Encouraging managers of care homes for older adults to participate in research

Smith, Nick; Towers, Ann‐Marie; Collins, Grace; Palmer, Sinead; Allan, Stephen; Beecham, Jennifer

doi:10.1108/qaoa-04-2019-0017

Cited by 11 publications

(20 citation statements)

References 34 publications

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“…Study 1 is the Measuring Outcomes Of Care Homes (MOOCH) project, funded by the National Institute for Health Research (NIHR) School for Social Care (2015-18). 20,153,154 This study recruited 294 older care home residents from 34 care homes (20 nursing and 14 residential) in two local authorities in England. Study 2 collected primary data as part of this research (see Chapter 4).…”

Section: Methodsmentioning

confidence: 99%

“…The first is the MOOCH project, funded by the NIHR School for Social Care (2015-19). 20,153,154 The second is this study, MiCareHQ, using data collected in WP2 (2017-20). Both studies used a cross-sectional design, in which researchers spent time in each care home, using the ASCOT-CH4 toolkit (herein referred to as CH4) to carry out observations and interviews with staff and (where possible) residents and family members.…”

Section: Methodsmentioning

confidence: 99%

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Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study

Towers

Smith

Allan

et al. 2021

Health Serv Deliv Res

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Background Care home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 (Great Britain. The Care Act 2014. London: The Stationery Office; 2014) requires services to improve ‘well-being’, but many residents cannot self-report and are at risk of exclusion from giving their views. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is currently no equivalent way of measuring aspects of residents’ health-related quality of life. We developed new tools for measuring pain, anxiety and depression using a mixed-methods approach. We also explored the relationship between care home quality, residents’ outcomes, and the skill mix and employment conditions of the workforce who support them. Objectives The objectives were to develop and test measures of pain, anxiety and depression for residents unable to self-report; to assess the extent to which regulator quality ratings reflect residents’ care-related quality of life; and to assess the relationship between aspects of the staffing of care homes and the quality of care homes. Design This was a mixed-methods study. Setting The setting was care homes for older adults in England. Participants Care home residents participated. Results Three measures of pain, anxiety and low mood were developed and tested, using a mixed-methods approach, with 182 care home residents in 20 care homes (nursing and residential). Psychometric testing found that the measures had good construct validity. The mixed-methods approach was both feasible and necessary with this population, as the majority of residents could not self-report. Using a combined data set (n = 475 residents in 54 homes) from this study and the Measuring Outcomes in Care Homes study (Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents’ quality of life in England. Health Qual Life Outcomes 2019;17:22) we found a significant positive association between residents’ social care-related quality of life and regulator (i.e. Care Quality Commission) quality ratings. Multivariate regression revealed that homes rated ‘good/outstanding’ are associated with a 12% improvement in mean current social care-related quality of life among residents who have higher levels of dependency. Secondary data analysis of a large, national sample of care homes over time assessed the impact of staffing and employment conditions on Care Quality Commission quality ratings. Higher wages and a higher prevalence of training in both dementia and dignity-/person-centred care were positively associated with care quality, whereas high staff turnover and job vacancy rates had a significant negative association. A 10% increase in the average care worker wage increased the likelihood of a ‘good/outstanding’ rating by 7%. Limitations No care homes rated as inadequate were recruited to the study. Conclusions The most dependent residents gain the most from homes rated ‘good/outstanding’. However, measuring the needs and outcomes of these residents is challenging, as many cannot self-report. A mixed-methods approach can reduce methodological exclusion and an over-reliance on proxies. Improving working conditions and reducing staff turnover may be associated with better outcomes for residents. Future work Further work is required to explore the relationship between pain, anxiety and low mood and other indicators of care homes quality and to examine the relationship between wages, training and social care outcomes. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 19. See the NIHR Journals Library website for further project information.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study

