Care homes for older people

2013 ◽  
Author(s):  
Tom Dening ◽  
Alisoun Milne
Keyword(s):  
Older People ◽  
Residential Care ◽  
Physical Disability ◽  
Care Home ◽  
Developed Countries ◽  
Care Homes ◽  
Standards Of Care ◽  
Ageing Population ◽  
Behavioural Disturbance ◽  
The Uk

Although only 5% of the total over 65 population in developed countries lives in a care home, the lifetime risk of needing residential care is considerable. In the UK, 418 000 older people occupy nearly 12 000 care homes; the sector has a total value of around £14 billion. Care home residents tend to be very old, most are women, and most have complex co-morbid needs. Most people enter a care home because they can no longer live independently due to ill health, notably dementia. Dementia affects over two thirds of all residents; physical disability and functional impairment are also common. Behavioural disturbance is common as is depression. There are concerns about excessive reliance on medication, and more emphasis recently has been placed on improving standards of care. Evidence suggests that training and good leadership is effective. With the ageing population, the provision and the funding of care home places will come under increasing pressure. The solutions to this are yet to be determined.

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

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.

scholarly journals Ownership and COVID-19 in care homes for older people: A living systematic review of outbreaks, infections, and mortalities

2021 ◽  
Author(s):  
Anders Malthe Bach-Mortensen ◽  
Ben Verboom ◽  
Ani Movsisyan ◽  
Michelle Degli Esposti
Keyword(s):  
Systematic Review ◽  
Older People ◽  
Care Home ◽  
Academic Research ◽  
Developed Countries ◽  
Care Homes ◽  
For Profit ◽  
News Reports ◽  
Increased Risk ◽  
New Research

AbstractBackgroundThe adult social care sector is increasingly outsourced to for-profit providers, who constitute the largest provider of care homes in many developed countries. During the COVID-19 pandemic, for-profit providers have been accused of failing their residents by prioritising profits over care, prevention, and caution, which has been reported to result in a higher prevalence of COVID-19 infections and deaths in for-profit care homes. Although many of these reports are anecdotal or based on news reports, there is a growing body of academic research investigating ownership variation across COVID-19 outcomes, which has not been systematically appraised and synthesised.ObjectivesTo identify, appraise, and synthesise the available research on ownership variation in COVID-19 outcomes (outbreaks, infections, deaths, shortage of personal protective equipment (PPE) and staff) across for-profit, public, and non-profit care homes for older people, and to update our findings as new research becomes available.DesignLiving systematic review.MethodsThis review was prospectively registered with Prospero (CRD42020218673). We searched 17 databases and performed forward and backward citation tracking of all included studies. Search results were screened and reviewed in duplicate. Risk of bias (RoB) was assessed in duplicate according to the COSMOS-E guidance. Data was extracted by ABM and independently validated. The results were synthesised by country, RoB, and model adjustments, and visualised using harvest plots.ResultsTwenty-nine studies across five countries were included, with 75% of included studies conducted in the Unites States. For-profit ownership was not consistently associated with a higher probability of a COVID-19 outbreak. However, there was compelling evidence of worse COVID-19 outcomes following an outbreak, with for-profit care homes having higher rates of accumulative infections and deaths. For-profit providers were also associated with shortages in PPE, which may have contributed to the higher incidence of infections and deaths in the early stages of the pandemic. Chain affiliation was often correlated with an increased risk of outbreak but was usually not reported to be associated with higher rates of deaths and infections.ConclusionFor-profit ownership was a consistent risk factor for higher cumulative COVID-19 infections and deaths in the first wave of the pandemic. Thus, ownership and the characteristics associated with FP care home providers may present key regulatable factors that can be addressed to improve health outcomes in vulnerable populations and reduce health disparities. This review will be updated as new research becomes published, which may change the conclusion of our synthesis.

scholarly journals Care homes and COVID-19 in Hong Kong: how the lessons from SARS were used to good effect

2020 ◽  
Author(s):  
Lina Chow
Keyword(s):  
Hong Kong ◽  
Older People ◽  
Asymptomatic Carrier ◽  
Care Home ◽  
Family Members ◽  
Virus Transmission ◽  
Developed Countries ◽  
Care Homes ◽  
Good Effect ◽  
Influenza Outbreaks

