scholarly journals Hybrid simulation modelling of networks of heterogeneous care homes and the inter-facility spread of Covid-19 by sharing staff

2022 ◽  
Vol 18 (1) ◽  
pp. e1009780
Author(s):  
Le Khanh Ngan Nguyen ◽  
Itamar Megiddo ◽  
Susan Howick
Keyword(s):  
Simulation Model ◽  
Care Home ◽  
Hybrid Simulation ◽  
Simulation Modelling ◽  
Care Homes ◽  
Risk Of Infection ◽  
Agency Staff ◽  
Policy Makers ◽  
Effective Interventions ◽  
Model Combining

Although system dynamics [SD] and agent-based modelling [ABM] have individually served as effective tools to understand the Covid-19 dynamics, combining these methods in a hybrid simulation model can help address Covid-19 questions and study systems and settings that are difficult to study with a single approach. To examine the spread and outbreak of Covid-19 across multiple care homes via bank/agency staff and evaluate the effectiveness of interventions targeting this group, we develop an integrated hybrid simulation model combining the advantages of SD and ABM. We also demonstrate how we use several approaches adapted from both SD and ABM practices to build confidence in this model in response to the lack of systematic approaches to validate hybrid models. Our modelling results show that the risk of infection for residents in care homes using bank/agency staff was significantly higher than those not using bank/agency staff (Relative risk [RR] 2.65, 95% CI 2.57–2.72). Bank/agency staff working across several care homes had a higher risk of infection compared with permanent staff working in a single care home (RR 1.55, 95%CI 1.52–1.58). The RR of infection for residents is negatively correlated to bank/agency staff’s adherence to weekly PCR testing. Within a network of heterogeneous care homes, using bank/agency staff had the most impact on care homes with lower intra-facility transmission risks, higher staff-to-resident ratio, and smaller size. Forming bubbles of care homes had no or limited impact on the spread of Covid-19. This modelling study has implications for policy makers considering developing effective interventions targeting staff working across care homes during the ongoing and future pandemics.

scholarly journals Understanding co-worker relationships for promoting quality in care homes: protocol for a scoping review.

2020 ◽  
Author(s):  
Kirsty Jayne Haunch ◽  
Karen Spilsbury
Keyword(s):  
Scoping Review ◽  
Social Care ◽  
Care Home ◽  
Evidence Base ◽  
Care Homes ◽  
Future Research ◽  
Care Home Staff ◽  
Team Working ◽  
Effective Interventions ◽  
Health And Social Care

Background: The relationships care home staff have with their co-workers influence how they feel about their work and their job performance. In care homes collaborative co-worker relationships are consistently linked to positive outcomes and have been identified as a key feature of overcoming challenges posed by COVID-19. Research on co-worker relationships in care homes to date however, is largely descriptive and poses knowledge gaps relating to the process of how co-worker relationships occur, along with what influences them. This hinders the development of targeted, effective interventions. Co-worker relationships to promote quality in care homes therefore demands clarity of understanding. The aim of the scoping review is to understand what is known about co-worker relationships and its applicability to care homes. We will synthesise evidence about both co-worker relationships in broader health and social care settings, which will allow us to draw on theories and find interventions potentially useful for a care home context.Methods: A scoping review will be undertaken to understand co-worker relationships in health and social care settings and to determine the volume, scope and quality of research in this field. Our review methods will follow scoping review guidance We will then work with stakeholders to understand the relevance and applicability of the evidence base for people living and working in, or visiting, care homes and to establish a future research agenda.Conclusion: This review is important and timely. Findings will assist care home managers to consider how to promote and improve effective team working. It will also provide the foundations for informing future research aimed at improving co-worker relationships in care homes for the benefit of residents.

scholarly journals The Development of a Care Home Data Platform in Scotland: Insights from the Care Home Innovation Partnership, Lothian

2020 ◽  
Author(s):  
Lucy Johnston ◽  
David AG Henderson ◽  
Jo Hockley ◽  
Susan D Shenkin
Keyword(s):  
Data Collection ◽  
Care Home ◽  
Current Data ◽  
Data Availability ◽  
Care Homes ◽  
Regulatory Agencies ◽  
Data Sets ◽  
Policy Makers ◽  
Individual Care ◽  
Data Platform

