Care homes based research in HertfordshireClaire GoodmanCentre for Research in Primary and Community Care

c.goodman@herts.ac.uk

Presentation

• Background• Relationship between

NHS and care homes• Recent and current

research• Example of

appreciative inquiry• New initiatives for

supporting research in care homes

Older People in the UK*• Increase in older people (23% popn by

2034)

• Largest user (2/3rd of hospital beds)

• Fastest increase >85s (5% popn by 2034)

• Public expenditure on long term care will rise by 94% to £15.9 billion by 2022

* Taken from J.Meyer City University slide based on Age UK, 2011 data

)

Size of care homes at 31 March 2010 (CQC, 2010)*

* Based on J.Meyer slide City University

Average size of care home by type and ownership (CQC,

2010)*

* Based on J.Meyer slide City University

Care homes in the UK

•167,000 NHS hospital beds•18,255 care homes provide 459,448 beds •Overlap’ in care needs between types of home•355,000 care workers and senior care workers•Unknown how many nurses working in care homes

Population with ongoing and complex needs

Questions?• How does the NHS work with care

homes?• What are the challenges and

opportunities?• Solutions and actions that can be taken?

Research projects • District nursing work with care homes in Herts

(2000)• Review of PCT involvement in 5 London LA

areas to support workforce (2002)• Essence of care intervention to support

continence care (2005)• EPOCH (2010): Older people’s accounts• Evidem end of life (2011) Appreciative inquiry• APPROACH (2011) Models of working with

care homes

Evidence reviews Surveys

In depth studies Experiment

Participatory

Research approaches used

NHS relationship with care homes

• Uneasy relationship : Care home staff do not feel valued

• Care homes the “solution” to NHS long term care needs

• NHS involvement idiosyncratic • Older people’s access to services inequitable• Minimal evidence of care home staff, residents

and relatives’ priorities informing service delivery• Evidence that structured, facilitated approaches

can improve care• Difficult to embed success into systems of care

Issues about working with the NHS

• Issue specific care (reactive )• Inconsistent use of frameworks• Care homes often not informed e.g.when

people die in hospital• Care home communication approaches

and language does not fit NHS• Difficult to embed success into systems of

care

A continuum of service delivery?• Episodic generalist/specialist support

focusing on individual• Education and training for all the care

home and then withdrawal• GP/nurse CH specific roles/teams• NHS care within a care home• Integrated/partnership that involves NHS

staff, residents, family, care staff in planning access to NHS resources

Example of appreciative inquiry

• Equal• All of organisation and

partners involved• Focus on current

achievement to inform future improvement

• Ongoing review and evaluation

• OOH, DNACPR, Talking about dying

Recognising and dealing with uncertainty

Holding

Relational interventions

Discussion and review

Documentation

Preparing for a range of possible

needs and outcomes

Advantages of research• Integration and partnership to work

together and identify questions of importance

• Opportunity to reflect with support, on questions, performance and issues

• Focus on a population whose needs are overlooked by NHS

• Opportunity for staff to receive training in care home

• care/increasing knowledge

Disadvantages• Time consuming: taking staff away from

providing care• Confusion over MCA and Data protection• Involving relatives • May feel vulnerable and under scrutiny• Social care governance• Increased paperwork and meetings• Questions not care home priorities, and

never hear the outcomes

Research enabled care homes

• Department of Health and DeNDRoN initiative

• Network of research ready care homes• Accredited as being suitable for research

studies• Recognition of costs, knowledge and skills

required to be involved in research• Explicit benefits