Integrated working for enhanced healthcare in English nursing homes

Background: The increasingly complex nature of care home residents’ health status means that this population requires significant multi-disciplinary team input from health services. To address this, a multi-sector and multi-professional enhanced healthcare programme was implemented in nursing homes across Gateshead Council in Northern England. Study aim: To explore the views and experiences of practitioners, social care officers and carers involved in the enhanced healthcare in care home programme, in order to develop understanding of the service delivery model and associated workforce needs for the provision of healthcare to older residents. Method: A qualitative constructivist methodology was adopted. The study had two stages. Stage one explored the experiences of the programme enhanced healthcare workforce through group, dyad and individual interviews with 45 participants. Stage two involved two workshops with 28 participants to develop stage one findings (data was collected during February - March 2016). Thematic and content analysis were applied. Findings: The enhanced healthcare programme provides a whole system approach to the delivery of proactive and responsive care for nursing home residents. The service model enables information exchange across organisational and professional boundaries that support effective decision making and problem solving

Using longitudinal qualitative research to explore extra care housing

Purpose: The process of individual ageing in the context of a care environment is marked by continuity and change. It is shaped by individual, health-related factors as well as by diverse social and environmental factors, including characteristics of the places where older people live. The aim of this paper was to explore how longitudinal qualitative research, as a research method, could be used to explore older people’s changing care needs. Methods: The study used a longitudinal design to examine how the care and support needs of residents and their expectations of services developed over time and how these were influenced by changes in the organisation of their housing as well as in the make-up of the resident population. Residents were interviewed on four occasions over twenty months. Results: The study highlighted the complex ways in which some participants proactively managed the care and support they received, which we argue would have been difficult to discern through other methods. Conclusion: The study adds to the growing evidence base that supports the use of qualitative longitudinal research, the approach enables the researcher to capture the diverse and mutable nature of older people’s experiences at a time of profound change in their lives

Active Residents in Care Homes (ARCH) : study protocol to investigate the implementation and outcomes of a whole-systems activity programme in residential care homes for older people

OBJECTIVES: To evaluate the effectiveness, acceptability and costs of Active Residents in Care Homes, ARCH - a programme aiming to increase opportunities for activity in older care home residents. DESIGN: Feasibility study. SETTING: Residential care homes for older people. PARTICIPANTS: 10-15 residents, staff and family members will be recruited in each of the three participating care homes. INTERVENTION: ARCH is a 12-month 'whole-systems' programme implemented by occupational therapists and physiotherapists. They will conduct a comprehensive assessment of each care home, considering the physical environment, working practices and organisation structure as well as residents' individual needs, and recommend ways to address barriers and increase residents' activity levels. The therapists will then work with staff to improve understanding of the issues, instigate training, environmental, organisational and working practice changes as necessary. MAIN OUTCOME MEASURES: Residents' activity levels, health and quality of life will be tested using several measures to see which are practicable and appropriate for this population in this context. This includes: Assessment of Physical Activity in Frail Older People; Pool Activity Level Checklist; Dementia Care Mapping observations; and EQ-5D-5L. Residents will be assessed prior to programme implementation then 4- and 12-months post-implementation. Semi-structured interviews will explore the experiences of residents, staff, family members and therapists. CONCLUSIONS: Providing evidence of effectiveness and acceptability of ARCH, and documenting factors that impede/facilitate implementation will help us identify ways to enhance the care and quality of life of older people in residential care, and our understanding of how to implement them