Evaluation of the Mental Health of Care Home Staff in the Covid‐19 Era. What price did care home workers pay for standing by their patients?

AimsTo understand the level of training given to staff in providers of accommodation in the London Borough of Hackney across mental and physical health.MethodThe Urgent and Emergency Care Collaborative (Health Education England) put out a call for funding bids around a number of workforce priority areas. This included upskilling care home staff to reduce admissions. We considered care home staff as those working across supported living schemes, housing with care, residential and nursing homes. Some of these settings exclusively support people with mental health needs.We obtained a list of accommodation providers across the borough via the Local Authority. As a Community Rehabilitation team we work closely with many of the providers. We also co-facilitate the Hackney Mental Health Supported Accommodation panel and review all funded placements annually. We made contact via email and phonecall and arranged face to face meetings with 11 providers. We asked a standard set of questions about the organisation and training provision. We also asked them to identify gaps in training.ResultThe level of training provided to staff varies vastly across different settings. There was a predominance of e-learning for some providers. Most staff in mental health settings are support worker level which limits the level of training offered/received.Providers varied greatly in size of project and management structure and this directly impacts on access to training, often as a result of cost.Providers were able to identify training gaps and were keen to have additional training.Some common themes emerged – dual diagnosis, psychosis, medication – and some setting specific themes – dementia.Based on the gaps identified we provided training sessions to a total of ~40 staff across a number of settings. Content included mental health awareness, crisis signposting and medicines management. All sessions were well received with pre and post-training questionnaires demonstrating an improvement in knowledge and confidence.ConclusionThere is potential for knowledge sharing across accommodation settings and for stronger links between accommodation providers and healthcare providers. We plan to explore the possibility of quantitative data on the number of Emergency Department presentations from accommodation settings locally.

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Medical Crises in Older People: cohort study of older people attending acute medical units, developmental work and randomised controlled trial of a specialist geriatric medical intervention for high-risk older people; cohort study of older people with mental health problems admitted to hospital, developmental work and randomised controlled trial of a specialist medical and mental health unit for general hospital patients with delirium and dementia; and cohort study of residents of care homes and interview study of health-care provision to residents of care homes

Programme Grants for Applied Research ◽

10.3310/pgfar03040 ◽

2015 ◽

Vol 3 (4) ◽

pp. 1-410 ◽

Cited By ~ 5

Author(s):

John Gladman ◽

Rowan Harwood ◽

Simon Conroy ◽

Pip Logan ◽

Rachel Elliott ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Cohort Study ◽

Randomised Controlled Trial ◽

Older People ◽

Controlled Trial ◽

Care Home ◽

Cost Effective ◽

Care Home Staff ◽

Randomised Controlled

BackgroundThis programme of research addressed shortcomings in the care of three groups of older patients: patients discharged from acute medical units (AMUs), patients with dementia and delirium admitted to general hospitals, and care home residents.MethodsIn the AMU workstream we undertook literature reviews, performed a cohort study of older people discharged from AMU (Acute Medical Unit Outcome Study; AMOS), developed an intervention (interface geriatricians) and evaluated the intervention in a randomised controlled trial (Acute Medical Unit Comprehensive Geriatric Assessment Intervention Study; AMIGOS). In the second workstream we undertook a cohort study of older people with mental health problems in a general hospital, developed a specialist unit to care for them and tested the unit in a randomised controlled trial (Trial of an Elderly Acute care Medical and mental health unit; TEAM). In the third workstream we undertook a literature review, a cohort study of a representative sample of care home residents and a qualitative study of the delivery of health care to care home residents.ResultsAlthough 222 of the 433 (51%) patients recruited to the AMIGOS study were vulnerable enough to be readmitted within 3 months, the trial showed no clinical benefit of interface geriatricians over usual care and they were not cost-effective. The TEAM study recruited 600 patients and there were no significant benefits of the specialist unit over usual care in terms of mortality, institutionalisation, mental or functional outcomes, or length of hospital stay, but there were significant benefits in terms of patient experience and carer satisfaction with care. The medical and mental health unit was cost-effective. The care home workstream found that the organisation of health care for residents in the UK was variable, leaving many residents, whose health needs are complex and unpredictable, at risk of poor health care. The variability of health care was explained by the variability in the types and sizes of homes, the training of care home staff, the relationships between care home staff and the primary care doctors and the organisation of care and training among primary care doctors.DiscussionThe interface geriatrician intervention was not sufficient to alter clinical outcomes and this might be because it was not multidisciplinary and well integrated across the secondary care–primary care interface. The development and evaluation of multidisciplinary and better-integrated models of care is justified. The specialist unit improved the quality of experience of patients with delirium and dementia in general hospitals. Despite the need for investment to develop such a unit, the unit was cost-effective. Such units provide a model of care for patients with dementia and delirium in general hospitals that requires replication. The health status of, and delivery of health care to, care home residents is now well understood. Models of care that follow the principles of comprehensive geriatric assessment would seem to be required, but in the UK these must be sufficient to take account of the current provision of primary health care and must recognise the importance of the care home staff in the identification of health-care needs and the delivery of much of that care.Trial registrationCurrent Controlled Trials ISRCTN21800480 (AMIGOS); ClinicalTrials.gov NCT01136148 (TEAM).FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 3, No. 4. See the NIHR Journals Library website for further project information.

