Care homes matter because…

Anyone of us, our family members or our friends could reside in a care home in older age and often that is not a welcome prospect for many reasons. Because the prospect might be displeasing, we tend to put ‘care homes’ out of our mind. This doesn’t improve things: we suggest it keeps us all in the status quo. In the paper and this blog we argue that the care home community needs to be thought about more and supported by the wider community.

A theory-based approach

In our paper we presented Axel Honneth’s recognition theory. This theory says that people need to be visible, listened to and affirmed if they are to experience wellbeing. They need to be recognised and be a recogniser: it is a mutual process.

We can see in practice how Axel Honneth’s theory played out during the COVID-19 pandemic. Early on events in the UK highlighted how care homes were noticeably absent in the political debate. There was a call for the community to rally around and protect the NHS. Important as this was and still is, care homes went unrecognised. Many have argued that the lack of attention to care homes contributed to the high death rates.

There is now a ‘fight for recognition’ with more talk about care homes in the media and a high court challenge against the UK government on the grounds that they failed to protect the right to life of care home residents.

The research problem

The lack of relevant ‘evidence’ to inform practice and the lack of an infrastructure to quickly acquire evidence through research were two factors contributing to suffering in care homes during the pandemic.

The lack of research is arguably rooted in our collective failure to recognise the value of our care homes and invest in them. We have also often failed to find effective ways to do research in the complex world of care homes or to share the knowledge we gain from research in meaningful ways. So, whilst care regulators encourage research, historically there has not been the necessary support and investment.

The evidence that building capacity in relational research makes a difference

One way that people who live and work in care homes can be ‘recognised’ is through research that responds to their needs, questions, and priorities. To make sure this type of research happens we need to develop better relationships between care homes and researchers. We also need to support everyone in the care home sector (providers, staff, residents, and their families) to inform the research agenda.

We champion this approach because:

• The Enabling Research in Care Homes (ENRICH) network in England and Wales (ENRICH Cymru), which supports a bottom-up research agenda and supports relationships between care homes and researchers, has had positive effects on the research being conducted.

• The NIHR Academic Research Collaboration network has developed an online platform for care homes to pose their most pressing questions, which the network will then try and answer through reviewing existing evidence. This has been warmly welcomed, especially throughout the COVID-19 pandemic.

• People who are experts because of their lived experience are increasingly driving change. For instance, older people living in care homes are helping to develop care home relevant policies in Wales (Older People’s Commissioner Wales).

Relational research capacity building is not a quick fix. Neither is it the only change that is needed. However, it has considerable potential.

Take-home message

The rights and wellbeing of care home residents have received more attention than ever in recent months. Covid-19 and social distancing regulations have changed life in care homes and we urgently need research to inform new ways of working.

To conclude

Realising the potential of research could lead to care homes becoming something we recognise and celebrate, rather than avoid thinking about. The recognition this would give really could make a difference to our lives and those of people we love, now and into the future.

This blog is based on the paper: Toms, Green, Orrell and Verity (2020) Building relational research capacity in care homes in the covid-19 era: applying Recognition Theory to the research agenda. Quality in Ageing and Older Adults, 21 (4) doi: 10.1108/QAOA-09-2020-0042 (Open access until 11^th April 2021)

About ENRICH Cymru

The ENRICH Cymru network is now co-hosted by a collaboration between the Centre for Ageing and Dementia Research and the Health and Care Research Wales Support and Delivery Centre. For more information about the network and joining please visit the Health and Care Research Wales website.

If you are interested in joining the ENRICH Cymru network in Wales, you can also contact one of the team.

Sondra Butterworth (ENRICH Cymru Research Facilitator)

Emma Richards (ENRICH Cymru Research Facilitator)