Crisis in care homes: the dentists don’t come

Abstract Aim/Objectives To present the findings of the challenges relating to access to dental care for older people in care homes from the Fluoride Interventions in Care Homes (FInCH) Trial. Methods Thematic analysis of 11 interviews / focus groups with care home managers and care staff were carried out against a framework informed by the literature drawing on lived experiences. Results The challenges identified mapped to Penchanksy and Thomas’s (1981) five dimensions of access but also highlighted themes specifically relevant to the care home population. These include a lack of suitable services for routine and urgent domiciliary and clinic care, complex referral processes, operational challenges in the need for appropriate care chaperones, expectations of information for dental charge exemption and capacity / consent processes within the home. Discussion There is a malalignment of dental services offered to meet the needs of care home residents which has resulted in a reactive dental care system that is not fit for purpose and an entire generation of older people living in care with dental neglect. Conclusion Urgent action is needed to commission not only the appropriate quantities of both routine and urgent dental care, but ensure it is delivered by clinicians who are appropriately skilled to meet the high levels of dental needs in an increasingly medically and behaviourally complex care home population. In line with eye tests and prescribing at the very least, free routine dental examinations should be offered to all care home residents, creating the opportunity for advice and prevention, and enabling care home residents to function and be free of pain. Trial Registration The FinCH Trial registration EudraCT number 2017-002248-34.

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What’s in a word? The importance of the concept of “values” in the prevention of abuse of older people in care homes

The Journal of Adult Protection ◽

10.1108/jap-01-2017-0001 ◽

2017 ◽

Vol 19 (3) ◽

pp. 130-145 ◽

Cited By ~ 9

Author(s):

Steve Moore

Keyword(s):

Older People ◽

Mixed Methods Research ◽

Care Home ◽

Care Staff ◽

Care Homes ◽

Contributory Factor ◽

Structured Interviews ◽

Content Type ◽

Personal Value ◽

Provision Of Care

Purpose The purpose of this paper is to present some of the findings from an empirical, mixed methods research project that reveal the importance of the personal value frameworks held by individual staff in the prevention of abuse of older people in private sector care homes. Design/methodology/approach Semi-structured interviews were undertaken with a sample of 36 care home personnel, including proprietors, care managers and care staff. Findings A significant number of respondents identified the importance of personal value frameworks among staff providing care as a potential contributory factor in the prevention of abuse of older people. Research limitations/implications Though the research draws upon the experiences of only 36 care home personnel through interviews, data suggest that the personal evaluations of staff towards those in their care is a significant contributory factor to the occurrence of abuse. Originality/value The research has identified individual staff value frameworks as a causal factor in the occurrence of abuse. The research also confirms that the perceptions of “values” among respondents directly involved in the provision of care are at odds with common understanding of “values” often cited elsewhere in connection with staff recruitment and training as a means of preventing the occurrence of abuse.

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Differing perspectives on a role for technology in care homes to improve the lives of older people and the work environment of staff

Housing Care and Support ◽

10.1108/hcs-10-2013-0019 ◽

2014 ◽

Vol 17 (2) ◽

pp. 84-94 ◽

Cited By ~ 1

Author(s):

Deidre Wild ◽

Ala Szczepura ◽

Clive Bowman ◽

Angela Kydd ◽

Richard Wallis

Keyword(s):

Older People ◽

Technology Development ◽

New Technology ◽

Care Home ◽

Care Homes ◽

Future Research ◽

Content Type ◽

Technology Advancement ◽

Fit For Purpose

Purpose – The purpose of this paper is to place the future development of technology within the existing reality of the diversity of care homes. Design/methodology/approach – Using the findings from a learning exercise, the paper illustrates “diversity” in terms of the meaning staff, relatives, and residents attach to the words “care home”. This tri-partite approach provides a basis for exploring types of technology that could, if appropriately introduced, prove to be of benefit to the different users and staff. Findings – Technology is more likely to be “fit for purpose” when it has been developed jointly with those who work, live in, and who visit care homes. Costs and benefits will be issues to be taken into account. Research limitations/implications – A lack of research evidence on the role of technology in care homes was a key limitation. In future, research should adopt a co-production approach to technology development. Practical implications – The authors take a pragmatic stance that if due care is taken in preparations for and the introduction of technology, this would increase uptake of technology to meet different needs. Social implications – The paper makes the points that: older people can learn new technological skills; the concept of care homes as user-led is in accord with increased opportunity to engage residents in new technology. Technology in care homes while posing challenges also could prove to be a major lucrative market. Originality/value – By triangulating the perspectives of residents, relatives, and staff the authors hope to have presented a realistic and evidence-based overview of the potential for technology advancement in care homes.