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National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

Programme Grants for Applied Research ◽

10.3310/pgfar02040 ◽

2014 ◽

Vol 2 (4) ◽

pp. 1-480 ◽

Cited By ~ 14

Author(s):

David Challis ◽

Sue Tucker ◽

Mark Wilberforce ◽

Christian Brand ◽

Michele Abendstern ◽

...

Keyword(s):

Mental Health ◽

Community Mental Health ◽

Older People ◽

Mental Health Problems ◽

Care Home ◽

Research Programme ◽

Community Services ◽

Care Homes ◽

Care Home Staff ◽

Mental Health Outreach

BackgroundThe rising number of older people with mental health problems makes the effective use of mental health resources imperative. Little is known about the clinical effectiveness and/or cost-effectiveness of different service models.AimsThe programme aimed to (1) refine and apply an existing planning tool [‘balance of care’ (BoC)] to this client group; (2) identify whether, how and at what cost the mix of institutional and community services could be improved; (3) enable decision-makers to apply the BoC framework independently; (4) identify variation in the structure, organisation and processes of community mental health teams for older people (CMHTsOP); (5) examine whether or not different community mental health teams (CMHTs) models are associated with different costs/outcomes; (6) identify variation in mental health outreach services for older care home residents; (7) scope the evidence on the association between different outreach models and resident outcomes; and (8) disseminate the research findings to multiple stakeholder groups.MethodsThe programme employed a mixed-methods approach including three systematic literature reviews; a BoC study, which used a systematic framework for choosing between alternative patterns of support by identifying people whose needs could be met in more than one setting and comparing their costs/outcomes; a national survey of CMHTs’ organisation, structure and processes; a multiple case study of CMHTs exhibiting different levels of integration encompassing staff interviews, an observational study of user outcomes and a staff survey; national surveys of CMHTs’ outreach activities and care homes. A planned randomised trial of depression management in care homes was removed at the review stage by the National Institute for Health Research (NIHR) prior to funding award.ResultsBoC: Past studies exhibited several methodological limitations, and just two related to older people with mental health problems. The current study suggested that if enhanced community services were available, a substantial proportion of care home and inpatient admissions could be diverted, although only the latter would release significant monies. CMHTsOP: 60% of teams were considered multidisciplinary. Most were colocated, had a single point of access (SPA) and standardised assessment documentation. Evidence of the impact of particular CMHT features was limited. Although staff spoke positively about integration, no evidence was found that more integrated teams produced better user outcomes. Working in high-integration teams was associated with poor job outcomes, but other factors negated the statistical significance of this. Care home outreach: Typical services in the literature undertook some combination of screening (less common), assessment, medication review, behaviour management and training, and evidence suggested intervention can benefit depressed residents. Care home staff were perceived to lack necessary skills, but relatively few CMHTs provided formal training.LimitationsLimitations include a necessary reliance on observational rather than experimental methods, which were not feasible given the nature of the services explored.ConclusionsBoC: Shifting care towards the community would require the growth of support services; clarification of extra care housing’s (ECH) role; timely responses to people at risk of psychiatric admission; and improved hospital discharge planning. However, the promotion of care at home will not necessarily reduce public expenditure. CMHTsOP: Although practitioners favoured integration, its goals need clarification. Occupational therapists (OTs) and social workers faced difficulties identifying optimal roles, and support workers’ career structures needed delineating. Care home outreach: Further CMHT input to build care home staff skills and screen for depression may be beneficial. Priority areas for further study include the costs and benefits for older people of age inclusive mental health services and the relative cost-effectiveness of different models of mental health outreach for older care home residents.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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43 A Model of Interdisciplinary Working to Enhance the Care of Residential Home Patients

Age and Ageing ◽

10.1093/ageing/afz185.06 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i11-i13

Author(s):

E Goodwin ◽

T Bacarese-Hamilton ◽

A Steel ◽

A Patel

Keyword(s):

