ENRICHEnabling Research in Care Homes
The role of
social care in
The University of the West of England in Bristol is offering a PhD studentship for research exploring continence care in care homes funded by the Abbeyfield Research Foundation. The studentship would start in October 2020.
The deadline for applications is 31 May 2020.
Guidance has been updated by the National Institute for Health Research (NIHR) to support research funded by NIHR affected by COVID-19.
This includes a statement on its website on continuity of research during the COVID-19 outbreak. The most up to date guidance can be found on the NIHR website.
The Department of Health and Social Care has issued new guidance to councils and care providers as the Government works to delay the spread of COVID-19 covering residential care, supported living and home care.
Guidance on residential care is available on Public Health England’s website.
A recent paper published in the BMC Health Services Research journal evaluated the implementation of a new Care Home Innovation Programme (CHIP) to reduce potentially avoidable hospital admissions.
The research team invited 32 care homes with 1,314 beds in South Sefton, Merseyside to sign up to CHIP which was launched in April 2015 which continued until June 2018. They found that “in comparison to the 12 months prior to launch, over a four-year period, implementation of the CHIP resulted in a 15% reduction of emergency calls, and in a 19% reduction of conveyances to hospital”.
The full paper is available at:
Clarissa Giebel, Debbie Harvey, Asangaedem Akpan and Peter Chamberlain (2020) Reducing hospital admissions in older care home residents: a 4-year evaluation of the care home innovation Programme (CHIP), BMC Health Services Research, 20, 94.
The University of Hull is carrying out research to explore the experiences of GPs who visit and work in care homes for older people. The GP Care Home Survey is open for responses from GPs to capture their experiences, difficulties and challenges and the things that support them in this role. The research team are also specifically interested in GPs’ role in safeguarding.
The survey can be completed at https://hull.onlinesurveys.ac.uk/gp-care-home-survey-october-2019.
A recently published paper in the BMC Health Services Research journal sets out findings from a study which explored the feasibility of conducting a trial of a full clinical medication review for care home residents with behaviour that challenges, combined with staff training. The paper by Maidment and colleagues focused on the feasibility of measuring clinical outcomes and intervention costs.
“People living with moderate to severe dementia, receiving psychotropics for behaviour that challenges, in care homes were recruited for a medication review by a specialist pharmacist. Care home and primary care staff received training on the management of challenging behaviour.
Data were collected at 8 weeks, and 3 and 6 months. Measures were Neuropsychiatric Inventory-Nursing Home version (NPI-NH), cognition (sMMSE), quality of life (EQ-5D-5 L/DEMQoL) and costs (Client Services Receipt Inventory).
Response rates, for clinical, quality of life and health economic measures, including the levels of resource-use associated with the medication review and other non-intervention costs were calculated.
Twenty-nine of 34 participants recruited received a medication review. It was feasible to measure the effects of the complex intervention on the management of behaviour that challenges with the NPI-NH. There was valid NPI-NH data at each time point (response rate = 100%). The sMMSE response rate was 18.2%. Levels of resource-use associated with the medication review were estimated for all 29 participants who received a medication review. Good response levels were achieved for other non-intervention costs (100% completion rate), and the EQ-5D-5 L and DEMQoL (≥88% at each of the time points where data was collected).”
The study found that it is “feasible to measure the clinical and cost effectiveness of a complex intervention for behaviour that challenges using the NPI-NH and quality of life measures”.
Full paper (open access):
Ian D. Maidment, Garry Barton, Niyah Campbell, Rachel Shaw, Nichola Seare, Chris Fox, Steve Iliffe, Emma Randle, Andrea Hilton, Graeme Brown, Nigel Barnes, Jane Wilcock, Sarah Gillespie & Sarah Damery (2020) MEDREV (pharmacy-health psychology intervention in people living with dementia with behaviour that challenges): the feasibility of measuring clinical outcomes and costs of the intervention, BMC Health Services Research, 20, 157.
The NIHR School for Social Care Research (NIHR SSCR) is seeking to appoint an individual to develop and manage the ENRICH Toolkit website.
The ENRICH toolkit identifies the principles that should guide research in care homes and signposts those involved in research in care homes to detailed sources of information. As well as the toolkit, the ENRICH website includes case studies, news and a blog to showcase research within care homes in the UK.
The ENRICH website is managed by NIHR SSCR. The ENRICH Research Ready Network is supported by the NIHR Clinical Research Network (NIHR CRN) and brings together care home staff, residents and researchers to facilitate the design and delivery of research.
This is an hourly-paid appointment for between 5 and 10 hours per week.
NIHR SSCR would be happy for an individual to take on this role as part of their continuing professional development or education, and to discuss how this might be managed with the successful applicant.
Further details are set out in the ENRICH hourly-paid position advert (PDF).
Application is by covering letter and CV to NIHR SSCR by 16.00 on Friday 17 January 2020.
The research found the optimal time – if any – to move to a care home depends on many different factors other than symptom severity. These include the wellbeing of the person living with dementia, family members’ ability to support them and the type and availability of care home places.
But dialogue with social care professionals and care home managers, as well as intermediate steps such as joining care home waiting lists and using respite offered by care homes, can help ease what for some is an agonising decision. Often the decision seemed to be harder if it had to be taken at a time of crisis, the research suggested.
“We would emphasise the value of conversation – really talking to people with the right experience – in managing potential distress and exploring options as early as possible,” said Dr Kritika Samsi, who led the team at NIHR Health & Social Care Workforce Research Unit (HSCWRU). She continued: “It was clear from this study that determining the ‘right time’ for any move was highly individual, contextual and not dependent on the ‘stage’ of someone’s dementia.”