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Protocol for A randomised feasibility trial comparing fluoride interventions to prevent dental decay in older people in care homes (FInCH trial)

BMC Oral Health ◽

10.1186/s12903-021-01650-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rakhee Patel ◽

Iftekhar Khan ◽

Mark Pennington ◽

Nigel B. Pitts ◽

Claire Robertson ◽

...

Keyword(s):

Older People ◽

Dental Care ◽

Care Home ◽

Community Dwelling ◽

Care Homes ◽

Feasibility Trial ◽

Search Query ◽

Dental Decay ◽

Home Setting ◽

Cochrane Reviews

Abstract Background The number and proportion of older people globally is growing faster than that of any other age group. At the same time the number of people retaining some of their own teeth is rising. There significant differences between those living in care and their community dwelling peers, with evidence showing those in care having fewer teeth and significantly higher levels of dental decay. There are numerous Cochrane reviews linking the use of fluoride to a reduction in dental decay, however, the majority of research on effectiveness has been conducted on children and consequently, children and adolescents tend to be the main recipients of fluoride interventions. There are to date no studies comparing the effectiveness of fluoride interventions in older people in care homes in the UK. However, prior to developing an appropriate protocol for full-scale trial comparing clinical effectiveness of fluoride interventions, there are a number of trial feasibility and statistical parameters that need to be clarified. Methods This trial is a single centre, multi-site randomised controlled assessor blind parallel group (three groups) trial, with the primary objective of establishing the feasibility, practicability and compliance of fluoride interventions to prevent dental decay in care homes. Secondary and tertiary objectives will aim to explore the acceptability of the interventions from resident, care home and dental services perspectives, and estimate the efficacy of the three different fluoride treatments. Discussion This feasibility trial will produce new knowledge and add value to a landscape that is under researched. Although the efficacy of fluoride interventions is proven, the feasibility of dental research and prevention in this vulnerable group and in the complex care home setting is novel. This work will not only add to our understanding of the interface of dental care and social care but will also contribute to our broader understanding on undertaking research in care home settings. Dental care for older people has been a longstanding issue, and the events of this past year has shone a light on the vulnerabilities of those residing in care homes and so this research is landing at a pivotal time. Trial registration EudraCT Registration 2017-002248-34. Registered 20th February 2018 https://www.clinicaltrialsregister.eu/ctr-search/search?query=2017-002248-34.

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A qualitative study exploring therapists’ experiences of implementing a complex intervention promoting meaningful activity for residents in care homes

Clinical Rehabilitation ◽

10.1177/0269215518815233 ◽

2018 ◽

Vol 33 (3) ◽

pp. 575-583 ◽

Cited By ~ 2

Author(s):

Raymond Smith ◽

Julia Wood ◽

Fiona Jones ◽

Sue Turner ◽

Michael Hurley

Keyword(s):

Care Home ◽

Complex Interventions ◽

Occupational Therapists ◽

Care Staff ◽

Care Homes ◽

Complex Care ◽

Meaningful Activity ◽

Qualitative Interview Study ◽

Home Intervention ◽

Trusting Relationships

Objectives: To explore the experiences of occupational therapists and physiotherapists and to reveal any factors that can facilitate delivering a complex care home intervention promoting meaningful activity. Design: Qualitative interview study using data from three focus groups conducted longitudinally post intervention implementation. Data were analysed thematically. Setting: Three residential care homes in South London, UK. Subjects: All therapists involved in the implementation of the intervention: three occupational therapists and three physiotherapists. Results: Three interconnected themes emerged from the analysis: (1) developing trusting relationships, (2) empowering staff and (3) remaining flexible. Therapists described how successfully implementing a complex care home intervention was dependant on developing trusting relationships with care staff. This enabled the therapists to empower care staff to take ownership of the intervention and help embed it in care home culture, facilitating long-term change. The therapists described how remaining flexible in their approach helped keep care staff engaged for the duration of implementation. Conclusion: This study has revealed several important factors that can help facilitate therapists delivering complex interventions in care homes.

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Urinary catheterization in care homes for older people: self-reported questionnaire audit of catheter management by care home staff

Journal of Hospital Infection ◽

10.1016/j.jhin.2005.03.008 ◽

2006 ◽

Vol 62 (1) ◽

pp. 29-36 ◽

Cited By ~ 15

Author(s):

C.A.M. McNulty ◽

J. Bowen ◽

C. Foy ◽

K. Gunn ◽

E. Freeman ◽

...