Care homes collect a large amount of data about their residents, and the care provided, but there is a lack of consistency in how this information is collected. There is also a need to minimise the burden of data collection on staff, ensure information informs and supports person-centred care, and that this data is then of use to regulatory agencies, policy makers and researchers. We examined the data collected in six Care Homes in Lothian, Scotland. We extracted the meta-data collected, cross-referenced definitions and assessed the degree of current harmonisation between individual care homes and with data sets currently in use in Scotland and internationally. We interviewed the care home managers to identify data collection processes, views and experiences of current data availability, gaps, access and issues of capacity and capability in relation to data management and analytics. Our work has illustrated the scale of the data collected by care homes, the varied formats and heterogeneity of scope and definition. The inventory of 15 core data items that emerged, serves to expose in detail the foundations of care home data sets. The groundwork illuminated the heterogeneity in tools and assessments used to generate the data and the way in which the data is to be used, affects how it is specified and frequency of collection. By making known the reality of how and why care home data is collected, we can understand better the nuances of each individual data item that collectively create a data platform. We make four recommendations for the development of a national care home data platform.

Infection prevention in care homes: the role of community nurses

2020 ◽  
Vol 22 (2) ◽  
pp. 83-85
Author(s):  
Dana Woods
Keyword(s):  
Infection Prevention ◽  
Care Home ◽  
Care Homes ◽  
Clinical Services ◽  
Risk Of Infection

Community nurses are often in the position of providing clinical services to residents in the care home sector. In doing so, they need to consider the factors that may increase the risk of infection and how these might be addressed. Dana Woods explains

GPs’ experience of safeguarding in care homes: what do they see and what do they do?

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711269
Author(s):  
Elisabeth Alton ◽  
Caroline White
Keyword(s):  
Online Survey ◽  
Qualitative Data ◽  
Care Home ◽  
Health Needs ◽  
Care Homes ◽  
Electronic Records ◽  
Multiple Relationships ◽  
Home Context ◽  
Emerging Themes ◽  
Multiple Health

BackgroundAbuse of older people in care homes is an on-going problem. GPs, as the most frequent practitioner group visiting care homes, have an important role in detecting and reporting abuse. However, there is little research about GPs’ experiences of working in care homes and how they work to safeguard residents.AimTo explore the challenges experienced by GPs working in this unique environment and how these impact on safeguarding.MethodAn online survey collected qualitative data about GPs’ experiences as visiting professionals to care homes, with an emphasis on safeguarding. A thematic analysis identified key themes.ResultsIn total, 58 completed surveys were returned, with a range of practitioner experience represented (1–30 years). Approximately 70% were GP partners, with the remainder salaried and locum doctors. Over one third reported they had witnessed signs of definite or possible abuse within care homes. Emerging themes related to the complex care home context, in which residents had multiple health needs and GPs had to build multiple relationships with managers, carers, families, and residents. Difficulties in accessing information were reported; residents could not always provide information, GPs had to rely on others for information, and rarely had access to electronic records.ConclusionGP work in care homes is a complex and skilled role, in which GPs encounter evidence of poor care and abuse. Key themes in respect of barriers and facilitators of good care were highlighted. The reliance on others for information and the need to build relationships with staff/managers may raise tensions in respect of safeguarding practice.

scholarly journals Experiences of a National Early Warning Score (NEWS) intervention in care homes during the COVID-19 pandemic: a qualitative interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045469
Author(s):  
Rachel Stocker ◽  
Siân Russell ◽  
Jennifer Liddle ◽  
Robert O Barker ◽  
Adam Remmer ◽  
...  
Keyword(s):  
Early Warning ◽  
Healthcare Professionals ◽  
Care Home ◽  
Qualitative Interview ◽  
Interview Study ◽  
Care Homes ◽  
Early Warning Score ◽  
Service Utilisation ◽  
Qualitative Interview Study ◽  
National Early Warning Score

BackgroundThe COVID-19 pandemic has taken a heavy toll on the care home sector, with residents accounting for up to half of all deaths in Europe. The response to acute illness in care homes plays a particularly important role in the care of residents during a pandemic. Digital recording of a National Early Warning Score (NEWS), which involves the measurement of physical observations, started in care homes in one area of England in 2016. Implementation of a NEWS intervention (including equipment, training and support) was accelerated early in the pandemic, despite limited evidence for its use in the care home setting.ObjectivesTo understand how a NEWS intervention has been used in care homes in one area of North-East England during the COVID-19 pandemic, and how it has influenced resident care, from the perspective of stakeholders involved in care delivery and commissioning.MethodsA qualitative interview study with care home (n=10) and National Health Service (n=7) staff. Data were analysed using thematic analysis.ResultsUse of the NEWS intervention in care homes in this area accelerated during the COVID-19 pandemic. Stakeholders felt that NEWS, and its associated education and support package, improved the response of care homes and healthcare professionals to deterioration in residents’ health during the pandemic. Healthcare professionals valued the ability to remotely monitor resident observations, which facilitated triage and treatment decisions. Care home staff felt empowered by NEWS, providing a common clinical language to communicate concerns with external services, acting as an adjunct to staff intuition of resident deterioration.ConclusionsThe NEWS intervention formed an important part of the care home response to COVID-19 in the study area. Positive staff perceptions now need to be supplemented with data on the impact on resident health and well-being, workload, and service utilisation, during the pandemic and beyond.

