Concerns about quality of care

As with all care settings, researchers may on occasion observe and document poor care or have general concerns about the quality of care and residents’ safety. The majority of care homes provide good care often with limited resources and limited access to external support and training. However, it is important that researchers be prepared for this eventuality and have given some consideration to appropriate responses.

ADVICE

The following suggestions may help researchers establish good working relationships with care homes and ensure that the safety and well-being of residents and staff are maintained:

  • Identify care homes through the regulator. Care homes can be identified through the regulator, the Care Quality Commission, Care Inspectorate in Scotland, or Care and Social Services Inspectorate Wales, which registers and inspects all care homes. Details of individual care homes and recent inspection reports can be located online (Care Quality Commission or Care Inspectorate in Scotland or CSSIW).  Care homes that have been identified as ‘inadequate’ or even in need of improvement may not be suitable for recruitment, particularly if participating in research is likely to distract from other areas of care. Care homes can also be identified and recommended by local health professionals, carer organisations and local authority staff.
  • Create and maintain a climate of trust with care homes. When gaining access to the care home it is important to create and maintain a climate of trust and assure staff of the care home’s anonymity. See the School for Social Care Research (SSCR) methods review for further advice.
  • Agree protocols and ground rules. All research in care homes needs to anticipate how researchers will work with care home staff and have agreed protocols and ground rules if problems arise (e.g. if bad practice is observed, or study findings highlight problems or if staff or residents identify areas of concern). The Nursing and Midwifery Council website gives useful advice on safeguarding to nurses but the requirements for researchers should have been addressed when seeking ethical permissions.
  • Agree how to feedback information. For concerns where there is no question of a resident being at risk of harm, it is helpful to agree procedures with the care home manager and build in methods for researchers to agree how to feedback information from residents (with their permission) on aspects of care and for care home staff to express their concern or feedback.  Should a researcher observe bad practice or something that is more serious then they should follow the local policy and procedures on adult safeguarding. Further safeguarding guidance is also available from SCIE. Researchers have a duty of care themselves, for example, in that many are nurses, and might find the National Midwifery Council (NMC) site on safeguarding very helpful.

“The underlying message is that there are many great care homes operating up and down the country but unfortunately it is the odd few that create the negative headlines."

David Leach, Managing Director, HWA, May 2013

Overall, concerns about safeguarding need to be raised with the local safeguarding service or with CQC (CI in Scotland). More general information and advice are at the following places:

  • Action on Elder Abuse  free advice for anyone concerned in any way about the abuse of older people.
  • The NHS and social care whistle-blowers helpline - 08000 724 725 - if you have concerns but are unsure how to raise them or simply want advice on best practice.
  • Panicoa: this resource includes studies of neglect and abuse that may help researchers understand the area of abuse and neglect.