25 A Pilot Implementation of Providing Enhanced Support to Care Homes within A Primary Care Network

Abstract Introduction People living with severe frailty in care homes are vulnerable to frequent non-elective hospital attendances. However provision of enhanced healthcare support to care home residents can reduce this risk and increase quality of life for residents.1 The framework for enhanced health in care homes (EHCH) summarises best practice in this area and provides guidance for implementing services.2 Methods This study was a pilot implementation of the EHCH framework based on a Primary Care and Specialist Frailty Multidisciplinary Team (MDT) and delivered on a Primary Care Network (PCN) footprint. The MDT targeted five care homes in a PCN area with historically high levels of non-elective attendances. The model of care was based on the principle of anticipatory care planning, training and support for care home staff to understand and implement plans. Results Over the pilot period of 9 months, non-elective attendances from the 5 homes reduced by 27% compared to the previous year, which was a significant reduction (p<0.042). There was variation between the homes in the reduction in non-elective attendances with the greatest impact seen in the homes that had the highest level of attendance at training and engagement in the care planning process. Feedback received from the care home staff indicated that they felt more confident to refer to the care plans and had alternative options to calling 999. A quality audit of the care plans completed as part of the pilot revealed a number of additional training needs for clinicians completing the plans to ensure consistency of recoding. This training was delivered following the pilot period. Conclusions The pilot demonstrated that the EHCH framework could be successfully implemented on a PCN footprint. Analysis shows this implementation coincided with a reduction in non-elective attendances from the targeted homes. Further analysis is required to compare the impact in different homes and to understand contributing factors. The pilot implementation provides helpful information to inform PCN development. References 1. Lloyd T, Wolters A and Steveton A (2014) The impact of providing enhanced support for care home residents in Rushcliffe: Health Foundation consideration of findings from the Improvement Analytics Unit. The Health Foundation. 2. NHS England (2016) The framework for enhanced health in care homes.

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Residents transitioning between hospital and care homes: protocol for codesigning a systems-level response to safety issues (SafeST study)

BMJ Open ◽

10.1136/bmjopen-2021-050665 ◽

2022 ◽

Vol 12 (1) ◽

pp. e050665

Author(s):

Jason Scott ◽

Katie Brittain ◽

Kate Byrnes ◽

Pam Dawson ◽

Stephanie Mulrine ◽

...

Keyword(s):

Data Extraction ◽

Care Home ◽

Incident Reporting ◽

Care Homes ◽

Structured Interviews ◽

Framework Analysis ◽

Safety Issues ◽

Care Home Staff ◽

Service Specification ◽

The Impact

IntroductionThe aim of this study is to develop a better understanding of incident reporting in relation to transitions in care between hospital and care home, and to codesign a systems-level response to safety issues for patients transitioning between hospital and care home.Methods and analysisTwo workstreams (W) will run in parallel. W1 will aim to develop a taxonomy of incident reporting in care homes, underpinned by structured interviews (N=150) with care home representatives, scoping review of care home incident reporting systems, and a review of incident reporting policy related to care homes. The taxonomy will be developed using a standardised approach to taxonomy development. W2 will be structured in three phases (P). P1a will consist of ≤40 interviews with care home staff to develop a better understanding of their specific internal systems for reporting incidents, and P1b will include ≤30 interviews with others involved in transitions between hospital and care home. P1a and P1b will also examine the impact of the SARS-CoV-2 pandemic on safe transitions. P2 will consist of a retrospective documentary analysis of care home data relating to resident transitions, with data size and sampling determined based on data sources identified in P1a. A validated data extraction form will be adapted before use. P3 will consist of four validation and codesign workshops to develop a service specification using National Health Service Improvement’s service specification framework, which will then be mapped against existing systems and recommendations produced. Framework analysis informed by the heuristic of systemic risk factors will be the primary mode of analysis, with content analysis used for analysing incident reports.Ethics and disseminationThe study has received university ethical approval and Health Research Authority approval. Findings will be disseminated to commissioners, providers and regulators who will be able to use the codesigned service specification to improve integrated care.

