Improving care in residential care homes : a literature review

Abstract

This review examines the research evidence available to support improved care for older people in residential homes. Key points: In general, few studies report specifically on residential care. Most research has been conducted in nursing homes; several other studies make no distinction between nursing and residential homes, using the umbrella term ‘care homes’ to encompass both. The literature on improved care focuses primarily on the quality of clinical care. There is a paucity of quality-of-life measures reflecting the resident’s voice. The voice of minority ethnic residents is almost entirely absent from the literature. There is evidence that medical cover for care home residents is sub-optimal. Care could be restructured to give greater scope for proactive and preventive interventions. Partnership working between district nurses and care home staff appears largely to occur by default at present. There is opportunity for a more strategic approach to providing nursing support in residential homes. There is considerable research on the relationship between nurse staffing and nursing care home quality in the US. Quality is measured through clinical-based outcomes for residents and organisational outcomes. Conclusions are difficult to draw, however, due to inconsistencies in the evidence base. There is evidence that better management of medication is needed in nursing homes. Pharmacist reviews of medication can have a positive effect. Similar evidence is lacking for residential care homes. Inter-institutional transfers and ensuring patient safety across settings is important. To date, research has mainly focused on the care home and hospital interface; transfers from residential to nursing homes represent a research gap. Interesting research is reported from the US and other non-UK sources. Some findings will be generalisable to UK residential care; a systematic process is recommended to identify these