Measuring safety in older adult care homes: a scoping review of the international literature

Abstract

BackgroundSafety is a key concern in older adult care homes. However, it is a less developed concept in older adult care homes than in healthcare settings. As part of study of the collection and application of safety data in the care home sector in England, a scoping review of the international literature was conducted.ObjectivesThe aim of the review was to identify measures that could be used as indicators of safety for quality monitoring and improvement in older adult residential or nursing care homes.Sources of evidenceSystematic searches for journal articles published in English language from 1 January 1970, without restriction to the study location or country, were conducted in Web of Science, Scopus and PubMed on 28 July 2019.Eligibility criteriaInclusion criteria were: peer-reviewed journal articles; qualitative or quantitative studies of older adult nursing and/or residential care homes; and related to any aspect of safety in care homes, including the safety of healthcare provision in the care home. A total of 45 articles were included after review of the title/abstract or full text against the inclusion criteria.Charting methodsKey information was extracted and charted. These findings were then mapped to the Safety Measurement and Monitoring Framework in healthcare (SMMF), adapted by the research team to reflect the care home context, to determine the coverage of different aspects of safety, as well as potential gaps.Results and conclusionsSystematic searches for journal articles published in English language from 1 January 1970, without restriction to the study location or country, were conducted in Web of Science, Scopus and PubMed on 28 July 2019. Inclusion criteria were: peer-reviewed journal articles; qualitative or quantitative studies of older adult nursing and/or residential care homes; and related to any aspect of safety in care homes, including the safety of healthcare provision in the care home.A total of 45 articles were included after review of the title/abstract or full text against the inclusion criteria. Key information was extracted and charted. These findings were then mapped to the Safety Measurement and Monitoring Framework in healthcare (SMMF), adapted by the research team to reflect the care home context, to determine the coverage of different aspects of safety, as well as potential gaps.The findings indicate that there are a range of available safety measures used for quality monitoring and improvement in older adult care homes. These cover all five domains of safety in the SMMF. However, there are potential gaps. These include user experience, psychological harm related to the care home environment, abusive or neglectful care practice and the processes for integrated learning. Some of these gaps may relate to challenges and feasibility of measurement in the care home context.

Abuse in Canadian long-term care homes: a mixed methods study

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Reducing the risk of falls in homes for older adults in Thailand

“…Some scholars have suggested that environmental hazard improvement would be effective for the elderly with limited mobility or health problems, irrespective of environmental quality (Gill et al, 2000). Those scholars also agreed that environmental safety could allow the elderly to feel more comfortable to live and move (Rand et al, 2011). Although this study was not focused on poor health and mobility conditions of the participants, those elderly people had lived in the below-standard environment and had no budget for home modifications.…”

The scope of safety in English older adult care homes: a qualitative analysis of Safeguarding Adult Reviews

“…Safety is usually seen to refer to the absence of preventable harm and features in government frameworks for long-term care, including care homes (NHS Digital, 2019), and is also reflected in England’s social care inspection regime (Care Quality Commission, 2016). Focus on assessment of safety in care homes is increasing (Rand et al , 2021), and attempts to improve safety in care homes have often drawn on initiatives and approaches from health care (Allen, 2009). These approaches mainly conceptualise safety narrowly as errors and harm arising from individual practice rather than a multi-dimensional systemic phenomenon.…”

“…Although we do not expect such models to offer a full reflection of safety in care homes, we believe they can be helpful in identifying the potential scope of future care home safety monitoring and measurement. This work is part of a larger study looking at the measurement of safety in care homes that includes a review of international literature (Rand et al , 2021) and qualitative interviews with stakeholders and care providers with the aim of informing how safety might be measured in older adult care homes.…”