What kind of home is your care home? A typology of personalised care provided in residential and nursing homes

Abstract

This paper examines how care home managers in England conceptualised the approach to delivering personalised care in the homes they managed. We conducted interviews with care home managers and mapped the approaches they described on two distinct characterisations of personalised care prominent in the research and practitioner literature: the importance of close care relationships and the degree of resident choice and decision-making promoted by the care home. We derived three ‘types’ of personalised care in care homes. These conceptualise the care home as an ‘institution’, a ‘family’ and a ‘hotel’. We have added a fourth type, the ‘co-operative’, to propose a type that merges proximate care relationships with an emphasis on resident choice and decision-making. We conclude that each approach involves trade-offs and that the ‘family’ model may be more suitable for people with advanced dementia, given its emphasis on relationships. While the presence of a range of diverse approaches to personalising care in a care home market may be desirable as a matter of choice, access to care homes in England is likely to be constrained by availability and cost.

Exploring resident experiences of person-centred care at mealtimes in long-term residential care: a rapid ethnography

“…Our results highlight the dilemma in providing individualised care within a communal setting, as has also been found in previous research [ 2 , 38 ]. At mealtimes, we saw a group of relative strangers with different, often complex needs and coming from different living situations come together to dine as a group.…”

“…At mealtimes, we saw a group of relative strangers with different, often complex needs and coming from different living situations come together to dine as a group. As Ettelt, Williams [ 38 ] found when speaking to LTRC managers, individualising care was a time-consuming process, which always took longer than catering for the whole group. In a setting with low staff resources, i.e.…”

Palliative Care, Intimacy, and Sexual Expression in the Older Adult Residential Care Context: “Living until You Don’t”

“…In relation to liminality, a family member is quoted in the findings referring to the facility as “a place like that.” It was notable across our dataset that family members and residents repeated used this phrase or the alternative, “in a place like this”, rather than ever naming the facility as their home. Although Ettelt et al [ 29 ] do not use the concept of liminality, they usefully point to the impact of care home managers’ architectural conceptualisations of facilities as an institution, home or hotel. Our data highlighted the importance staff and family members placed on facilities being home-like or not and in part made this assessment based on staff expressions of closeness and friendly touch with residents as part of personalised care.…”

“…How care is conceptualized is also impacted by managers’ social constructs about care homes. Ettelt et al [ 29 ], in a UK qualitative study with 24 care home managers noted that the ways care managers thought about personalised care differed depending on the overall metaphors they applied to care homes. Their analysis identified three different architectural conceptualisations: institution, home, and hotel.…”

Forming nursing home practices that support quality care for residents. A qualitative observational study

“…Less attention has been given to these interpersonal aspects of care practices in a nursing home and how they affect the quality of care and the patient's quality of life (18). Residents' well-being also depends on how they experience the social life in a nursing home and the quality of the care that they receive (19).…”