Keyword(s):

Older People ◽

Care Home ◽

Care Homes ◽

Urinary Catheterization ◽

Care Home Staff

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Quality improvement collaborative aiming for Proactive HEAlthcare of Older People in Care Homes (PEACH): a realist evaluation protocol

BMJ Open ◽

10.1136/bmjopen-2018-023287 ◽

2018 ◽

Vol 8 (11) ◽

pp. e023287 ◽

Cited By ~ 4

Author(s):

Reena Devi ◽

Julienne Meyer ◽

Jay Banerjee ◽

Claire Goodman ◽

John Raymond Fletcher Gladman ◽

...

Keyword(s):

Quality Improvement ◽

Older People ◽

Care Home ◽

Realist Evaluation ◽

Evaluation Framework ◽

Care Homes ◽

Quality Improvement Initiative ◽

Quality Improvement Collaborative ◽

Programme Theory ◽

Health And Social Care

IntroductionThis protocol describes a study of a quality improvement collaborative (QIC) to support implementation and delivery of comprehensive geriatric assessment (CGA) in UK care homes. The QIC will be formed of health and social care professionals working in and with care homes and will be supported by clinical, quality improvement and research specialists. QIC participants will receive quality improvement training using the Model for Improvement. An appreciative approach to working with care homes will be encouraged through facilitated shared learning events, quality improvement coaching and assistance with project evaluation.Methods and analysisThe QIC will be delivered across a range of partnering organisations which plan, deliver and evaluate health services for care home residents in four local areas of one geographical region. A realist evaluation framework will be used to develop a programme theory informing how QICs are thought to work, for whom and in what ways when used to implement and deliver CGA in care homes. Data collection will involve participant observations of the QIC over 18 months, and interviews/focus groups with QIC participants to iteratively define, refine, test or refute the programme theory. Two researchers will analyse field notes, and interview/focus group transcripts, coding data using inductive and deductive analysis. The key findings and linked programme theory will be summarised as context-mechanism-outcome configurations describing what needs to be in place to use QICs to implement service improvements in care homes.Ethics and disseminationThe study protocol was reviewed by the National Health Service Health Research Authority (London Bromley research ethics committee reference: 205840) and the University of Nottingham (reference: LT07092016) ethics committees. Both determined that the Proactive HEAlthcare of Older People in Care Homes study was a service and quality improvement initiative. Findings will be shared nationally and internationally through conference presentations, publication in peer-reviewed journals, a graphical illustration and a dissemination video.

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An exploration of hydration practices in Maltese residential care homes for older people

Nursing and Residential Care ◽

10.12968/nrec.2021.23.11.3 ◽

2021 ◽

Vol 23 (11) ◽

pp. 1-12

Author(s):

Francesca Micallef ◽

Marisa Vella ◽

Alan Sciberras Narmaniya ◽

Glenda Cook ◽

Juliana Thompson

Keyword(s):

Older People ◽

Residential Care ◽

Care Home ◽

Good Health ◽

Care Homes ◽

Complex Needs ◽

Increased Risk ◽

Adequate Hydration ◽

Axial Coding ◽

Sugary Beverages

Background/aims The integral relationship between adequate hydration and good health is widely recognised. Older people with complex needs and frailty can struggle to maintain adequate hydration, with residents in care home settings being at an increased risk of dehydration. The aim of this study was to explore current hydration practices in residential care homes in Malta. Methods An exploratory qualitative approach was adopted to explore staff's views and approaches in supporting residents' hydration. Data was collected via semi-structured, individual and small group interviews with staff from two care homes from the central and southern region of Malta. A process of open coding, followed by axial coding, was used to analyse the data. Peer debriefing was performed throughout, until agreement was reached among the research team about the final themes and sub-themes. Results Three themes emerged from the data: culture of promoting fluid intake; challenges in supporting older people to achieve optimum hydration; hydration practices and approaches. Conclusions A hydration promotion culture was demonstrated through various practices adopted in the care homes. The strong focus on water intake, in response to concerns about consuming sugary beverages, has implications for the promotion of a person-centred approach to hydration care. Inconsistencies in monitoring of fluids and daily recommended targets highlights the importance of policies or guidelines to guide hydration practice. Challenges related to refusal of fluids and language barriers among non-native staff were evident and justify further research is this area.

