COVID, Communication and Care Homes: A Staffs’ Perspective of Supporting the Emotional Needs of Families

Abstract

An important part of care home life is the support given to older residents by their families/friends through regular visiting. Social visits to residents by their families ceased in response to the COVID-19 pandemic and residents were confined to their rooms. This paper reports on how care home staff improvised to address this situation during the first wave of the pandemic. It focuses on steps taken to maintain communication between residents and families to support emotional well-being. We undertook in-depth café-style interviews with twenty-one staff to explore creative practices that they introduced. It was part of a wider Scottish study examining the effect of lockdown on families whose relative was living/dying in a care home (May-October, 2020). Findings reveal the enormous effort by care staff to maintain family connections and the rapid acclimatisation involved working with a number of different on-line platforms, the pulling together of staff from across the care home, and, the attention to emotional well-being of residents living and dying in the care home. Findings highlight the professionalism and commitment of the leadership and staff involved. Whilst some of the staff accounts need no further comment, we draw on some themes from the care home research literature to make sense of the findings in terms of what we might learn going forward. This in-depth qualitative study emphasises the importance of recognising, fostering and nurturing relational compassionate care within long-term care. There is however little evidence whether health and social care policies recognise the importance of this on-going relationship.

Understanding advance care planning in care homes throughout the COVID-19 pandemic: A critical realist review and synthesis

“…Conducting sensitive and personal discussions remotely was found to add to the existing emotional toll associated with advance care planning. 30,31,33 Specifically, the reduction of face-to-face contact and non-verbal communication made it harder to share, express and recognise emotions and build trusting relationships. 30,33 Despite the increased emotional toll, care home staff had reduced time due to workload to focus on self-care.…”

“…Specifically, our synthesis suggested that the reality of death and decline brought by COVID-19 encouraged more care home staff, residents and relatives to want to prepare for the end of life, cultivating a more open culture and increased recognition of care planning. 30,31,33 In terms of care home staff, this change was manifested in their triggering of earlier and more frequent discussions with residents and relatives, 33,38 with changed communication patterns more conducive to regular contact between staff and relatives. 31 Furthermore, a change in preference was noted in regard to relatives' and residents' opinions of hospitalisation and intensive care unit use at the end of life.…”

“…Of the included papers, six were qualitative, [29][30][31][32][33][34] one used a mixed method design 35 and four used quantitative methods. [36][37][38][39] The studies collected data from seven countries which included the UK (N = 3), 31,34,39 Australia (N = 1), 35 Netherlands (N = 1), 33 Italy (N = 1), 30 Sweden (N = 1), 36 Canada (N = 2) 29,32 and the United States of America (N = 2). 37,38 Participants consisted of care home staff, managers, physicians, residents, surrogate decision makers and nurse practitioners.…”

“…29,32,34 N = 3 studies explored stakeholders' experiences of providing advance care planning during pandemic conditions and the use of remote communication. 33,31,35 N = 1 study focused on the number of advance care planning discussions offered during the pandemic. 36 See Table 3 for a breakdown of each included study and a summary of the extracted causal data.…”

“…33 The increased workloads and expectations caused by the changes in practice was a consistent finding, regardless of country. [31][32][33] Staff sickness and shortages. The increases in workload were further compounded by increased staff sickness and shortages due to the pandemic.…”