scholarly journals Is area deprivation associated with greater impacts of COVID-19 in care homes across England? A preliminary analysis of COVID-19 outbreaks and deaths

2021 ◽  
pp. jech-2020-215039 ◽  
Author(s):  
Anders Malthe Bach-Mortensen ◽  
Michelle Degli Esposti
Keyword(s):  
Negative Binomial ◽  
Care Home ◽  
Negative Binomial Regression ◽  
Population Characteristics ◽  
Care Homes ◽  
Future Research ◽  
Area Deprivation ◽  
Binomial Regression ◽  
Index Of Multiple Deprivation

IntroductionThe COVID-19 pandemic has disproportionately impacted care homes and vulnerable populations, exacerbating existing health inequalities. However, the role of area deprivation in shaping the impacts of COVID-19 in care homes is poorly understood. We examine whether area deprivation is linked to higher rates of COVID-19 outbreaks and deaths among care home residents across upper tier local authorities in England (n=149).MethodsWe constructed a novel dataset from publicly available data. Using negative binomial regression models, we analysed the associations between area deprivation (Income Deprivation Affecting Older People Index (IDAOPI) and Index of Multiple Deprivation (IMD) extent) as the exposure and COVID-19 outbreaks, COVID-19-related deaths and all-cause deaths among care home residents as three separate outcomes—adjusting for population characteristics (size, age composition, ethnicity).ResultsCOVID-19 outbreaks in care homes did not vary by area deprivation. However, COVID-19-related deaths were more common in the most deprived quartiles of IDAOPI (incidence rate ratio (IRR): 1.23, 95% CI 1.04 to 1.47) and IMD extent (IRR: 1.16, 95% CI 1.00 to 1.34), compared with the least deprived quartiles.DiscussionThese findings suggest that area deprivation is a key risk factor in COVID-19 deaths among care home residents. Future research should look to replicate these results when more complete data become available.

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

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.

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

Pharmacy ◽  
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.

scholarly journals Examining the magnitude and perception of summertime overheating in London care homes

2021 ◽  
pp. 014362442110136
Author(s):  
Rajat Gupta ◽  
Alastair Howard ◽  
Mike Davies ◽  
Anna Mavrogianni ◽  
Ioanna Tsoulou ◽  
...  
Keyword(s):  
Thermal Comfort ◽  
Care Home ◽  
Thermal Conditions ◽  
Care Homes ◽  
Structured Interviews ◽  
Night Time ◽  
Institutional Practices ◽  
Subjective Data ◽  
Hybrid Buildings ◽  
Hot Weather

This paper brings together objective and subjective data on indoor temperature and thermal comfort to examine the magnitude and perception of summertime overheating in two London-based care homes occupying modern and older buildings. Continuous monitoring of indoor and outdoor temperature, relative humidity and CO2 levels was conducted in summer 2019 along with thermal comfort surveys and semi-structured interviews with older residents and staff of the care settings. Indoor temperatures were found to be high (>30°C) with bedroom temperatures often higher at night than daytime across both care settings. Limited opening due to window restrictors constrained night-time ventilation. Overheating was prevalent with four out of the five monitored bedrooms failing all four overheating metrics investigated. While 35–42% of staff responses perceived indoor temperatures to be uncomfortably hot, only 13–19% of resident responses were found to do so, indicating that elderly residents tend to be relatively insensitive to heat, leaving them open to overheating without realising it. Residents and staff in the modern care setting were less satisfied with their thermal conditions. As hybrid buildings, care settings need to keep both residents and staff comfortable and healthy during hot weather through night-time ventilation, management of heating and supportive institutional practices. Practical application: Care home designs have focused on keeping residents warm through the winter, neglecting the risks of summertime overheating. Care homes are hybrid buildings serving as living spaces for vulnerable older residents and offices/workspaces for staff. Providing comfort to both groups during periods of hot weather is challenging. Opportunities for ventilation are limited by Health & Safety regulations that mandate up to 10 cm maximum window openings and institutional practices that result in windows routinely kept closed, particularly at night. Utilising natural and where possible cross-ventilation should be considered along with external shading. Heating should be managed to avoid unwanted heat gains in the summer.

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

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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