Research findings
ENRICHEnabling Research in Care Homes
If you missed our CRED talk this week we have recorded it, therefore you do not need to miss a thing!
We heard from:
Chair: Professor Deborah Sturdy, England’s Chief Nurse for Adult Social Care
Adeela Usman, Doctoral Fellow at the University of Nottingham: QUINCE study: How quality of life is described and can be delivered in care homes
Dr Kellyn Lee, WISER Health and Social Care, and Dr Jane Frankland, University of Southampton: Material Citizenship training: how thinking about everyday objects differently can improve quality of life in care homes
Bryony Beresford, Professor of Health and Care Services Research, University of York: Behind the scenes: organisational features and practices which support and nurture relationship-centred homecare
Please see the recording of the webinar here.
We are now welcoming proposals for #CRED talks on other topics in the months to come. If you are a research team or research-practice partnership with social care research to share, please contact arcwessex@soton.ac.uk to find out more.
The NIHR ARC East Midlands team are now able to share our implementation training booklets with you all. 4 booklets are available:
- Implementation: Principles and Perspectives
- Engagement, Involvement & Coproduction
- Planning for Impact
- Measuring & Evidencing Impact
Download free of charge here
“Greater attention is rightly being paid to the valuable work that social care staff do to support living and dying well in care home and domiciliary care settings. The evidence base is growing about promoting continence and preventing urinary tract infection (UTI) in old age and is a potentially helpful resource for social care staff and managers. This #CRED talk showcases the best of this research in the UK, with a focus on practical take-home messages for people working in social care.
When the need to go to the toilet is complicated by mobility, sensory and cognitive challenges the health and social care needs of the person often intersect. This #CRED talk will consider the value of reframing different interventions as integral to intimate and personal care work and of fitting them alongside other care being delivered. It discusses how opportunities to reflect on practice and learn from each other about how to promote continence and prevent UTI, help to ensure that existing evidence is used more effectively.
This #CRED talk will bring you up to date with the latest evidence and associated learning resources in care home and domiciliary settings, with the aim of supporting you in the work that you do.”
Date: Thursday 4th May 2023
Time: 15:00 – 16:00
Venue: Online
For more details please click here
ENRICH has been developed by the National Institute for Health and Care Research (NIHR), and is a resource supported by the NIHR
“Material Citizenship, a new approach to dementia care, uses objects used to carry out tasks (such as a mobile phone or curling tongs) as a mechanism for improving the care experience for care home staff and people living with dementia in care homes. It does so by:
- Encouraging care home staff to include personal possessions in care plans
- Support use of personal possessions to maintain routines and rituals
- Enable people living with dementia to carry out everyday tasks, supporting them to the live the life they want to live
According to one care home manager, taking a Material Citizenship approach has transformed how they provide care.
They have seen an improvement in the wellbeing of residents and increased confidence in staff who attended the training. Care home staff are now supporting people living with dementia to engage in meaningful activities such as delivering newspapers, baking bread and polishing their own rooms – with the polish they like. It has also had a more fundamental impact on the care practices of a care home. In one care home the manager gave an example of how it has changed the culture in the care home. Prior to introducing Material Citizenship catering staff worked certain times of the day and food was restricted to set meal times. This has changed and catering staff are now available to support residents in meal choices and meal times that suit them. It was also reported that prior to Material Citizenship, time restrictions of when people should leave the care home and return to the care home were in place. Residents no longer need to be back at certain times, they have more freedom to come and go as they wish, something noted by an external healthcare professional as being wonderful.”
Click here to see Dr Kellyn Lee (Visiting Fellow, School of Health Sciences, University of Southampton) explain how it works
For more information on Material Citizenship contact: info@materialcitizenship.com
“The THRIVE study aimed to understand nurses’ experiences of working in care homes during the COVID-19 pandemic, and how their experience impacted on resilience, mental health and wellbeing.
The study highlighted not only a range of strategies to help nurses accept and recover from their experiences, but also suggestions for better preparation methods for future pandemics.
Findings will be presented at the winter symposium of the British Society of Gerontology’s Care Homes Research Special Interest Group on 22 February 2023, 12pm to 2pm. The symposium is being held online and will focus on wellbeing and resilience among staff working in care homes for older people.
Thank you to the care homes and nurses who took part in this study. The THRIVE Report is available to download from the University of East Anglia’s THRIVE study page.”
Research funded by the Burdett Trust for Nursing and supported by the National Institute for Health Research (NIHR) Applied Research Collaboration East of England.
Key Points
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Pathways into care home are a topic of public, professional and policy interest.
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Individuals moving-in to care homes from hospital are clinically distinct from those moving-in from the community.
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Differences include greater dependency, frailty and recent health events including fracture, stroke, and significant mental illness.
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National cross-sectoral data linkage between social care and health data is feasible as a research methodology.
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However, linked data are biased towards health measures with limited information on care needs, complexity and social networks.
Abstract
Background
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.
Objective
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.
Methods
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.
Results
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).
Conclusions
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.
Authors:
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
Streams include:
- 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. “
Read more at: https://www.kingsfund.org.uk/publications/first-days-statutory-integrated-care-systems”
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; clare.burgon@nottingham.ac.uk
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