Towers

Smith

Allan

et al. 2021

Health Serv Deliv Res

Self Cite

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“…Our finding extends earlier research identifying challenges in supporting a sector that has a wide range of Providers and knowledge users with varied access to libraries, technology, and training and development budgets (Rutter & Fisher, 2013). Consequently, further work to address how to engage managers in research (Smith et al, 2019) and improve the relevance and usefulness of research knowledge would be beneficial. As Nutley, Davies, and Hughes (2019) argue, there is a need to be realistic about the extent to which research-informed recommendations will be compelling in a sector where tacit hierarchies of evidence may look very different from explicit methodological and technical hierarchies.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, care home provision differs regionally and locally depending on Providers, local demographics, supply structures and actions of local authorities (Competition & Markets Authority, 2017). The sector also faces significant pressures relating to staffing, finance and regulation (Smith et al, 2019). Many older people living in nursing (personal care with nursing) and residential (personal care without nursing) care homes have increasingly high levels of dependency, cognitive impairment and multimorbidity (Gordon et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Knowledge needs and use in long‐term care homes for older people: A qualitative interview study of managers’ views

Day

Dean

Reed

et al. 2020

Health Social Care Comm

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We explore the views of managers' knowledge needs and use to optimise care practices and enhance the life experience for older people living, and staff working, in long-term care homes (with and without nursing). This paper contributes to previous research by offering insights into the knowledge types drawn upon and used by managers to inform efforts to better support gaining and mobilising knowledge.Using a pragmatic qualitative approach, we undertook 19 semi-structured interviews with managers and leaders in 15 care homes in the South West of England, varying in geographical location, size and type of ownership. We did a thematic analysis of the data using Framework Analysis. Our interpretations were informed by the existing literature on knowledge types. We identified three themes from our analysis as to managers' knowledge needs and use when implementing changes. First, views about training and formal reports or "explicit knowledge" consisting of the two sub-themes "gaining explicit knowledge" and "research knowledge". Second, perspectives relating to practical experience or "tacit knowledge" and judging the use of knowledge in particular cases or "phronesis". Third, the role of emotion in managers' knowledge needs and use. We found that having knowledge was positively valued by managers and leaders for improving care practices and enhancing the lives of people residing in care homes. Tacit knowledge and phronesis were particularly highly valued and we note challenges with the perceived applicability, relevance and use of research evidence.We identify that emotions are an important component within knowledge use and a need to further understand how to support the emotional wellbeing of managers so they can support care staff and residents. Greater consideration is needed as to how to optimise gaining and mobilising all knowledge types -"know-what," "know-how," "know-when" and "know-feel" -to benefit people living, and staff working, in care homes.

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“…It can also promote staff professional development (Jenkins et al , 2016), drive up prestige and improve the perception of care homes (Johnstone and Donaldson, 2019). In recognition of this, the care regulator in England explicitly encourages providers to participate in research (Smith et al , 2019).…”

Section: Introductionmentioning

confidence: 99%

Building relational research capacity in care homes in the COVID-19 era: applying recognition theory to the research agenda

Toms

Green

Orrell

et al. 2020

QAOA

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Purpose Research can be an influential driver in raising care home standards and the well-being and human rights of residents. This paper aims to present a case for how a relational research capacity building programme could advance this agenda. Design/methodology/approach This study uses Axel Honneth’s Recognition Theory as a lens through which to explore organisational and institutional factors (such as research capacity and investment) that can either enable or limit “recognition” in the context of research in care homes. This paper draws on recent evidence from the COVID-19 pandemic in the UK and worldwide, to argue that such a relational capacity building agenda is even more pressing in the current context, and that it resonates with evidence from existing relational capacity building initiatives. Findings A lack of relevant research arguably contributed to the crisis experienced by the care home sector early in the pandemic, and there are only tentative signs that residents, care home providers and staff are now informing the COVID-19 research agenda. Evidence from pre COVID-19 and insights from Honneth’s Recognition Theory suggest that relational approaches to building research capacity within the care home sector can better generate evidence to inform practice. Originality/value This is a novel application of recognition theory to research in the care home sector. Drawing on theory, as well as evidence, has enabled the authors to provide a rationale as to why relationship-based research capacity building in care homes warrants further investment.

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Encouraging managers of care homes for older adults to participate in research

Cited by 11 publications

References 34 publications

Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study

Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study

Knowledge needs and use in long‐term care homes for older people: A qualitative interview study of managers’ views

Building relational research capacity in care homes in the COVID-19 era: applying recognition theory to the research agenda

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