. Greater Glasgow NHS Health Board. A stratified random selection of 16 private, 3 voluntary and 6 NHS continuing care homes from which a sample of 115 trained nurses and 19 senior care assistants was drawn. The overall response rate for care home nurses was 64.3% and for senior care assistants, 73.6%. Both care home nurses and senior care assistants preferred accredited stroke education. Care home nurses wanted more training in stroke assessment, rehabilitation and acute interventions whereas senior care assistants wanted more in managing depression, general stroke information and communicating with dysphasic residents. Senior care assistants needed more information on multidisciplinary team working while care home nurses were more concerned with ethical decision-making, accountability and goal setting. Care home staff need and want more stroke training. They are clear that stroke education should be to the benefit of their resident population. Guidelines on stroke care should be developed for care homes and these should incorporate support for continuing professional learning in relation to the resident who has had a stroke.

Covert medication

The practice of nurses hiding drugs in food and drink has been raised publicly by campaigner Hunter Watson, who discovered that staff in a Scottish care home had sedated his mother without consent, and had disguised drugs in her meals. Mr Watson has raised this serious issue with the Scottish Parliament. He told the BBC News at Ten (2nd October 2007), ‘It shouldn't happen. It is very convenient for staff at care homes to conceal drugs in the food and drink of residents, not for therapeutic problems but to make the residents easier to manage’. Covert medication and issues of consent have been debated by nurses and doctors for many years, it is often based on the judgement of a single nurse, and relatives may be kept in ignorance. This may be attributable to a culture of fear surrounding covert medication' (Treloar et al, 2000). However, today there are written guidelines for care home staff in Scotland stating that medication should be hidden in food or drink only when it is in the best interests of a resident, not for the convenience of staff. In England, the Commission for Social Care Inspection rules that staff may not administer medication covertly without the permission of a resident, the resident's family or representative if they are incapacitated, or a doctor who decides that unwanted medication is essential for their health and wellbeing. A doctor or a pharmacist should also be consulted to check that crushing tablets to hide in food is safe.

Providing support at home for families whose children have complex needs

This paper discusses the experiences of parents whose children have complex and continuing health needs in relation to receiving assistance to enable their child to live at home. It focuses on the provision of support in the family home and the challenges as well as benefits that this can present. The findings are taken from a qualitative study of parents’ experiences of having a child who has complex and continuing health needs. While it is a relatively small study, it contributes to an increasing body of evidence that should inform the delivery of support for children and their families. The principal findings of the study are: that despite their necessity, having staff in the family home can constitute a significant intrusion on the lives and privacy of individuals and families; the level of involvement which individuals and families prefer to have with staff varies; having staff in the family home can change the experience of parenting; and that although the provision of staff is intended to assist families, staff can of themselves increase families’ workload. These findings suggest that staff who are involved in supporting children with complex and continuing health needs and their families need to be able to work flexibly, respecting their clients’ choices regarding their home, relationships, child-care practices, and their time. They need to explore how the support provided can maximize quality of life for the child and family while minimizing intrusion.

The Mental Capacity Act 2005 — Issues for managers of care homes and home care services

AbstractThe coming into force of the Mental Capacity Act has been universally welcomed by all involved in the health and social care sector as addressing a much felt need. A closer examination of certain sections of the Act gives reason to believe that its implementation may be by no means as straightforward as one might believe. There are concerns about how staff will be enabled to make the principles underpinning the Act an enduring reality. The concerns around the determination of best interest are discussed and these are examined in the context of caring for clients with complex needs. The issues surrounding the lasting power of attorney for personal welfare are discussed and use is made of a scenario to explore the interaction of a range of factors. The findings give cause for concern to managers and staff in care homes and home care services.

Analysis of a care planning intervention for reducing depression in older people in residential care

Approximately 40% of older people in residential care have significant symptoms of depression. A training and care-planning approach to reducing depression was implemented for 114 depressed residents living in 14 residential care homes in North Yorkshire, UK. Care staff were offered brief mental health training by community mental health teams for older people. They were then assigned to work individually with residents in implementing the care-planning intervention, which was aimed at alleviating depression and any health, social or emotional factors that might contribute to the resident's depression. Clinically significant improvements in depression scores were associated with implementation of the care-planning intervention as evidenced by changes in scores on the Geriatric Mental State Schedule—Depression Scale. There was evidence of an interaction between the power of the intervention and degree of dementia. These improvements were not accounted for by any changes in psychotropic medication. The training was highly valued by care staff and heads of homes, and they considered that the care-planning intervention represented an improvement in quality of care for all residents, irrespective of levels of dementia. Staff also reported improvements in morale and increased confidence in the caring role as a result of their participation. The limitations of this study are discussed. On the basis of a growing body of evidence, it is argued that there is an urgent need for a suitably powered randomised controlled trial and economic evaluation, to test the cost-effectiveness of personalised care planning interventions aimed at reducing depression in older people in residential care.

Police and carers’ views on reporting alleged offences by people with intellectual disabilities

Evidence suggests that care staff have difficulty recognizing offending behaviour in adults with intellectual disabilities (ID) and that they are reluctant to report such behaviour to the police. Whilst there has been speculation as to why there may be such reluctance, there are no empirical studies. In this study, questionnaires using vignettes of fictitious crimes were completed by 80 care staff in residential homes and 65 police officers. The fictitious perpetrators in the vignettes were described either as non-disabled or as having ID. Care staff and police ratings of causal attributions and affect were compared, and the effect of perpetrator status (with or without ID) was also examined. The findings confirmed that care staff are still reluctant to report incidents by people with ID to the police. Carer and police views were generally in accord concerning perpetrators without ID but there were significant differences between groups rating perpetrators with ID.