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Are we allowed to visit now? Concerns and issues surrounding vaccination and infection risks in UK care homes during COVID-19

10.1101/2021.05.20.21257545 ◽

2021 ◽

Author(s):

Clarissa Marie Giebel ◽

Kerry Hanna ◽

Jacqueline Cannon ◽

Paul Marlow ◽

Hilary Tetlow ◽

...

Keyword(s):

Scientific Evidence ◽

Care Home ◽

Home Visitation ◽

Control Measures ◽

Care Homes ◽

Family Carers ◽

Care Home Staff ◽

The Uk ◽

The Impact

Background: Vaccination uptake in the UK and increased care home testing are likely affecting care home visitation. With scant scientific evidence to date, the aim of this longitudinal qualitative study was to explore the impact of both (vaccination and testing) on the conduct and experiences of care home visits. Methods: Family carers of care home residents with dementia and care home staff from across the UK took part in baseline (October/November 2020) and follow-up interviews (March 2021). Public advisers were involved in all elements of the research. Data were analysed using thematic analysis. Results: Across 62 baseline and follow-up interviews with family carers (n=26; 11) and care home staff (n=16; 9), five core themes were developed: Delayed and inconsistent offers of face-to-face visits; Procedures and facilitation of visits; Frustration and anger among family carers; Variable uptake of the COVID-19 vaccine; Misinformation, education, and free choice. The variable uptake in staff, compared to family carers, was a key factor seemingly influencing visitation, with a lack of clear guidance leading care homes to implement infection control measures and visitation rights differently. Conclusions: We make five recommendations in this paper to enable improved care home visitation in the ongoing, and in future, pandemics. Visits need to be enabled and any changes to visiting rights must be used as a last resort, reviewed regularly in consultation with residents and carers and restored as soon as possible as a top priority, whilst more education needs to be provided surrounding vaccination for care home staff.

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The “Cameos of Care Homes” project – care home staff’s Vanguard involvement and reflections

Working with Older People ◽

10.1108/wwop-11-2018-0024 ◽

2019 ◽

Vol 23 (2) ◽

pp. 107-115

Author(s):

Jess Harris ◽

Jill Manthorpe

Keyword(s):

Design Methodology ◽

Research Output ◽

Care Home ◽

Care Homes ◽

Content Type ◽

Care Home Staff ◽

Learning Cultures ◽

Care Workers ◽

The Impact ◽

Practical Implications

Purpose The Cameos of Care Homes project is an opportunity to use the medium of film to showcase the experiences and reflections of frontline care home staff whose employers participated in the National Health Service (NHS) England Vanguard programme. Reflecting on their involvement in one of the Enhanced Health in Care Homes Vanguards, 12 staff describe, in front of the camera, the impact on themselves and their colleagues, on their care for their older residents, and on the wider culture of the care home. The paper aims to discuss this initiative. Design/methodology/approach The paper reports the experiences of care home staff that were purposefully recorded on film about their participation in a care home Vanguard. The recruitment of the care homes and staff is described, as are the development of interview questions and approaches needed when filming is considered as a research method. Findings Participating care home staff reported that their involvement in the Vanguard programme had improved knowledge, confidence, morale, communication skills and the homes’ learning cultures. They were enthusiastic about reporting their experiences on film. Examples were given of proactive early support from local NHS staff leading to improvements in care, thereby reducing demand on the NHS. However, participation was resource intensive for care homes. Care home staff hoped the support that accompanied the Vanguard programme would continue but were uncertain to what degree this would happen once the Vanguard programme ceased. Research limitations/implications The interviews were undertaken with a self-selecting group of care home staff from two care homes operating in one of the six Vanguard sites in England. By their very nature, interviews for a public film cannot provide anonymity. Practical implications Researchers seeking the views of care home staff may wish to consider filming interviews and presenting the film as a research output that is engaging and informative for care home and wider audiences. Originality/value The paper presents an analysis of filmed interviews with care home managers and care workers working with older people. Their views on the Vanguard initiative have not been widely considered, in contrast to the sizeable literature relating to NHS activity and expenditure.

