Practical advice

Researchers who have undertaken research in care homes have given the following advice on recruitment, set up, sharing information, consent and maintaining relationships:

When recruiting care homes to studies consider the following:

1. Identifying care homes

  • It will take much longer than you might expect, so allow much longer than anticipated to identify initial participants.
  • The ENRICH Research Ready Care Home Network brings together researchers with enthusiastic research friendly care homes. Currently there are around 1,000 care homes participating, through local networks and corporate partnerships with large national providers. For information on how the network can support recruitment / identification of care home to support research at any stage of the development cycle email  enrich.crndementias@nihr.ac.uk or contact your local ENRICH Office.
  • Lists and contact details for local care homes can be found through the Care Quality Commission at www.cqc.org.uk (or Care Inspectorate in Scotland or CSSIW in Wales)
  • Local Community Mental Health Teams (CMHT) or General Practices often have a good relationship with care homes and can be an invaluable resource.
  • Care homes that have been identified as ‘at risk’ may not be suitable for recruitment, particularly if participating in research is likely to distract from other areas of care. Care homes can be identified and recommended by local health care professionals, carer organisations and local authority staff.
  2. Approaching care homes (NB care homes that are members of ENRICH network can be contacted via the network)
  • Send out invitation letters to the care home manager. You may find it helpful to ask an appropriate care home manager to read through a draft and give you feedback.
  • Follow up invitation letters with a phone call to the care home manager.
  • In your letter and telephone call:
  • Be explicit about the amount of time, resource and involvement required of staff.  Estimate the level of disruption that participation in the study will cause, and ensure you have costed compensation for it.
  • Highlight the benefits of being involved; ask yourself the question ‘what’s in it for them?’
  • Describe incentives for care homes to join the study (for the organisation and staff involved).
  • Discuss anonymity and confidentiality.

  • Discuss in advance what would happen in the event that a member of the research team had concerns about a resident’s care or concerns about abuse.
  • Provide the care home with assurances that the researchers have had Criminal Record Bureau/Disclosure and Barring Service checks if needed, are insured, and ask about any possible requirements for immunisations.
  • Provide care homes with examples of studies carried out in other care homes.
  • Check if there is anyone else in the organisation that needs to be contacted to agree to the care homes participation e.g. the owner. This is particularly important for the larger chains and often it is better to make the first approach to head office.
  • Finding appropriate, interested and supportive care homes to partner with and support a study is a key element. Researchers consulted in production of this toolkit all advise that this stage will take much longer than anticipated, and should be started as soon as possible.
  • Be aware of ‘winter pressures’ on care homes, as this can influence which months to start your study.
  • Stage the recruitment of care homes into groups. This allows time to establish relationships with the managers and staff, and to understand how that care home runs, their priorities, concerns, goals of care and everyday routines.
  • The normal research “best practice” standards should be applied irrespective of where the research is conducted.
  • Sharing information is essential to the smooth running of a study. Ensure you agree with the care home manager the best approach for researchers to communicate with staff, residents and resident’s family members.
  • Be prepared to answer questions that the care home staff are likely to ask. These can be found in Questions to Ask Researchers.
  • Give enough information to staff and residents and provide them with opportunities to ask questions about the proposed study.
  • Use various communication materials to inform care home staff, residents and family members about the study.  Try using a resident information leaflet, staff posters, staff handover meetings, workshops, study champions, letters to residents’ families and friends, and newsletters.
  • Find out where you can take residents and staff for private conversations if possible.
  • If appropriate, let all the GPs with residents in the home know of the study and seek their ‘buy-in’.
  • Family members (or the person who knows the resident best) should be treated as an expert partner in care in all settings and be involved in all care-planning and decisions.
  • Normal research “best practice” standards should be applied irrespective of where the research is conducted.
  • Care home managers and/or senior care staff will know their residents well so involve them in identifying residents to take part in the study.
  • Plan how you intend to gain consent, and allow ample time for this.
  • For some residents you may need to seek the views of consultees or people who have been given Lasting Power of Attorney (See Mental Capacity Act 2005) or legal representatives (see Medicines for Human Use (Clinical Trials) Regulations 2004), this can sometimes take longer.  Ensure you work with the care home to identify the best method for achieving this.
  • The normal research “best practice” standards for gaining consent consistent with the Mental Capacity Act and other requirements should be applied, such as approaching consultees. More and more residents will have set up a Lasting Power of Attorney so be familiar with this.

Maintaining relationships is vital to completing the study:

  • Develop strategies that encourage a sense of involvement and partnership with all staff.  Researchers may want to identify ‘study champions’.
  • Be respectful of people’s time.
  • Build a good relationship with the manager, staff, residents and families / visitors; get to know the home and how it runs.
  • Experienced researchers should pass on to the research team their experiences of working in a care home environment and prepare them mentally and emotionally for working in this setting.
  • Researchers may need to visit the home outside of usual hours of work, at night or over weekends, to fit in with the work schedules or care home work shifts.
  • Research in care homes is different from hospitals, as the place you will be working is the resident’s home. There will likely be some research in public areas. However your research may involve spending time in the resident’s private spaces or bedroom. It is essential that you recognise and respect this and ensure you have permission to be there.
  • Researchers who are not familiar with the MCA could consult the general document What every Carer Needs to Know – a guide to mental capacity. It is in plain English and helpful to understanding what processes might be involved and that gaining consent has to be decision-specific.
  • If the researcher is dealing with people whose cognition is impaired, it is very helpful if the person who knows the resident best (and maybe has been their main carer prior to moving to the care home) can be involved as much as possible with the research.
  • The normal research “best practice” standards should be applied irrespective of where the research is conducted.

“Support and advice from other researchers and networks, such as ENRICH, is vital for conducting research in this setting. Many of the challenges encountered are unique to this setting and addressing them is essential in order to produce the high quality research required  to provide the best evidence-based practice for this  much under-represented population.”

Victoria Shepherd, Research Lead for PAAD, South East Wales Trials Unit at Cardiff University, March 2015

PRACTICAL ADVICE: INVITE STUDY CHAMPIONS

At the beginning of the study, researchers may want to identify particular care home staff to act as ‘study champions’.  Identifying interested and enthusiastic people at the outset may help to spread news about the study, gain ‘buy in’, and encourage others to get involved.  

Some researchers have worked with ‘study champions’ to:

  • Advocate for their study; to provide a simple and clear description of the study to other members of staff to help improve everyone’s understanding;
  • Act as good role models by piloting the study intervention within the care home (i.e. carrying out some aspect of occupational therapy, cannula checks, physical exercise, etc);
  • Improve communication channels between the research team and the care home;
  • Speak up when they become aware of concerns about the research or quality of care being provided to residents.

It is important when recruiting ‘study champions’ to communicate at the outset the benefits of them getting involved in the study, how much time will be taken from their shift to complete the role and to discuss it with their manager.  Studies should provide staff with incentives to get involved such as compensation, vouchers, training or educational seminars to help with professional development.

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