ENRICHEnabling Research in Care Homes
Pathways into care home are a topic of public, professional and policy interest.
Individuals moving-in to care homes from hospital are clinically distinct from those moving-in from the community.
Differences include greater dependency, frailty and recent health events including fracture, stroke, and significant mental illness.
National cross-sectoral data linkage between social care and health data is feasible as a research methodology.
However, linked data are biased towards health measures with limited information on care needs, complexity and social networks.
Pathways into care are poorly understood but important life events for individuals and their families. UK policy is to avoid moving-in to care homes from acute hospital settings. This assumes that moves from secondary care represent a system failure. However, those moving to care homes from community and hospital settings may be fundamentally different groups, each requiring differing care approaches.
To characterise individuals who move-in to a care home from hospital and compare with those moving-in from the community.
Design and setting
A retrospective cohort study using cross-sectoral data linkage of care home data.
We included adults moving-in to care homes between 1/4/13 and 31/3/16, recorded in the Scottish Care Home Census. Care home data were linked to general and psychiatric hospital admissions, community prescribing and mortality records to ascertain comorbidities, significant diagnoses, hospital resource use, polypharmacy and frailty. Multivariate logistic regression identified predictors of moving-in from hospital compared to from community.
We included 23,892 individuals moving-in to a care home, 13,564 (56.8%) from hospital and 10,328 (43.2%) from the community. High frailty risk adjusted Odds Ratio (aOR) 5.11 (95% Confidence Interval (CI): 4.60–5.68), hospital discharge with diagnosis of fracture aOR 3.91 (95%CI: 3.41–4.47) or stroke aOR 8.42 (95%CI: 6.90–10.29) were associated with moving-in from hospital. Discharge from in-patient psychiatry was also a highly significant predictor aOR 19.12 (95%CI: 16.26–22.48).
Individuals moving-in to care homes directly from hospital are clinically distinct from those from the community. Linkage of cross-sectoral data can allow exploration of pathways into care at scale.
For access to the full paper click here
The British Society of Gerontology Annual Conference is being hosted by the University of East Anglia, Norwich, UK on 5-7th July 2023.
Abstract submission closes soon (27th January).
Plenary Speakers: Adelina Comas-Herrera, Aravinda Meera Guntupalli, Karl Pillemer Find out more here
- Hearing older people’s voices
- Cultural ageing; Ageing in the community
- Ageing at a time of global crisis
- Technology and social interventions for independence, support and care
- Ageing in urban and rural spaces
- Empowering and supporting people moving to end-of-life
Please do consider submitting your research abstract to this vibrant and friendly conference. Submit your abstract here
Find us on Twitter: @bsg2023
“The first days of statutory integrated care systems: born into a storm
On 1 July 2022, integrated care systems (ICSs) finally arrived in statutory form, some five years after their initial conception through the first of the sustainability and transformation plans.
ICSs are partnerships that bring together NHS organisations, local authorities and others to take collective responsibility for planning services, improving health and reducing inequalities across geographical areas. There are 42 of them in England. They stem from a recognition that the traditional barriers between GPs, hospitals and community services, between physical and mental health, and between health and social care need to be broken down to provide care that is much better integrated. So that people with multiple health conditions, not just single diseases, are better supported. Integral to the concept is that a much stronger emphasis needs to be placed on prevention, on population health and on tackling socio-economic inequalities and the health consequences that flow from them – things that neither local authorities, nor the NHS can achieve on their own, even when working with the voluntary, community and social enterprise (VCSE) sector.
Following the 2022 Health and Care Act, what in most places was a single non-statutory partnership board for an ICS has been replaced by two statutory parts: an integrated care board (ICB), responsible for NHS services but with much wider duties, and a statutory integrated care partnership (ICP), convened by local government and the NHS, which brings together local authorities, the VCSE sector and others concerned with health and wellbeing to develop a health and care strategy for the ICS. ICPs have until December to produce a draft of these strategies, which the ICB will be required by law to take into account when commissioning and delivering NHS services. And the near alliteration between an ICB and an ICP operating as part of an ICS does not making explaining any of this to non-specialists easy, especially verbally. “
Authors: Nicholas Timmins, Chris Naylor, Anna Charles
Objective To explore the experiences of healthcare professionals working in falls prevention and memory assessment services in providing assessments and interventions for falls risk reduction in people with dementia.
Design This is a qualitative study using 19 semistructured interviews. Interviews were analysed through thematic analysis.
Setting Community-based falls and memory assessment services in the East Midlands, UK.
Participants Nurses (n=10), physiotherapists (n=5), occupational therapists (n=3) and a psychiatrist (n=1).
