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

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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Care homes for older people

10.1093/med/9780199644957.003.0027 ◽

2013 ◽

Cited By ~ 1

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.

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

10.1101/2021.01.28.21250547 ◽

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.

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

BMJ Quality & Safety ◽

10.1136/bmjqs-2018-009130 ◽

2019 ◽

Vol 28 (7) ◽

pp. 534-546 ◽

Cited By ~ 5

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.

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Enhanced healthcare in care homes for people with dementia: the Admiral nursing offer

Nursing and Residential Care ◽

10.12968/nrec.2021.23.7.4 ◽

2021 ◽

Vol 23 (7) ◽

pp. 1-10

Author(s):

Karen Harrison Dening ◽

Zena Aldridge

Keyword(s):

Primary Care ◽

Residential Care ◽

Social Care ◽

Care Home ◽

Dementia Care ◽

Care Homes ◽

Complex Needs ◽

Care Home Staff ◽

People With Dementia ◽

Health And Social Care

Background The UK older population is higher than the global average. Over the next 20 years, England will see an increase in the number of older people who have higher levels of dependency, dementia and comorbidity, many of whom will require 24-hour residential care. It is estimated that 70% of residents in nursing and residential care homes either have dementia on admission or develop it while residing in the care home, many of who will have complex needs with high levels of multimorbidity. However, there is a lack of consistency in the provision of primary care and specialist services to this population and a known gap in knowledge and skills of dementia care in care home staff and primary care teams. Methods This article considers the current health policy drivers to enhance integrated health and social care provision to care homes and proposes a model of care that would support the aims of the NHS Long Term Plan for care to be delivered closer to home and improve out of hospital care which includes people who live in care homes by introducing Enhanced Health in Care Homes. It is crucial that such a model includes the correct skill mix to meet the needs of the care home population. Conclusions There are currently gaps in service provision to many care homes. Admiral nurse case managers and specialists in dementia care, are well placed to support the delivery of Enhanced Health in Care Homes and improve access to specialist support to care home residents, their families, care home staff and the wider health and social care system.

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

Dementia ◽

10.1177/1471301217727129 ◽

2017 ◽

Vol 18 (5) ◽

pp. 1942-1947 ◽

Cited By ~ 4

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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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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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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Barriers and facilitators to cross-sector workforce competency assessment in the care of older people residing in care homes

10.1101/2021.01.21.21250213 ◽

2021 ◽

Author(s):

Sue Tiplady ◽

Juliana Thompson ◽

Glenda Cook ◽

Lesley Bainbridge

Keyword(s):

Older People ◽

Care Delivery ◽

Barriers And Facilitators ◽

Assessment Process ◽

Care Homes ◽

Competency Assessment ◽

Competency Development ◽

Learning And Development ◽

Complex Needs ◽

Assessment Of Competence

AbstractIn recent years, transformation in care delivery towards cross-sector models has occurred with the aim of providing safe, efficient care for older people with complex needs, including those living in care homes. Effective workforce competency development and assessment across sectors is integral to these models. However, there is much evidence to suggest a distinct lack of cross-sector alignment with regard to competency development and assessment, which could lead to variations in practice and affect outcomes for older people. This qualitative study explored the barriers and facilitators to cross-sector workforce competency assessment in the care of older people residing in care homes. Twenty nine staff with responsibility for staff learning and development participated. Data were analysed using Braun and Clarke’s (2006) six phase thematic analysis approach. Findings indicate that a significant challenge to the development of a competent workforce is evidencing competency, due to difficulties in finding appropriate assessors and inconsistencies in the assessment process. Findings also indicate potential solutions including: a system-wide, standardised framework and strategy for assessment of competence; policy for the ‘sign-off’ of competencies that is recognised across organisational boundaries; and adopting practice-based approaches to competence development and assessment.

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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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