Rhetoric and reality of daily life in English care homes: the role of organised activities

In divergent ways, both government policy and care home practices influence the everyday life of older people living in English care homes. The rhetoric of choice for care home residents may be in conflict with the reality of government policy-driven service delivery. The aim of the article is to examine the role of organised activities in facilitating choice and active ageing among care home residents. Findings from a study of ten care homes in South East England exemplify the conflict between government policy rhetoric and the reality of care home life. The indication is that the formality of the ’’activities of daily living’’ support procedures restricts residents’ involvement in the organised social activities.Within the general provision of services, the organised ’’social activities’’ offered failed to meet the interest, cognitive and physical abilities of residents. The reality of ’’choice’’ is therefore questionable. Policy needs to support a transformation in the delivery of care to ensure it addresses the actual needs and expectations of older people experiencing care home life.

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Older care home residents’ and their relatives’ knowledge, understanding and views of shift handovers: an exploratory, focused-ethnographic qualitative study using interviews and observations

BMJ Open ◽

10.1136/bmjopen-2019-032189 ◽

2019 ◽

Vol 9 (12) ◽

pp. e032189

Author(s):

Katharine Orellana ◽

Valerie Lipman ◽

Jill Manthorpe ◽

Jo Moriarty ◽

Caroline Norrie ◽

...

Keyword(s):

Older People ◽

Care Home ◽

Care Homes ◽

Clinical Settings ◽

Study Participation ◽

Underlying Assumption ◽

Home Setting ◽

Evidence Review ◽

Administrative Procedures ◽

South East England

ObjectivesTo investigate residents’ and relatives’ views and experiences of handovers in care homes. This paper reports residents’ and relatives’ awareness of handovers, knowledge of and views on handover practices and purpose, and views on handover effectiveness. Outcomes, safety and satisfaction in clinical settings are influenced by shift handovers. Despite this link with quality, residents’ increasing support needs and the provision of 24 hours care in care homes for older people, little is known about handovers in these settings from a resident and visiting relative perspective.SettingFive purposively sampled care homes for older people in South East England.ParticipantsHome managers (n=5), residents (n=16) relatives of residents (n=10) were interviewed; residents (n=15) and their interactions with staff were observed during handover periods. Participation was voluntary and subject to consent. Residents were identified by managers as having mental capacity to take a decision about participation which was then assessed. An ethnographic approach to data collection was taken, preceded by an evidence review.ResultsShift handovers were largely invisible processes to participating residents and relatives, many of whom had given little thought to handover practice, logistics or effectiveness prior to study participation. Their awareness and understanding of handovers, handover practices, and handover purpose and effectiveness varied. There appeared to be an underlying assumption that administrative procedures in care homes would operate without input from residents or relatives. A small number of residents, however, were highly aware of the routine of handovers and the implications of this for the timing of and response to their requests for care or support.ConclusionsThe care home setting and perspectives of the effectiveness of handovers may influence awareness of, knowledge of and levels of interest in involvement in handovers.

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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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Impact of COVID-19 on Care-Home Mortality and Life Expectancy in Scotland

10.1101/2021.01.15.21249871 ◽

2021 ◽

Author(s):

Jennifer K Burton ◽

Martin Reid ◽

Ciara Gribben ◽

David Caldwell ◽

David N Clark ◽

...

Keyword(s):

