Remote health care provision in care homes in England: An exploratory mixed methods study of Yorkshire and the Humber †

An increasing demand for care homes in the UK, has necessitated the evaluation of innovative methods for delivering more effective health care. Videoconferencing may be one way to meet this demand. However, there is a lack of literature on the provision of videoconferencing in England. This mixed-methods study aimed to map current attitudes, knowledge and provision of videoconferencing in the Yorkshire and Humber region of England. Qualitative interviews with care home managers, a scoping review and field notes from a Special Interest Group (SIG) informed the development of a descriptive convenience survey which was sent out to care home managers in the Yorkshire and Humber region of England. The survey had a 14% (n = 124) response rate. Of those who responded, 10% (n = 12) reported using videoconferencing for health care; with over 78% (n = 97) of respondents’ care homes being based in urban areas. Approximately 62% (n = 77) of the 124 respondents had heard of videoconferencing for health care provision. Of those who reported not using videoconferencing (n = 112), 39% (n = 48) said they would consider it but would need to know more. The top ranked reason for not introducing videoconferencing was the belief that residents would not be comfortable using videoconferencing to consult with a healthcare professional. The main reason for implementation was the need for speedier access to services. Those already using videoconferencing rated videoconferencing overall as being very good (50%) (n = 6) or good (42%) (n = 5). Those who were not using it in practice appeared sceptical before implementing videoconferencing. The main driver of uptake was the home’s current access to and satisfaction with traditionally delivered health care services

Using online consultations to facilitate health and social care delivery during COVID-19: an interview study of care home staff

Context: During the COVID-19 pandemic, UK care homes rapidly adopted videoconferencing to communicate with health and social care colleagues. Studies show that health and social care professionals adapted well to online consultations. Less well known are the views of care home staff on using online consultations and how it impacted their workload and responsibilities. Objective: To explore the experience of using videoconferencing for consultations during the COVID-19 pandemic from the perspective of care home staff. Method: Online interviews with care home staff [n = 13] who had facilitated videoconferencing between residents and health and social care professionals. Data were collected from June to October 2021 and analysed thematically. Findings: Experiences varied but key facilitators were having the infrastructure, training, and support for staff. Barriers were concerns about the benefits and suitability for use with older people living with dementia and/or frailty. Care home staff discussed new ways of working and undertaking new tasks. Consequently, staff developed new skills and confidence in using the technology. However, considerable time was needed to schedule, prepare, and facilitate consultations. Videoconferencing had the potential to support staff and strengthen working relationships with external professionals. Limitations: This is a small study with 13 participants from 11 care homes. It complements professional accounts of videoconferencing privileging the care home view. Implications: Fewer face-to-face meetings are anticipated to discuss residents’ care with visiting professionals. We need to address care home IT infrastructure and implicit expectations that care home staff can assimilate these changes amidst staffing shortages. A better understanding is needed about how to support care home staff in these roles, how this changes interdisciplinary working, and effects on residents’ care

Using video consultation technology between care homes and health and social care professionals: a scoping review and interview study during COVID-19 pandemic

© 2022 The Author(s). Published by Oxford University Press on behalf of the British Geriatrics Society. This is the accepted manuscript version of an article which has been published in final form athttps://doi.org/10.1093/ageing/afab279Background the COVID-19 pandemic disproportionately affected care home residents’ and staffs’ access to health care and advice. Health and social care professionals adapted rapidly to using video consultation (videoconferencing) technology without guidance. We sought to identify enablers and barriers to their use in supporting care home residents and staff. Methods a scoping review of the evidence on remote consultations between healthcare services and care homes. Interviews with English health and social care professionals about their experiences during the pandemic. Findings were synthesised using the non-adoption, abandonment, scale-up, spread, sustainability framework. Results 18 papers were included in the review. Twelve interviews were completed. Documented enablers and barriers affecting the uptake and use of technology (e.g. reliable internet; reduced travelling) resonated with participants. Interviews demonstrated rapid, widespread technology adoption overcame barriers anticipated from the literature, often strengthening working relationships with care homes. Novel implementation issues included using multiple platforms and how resident data were managed. Healthcare professionals had access to more bespoke digital platforms than their social care counterparts. Participants alternated between platforms depending on individual context or what their organisation supported. All participants supported ongoing use of technologies to supplement in-person consultations. Conclusions the evidence on what needs to be in place for video consultations to work with care homes was partly confirmed. The pandemic context demolished many documented barriers to engagement and provided reassurance that residents’ assessments were possible. It exposed the need to study further differing resident requirements and investment in digital infrastructure for adequate information management between organisations.Peer reviewe

A critical realist evaluation of end of life care in care homes.

Numbers of advance care plans and unnecessary admissions to hospital at the end of life are outcomes commonly used to determine the quality of end of life care in UK care homes. However, there is currently a sparsity of research systematically exploring the underlying processes behind these outcomes. This gap in knowledge has limited the effectiveness of interventions designed to improve end of life care in care homes. The study aim was therefore to inform the design and development of interventions capable of supporting the delivery of high-quality end-of-life care in UK care homes. A two-phased study design utilising Critical Realist Evaluation was used to address this gap in knowledge and achieve the study aim. Qualitative data was collected (using focus groups and semi-structured interviews) from three care homes in the South West of England from participants comprising of registered nurses, non-registered care home staff and bereaved relatives. Findings highlighted variable quality of advance care planning discussions in care homes. It was found that the current educational focus on gathering information, combined with some care home staff’s emotional reluctance to discuss death and dying, and a taboo culture within the commercial sector associated with death and dying impacted on the quality of advance care planning discussions. Moreover, findings identified several underlying factors which may contribute to unnecessary admissions to hospital at the end of life from care homes. It was apparent that some care home staff’s emotional attachments to residents, a sparsity of support during out of hours shifts, and a lack of interventional support could contribute to the likelihood of unnecessary admissions at the end of life. This situation was further influenced by relatives. Some relatives’ difficulties accepting a different identity when their caring role ceases and then when bereaved was found lead to conflict and relatives wanting to prolong their loved one’s life. The findings were used to develop intervention theories which provide recommendations for practice accounting for the diverse social, economic and organisational contexts of care homes in their design. These intervention theories provide the foundational components and rationale for the development of an evidence based multicomponent end of life care intervention; however, the development and evaluation of this intervention requires further research