Abstract In Hong Kong, about 15% of older people (aged 80 and above) live in care homes, one of the highest proportions in the world. During the spread of severe acute respiratory syndrome in 2003, the crude fatality rate for older people in care homes that were infected was 72%. After taking the advice of a team of international experts, the Hong Kong Government implemented comprehensive preventive measures to cope with the future epidemics. This commentary evaluates the effectiveness of these measures in coping with both influenza outbreaks and COVID-19 and suggests the lessons learnt are relevant to both developed and less developed countries? Lockdown in care homes is very effective under two conditions. Healthcare workers must wear surgical masks in the care home. Hospitals must adopt a strict policy to prevent virus transmission by discharged patients. Care homes situated within high-rise residential towers are particularly vulnerable to COVID-19 transmission; their residents can more easily be infected by asymptomatic carriers from the community. Airborne virus can also be transmitted more swiftly in care homes with open-plan layouts. Lockdown had been shown to significantly reduce influenza outbreaks in care homes. On the other hand, lockdown causes loneliness to residents. Care homes allow residents to move freely within the care home though with the risk of spreading the virus by resident who is an asymptomatic carrier. Finally, lockdown may cause family members to have guilty feelings. Family members can only make video call or window visit to residents.

scholarly journals Effect on secondary care of providing enhanced support to residential and nursing home residents: a subgroup analysis of a retrospective matched cohort study

2019 ◽  
Vol 28 (7) ◽  
pp. 534-546 ◽  
Author(s):  
Therese Lloyd ◽  
Stefano Conti ◽  
Filipe Santos ◽  
Adam Steventon
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Older People ◽  
Residential Care ◽  
Rate Ratio ◽  
Care Home ◽  
Nursing Home Residents ◽  
Care Homes ◽  
Emergency Admissions ◽  
Hospital Use

BackgroundThirteen residential care homes and 10 nursing homes specialising in older people in Rushcliffe, England, participated in an improvement programme. The enhanced support provided included regular visits from named general practitioners and additional training for care home staff. We assessed and compared the effect on hospital use for residents in residential and nursing homes, respectively.MethodsUsing linked care home and administrative hospital data, we examined people aged 65 years or over who moved to a participating care home between 2014 and 2016 (n=568). We selected matched control residents who had similar characteristics to the residents receiving enhanced support and moved to similar care homes not participating in the enhanced support (n=568). Differences in hospital use were assessed for residents of each type of care home using multivariable regression.ResultsResidents of participating residential care homes showed lower rates of potentially avoidable emergency admissions (rate ratio 0.50, 95% CI 0.30 to 0.82), emergency admissions (rate ratio 0.60, 95% CI 0.42 to 0.86) and Accident & Emergency attendances (0.57, 95% CI 0.40 to 0.81) than matched controls. Hospital bed days, outpatient attendances and the proportion of deaths that occurred out of hospital were not statistically different. For nursing home residents, there were no significant differences for any outcome.ConclusionsThe enhanced support was associated with lower emergency hospital use for older people living in residential care homes but not for people living in nursing homes. This might be because there was more potential to reduce emergency care for people in residential care homes. In nursing homes, improvement programmes may need to be more tailored to residents’ needs or the context of providing care in that setting.

Paying for end of life care in the UK

2020 ◽  
Vol 104 (561) ◽  
pp. 495-506
Author(s):  
John Stubbs ◽  
Jacob Adetunji
Keyword(s):  
End Of Life ◽  
Old Age ◽  
End Of Life Care ◽  
Care Home ◽  
Developed Countries ◽  
Care Homes ◽  
Life Care ◽  
Financial Cost ◽  
The Uk

To live to a ripe old age, untroubled by health problems, physical or mental, is an almost universal aspiration. But most people are not so lucky and will likely be in care homes for their final years, with varying levels of disease, disability and dementia. Kinley et al [1] maintain that over a fifth of the population of developed countries die in care homes. Moreover, the financial cost of this end of life care, which is the focus of this paper, can be daunting and require much planning [2]. It was reported in 2017 that, in the UK, care home costs are rising up to twice as fast as inflation [3]. Consequently the question arises about the long term affordability of such care to those having to fund it, a question that ever more people both nationally and globally are having to confront.

scholarly journals Defenders against Threats or Enablers of Opportunities: The Screening Role Played by Gatekeepers in Researching Older People in Care Homes

2015 ◽  
Author(s):  
Peter Scourfield
Keyword(s):  
Older People ◽  
Access To Care ◽  
Care Home ◽  
Care Homes ◽  
Research Subjects ◽  
Critical Account ◽  
The Uk

This paper emerges from a case study of the system of statutory reviews in older people’s care homes in the UK. Informed by a review of selected literature on gaining access, this paper provides a critical account of the process of negotiating access with gatekeepers (chiefly, care home managers). The negotiations were time-consuming and largely fruitless in terms of actually gaining access to care home residents. Nevertheless, much was learned about the field, in particular, about the attitudes of those with responsibility for caring for older care home residents. The residents in care homes became “hard to reach” research subjects not necessarily because of any cognitive or communicative impairments on their part, but by the defensive attitudes adopted by gatekeepers. It concludes by suggesting that, in this case, the ambiguous shades of meaning conveyed by the concept of “screener” make it a more appropriate term to describe the role than that of “gatekeeper”.