Her colleague Dr Laura Cole who interviewed many of the people affected by dementia in this study added: “Moving to a care home was a highly emotional time for many families. And some continued to ruminate on their decision long after it had happened. It is important to bear in mind that there is no perfect time – but the aim is that everyone’s point of view is taken into account.”
‘Feeling ready’ for a move to a care home
The research team found that existing evidence says that in most cases decisions about moving to a care home are largely driven by whether people living with dementia and their family carers ‘feel ready’ for a move. This consideration is also strongly influenced by negative perceptions of care homes being a ‘last resort’ option especially when people are unfamiliar with care homes and what they can offer.
Interviews with family carers underscored the “frustration, grief, guilt and sorrow” some people experience when trying to decide whether their relative should make a move to a care home.
Many family carers – especially self-funders – felt poorly supported by local authority adult social care services and were frustrated by a lack of easily available advice.
When deciding whether to take a vacancy at a care home, families notably valued facilities’ ‘feel’, whether staff seemed caring, and the ease of visiting. Some found that having used the short-break services of a care home for respite or having been in contact by joining a waiting list helped establish a relationship with the care home’s staff.
Only five people living with dementia – all of whom had recently moved to a care home – were interviewed for the study as many care home residents were not able to talk about the decisions. But within that small sample, there were strong indications that involving the person living with dementia in the decision helped them adapt to their new surroundings.
Maximising time at home
Practitioners tended to prioritise the wishes of people living with dementia when it came to the time of moving to a care home, although the need to make best-interests decisions overrode these on occasion.
While noting the importance of managing risks and family carers’ ability to cope, many social workers believed that people living with dementia should continue to live at home for as long as possible. A follow-up survey of dementia care practitioners reinforced this notion, and many maximised home care support before recommending a care home move.
However, some care home managers who were interviewed by the researchers, while acknowledging the value of time at home, noted that moving to a care home early could help staff get to know people before their symptoms became too severe. Moving earlier could also enable people living with dementia to be more involved in the decision.
Like social workers, care home managers said that joining waiting lists or making use of short-stay or respite care could help people prepare for a later long-term move.
Moving to a care home ‘not a failure’
Commenting on the findings, Professor Jill Manthorpe, another member of the research team, said: “We would like to shift the idea that moving to a care home is a failure or a last resort – it’s another step in people’s care journey that may be necessary, the optimal time will depend on the person living with dementia, their carers and local facilities.
“Where possible, conversations in this area may be helpful if held in advance, although we acknowledge that for some people it’s too distressing – you cannot enforce care planning if people feel unable to do it.
“Our study also suggests people may settle better in a care home and enjoy life there more if they have been involved in the decision rather than experiencing it as a crisis – our sample was too small to draw firm conclusions but future work is needed to investigate this further.”
Full summary findings
NIHR SSCR (2019) Investigating ‘Optimal Time’: Perspectives on the Timing of People Living with Dementia Moving into Care Homes, Research Findings 88, NIHR School for Social Care Research, London.
The research team led by Nick Smith from the Personal Social Services Research Unit conducted a nested, cross-sectional study, collecting SCRQoL data using the Adult Social Care Outcomes Toolkit at two time points, office hours (Monday-Friday between 9.00 and 16.30) and outside of office hours. Data were collected for 99 older adult care home residents in 13 care homes (5 residential and 8 nursing) and analysed using a combination of non-parametric and parametric techniques.
The paper reports that SCRQoL ratings were lower during the weekends and early evenings than during office hours. The differences were most pronounced in the higher order domains of social participation, occupation and control over daily life.
Although the paper notes that further research is needed, the authors suggest that this study challenges the traditional model of care, in which social activities and meaningful pastimes are mostly organised during ‘office hours’. They observed evenings that were very short, as residents tended to return to their room shortly after dinner, and quiet weekends, and this was reflected in residents’ quality of life. This is contrary to the rhetoric of care homes being people’s own homes, where they would be able to choose to remain active and engaged into the evening and on the weekends, as they may have done throughout their lives.
The full paper is available through the Journal of Long-term Care.
The Department of Health and Social Care (DHSC) announced in May that it will open a new, single centre to develop and enhance the ways that patients, carers, and the public can partner with the NIHR to advance research. The new centre will integrate this with work to enable health and care professionals, researchers, policy makers and the public make better use of the broad range of research evidence that the NIHR generates.
Establishment of the new centre, which will open in April 2020, is now underway.
Dr Louise Wood, Director of Science, Research and Evidence at DHSC, said:
“We believe this is an innovative step forward which will keep NIHR at the forefront of national and international efforts to put the needs of patients and the public first in health, social care and public health research. We are excited about the opportunity to unify this with our research dissemination activities, getting research evidence into the hands of front line health and care staff, commissioners, policy makers, patients and the public.
“Our commitment to public involvement is unwavering, and we are proud of our track record thus far. The new centre will be expected to embrace INVOLVE’s values and principles and will work to deliver the recommendations in Going the Extra Mile, including embedding the UK Standards for Public Involvement across our infrastructure and funding programmes.
“Our public contributors continue to challenge us to improve what we do. The new centre will put us in a better position to build new partnerships and to work differently, including using co-production and co-design.”
Discussions are in progress with the current providers to ensure continuity. The work of INVOLVE and the NIHR Dissemination Centre will continue unchanged through to March 2020.
Dr David King, Director of the NIHR Central Commissioning Facility and LGC’s Grant Management Group, said:
“As the incoming provider for the new centre, we are working together with the NIHR INVOLVE and Dissemination Centre teams to plan and oversee the transition process.
“Our first priority has been to make sure that current staff are supported through transition. Now that this process has begun, I am pleased to say we are in a position to engage with and involve all partners interested in the development of the new centre, with a view to getting everything ready for its launch in April 2020.”
Further information is available on the NIHR website.