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

Age and Ageing ◽

10.1093/ageing/afab030.100 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

K Chumbley

Keyword(s):

Primary Care ◽

Health Care ◽

Palliative Care ◽

Health Care Professionals ◽

Care Home ◽

Skills Training ◽

Care Homes ◽

Technological Support ◽

Care Home Staff ◽

North East

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.

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Remembering the past, enhancing the present and sharing the future: a qualitative study of the impact of film screenings in care home communities

Ageing and Society ◽

10.1017/s0144686x20000501 ◽

2020 ◽

pp. 1-26

Author(s):

Jenna P. Breckenridge ◽

Thilo Kroll ◽

Gavin Wylie ◽

Ana Salzberg

Keyword(s):

Qualitative Study ◽

Care Home ◽

Social Activity ◽

Care Homes ◽

Social Connection ◽

Emotional Wellbeing ◽

Care Home Staff ◽

People With Dementia ◽

The Rich ◽

The Impact

Abstract Many care home residents lack opportunities for meaningful activity and social connection, resulting in poor physical and emotional wellbeing. Providing residents with varied activities and social opportunities can improve their quality of life. In this paper, we examine the potential for film to provide a meaningful, social activity. The limited existing research on film in care homes has predominantly examined the use of film clips and materials in stimulating reminiscence for people with dementia. In this paper, we adopt a broader, trans-disciplinary perspective of film, drawing on evidence from Film Studies that shared spectatorship has social and emotional benefits for the viewer. We offer the first qualitative study of care home residents’ social, emotional and embodied engagement with feature-length film and identify the key benefits of film in this setting. We ran social film screenings in two Scottish care homes over six weeks. Underpinned by psycho-cinematic theory, we collected and analysed observational data alongside interviews with care home staff and discussion groups with residents. Our findings identified three ways in which film screenings benefit residents and supports social connection: prompting reminiscence; enhancing residents’ experiences in the present; and creating a shared future and intergenerational connections. The paper offers useful insights into the rich potential for film to enhance the care home community, facilitate social connectivity and promote resident wellbeing.

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OP9 Perch – preliminary exploration of the role of paramedics in care homes

Emergency Medicine Journal ◽

10.1136/emermed-2020-999abs.9 ◽

2020 ◽

Vol 37 (10) ◽

pp. e5.2-e6

Author(s):

Mark Kingston ◽

Leigh Keen ◽

Stephanie Green ◽

Lesley Griffiths

Keyword(s):

Primary Care ◽

Care Home ◽

Care Homes ◽

Health Board ◽

List Type ◽

Role Clarity ◽

England And Wales ◽

Fact Finding ◽

The Impact

BackgroundHalf a million people live in UK care homes. General practices struggle to deliver primary care for residents due to high demand and staff shortages. Meanwhile, ambulance services are seeing an increase in 999 calls from care homes. In response, some areas are involving paramedics in proactive support to care homes, part of a shift towards paramedics undertaking non-emergency community care. Yet such workforce changes require urgent evaluation to understand implications for residents, staff and health services. We aimed to explore the role of non-emergency paramedics in care homes to support the design of portfolio research.MethodsWe convened a Research Development Group of care home, ambulance service, health board, primary care, public and academic representatives. We:Conducted fact-finding visits to sitesAnalysed 999 call data from care homesSurveyed ENRICH (Enabling Research in Care Homes) care home managers in England and WalesHeld a stakeholder workshop to explore the issuesResultsWe identified sites in England and Wales where paramedics provide non-emergency care in care homes. Operating models varied with paramedics employed by ambulance services, health boards and practices. Monthly 999 data from 300 homes confirmed high call and hospital conveyance rates. Survey respondents thought paramedics were well suited to assessing residents, identifying issues, improving care and avoiding admissions. They foresaw benefits to inter-professional working, clinical support and person-centred care, but raised concerns over professional boundaries and role clarity. These messages were reinforced in our workshop, where the value of timely assessment was highlighted, alongside challenges of funding and governance.ConclusionsThe role of paramedics is shifting into dedicated primary and community work, including care homes. It is imperative that research is aligned and informs evidence based practice. We are developing PERCH2, a feasibility study evaluating the impact of paramedics working in this way.

