Guest Blog written by Francesca LaFrenais on Monday October 5, 2015
If you are new to working in care homes, please see the "Understanding care homes" page on this site for a comprehensive background to this sector.
Care home research has traditionally been considered too difficult, and perhaps unnecessary, but while there are challenges to working in this sector, it can be very rewarding. I have reflected on my own experiences working as a researcher in this environment and due to limited space I have chosen to focus on several key points.
Care homes are complex organisations, with a busy unpredictable nature, so finding the simplest and least time-consuming methods for your research will make everyone’s lives easier and will hopefully save you from feeling that you are harassing the staff. There isn’t a one size fits all approach to this; at the start of a project when you hold an initial meeting with a manager to discuss the study it is worth identifying realistic targets, including appropriate delegation. For example, you could meet with individual unit managers to discuss eligibility of residents, or assign the administrative or activity staff to make initial phone calls to relatives (ethically the research team cannot contact the families without their consent).
According to the Alzheimer’s Society, 80% of care home residents have dementia or severe memory problems1, so for many potential participants you will need to seek consultee assent, usually from a family member or friend. This can be a time consuming process as it can be difficult to reach relatives on the phone, and if they work full-time you may need to try calling in the evening or at the weekend (which may also be the only time they visit the care home, especially if they don’t live locally) so flexibility is essential.
Moving into a care home is often precipitated by a critical event such as a hospital admission, which can be distressing for the resident and those close to them. In both my professional and personal experience, I’ve found that families can feel very differently about the situation ranging from gratitude towards care staff to feelings of guilt surrounding the admission, and it is important to be sensitive to this. Relatives often value spending time chatting to researchers as we have more time to offer than clinical professionals and more of an understanding around dementia and care homes than their peers. Meetings can take longer than anticipated and, understandably, sometimes relatives can become upset during the visit.
While research may be top of your priority list, care will always come first for the nurses. Take the time to learn about shift patterns and meal times; mornings are generally not a good time to go in as staff are very busy helping residents with personal care. Even if you book staff cover there will be occasions when the nurse will have to help their colleagues with an emergency, or speak to a relative.
There is often a large number of staff in a care home (working day, night and weekend shifts) as well as high staff turnover in this sector, and you may have to introduce yourself to new people every time you visit the home – in many cases they may not have heard about your research study at all. Find out if the care home holds staff meetings and if appropriate, arrange with the manager to come along so you can talk about the study. It can also be useful to produce posters with your picture for staff rooms and nursing stations.
Before contacting relatives, check the health status of the resident with the home – are they in hospital, on end-of-life care, or have they passed away since your last visit? The average stay in a care home is 2-2.5 years; this high mortality rate is worth bearing in mind when calculating recruitment targets. It may also be worth asking staff if there is anything else it may be useful to know before contacting the relatives, in order to maximise engagement.
Remember your role as a researcher, not carer. Residents will often ask for help e.g. transfers or for a drink, but its always best to ask a staff member.
If you need copies of medication records, try and get these on the day as they will be archived each month.
Familiarise yourself with legislation around care homes, for example the recent DoLS legislation which has recently provided a lot of work for care home staff. This blog explains the practicalities: http://publicregulatoryblog.fieldfisher.com/2015/deprivation-of-liberty-safeguards-dols-dealing-with-the-practicalities