ENRICHEnabling Research in Care Homes
“The Queen’s Nursing Institute (QNI) was commissioned by NHS England and NHS Improvement (NHSE/I) to develop standards of education and practice which would support the transition of a Registered Nurse who is new to working in the care home sector. For the purpose of this report the focus will be on Care Homes for older residents who require nursing care to be provided by the home.
The development of these standards is timely as the focus and attention being given to Care Homes is greater than it has ever been, demonstrating a policy shift to community based, integrated health and social care across all community care delivery (NHSE 2014; NHSE/I 2019). Reports show there is an increase in the number of people over the age of 65 who are requiring either residential or nursing care (Bennett et al 2018; NHSE/I 2019). The British Geriatric Society (2016) suggest that 75-80% of those living in Care Homes have cognitive impairment with the average care home resident having multiple long-term conditions, functional dependency and frailty.”
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“The COVID-19 pandemic has disproportionately affected older people with 90% of deaths from COVID occurring in those aged over 65. It should therefore come as no surprise that BGS members – geriatricians, GPs, nurses, allied health professionals, care home staff and other healthcare professionals working with older people – have been among those most involved in the treatment of people with COVID, both in hospitals and in the community.
BGS members reflected on the practical elements of managing the pandemic, including variable access to personal protective equipment (PPE) and testing for staff and patients and the confusion caused by constantly changing guidance. Concern about the impact of COVID-19 in care homes was a source of anxiety, and the implication that discharge from hospitals to care homes early in the pandemic without negative COVID tests contributed to outbreaks.
More than three quarters (77%) of respondents stated that they had had a change in their job plan or rota due to the pandemic. This took the form of increased out-of-hours work, cancellation of scheduled clinics and treating all adults as opposed to older adults only. While some volunteered for these changes, others had them imposed and it will be important to ensure that regular rotas are restored as quickly as possible. Concerns about future careers were also expressed with many trainees describing a lack of training opportunities over the past year.”
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“This report aims to provide an overview of data and policies in relation to COVID-19 vaccinations for people who use and provide long-term care. It is a “living report” that will be updated regularly, please email email@example.com if you would like to contribute or aware of relevant sources of information.
- The report shows data for populations that either use and provide long-term care or are likely to do so. So far very few countries routinely share data on the characteristics of people who are receiving vaccinations. In all other countries the data has been announced by official sources to the media.
- On the 11th January we have found data on COVID-19 vaccinations in care homes for 8 countries, and for some regions/nations in Spain and the United Kingdom.
- 2 countries (Denmark and Israel) and a region in Spain (Asturias) report having completed first doses of vaccination for all care home residents and staff. Over half of all care home residents are reported to have been given a first dose of vaccine in Catalonia (Spain), Northern Ireland and Scotland, and over a quarter in Croatia, Cyprus and Germany, and close to 15% in Italy and the United States.
- The share of doses of vaccines given to people living in care homes ranges from 6% in Italy to 73% in Croatia.
- We have not found official data, so far, on the share of care home residents who either refuse the vaccination, cannot consent or are excluded from vaccination due to other reasons.
- Initial review of prioritization documents shows that all countries prioritise vaccinations for healthcare staff, and, with slight variations in order, care home residents and staff, older people and, less frequently, people who rely on care in the community and unpaid carers.
- Indonesia is an exception in that the working age population is currently prioritised and not older people.
- There are few mentions of people living with dementia or people with learning disabilities.”
The full report is available here
Authors: Shoshana Lauter, Klara Lorenz-Dant, Adelina Comas-Herrera (Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science) and Eleonora Perobelli (Observatory on Long-Term Care, CERGAS SDA Bocconi)
“An evidence-based programme for care home residents living with dementia improved their quality of life and reduced agitation and other symptoms of dementia. A major study across the UK found that the Well-being and Health for People Living with Dementia (WHELD) programme was effective and cost less to deliver than usual care.
The WHELD programme supports care home staff to deliver patient-centred interventions for residents with dementia. It seeks to reduce reliance on antipsychotic drugs and uses social interaction, personalised activities and exercise to improve care.