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Hearing and vision care provided to older people residing in care homes: a cross-sectional survey of care home staff

10.21203/rs.2.21638/v1 ◽

2020 ◽

Author(s):

Wendy Andrusjak ◽

Ana Barbosa ◽

Gail Mountain

Keyword(s):

Older People ◽

Vision Loss ◽

Care Home ◽

Care Homes ◽

Eye Care ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Care Home Staff ◽

Chi Square Analysis ◽

Vision Care

Abstract Background: Hearing and vision loss in older people has proven to affect physical and mental health and increase the speed of cognitive decline. Studies have proven certain practices and aspects of staff knowledge increase the effective care of residents’ ears and eyes, yet it is not known which of these are being implemented in care homes. This study aims to identify the gaps in staff knowledge and underused practices evident in long term care homes when identifying and managing hearing and vision difficulties in older residents. Methods: This study used a cross-sectional survey design. Survey questions were informed by the existing literature and were focused on practices, staff knowledge, and other aspects that have shown to affect residents’ hearing and vision care. The survey was sent to care homes across England between November 2018 and February 2019 both via Email and in paper format for care home staff to complete. Descriptive statistics and Chi-Square analysis was used to assess the factors particularly influencing the current care being provided to care home residents. Results: A total of 400 care home staff responded from 74 care homes. The results revealed that screening tools are rarely used by staff to identify hearing and vision impairments, care homes have limited access to other assistive devices, and audiology services do not regularly assess care home residents. A majority of staff were also not entirely confident in their knowledge of ear and eye care. Responses were also affected by the respondents’ job role, length of time working in care homes and also the care home type and care home capacity revealing a lack of standardised practice and shared communication. Conclusion: This study identifies which practices known to facilitate ear and eye care are currently under used in care homes across England and what particularly staff are not knowledgeable on when it comes to ear and eye care. This can now inform future research of the areas requiring improvement to as effectively address to acknowledged slow identification and poor management of hearing and vision loss in older people residing in care homes.

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Multifaceted competence requirements in care homes: Ethical and interactional competence emphasized

Nordic Journal of Nursing Research ◽

10.1177/2057158517712084 ◽

2017 ◽

Vol 38 (1) ◽

pp. 48-58 ◽

Cited By ~ 3

Author(s):

Outi Kiljunen ◽

Tarja Välimäki ◽

Pirjo Partanen ◽

Päivi Kankkunen

Keyword(s):

Older People ◽

Registered Nurses ◽

Delphi Study ◽

Care Home ◽

Care Homes ◽

Interactional Competence ◽

Licensed Practical Nurses ◽

Modified Delphi ◽

Practical Nurses ◽

Care For Older People

Nurses need versatile competence to care for older people in care home settings. A modified Delphi study was conducted to identify competencies registered nurses and licensed practical nurses need to care for older people in care homes. A total of 38 panelists consisting of experienced professionals in clinical and managerial roles were recruited to identify types of competencies these nurses require. In total, 80 competencies for licensed practical nurses and 81 competencies for registered nurses were identified as necessary. This study has shown that licensed practical nurses are required to have similar competencies to registered nurses in care homes. Nurse managers, nurse educators, and policy makers should pay more attention, to nurses’ work requirements, especially for licensed practical nurses, and support nurses to meet the needs of older people living in care homes.

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The ambulance service advanced practitioner's role in supporting care homes: a qualitative study of care staff experiences

British Journal of Healthcare Management ◽

10.12968/bjhc.2020.0145 ◽

2021 ◽

Vol 27 (8) ◽

pp. 1-8

Author(s):

Chris Harvey ◽

Simon Froggatt ◽

Bryan Lightowler ◽

Andrew Hodge

Keyword(s):

Qualitative Study ◽

Care Home ◽

Community Services ◽

Ambulance Service ◽

Care Staff ◽

Care Homes ◽

Service Demand ◽

Staff Members ◽

Care Home Staff ◽

Advanced Practitioner

Background/Aims The demand from care homes on NHS services continues to rise, with little evidence of ambulance service contribution in this area. The Yorkshire Ambulance Service provides an advanced practitioner model to support care homes in Sheffield, as an alternative to calling 999. This study investigated the experiences and needs of the care home staff who use the ambulance service advanced practitioner model. Methods This qualitative study conducted semi-structured, face-to-face interviews with 19 staff members from 10 different care home settings. Thematic analysis using a combination of NVivo and manual coding was undertaken. Results The three key themes from the interviews were variations in service demand, the service user's expectations and experience, and benefits to residents. Participants reported that good community services reduced the need to call 999, empowering carers to support residents to remain in the community. Conclusions Care homes require comprehensive services that meet their needs. The advanced practitioner model provided by the ambulance service supports this, preventing unnecessary 999 calls and fitting with other community service provision.

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