Mental Health ◽

Clinical Skills ◽

Care Home ◽

Psychological Needs ◽

Professional Relationships ◽

Residential Home ◽

Clinical Frailty Scale ◽

Home Setting ◽

Care Home Staff ◽

Care Plans

Abstract Introduction 291,000 patients in the UK live within the care home setting. The King’s Fund reports that the average residential home patient is an 85-year-old female with a 12-30 month life expectancy. Care needs are complex with six or more diagnosed conditions, seven or more prescribed medications and a combination of physical frailty, disability and mental health conditions. In line with the NHS Long Term plan 2019 the Care Home project sought to promote ageing well through interdisciplinary working. Aims Provide cost neutral interdisciplinary review of care home residents Review the medication of all residents Review resuscitation status and initiate anticipatory care plans for appropriate residents To further the education and professional relationships across primary, secondary and mental health interface. Reduction of transitions between care settings for residents. Methods 12 sessions in 1 care home over a year (2018-2019) Team consisted of GPs, Geriatric Registrars, Old Age Psychiatry Registrar, care home staff and CCG pharmacist 2-4 patients per session chosen on the basis of complex physical and/or psychological needs Format of session consisted of: o Pre-assessment discussion of patient o Interdisciplinary patient review o Debriefing and formulation of management plan Sessions concluded with teaching from the different disciplines. Results We reviewed 25 residents with an average Clinical Frailty Scale score of 7. 100% patients had a medication and psychiatric review. 100% had review of DNAR status with 40% increase in DNAR forms completed. There was a 60% increase in anticipatory care plans initiated. There was a reduction in acute admissions from the care home with a resultant cost saving of over £45,000. 100% of participants would strongly recommend the project and reported improved relationships. 90% of care home staff thought the project was beneficial to the residents and staff felt more supported. Conclusions Interdisciplinary working within the patient’s own setting provides patient centred care, promotes sharing of professional expertise, enhances clinical skills and builds professional relationships. This model of project is easily scalable and is a cost-effective way of providing high quality care for patients in their own residence.

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462 COUNSELLING IN CARE HOMES

Age and Ageing ◽

10.1093/ageing/afab117.06 ◽

2021 ◽

Vol 50 (Supplement_2) ◽

pp. ii1-ii4

Author(s):

J Pybis ◽

N Chigariro ◽

J Bacon

Keyword(s):

Mental Health ◽

Service Delivery ◽

Care Home ◽

Poor Mental Health ◽

Care Homes ◽

Structured Interviews ◽

Home Setting ◽

Care Home Staff ◽

People With Dementia ◽

Mental Health Foundation

Abstract Introduction Although many people live well within care homes, it is estimated that 60% of those living in residential care have poor mental health (Age Concern & Mental Health Foundation, 2006) and 40% suffer from depression (The Royal College of General Practitioners, 2014). Antidepressant prescribing has been reported to be nearly four times greater in care homes than for older people living in the community (Harris, Carey, Shah, Dewilde & Cook, 2012). However, antidepressants have been found to be ineffective for people with dementia (Dudas, Malouf, McCleery & Dening, 2018). With two-thirds of care home residents having some form of dementia, there is a need to find alternative interventions. Talking therapies, such as counselling, may be a useful alternative. Method Adopting a qualitative approach using semi-structured interviews and focus groups with counsellors (N = 12) who have experience of working in this context and with care home managers (N = 3) and care teams (N = 6), this study aimed to explore the feasibility of implementing counselling in a care home setting. We explored the views of care home staff towards counselling and identify barriers to service implementation, alongside the experience of counsellors who have delivered counselling in care homes to understand what service delivery models are currently adopted. Data were analysed thematically. Results Findings fell under the following key themes: The funding and referral process for counselling in a care home; skills and competences required; training needs; adaptations to practice; barriers to implementing counselling in a care home. Conclusions It is timely to consider the role of psychological therapy in supporting the mental health of care home residents. There is a need for further research to explore a service delivery model of counselling in care homes.

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Mandatory covid-19 vaccination for care home workers

BMJ ◽

10.1136/bmj.n1684 ◽

2021 ◽

pp. n1684 ◽

Cited By ~ 1

Author(s):

Lydia Hayes ◽

Allyson M Pollock

Keyword(s):

Care Home ◽

Home Workers

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

BMC Geriatrics ◽

10.1186/s12877-021-02053-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fiona Marshall ◽

Adam Gordon ◽

John R. F. Gladman ◽

Simon Bishop

Keyword(s):

Central Government ◽

Resource Constraints ◽

Care Delivery ◽

Care Home ◽

Third Sector ◽

Care Homes ◽

Framework Analysis ◽

Local Networks ◽

Care Home Staff ◽

East Midlands

Abstract Background From 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. Methods Ten 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. Results Three 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. Conclusions This 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.