Most person-centred interventions used in care homes are not based on scientific evidence. WHELD was tested in a large clinical trial, which showed that it improved quality of life for people with dementia. The programme also reduced agitation and the overall burden of neuropsychiatric symptoms such as depression or aggression. A reduction in the number of hospital and GP visits made the approach less expensive to deliver than usual care.
What’s the issue?
A third of people with dementia in the UK (288,000) live in care homes. Those in care homes tend to have more severe dementia than those living in the community. Agitation and a range of other behavioural and psychological symptoms make it challenging to care for these people.
Person-centred care is the gold standard of care for people with dementia. Yet previous research has found that many care home residents have as little as two minutes of social interaction each day. There is currently no effective, evidence-based intervention to help staff care for these patients without using drugs.
In the first stages of this programme, researchers reviewed 40 studies on psychosocial interventions for people with dementia in care homes. These studies supported the use of person-centred approaches such as reminiscence therapy, in which photographs or other mementoes are used to help someone recall life events and memories. Walking, seated exercise, circle dance or other pleasant activities of the person’s choice were also found to help.
The researchers then looked at training manuals for person-centred care in dementia. Only four out of 170 manuals described interventions with proven benefits.
The team developed the first version of the WHELD programme based on the most practical and effective therapies. It combined person-centred care, management of agitation and non-drug approaches. A first randomised controlled trial tested this version of WHELD in 16 care homes over a period of nine months. It found that reviews of antipsychotic medication halved the use of these drugs. This increased the behavioural and psychological symptoms of dementia unless the medication review was combined with personalised activities. The combination of review plus social interaction significantly improved quality of life and reduced the risk of dying among people with dementia by 30%. Exercise reduced symptoms of agitation.”
For more details on this programme click here
Public Health England has published a toolkit to “help with the implementation of NICE guidelines for improving the oral health of adults in care homes.
Public Health England and stakeholders have produced a toolkit to support care homes and commissioners to implement the NICE guideline (NG48): Oral health for adults in care homes. The toolkit also contains useful links for care home staff, residents, their families and friends to support good oral health and reduce oral health inequalities.”
For more details and access to this toolkit click here
“The British Geriatrics Society has just published an update to their good practice guidance, COVID-19: Managing the COVID-19 pandemic in care homes for older people.
The COVID-19 pandemic raises particular challenges for care home residents, their families and the staff that look after them. This guidance has been developed to help care home staff and NHS staff who work with them to support residents through the pandemic. This is Version 4 of the document.
This guidance is written as the United Kingdom moves into the second wave of the COVID-19 pandemic. It is designed to be applicable to care home residents across all four nations of the UK. Residents of care homes for older people have been particularly affected by COVID-19. Across the four nations 28-50% of all COVID-related deaths occurred in care home residents.
This guidance covers the following issues that care home staff are likely to come across when managing COVID-19 in a care home environment:
- Infection control
- Staff and resident testing
- Admissions to care homes
- Family visiting
- Diagnosing COVID-19 in care homes
- Management and treatment of COVID-19 in care homes
- Advance Care Planning
- End of life care
- Continuing routine healthcare
The intended audience includes, but is not limited to, care home staff, primary care teams including general practitioners (GPs), community teams providing care for older people including Hospital At Home teams, hospital discharge teams, and those providing advice on infection control to care homes.
To access this publication click here
“This report sets out the Care Quality Commission’s (CQC’s) assessment of the state of care in England in 2019/20. We use data from our inspections and ratings, along with other information, including that from people who use services, their families and carers, to inform our judgements of the quality of
care. Most of the analysis in this report is generated by CQC, specifically:
Quantitative analysis of our inspection ratings of more than 31,000 services and providers, drawing on other monitoring information including surveys to engage staff and the public including using CQC’s online participation platform. In previous years, we have used ratings as at 31 July, to enable as contemporaneous a view as possible. Because we suspended our routine inspections and ratings in March 2020 as a result of the coronavirus pandemic, the ratings in this report are as at 31 March 2020 and all comparisons with the previous year are with ratings as at 31 July 2019.