Older Adults ◽

Length Of Stay ◽

Life Expectancy ◽

Older People ◽

Care Home ◽

Care Homes ◽

Years Of Life Lost ◽

Home Life ◽

Scottish Population ◽

The Impact

AbstractIntroductionCOVID-19 deaths are commoner among care-home residents, but the mortality burden has not been quantified.MethodsCare-home residency was identified via a national primary care registration database linked to national mortality data. Life expectancy was estimated using Makeham-Gompertz models, to (i) describe yearly life expectancy from Nov 2015 to Oct 2020 (ii) compare life expectancy (during 2016-2018) between care-home residents and the wider Scottish population and (iii) apply care-home life expectancy estimates to COVID-19 death counts to estimate years of life lost (YLL).ResultsAmong care-home residents, life expectancy in 2015/16 to 2019/20 ranged from 2.7 to 2.3 years for women and 2.3 to 1.8 years for men. Life expectancy was lowest in 2019/20. Age-sex specific life expectancy in 2016-2018 in care-home residents was lower than in the Scottish population (10 and 2.5 years in those aged 70 and 90 respectively). Rather than using national life tables, applying care-home specific life expectancies to COVID-19 deaths yields, mean YLLs for care-home residents were 2.6 and 2.2 for women and men respectively, with total care-home resident YLLs of 3,560 years in women and 2,046 years in men. In people aged over-70, approximately half of deaths and a quarter of YLL attributed to COVID-19 were accounted for by the 5% of over-70s who were care-home residents.ConclusionPrioritising care-home residents for vaccination is justified not only in terms of total deaths, but also in terms of years of life lost.Research in contextEvidence before this studyWe searched PubMed to 1st December 2020, with the terms (“nursing home” OR “care-home” OR “long-term care” OR “residential care”) AND (“mortality” OR “life expectancy” OR “length of stay”). We also searched for studies specific to the impact of the COVID-19 pandemic on those living in care-homes. We restricted our search to publications in English. Usual care-home life expectancy, in a UK context, has not previously been defined. One systematic review of length of stay was identified, which found significant heterogeneity in factors and associations. The impact of COVID-19 on excess mortality among care-home residents was noted, but the impact on life expectancy was not reported. Studies evaluating life expectancy among older people in the COVID-19 pandemic have not taken account of residency in their estimates.Added value of this studyUsing Scottish national representative linked data we describe the usual life expectancy of older adults (aged ≥70 years) living in care-homes, compared to older people living elsewhere. Deaths among care-home residents account for a considerable proportion of all mortality in older adults, around 19% for men and 30% for women. Life expectancy in care-home residents during the pandemic fell by almost 6 months, from 2.7 to 2.3 years in men and 2.1 to 1.8 years in women. In total, over 5,600 Years of Life were Lost (YLL) by care-home residents in Scotland who died with COVID-19. Around half of COVID-19 deaths and a quarter of YLL in those aged 70 years and over occurred among care-home residents. During the COVID-19 pandemic a smaller proportion of deaths among care-home residents occurred in hospitals.Implications of all the available evidencePrioritising the 5% of older adults who are care-home residents for vaccination against COVID-19 is justified both in terms of total deaths and total years of life lost. Individual and societal planning for care needs in older age relies on understanding usual care-home life expectancy and patterns of mortality. Understanding life expectancy may help clinicians, residents and their families make decisions about their health care, facilitating more informed discussions around their priorities and wishes. Population-wide estimates of YLL and burden of disease should take account of residency status, given the significant differences between life expectancy of those living in care-homes from their peers in other settings.

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

Journal of Epidemiology & Community Health ◽

10.1136/jech-2020-215039 ◽

2021 ◽

pp. jech-2020-215039 ◽

Cited By ~ 2

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.

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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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Care homes for older people

Oxford Textbook of Old Age Psychiatry ◽

10.1093/med/9780198807292.003.0026 ◽

2020 ◽

pp. 371-394

Author(s):

Tom Dening ◽

Alisoun Milne

Keyword(s):

Older People ◽

Late Stage ◽

Care Home ◽

Care Homes ◽

Sensory Impairment ◽

Comorbid Conditions ◽

Illness Trajectory ◽

Home Culture ◽

Independent Sector

The care home sector has changed significantly in recent years: the vast majority of care homes are now in the independent sector, funding of care is complex, with greater reliance on self-funders to ensure profitability, and regulation has shifted to a more targeted model. In terms of the care home population, as most people are admitted at a late stage of their illness trajectory, many have comorbid conditions and multiple needs. Frailty is a dominant issue, often combined with dementia and other problems, e.g. sensory impairment and incontinence. The dimensions of a positive care home culture include a well-managed transition into the home, a commitment to person-centred care, and a well-trained and supported workforce. Over the last few years there has been a growing interest in care homes as major providers of care to some of the UK’s most vulnerable citizens; this includes welcome attention to research.

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