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

Pharmacy ◽

10.3390/pharmacy9010034 ◽

2021 ◽

Vol 9 (1) ◽

pp. 34

Author(s):

Sally Fowler Davis ◽

Rachel Cholerton ◽

Louise Freeman-Parry ◽

Jo Tsoneva

Keyword(s):

Care Home ◽

Pharmacy Practice ◽

Qualitative Evaluation ◽

Care Homes ◽

Framework Analysis ◽

Medicines Management ◽

Team Members ◽

Care Home Staff ◽

Management Interventions ◽

Pharmacy Technicians

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.

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Survival and community care use by care home residents in England: does mental health matter?

Ageing and Society ◽

10.1017/s0144686x21001148 ◽

2021 ◽

pp. 1-15

Author(s):

Apostolos Tsiachristas ◽

Antoinette Broad ◽

Alice Coates ◽

Surya Singh ◽

Jane Fossey

Keyword(s):

Mental Health ◽

Community Care ◽

Cox Regression ◽

Care Home ◽

Care Homes ◽

Health Conditions ◽

Rank Test ◽

Cox Regression Analysis ◽

Mental Health Conditions ◽

Care Costs

Abstract The aim was to provide evidence of mortality and community care costs of people living in care homes and to investigate its association with mental health based on the Mental Health Clustering Tool (MHCT). In an observational study, 5,782 residents living in 104 care homes were followed from 2014 to 2016. Residents were categorised into four groups using the MCHT: three with mental health conditions, ‘non-psychotic’, ‘psychotic’ or ‘organic’; and one without mental health conditions, ‘non-clustered’. Generalised estimating equations were used to explore associations between mean community care costs over 6 months per patient and the clustering of residents into the four groups. Differences in survival rates of residents were plotted using Kaplan–Meier curves and tested with the log-rank test and Cox regression analysis. Community care costs were similar among residents with dementia (£431) and without mental health conditions (£407), while costs were higher among residents with non-psychotic (£762) and psychotic (£1,724) mental health conditions. After adjusting for patient and care home characteristics, residents with dementia were 30 per cent less likely to die compared with residents without mental health conditions. Similarly, residents with psychotic conditions and residents with non-psychotic conditions were 25 and 20 per cent less likely to die, respectively, than residents without mental health conditions. The MHCT seems to provide an informative stratification of care home residents with regards to survival and community care use.

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Improving the oral health of older people in care homes (TOPIC): a protocol for a feasibility study

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00872-6 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Georgios Tsakos ◽

Paul R. Brocklehurst ◽

Sinead Watson ◽

Anna Verey ◽

Nia Goulden ◽

...

Keyword(s):

Health Promotion ◽

Oral Health ◽

Complex Intervention ◽

Assessment Tool ◽

Care Home ◽

Care Homes ◽

Routine Practice ◽

Oral Health Promotion ◽

Nice Guideline ◽

Care Home Staff

Abstract Background Evidence for interventions promoting oral health amongst care home residents is weak. The National Institute for Health and Care Excellence (NICE) guideline NG48 aims to maintain and improve the oral health of care home residents. A co-design process that worked with residents and care home staff to understand how the NG48 guideline could be best implemented in practice has been undertaken to refine a complex intervention. The aim of this study is to assess the feasibility of the intervention to inform a future larger scale definitive trial. Methods This is a protocol for a pragmatic cluster randomised controlled trial with a 12-month follow-up that will be undertaken in 12 care homes across two sites (six in London, six in Northern Ireland). Care homes randomised to the intervention arm (n = 6) will receive the complex intervention based on the NG48 guideline, whilst care homes randomised to the control arm (n = 6) will continue with routine practice. The intervention will include a training package for care home staff to promote knowledge and skills in oral health promotion, the use of the Oral Health Assessment Tool on residents by trained care home staff, and a ‘support worker assisted’ daily tooth-brushing regime with toothpaste containing 1500 ppm fluoride. An average of ten residents, aged 65 years or over who have at least one natural tooth, will be recruited in each care home resulting in a recruited sample of 120 participants. Assessments will be undertaken at baseline, 6 months and 12 months, and will include a dental examination and questionnaires on general health and oral health administered by a research assistant. A parallel process evaluation involving semi-structured interviews will be undertaken to explore how the intervention could be embedded in standard practice. Rates of recruitment and retention, and intervention fidelity will also be recorded. A cost-consequence model will determine the relevance of different outcome measures in the decision-making context. Discussion The study will provide valuable information for trialists, policymakers, clinicians and care home staff on the feasibility and associated costs of oral health promotion in UK care homes. Trial registration ISRCTN10276613. Registered on 17th April 2020. http://www.isrctn.com/ISRCTN10276613.

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