A programme of primary qualitative data collection and analysis to gather evidence to inform the messages of this report. Through this work, we have heard from 153 people through focus groups or interviews with CQC inspection colleagues and external stakeholders. All interviews and focus groups took place between February and April 2020. Due to the timing of the data collection, these evidence sources represent a pre-pandemic view. We adopted the following methods and objectives for this work:
− Thematic analysis of 22 focus groups, four interviews and five written responses. These were conducted with CQC inspection colleagues and representatives from local Healthwatch and supplemented by a small number of interviews with other external stakeholders. Focus groups with inspection colleagues operating in each of the seven NHS England/Improvement regions aimed to gather insight about cross-sector working and successes and challenges at a regional level. In addition, interviews and focus groups with external stakeholders in each of the regions aimed to explore what stakeholders understood to be the primary successes and challenges for their local health and social care systems. The discussion focused on pre-defined themes: access, local communities and innovation. Analysis identified high-level findings related to these three themes.
− Thematic analysis of two focus groups with a total of 19 CQC inspection colleagues, including mental health and adult social care inspectors and Mental Health Act reviewers with a particular knowledge and interest in Deprivation of Liberty Safeguards (DoLS). Acute hospital inspectors were unable to take part due to operational pressures relating to COVID-19. The work aimed to provide insight into CQC’s knowledge about the operation of the DoLS system this year. We also carried out secondary qualitative analysis of 100 care home and 40 hospital inspection reports to understand what good, poor and improvement in DoLS practice looked like.”
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Would you like to join the British Society of Gerontology Care Homes Research Special Interest Group?
The BSG Care Homes Research SIG is a collective of academics, practitioners and other stakeholders with a common interest in care home research.
‘The SIG aims to strengthen research, policy, and practice in all areas of care homes research, including those related to staff, residents, family members and carers, as well as the home environment, and its links with external organisations. We also aim to develop complementary working relationships with the other British Society of Gerontology SIGs, as well as other groups and organisations that support care homes research.
Our objectives are to:
· provide platforms for discussion and debate;
· facilitate the development of research collaborations and funding proposals;
· increase capacity for care home research;
· promote methodological development around the novel challenges in care homes research;
· support the dissemination and application of research findings to improve the lives of residents, carers and other stakeholders’
If you are interested in becoming part of the BSG Care Homes Research SIG, please contact the SIG at BSGcarehomes@gmail.com
You can also follow them on Twitter @BSGcarehomes
The LTCcovid attempt to present comparable data and statistics on the effect of COVID-19 within long-term care (LTC) settings in the UK, with a particular focus on care homes.
‘The impact of the COVID-19 pandemic on the oldest old, especially those within care home settings, has been devastating in many countries. The UK was no exception. This article reviews the path of the COVID-19 pandemic across the UK long-term care (LTC) sector, indicating how it evolved in each of the four home nations. It prefaces this with a description of LTC across the UK, its history and the difficulties encountered in establishing a satisfactory policy for the care of frail older people across the home nations.’
The paper makes several contributions:
- First, it provides an up to date estimate of the size of the adult care home sector across the UK – previous work has been bedevilled by inaccurate estimates of the number of care home places available.
- It assembles the limited information that is available on delayed transfers of care and testing of care home residents, both of which played a role in the evolution and consequences of the pandemic.
- It estimates the number and share (the P-Score) of “excess deaths” in care homes in each of the home nations. The P-Scores provide measures that allow comparisons across care home populations of different size.
‘Not only do we discuss the number of individuals affected, we also compare the proportions of care homes in each of the home nations that experienced a COVID-19 infection. The paper also discusses deaths of care home residents outside care homes, largely in hospitals. It reviews the sparse information on deaths at home of people who were receiving social care.’
For access to the full report click here
The University College London has published a new guide for family and/or friends caring for a person living with dementia to support decision-making during COVID-19 and beyond:
‘We are an experienced team of researchers and health and social care professionals including GPs and Psychiatrists from University College London and King’s College London, and a group of people living with dementia and family carers. We have used the latest evidence from research and clinical practice, together with the views and experiences of people with dementia and family carers. We have received expert input and this document has been reviewed by GPs, palliative medicine doctors, nurses, geriatricians, psychiatrists, and social care professionals. This project has been supported by Marie Curie, Alzheimer’s Society, Dementia UK, and Royal College of Nursing who have all contributed to the development and reviewed this document.’
To access the guide please click here