Alcohol use in care homes

For some older people, having a few drinks is part of everyday life.  And moving into a care home doesn’t have to get in the way of this.  Small amounts of alcohol have been shown to increase happiness, friendliness and pleasant and carefree feelings.

In some fascinating experiments in the 1960’s and 1970’s, older people in nursing homes and psychiatric wards were given either alcohol or fruit juice.  Those who received alcohol were more socially active, alert, friendly and communicative. Alcohol seemed to increase morale and reduce worrying and difficulties falling asleep.  The relationship between older people and staff improved.

But even small amounts of alcohol can cause problems in older people living in care homes.  These problems include confusion, falls, injuries and dangerous interactions with medicines.  Some older people in care homes are dependent on alcohol or have alcohol related brain damage.  For them, drinking alcohol can be especially risky.

How this study came about

In 2018, we were approached by an Inspection Manager from the Care Quality Commission (CQC).  The CQC is the public body which regulates and inspects care homes in England.  She told us that inspectors were finding more cases of poor care of people who are dependent on alcohol or have alcohol-related brain damage.

To try and understand the issue better, we spoke to a small number of people working in care homes.  They described a number of challenges in terms of alcohol

• Deciding how alcohol should be controlled within the home (if at all)
• Knowing when a person’s use of alcohol is unsafe
• Balancing a person’s rights to make choices about alcohol with the need to keep them safe
• Knowing what to do when a person’s alcohol use is causing problems
• Knowing how to recognise when people are dependent on alcohol

We found a number of cases where people had been harmed because of poor practice.  For example, one man was dependent on alcohol when he moved into a care home.  Sadly, he died from drinking heavily in the care home.  He hadn’t been asked about his alcohol use when he moved into the home and staff didn’t know he was dependent on alcohol.  In another example, a care worker had given someone alcohol with medicines that shouldn’t be taken with alcohol.

We also wanted to find out what people living in care homes and their families think about alcohol use in care homes.  The small number of residents and families we spoke to told us

• Alcohol can be important to having a ‘good life’
• Freedom of choice and the right to make your own decision about alcohol is important

This reminded us how important it is to consider the positive aspects of alcohol use for people living in care homes rather than just focusing on the negative aspects.

What we will do

The questions we want to answer are:-

1. What practices, rules and policies currently exist in relation to alcohol use in care homes?
2. How and why do practices, rules and policies vary between care homes?
3. What problems arise in practice in relation to alcohol use and why do they occur?
4. What are residents’, staff and family members’ perceptions, values and priorities in relation to alcohol use in care homes?
5. How and why do perceptions, value and priorities differ between individuals and groups?
6. What does good practice look like in relation to alcohol use in care homes?

To answer these questions, we will carry out an intensive study of 12 care homes, gathering the views of residents and staff and observing events such as mealtimes where alcohol plays a part. We will then set this into the wider context by carrying out a telephone survey of 150 care homes.

Once all the information has been collected and analysed, we will bring together care home residents and families, care staff and CQC inspectors to develop a set of good practice recommendations.  The recommendations will be included in training for care home workers and care home inspectors.

Carrying out research during the Covid pandemic

We have had to rethink how we will carry out this study because of the Covid pandemic.  We are now unable to enter care homes to do the research.  Instead, we speak to residents and staff by telephone or video call.  Care home staff will film events such as mealtimes where alcohol plays a part.  They will send the films to the research team so that they can watch them at the University.