Results Three substantive themes were identified: challenges posed by dementia, adaptations to make falls prevention appropriate for people with dementia and organisational barriers. Patients’ poor recall, planning and increased behavioural risk associated with dementia were key problems. Healthcare professionals provided many suggestions on how to overcome these challenges, such as adapting exercise interventions by using more visual aids. Problems associated with cognitive impairment created a need for additional support, for instance longer interventions, and supervision by support workers, to enable effective intervention, yet limited resources meant this was not always achievable. Communication between mental and physical health teams could be ineffective, as services were organised as separate entities, creating a reliance on third parties to be intermediaries. Structural and organisational factors made it difficult to deliver optimal falls prevention for people living with dementia.
Conclusions Healthcare professionals experience challenges in providing falls prevention to people with dementia at the individual and organisational levels. Interventions can be adapted for people with dementia, but this requires additional resources and improved integration of services. Future research is needed to develop and test the effectiveness and cost-effectiveness of such services.
Correspondence to Clare Burgon;
Authors of the article: Clare Burgon, Janet Darby, Kristian Pollock, Veronika van der Wardt, Tamsin Peach, Lyndsay Beck, Pip Logan, and Rowan H Harwood
“Care homes are a fundamental part of the health and social care system, and with demand in the sector expected to increase, it is important to better understand how the sector can improve
recruitment and retention, be sustainably staffed, and promote collaborative practice. While interprofessional training environments are increasingly seen as a key stage in advancing health and
social care systems, little is known about interprofessional student training schemes in the context of the UK care home environment.
This pilot study aimed to implement and evaluate a 6-week IPE student training placement scheme across three care homes across in Greater Manchester. Students (n=15) across a variety of disciplines – including nursing, physiotherapy, social work, podiatry, counselling, and sports rehabilitation – were placed within the homes to work in an interprofessional environment and address the goals of residents as a collaborative team.
A total of 52 qualitative semi-structured interviews were undertaken with residents (n=10), care home staff (n=12) and students (n=30), over a period of 5 months. Quantitative data was collected by administering an AGEIN questionnaire to students pre and post placement (n=13). The questionnaire asked students about their perceptions of, and attitudes toward, working with older people.
Our study suggests that care homes provide students with an ideal environment for interprofessional working and learning. Through better understanding the dimensions of difference perspectives and approaches, students felt the project improved their education and shifted their perceptions of aged care. Staff benefit from new ways of working, improving their knowledge and skills, which in turn enhances the care the residents receive. Findings also highlight the complex barriers that influence interprofessional learning in the care home setting. In this report we will discuss the benefits and challenges of implementing interprofessional education in care home settings, detail the positive and transformative impacts the experience had on residents, staff and students and consider the future direction of such schemes.”
Authors: Melanie Stephens, Siobhan Kelly, Andrew Clark, Malcom Granat, Ruth Garbutt and Lydia Hubbard – University of Salford
This report details the outcomes of a research project led by the University of Salford with partners at Manchester Metropolitan University, Bolton University and the University of Manchester, and core support from Greater Manchester Project Management Office. It has received external funding as part of a series of initiatives from the GM Enabling Effective Learning Environments workstream.
For access to the full report click here
Dr Caroline Emmer De Albuquerque Green a researcher at Kings College London conducted a collaborative research study with Palvi Dodhia, Co-Founder and Director at Serene Care Ltd examining the urgent barriers and facilitators to digitise small care home companies. They found that the current landscape of funding, knowing how to navigate the wealth of products and how to support staff are really important factors.
For the full report click here
This research was undertaken by Dr Caroline Green at King’s College London and Palvi Dodhia, COO of Serene Care Ltd. We thank all the care home managers, providers and
experts who took the time to speak to us and share their experiences.
This project is supported by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
“There is limited literature about the experiences of older people living in care homes from the viewpoint of older people, and the literature available tends to focus on quality of life. Although connections to the wider community are recognised as important, what these connections mean to older people is not explored in depth, nor is this explored from a theological perspective. This article is based on research carried out in four residential care homes in North West England comprising of participant observation and in-depth interviews with four older people in each home. The theological reflection takes inspiration from Julian of Norwich, confined to a cell, but with windows on the Church and street providing opportunities for connection. I demonstrate that physical and metaphorical windows provide opportunities for relationships to develop and a sense of belonging to the wider world. I argue that a liberation theology of ageing should include older people having a place of belonging in the wider community, and that this is necessary for the community to have shalom. Belonging frees older people from feelings of shame and marginalisation, enabling them to flourish. This paper concludes by outlining its implications for the care home and the wider society.”
“The purpose of this paper is to theologically reflect on an investigation into how older people perceive their connections to people in the wider community in terms of their community networks and the functions these relationships fulfil. Community also includes connections to creation, the past and the future or spiritual and psychological dimensions, but this is beyond the scope of this article. Considering older people’s connections to the wider world leads me to argue that a liberation theology of ageing should include older people having a place of belonging in the wider community. This is necessary for the community to have shalom.”