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EMPOWERING CARE HOME STAFF TO DELIVER QUALITY END OF LIFE CARE: THE IMPACT OF THE SIX STEPS TO SUCCESS PROGRAMME ON END OF LIFE CARE IN CARE HOMES IN NORTH WEST ENGLAND

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2014-000654.89 ◽

2014 ◽

Vol 4 (Suppl 1) ◽

pp. A32.2-A32

Author(s):

Mary O'Brien ◽

Jennifer Kirton ◽

Katherine Knighting ◽

Rob Gandy ◽

Barbara Jack ◽

...

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Care Home ◽

Care Homes ◽

Life Care ◽

North West ◽

Care Home Staff ◽

The Impact

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210 - Are visits allowed? The impact of the COVID-19 pandemic on care home visitation and care delivery in the UK

International Psychogeriatrics ◽

10.1017/s1041610221001435 ◽

2021 ◽

Vol 33 (S1) ◽

pp. 12-13

Author(s):

Clarissa Giebel ◽

Kerry Hanna ◽

Jacqueline Cannon ◽

Hilary Tetlow ◽

Paul Marlow ◽

...

Keyword(s):

Research Team ◽

Care Delivery ◽

Care Home ◽

Family Members ◽

Care Homes ◽

Family Carers ◽

Care Home Staff ◽

The Uk ◽

The Impact

Background:COVID-19 has caused the sudden closure of care homes to the outside world, to stem the virus from infecting some of the most vulnerable groups of people – older adults residing in care homes. With very little knowledge to date, we aimed to explore the impact of COVID-19 on care provision and visits in care homes from staff and family members’ perspectives.Methods:Care home staff and family carers of people living with dementia (PLWD) across the UK were recruited via convenience sampling and participated via telephone or Zoom. Participants took part in a semi-structured remote interview. Baseline data were collected between October and November 2020, and follow-up interviews were collected throughout March 2021. Anonymised transcripts were analysed separately by two research team members using thematic analysis, with codes discussed and themes generated jointly, supported by research team input.Results:42 participants (26 family carers and 16 care home staff) took part in the baseline interviews, and 20 purposefully sampled participants (11 family carers and 9 care home staff) were followed up. Prior to vaccination roll out in the UK, at baseline, family carers expressed concern about a lack of clear guidance throughout the pandemic, with care homes delivering care differently and disparities noted in the levels and types of visiting allowed for family members. Lack of communication between care homes and family members, but also government and care homes, led to family carers feeling excluded and concerned about the well-being of their relative. Data on follow-up interviews are still being analysed.Conclusions:This is the first empirical evidence to show how the pandemic has caused severe difficulties in providing adequate care for care home residents, with not only residents, but also care home staff and family carers being negatively affected. Follow-up data will shed light onto the impact of vaccination and eased visitation rights put in place since March 2021 on care delivery and connections between family carers and residents.

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Study Protocol: Understanding SARS-Cov-2 infection, immunity and its duration in care home residents and staff in England (VIVALDI)

Wellcome Open Research ◽

10.12688/wellcomeopenres.16193.2 ◽

2021 ◽

Vol 5 ◽

pp. 232

Author(s):

Maria Krutikov ◽

Tom Palmer ◽

Alasdair Donaldson ◽

Fabiana Lorencatto ◽

Gill Forbes ◽

...

