Older care-home residents as collaborators or advisors in research: a systematic review

Background: patient and public involvement (PPI) in research can enhance its relevance. Older care-home residents are often not involved in research processes even when studies are care-home focused. Objective: to conduct a systematic review to find out to what extent and how older care-home residents have been involved in research as collaborators or advisors. Methods: a systematic literature search of 12 databases, covering the period from 1990-September 2014 was conducted. A lateral search was also carried out. Standardised inclusion criteria were used and checked independently by two researchers. Results: 19 reports and papers were identified relating to 11 different studies. Care-home residents had been involved in the research process in multiple ways. Two key themes were identified: (i) the differences in residents’ involvement in small-scale and large-scale studies, (ii) the barriers to and facilitators of involvement. Conclusions: small-scale studies involved residents as collaborators in participatory action research, whereas larger studies involved residents as consultants in advisory roles. There are multiple facilitators of and barriers to involving residents as PPI members. The reporting of PPI varies. While it is difficult to evaluate the impact of involving care-home residents on the research outcomes, impact has been demonstrated from more inclusive research processes with care-home residents. The review shows that older care-home residents can be successfully involved in the research process

Organizational Support Experiences of Care Home and Home Care Staff in Sweden, Italy, Germany and the United Kingdom during the COVID-19 Pandemic

The COVID-19 pandemic has affected care workers all over the globe, as older and more vulnerable people face a high risk of developing severe symptoms and dying from the virus infection. The aim of this study was to compare staff experiences of stress and anxiety as well as internal and external organizational support in Sweden, Italy, Germany, and the United Kingdom (UK) in order to determine how care staff were affected by the pandemic. A 29-item online questionnaire was used to collect data from care staff respondents: management (n = 136), nurses (n = 132), nursing assistants (n = 195), and other healthcare staff working in these organizations (n = 132). Stress and anxiety levels were highest in the UK and Germany, with Swedish staff showing the least stress. Internal and external support only partially explain the outcomes. Striking discrepancies between different staff groups’ assessment of organizational support as well as a lack of staff voice in the UK and Germany could be key factors in understanding staff’s stress levels during the pandemic. Structural, political, cultural, and economic factors play a significant role, not only factors within the care organization or in the immediate context

Care home and home care staff’s learning during the COVID-19 pandemic and beliefs about subsequent changes in the future: A survey study in Sweden, Italy, Germany and the United Kingdom

The aim of this study was to compare perceptions of learning from the COVID-19 pandemic and beliefs in subsequent changes for the future, among care home and home care staff, in four European countries. A 29-item on-line questionnaire was designed in English and later translated into Swedish, Italian, and German on the impact of the pandemic on stress and anxiety. Anonymous data from care staff respondents was collected in four countries between 07.10.2020 and the 17.12.2020: Sweden (n = 212), Italy (n = 103), Germany (n = 120), and the United Kingdom (n = 167). While care staff in all countries reported learning in multiple areas of care practice, Italy reported the highest levels of learning and the most agreement that changes will occur in the future due to the pandemic. Conversely, care staff in Germany reported low levels of learning and reported the least agreement for change in the future. While the pandemic has strained care home and home care staff practices, our study indicates that much learning of new skills and knowledge has taken place within the workforce. Our study has demonstrated the potential of cross-border collaborations and experiences for enhancing knowledge acquisition in relation to societal challenges and needs. The results could be built upon to improve future health care and care service practices

Adapting and Designing Spaces: Children and their Schools

In schools, children experience their environment on three different levels: firstly, they constantly make spatial decisions by positioning themselves in relation to others and organising their immediate environment; secondly, they can potentially contribute to shaping the classroom spaces; and, thirdly, they are confronted with the designed school as a whole.It is argued here that our experiences of spaces are related to our memories, which provide us with a framework of references that allows us to ‘read’ and construct spaces. Whereas on the lowest level of spatial involvement children are natural decision makers, the higher levels require access to, and an understanding of, shared practices and discourses. Although existing data on children’s perceptions of their schools suggest that children’s participation in the school design process is laudable for all sorts of reasons, such participation means overcoming considerable barriers for omparatively little gain in terms of the design quality. It is the level of the classroom where a more genuine shared organisation and (re)creation of space can take place on an everyday basis