For full access to this care home research click here
The cost of caring: poverty and deprivation among residential care workers in the UK
“Around 1 in 5 people in the UK live in poverty. They may be deprived of food, shelter, clothing, and other essentials. Poverty and deprivation affect people’s health and limit their ability to live a healthy life. Government policy is that ‘work is the best route out of poverty’. But while employment is one of the main ways to exit poverty, around half of those experiencing poverty in the UK live in households where at least one adult is in paid work.
Adult social care workers – who are mostly women – are among the lowest paid in the UK. Social care staff also experience insecure employment conditions and are more likely to be on zero-hours contracts and carry out shift and night work than other low-paid UK workers. Perhaps unsurprisingly, vacancy and turnover rates in the sector are high and rising. The social care system is under extreme strain, unable to provide care to everyone who needs it.
Unlike other low-paid sectors, such as retail and hospitality, government has a large influence on pay in social care. Levels of central government funding affect how much local authorities can pay care providers to deliver services, and how far many care providers can increase wages for staff. Yet social care has suffered years of underfunding by central government: when the pandemic hit in 2020, government spending per person on adult social care services in England was lower in real terms than in 2010. In recent years, devolved governments in Scotland, Wales, and Northern Ireland have introduced policies to increase pay or offer one-off payments for care staff. But policy to improve pay for social care staff in England has been limited.
Evidence suggests residential care workers in the UK face among the highest rates of poverty and experience financial difficulties, like being unable to pay rent. Analysis of data from 2013–2018 in the US found residential care workers more likely to experience food insecurity than other workers. But we know little about experiences of poverty and deprivation among social care workers in the UK, and the factors that shape them.”
“Residents’ quality of life is better in care homes rated as good or outstanding by the Care Quality Commission (CQC). Research found that their quality of life is better in fully-staffed homes, and where staff have better pay and training.
Care providers are obliged to nurture residents’ quality of life, but there is no standard way of measuring quality of life in care homes. The CQC rates whether homes are safe, effective, caring, responsive and well-led. But before this study, it was not known whether CQC ratings were a good reflection of residents’ quality of life. It was also not known whether staff numbers, pay and training were linked to CQC ratings. This is important because care workers often have poor pay and little training beyond basic induction training. Staff shortages, which increase time pressures, are common.
Staff need the right tools to gather information about residents’ health and quality of life. Many care home residents have dementia and may find it difficult to tell staff how they are feeling. In the first part of this study, the research team worked with staff, residents and families to develop tools to help care home staff identify pain, anxiety and low mood in residents. These tools are suitable for residents with dementia and those with communication difficulties; staff do not need clinical training to use them.
The study also found that better CQC ratings were linked with higher quality of life among the residents who need most help. Caring and well-led services made a measurable difference, especially for residents who rely on staff to meet their basic needs. Better pay and training for staff were linked to higher CQC ratings. A 10% wage increase was linked to a 7% higher chance of a care home being rated as good or outstanding.
Together, the findings show the link between working conditions, care quality and residents’ quality of life. The researchers say that policies to improve working conditions for staff are essential to improve outcomes for people living in care homes.”
If you would like to read more about this study click here.
Health Data Research UK North (HDR UK) and NIHR Yorkshire and Humber invite you to register for our Care Homes Research Workshop.
This event will provide a platform for researchers, stakeholders and public and patient representatives from across the Care Home sector to come together and discuss the latest research within the field. The workshop will be split into two sessions; the first will include a panel discussing how to make research findings useable in care homes and a second session will discuss future research priorities in the sector.
Venue: INOX The University of Sheffield
Date: 20th October 2022
Time: 12:00 – 16:00
The order of the day is as follows:
12:00 – 12:45 Welcome Buffet Lunch
12:45 – 13:00 Introductions and Welcome by Professor Peter Bath and Carl Marincowitz
13:00 – 13:15 Liz Jones, Policy Director & Professor Julienne Meyer National Care Forum – The view from the care home: benefits and challenges of research
13:40 – 13:55 Duncan Chambers University of Sheffield – Reducing unplanned hospital admissions from care homes: an updated and extended systematic review
13:55 – 14:25 Panel discussion and questions: Making research findings useable in care homes
14:25 – 14:45 Refreshments
14:45 – 15:00 Academic Health Science Network (Speaker TBC) – National work stream managing deterioration in care homes
15:00 – 15:15 Professor Suzanne Mason University of Sheffield – Evaluation of use Health Call app in care homes
15:15 – 15:30 Professor Karen Spilsbury & Peter Hodkinson (Chair of Leeds Care Association and Managing Director of Westward Care) – NICHE Leeds: A care and science partnership enhancing the quality in care homes
15:30 – 16:00 Panel discussion and questions: Future research priorities
16:00 – onwards Refreshments and networking
Please register to join us by clicking here