Approaches to care

The ownership, size and range of services provided affect the organisation of a care home. It would be unwise to think that all the care homes are the same in culture and ideology. For example, a faith based care home may engage in conversations about dying and end-of-life in a different way to care homes that have intermittent contact with faith groups.

From the outset researchers are advised to spend time understanding how the care home is managed, how care is delivered and the overall culture of the setting. Taking time out to understand the workings of the physical environment, schedules and day-to-day routines of the care home, and motivations of and pressures on staff can ensure that studies are conducted in a way that is achievable.

Understanding the history of a care home and who its residents are is important. Care homes that used to be owned by the local authority and cater mainly for people funded by the local authority will have different experiences and patterns of organisation to care homes that have a high proportion of self-funders and/or are part of a for-profit organisation.

There is a range of frameworks that can be used to inform a systematic assessment of the culture of a care home. The following are examples of different ways of assessing and categorising care that have been used in long-term settings

  • Sheltered Care Environment Scale (Moos and Lemke 1992);
  • Controlled, Cosmetic and Complete Community Categories: Davies (2002) classified care homes into three categories of how they approached the delivery of care;
  • The VIPS framework Brooker (2007) designed to help service providers for people with dementia to assess the relative strengths and weaknesses with regard to providing person-centred care;
  • Promoting Action on Research Implementation in Health Services Framework (PARIHS): Developed to support practice development, through observations and field notes the framework can be used to assess a care home’s environment and culture using an inventory form (informed by the PARIHS framework, Rycroft-Malone et al, 2002). This includes an assessment of the physical environment, staff/resident relationship and resident well-being;
  • Senses Framework:  Nolan (2004, 2006) and Faulkner et al (2006). Based on a model that advocates relationship-centred care, six dimensions are identified that, with supporting questions help to structure a review of how care is organised and experienced by residents and the staff that care for them. These dimensions are a sense of security, a sense of continuity, a sense of belonging, a sense of purpose, a sense of fulfillment and a sense of significance.
  • Dementia Care Mapping (University of Bradford, 2007) is an observational practice development framework which documents the culture of care from the perspective of people with dementia. It records: how the resident spends their time; their level of mood and engagement; and the number and type of personal detractors and personal enhancers. Staff teams are supported to use this evidence-base to reflect on their practice and to create, implement and monitor action plans designed to improve residents' quality of life.

"Research and development work may challenge care homes, as it adds yet another pressure on an already heavily-burdened sector."

Understanding Care Homes: A Research and Development Perspective, Jessica Kingsley Publishers, ISBN1843105535 (Froggatt et al 2009)

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