The notion of the other in Heidegger's philosophy

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Organizational dynamics of respect and elder care:Final report DoH Policy Research Programme 025/0054

This is a report of a study to examine the organisational dynamics associated with abuse, neglect and/or loss of dignity of older people being cared for in care homes. The report identifies the organisational factors associated with mistreatment and examines the ways in which these factors can interact to shape the provision of care and the care experiences of residents. A participative research approach was used in order to involve the people affected by the issues under study as active participants throughout the whole research process. The study draws on a quasi-systematic review of the literature and on data from a purposive sample of eight care homes in the East Anglia and North West regions of England. Among the factors underlying mistreatment in the care of older people the study highlights: the organisational infrastructure; management and procedures, including management of the workforce; inadequate skill mix, training and numbers of staff; resident population characteristics, including cognitive impairment and dementia; and combined factors, including organisational culture, isolation and changes from outside the organisation. The report also examines patterns of organisational dynamics grouped around key elements found to be important in the organisation of care. These include: team work; routines and work based norms; openness and relatives’ participation; meeting residents’ needs and skilful practice; care quality and responding to mistreatment; being resourceful; and feeling of ‘being at home’

Organizational dynamics of respect and elder care

Problem: Mistreatment of older people cared for in care homes is a global and persistent concern that has tended to be examined at the level of individuals. However this focus draws attention away from understandings of how and why mistreatment may arise, despite the best intentions of staff and managers of care homes. Aim: To examine the organizational dynamics associated with abuse, neglect and/or loss of dignity of older people cared for in care homes. Research approach: This study combined participatory research approaches with ethnographic case study. A scoping review informed collection of ethnographic data from a purposive sample of eight care homes in East and North England varying in size and provider type. Comparative case study methodology (Eisendhardt and Graebnor, 2007) was used to examine the organization of care in these homes, focusing on organizational factors, care practices and experiences of providing and receiving care. Findings: Organizational dynamics may include external factors beyond the control of staff and residents and can lead to a) care that is inconsistent at different times or places in a home or b) entrenchment of practices in routines, norms and organizational cultures. Both poor care and good care may remain hidden. Contrastingly interaction of organizational factors can contribute to robust systems responding positively to challenges. Implications: Inspectors, managers and care staff need to better identify institutional abuse and quality assurance processes need to consider organizational dynamics in care homes. A resource to support the identification of organizational dynamics within care homes is proposed. This paper is based on a research study funded by the Department of Health and Comic Relief. The views expressed in this paper are not necessarily the views of the Department of Health or Comic Relief

Health, wellbeing and nutritional status of older people living in UK care homes: an exploratory evaluation of changes in food and drink provision

Background Food and drink are important determinants of physical and social health in care home residents. This study explored whether a pragmatic methodology including routinely collected data was feasible in UK care homes, to describe the health, wellbeing and nutritional status of care home residents and assess effects of changed provision of food and drink at three care homes on residents' falls (primary outcome), anaemia, weight, dehydration, cognitive status, depression, lipids and satisfaction with food and drink provision. Methods We measured health, wellbeing and nutritional status of 120 of 213 residents of six care homes in Norfolk, UK. An intervention comprising improved dining atmosphere, greater food choice, extended restaurant hours, and readily available snacks and drinks machines was implemented in three care homes. Three control homes maintained their previous system. Outcomes were assessed in the year before and the year after the changes. Results Use of routinely collected data was partially successful, but loss to follow up and levels of missing data were high, limiting power to identify trends in the data. This was a frail older population (mean age 87, 71% female) with multiple varied health problems. During the first year 60% of residents had one or more falls, 40% a wound care visit, and 40% a urinary tract infection. 45% were on diuretics, 24% antidepressants, and 43% on psychotropic medication. There was a slight increase in falls from year 1 to year 2 in the intervention homes, and a much bigger increase in control homes, leading to a statistically non-significant 24% relative reduction in residents' rate of falls in intervention homes compared with control homes (adjusted rate ratio 0.76, 95% CI 0.57 to 1.02, p = 0.06). Conclusions Care home residents are frail and experience multiple health risks. This intervention to improve food and drink provision was well received by residents, but effects on health indicators (despite the relative reduction in falls rate) were inconclusive, partly due to problems with routine data collection and loss to follow up. Further research with more homes is needed to understand which, if any, components of the intervention may be successful