scholarly journals THE EFFECTS OF BUILT ENVIRONMENT DESIGN ON OPPORTUNITIES FOR WELLBEING IN CARE HOMES

2017 ◽  
Vol 11 (1) ◽  
pp. 138 ◽  
Author(s):  
Lesley J McIntyre ◽  
Ian Ruaraidh Harrison
Keyword(s):  
Built Environment ◽  
Older People ◽  
Care Home ◽  
Spatial Diversity ◽  
Care Homes ◽  
Environment Design ◽  
Social Connectivity ◽  
Future Improvement ◽  
The Uk ◽  
Insight Into

The built environment influences the wellbeing of older people in care homes. In order to design for enablement, physical activity, and social connectivity there are lessons to be learnt from current care home buildings. Uncovering this design information is key for the future improvement of environments for older people. To the field of architecture, this paper presents an analysis of ethnographic observations (utilising an adapted form of the AEIOU heuristic) from five urban care homes in the UK. Findings provide insight into the qualities of the built environment that have impact on the activity and potential wellbeing of older residents. Five significant qualities of the built environment are identified:  Spatial Legibility, Spatial Interconnectedness, Spatial Traversability, Spatial Diversity, and Spatial Aesthetics.

scholarly journals Sporting memories, dementia care and training staff in care homes

2017 ◽  
Vol 12 (1) ◽  
pp. 55-66 ◽  
Author(s):  
Michael Clark ◽  
Charlie Murphy ◽  
Tony Jameson-Allen ◽  
Chris Wilkins
Keyword(s):  
Older People ◽  
Care Home ◽  
Training Session ◽  
Health And Safety ◽  
Care Homes ◽  
Ageing Population ◽  
Content Type ◽  
Care Home Staff ◽  
Key Issues ◽  
Direct Feedback

Purpose The purpose of this paper is to describe the findings from a pilot and a follow-on study in which care assistants in care homes were trained to use sporting memories work to better help and engage with residents with dementia and low mood. Care homes have to support increasingly more fragile people and often the range of activities in the homes do not offer the best engagement between residents and staff to benefit the residents. This is for reasons of time to run activities in a busy home, and because of the need to find financially viable means of running a range of activities. Care assistants in care homes are a group of non-professionally educated workers and are often overlooked for training beyond basic health and safety training to help them improve their work and the care they provide. This work sought to explore whether sporting memories work was viable as an activity to offer in care homes via the training of care assistants. Design/methodology/approach The paper discusses the evidence from a pilot and then follow-on project in care homes in one city area. In the pilot observation was made of a training session and follow up interviews were undertaken with care home managers to see how the implementation of sporting memories was going. In the follow-on project the support to those undertaking the training was modified to include three learning network sessions. Data were collected on the experience of participants and their use of sporting memories work. Findings The findings were that care assistants could be trained in using sporting memories work and they often found it easy to use and fulfilling for them and people they cared for. This was despite the care assistants who participated often not having much interest in sports and little experience in this kind of work. However, practical barriers to maintaining the use of sporting memories work did remain. Research limitations/implications The evidence to date is of case studies of training staff in care homes in the use of sporting memories work, which provides good grounding for proof of the concept and key issues, but further research is needed on the costs and impacts of sporting memories work in care homes. The lack of direct feedback about experiences of care home residents of sporting memories work and its impact on them is a further limitation. Practical implications Sporting memories work is a flexible and readily adoptable intervention to engage older people in care homes and the evidence to date is that care assistants in care homes can be trained to use this approach to engaging older people. Practical challenges still remain to using sporting memories work in care homes, notably the issue of time for staff to do the work, but it is an approach for care homes to have available to them to match up to the interests of residents. Social implications Sporting memories work can be an important part of meeting some of the challenges society faces with an ageing population profile and to enhancing the care home environment and care assistants can be trained to use the approach. Originality/value This is the first paper to discuss training care home staff in the use of sporting memories work.

scholarly journals Active residents in care homes: A holistic approach to promoting and encouraging meaningful activity for residents living in care homes: Innovative Practice

Dementia ◽  
2017 ◽  
Vol 18 (5) ◽  
pp. 1942-1947 ◽  
Author(s):  
Raymond Smith ◽  
Julia Wood ◽  
Fiona Jones ◽  
Liezl Anderson ◽  
Michael Hurley
Keyword(s):  
Residential Care ◽  
Systems Approach ◽  
Care Home ◽  
Family Members ◽  
Occupational Therapists ◽  
Holistic Approach ◽  
Care Homes ◽  
Care Home Staff ◽  
Meaningful Activity ◽  
Whole Systems

The active residents in care homes intervention aim to promote meaningful activity among care home residents. Residents, family members and staff from three residential care homes in South London are participating. It is a whole systems approach which involves formal and ‘on the floor’ training to empower care home staff to facilitate activity. Training is delivered by two occupational therapists, a physiotherapist and a rehabilitation assistant. This paper describes the active residents in care homes intervention, the evaluation methods and discusses some preliminary findings.

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