Keyword(s):

Hospital Admissions ◽

Qualitative Interviews ◽

Care Home ◽

Care Homes ◽

Test Results ◽

Care Home Staff ◽

Co Morbidity ◽

National Public Health ◽

Protocol Registration ◽

The Impact

Global infection and mortality rates from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are disproportionately high in certain populations, including amongst older people. Care home residents are frequently exposed to infection due to contact with staff and other residents, and are highly susceptible to infection due to their age and co-morbidity. In England, official statistics suggest that at least 25% of all deaths in care home residents since the start of pandemic are linked to coronavirus disease 2019 (COVID-19), but limited testing for SARS-CoV-2 early in the pandemic means estimates of the true burden of disease are lacking. Additionally, little is known about patterns of transmission between care homes, the community and hospitals, or the relationship between infection and immunity in care home staff and residents. The VIVALDI study plans to address these questions. VIVALDI is a prospective cohort study aiming to recruit 6,500 staff and 5000 residents from 105 care homes across England. Successive rounds of testing for infection will be performed over a period of 12 months. Nasopharyngeal swabs will detect evidence of viral RNA and therefore active infection (accompanied by collection of data on symptoms), whereas blood tests will detect antibodies and evidence of cellular immunity to SARS-CoV-2. Whole genome sequencing of viral isolates to investigate pathways of transmission of infection is planned in collaboration with the COVID-19 Genomics UK Consortium. Qualitative interviews with care home staff will investigate the impact of the pandemic on ways of working and how test results influence infection control practices and behaviours. Data from residents and staff will be linked to national datasets on hospital admissions, antibody and PCR test results, mortality and care home characteristics. Data generated will support national public health efforts to prevent transmission of COVID-19 and protect care home staff and residents from infection. Protocol registration: ISRCTN14447421 05/06/2020

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Using a multi-disciplinary process-mapping approach for care plan program design.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18203 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18203-e18203

Author(s):

Meredith Jones

Keyword(s):

Planning Process ◽

Clinical Information ◽

Care Plan ◽

Successful Implementation ◽

Care Planning ◽

Process Mapping ◽

Care Coordinator ◽

Care Plans ◽

Care Coordinators ◽

The Impact

e18203 Background: The Center for Medicare and Medicaid Innovation has challenged oncology practices to engage in practice transformation activities through participation in the Oncology Care Model (OCM). One difficult requirement of OCM is the creation of care plans inclusive of the 13 IOM components. Though OCM does not require that care plans be given to patients, true practice transformation exists not only with care plan creation, but with delivery and education to patients and caregivers. Many challenges to care plan implementation exist, starting with the lack of staff dedicated to the care planning process. Methods: Two multi-disciplinary teams representing the Medical Oncology Clinic were formed to simulate and process-map current workflow, incorporating care plan generation and delivery. First, teams process-mapped current workflows utilizing existing staff to establish a baseline. Second, teams added care planning to the baseline and determined whether existing or new staff would be needed to accomplish the OCM care plan requirements. Both teams received the same 6 care planning steps: 1. Enter patient demographics into software, 2. Give patient survey, 3. Enter clinical information in software, 4. Generate plan, 5. Print/deliver plan, and 6. Scan into EMR. Results: Both teams completed process mapping with minimal variation at baseline. However, the teams disagreed on responsible staff for each care planning step. Both teams agreed, though, that 4 out of 6 steps must be completed by RNs, NPs or Physicians. Both teams also indicated that current RN staffing levels would not accommodate capacity to add care planning responsibilities to existing positions, due to the time-consuming nature of the care planning process. Conclusions: Multi-Disciplinary teams recommended addition of RN Care Coordinator positions to oversee the care planning process. Successful implementation requires hiring adequate numbers of RN Care Coordinators that, with a reasonable caseload each, will manage the process, track patients and evaluate outcomes. Future opportunities exist to research the impact that the addition of both care plan delivery and RN Care Coordinators have on patient satisfaction and outcomes.

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