Care homes based research in Hertfordshire Claire Goodman

1. Care homes based research in Hertfordshire Claire Goodman Centre for Research in Primary and Community Care c.goodman@herts.ac.uk

2. Presentation • Background • Relationship between NHS and care homes • Recent and current research • Example of appreciative inquiry • New initiatives for supporting research in care homes

3. Older People in the UK* • Increase in older people (23% popn by 2034) • Largest user (2/3rd of hospital beds) • Fastest increase >85s (5% popn by 2034) • Public expenditure on long term care will rise by 94% to £15.9 billion by 2022 * Taken from J.Meyer City University slide based on Age UK, 2011 data )

4. Size of care homes at 31 March 2010 (CQC, 2010)* * Based on J.Meyer slide City University

5. Average size of care home by type and ownership (CQC, 2010)* * Based on J.Meyer slide City University

6. Care homes in the UK • 167,000 NHS hospital beds • 18,255 care homes provide 459,448 beds • Overlap’ in care needs between types of home • 355,000 care workers and senior care workers • Unknown how many nurses working in care homes

7. Population with ongoing and complex needs

9. Questions? • How does the NHS work with care homes? • What are the challenges and opportunities? • Solutions and actions that can be taken?

10. Research projects • District nursing work with care homes in Herts (2000) • Review of PCT involvement in 5 London LA areas to support workforce (2002) • Essence of care intervention to support continence care (2005) • EPOCH (2010): Older people’s accounts • Evidem end of life (2011) Appreciative inquiry • APPROACH (2011) Models of working with care homes

11. Research approaches used

13. NHS relationship with care homes • Uneasy relationship : Care home staff do not feel valued • Care homes the “solution” to NHS long term care needs • NHS involvement idiosyncratic • Older people’s access to services inequitable • Minimal evidence of care home staff, residents and relatives’ priorities informing service delivery • Evidence that structured, facilitated approaches can improve care • Difficult to embed success into systems of care

14. Issues about working with the NHS • Issue specific care (reactive ) • Inconsistent use of frameworks • Care homes often not informed e.g.when people die in hospital • Care home communication approaches and language does not fit NHS • Difficult to embed success into systems of care

15. A continuum of service delivery? • Episodic generalist/specialist support focusing on individual • Education and training for all the care home and then withdrawal • GP/nurse CH specific roles/teams • NHS care within a care home • Integrated/partnership that involves NHS staff, residents, family, care staff in planning access to NHS resources

16. Example of appreciative inquiry Equal All of organisation and partners involved Focus on current achievement to inform future improvement Ongoing review and evaluation OOH, DNACPR, Talking about dying

17. Recognising and dealing with uncertainty

18. Advantages of research •  Integration and partnership to work together and identify questions of importance •  Opportunity to reflect with support, on questions, performance and issues •  Focus on a population whose needs are overlooked by NHS •  Opportunity for staff to receive training in care home •  care/increasing knowledge

19. Disadvantages • Time consuming: taking staff away from providing care • Confusion over MCA and Data protection • Involving relatives • May feel vulnerable and under scrutiny • Social care governance • Increased paperwork and meetings • Questions not care home priorities, and never hear the outcomes

20. Research enabled care homes • Department of Health and DeNDRoN initiative • Network of research ready care homes • Accredited as being suitable for research studies • Recognition of costs, knowledge and skills required to be involved in research • Explicit benefits