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Towers AM, Smith N, Allan S, Vadean F, Collins G, Rand S, Bostock J, Ramsbottom H, Forder J, Lanza S, Cassell J. Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background
Care home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 (Great Britain. The Care Act 2014. London: The Stationery Office; 2014) requires services to improve ‘well-being’, but many residents cannot self-report and are at risk of exclusion from giving their views. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is currently no equivalent way of measuring aspects of residents’ health-related quality of life. We developed new tools for measuring pain, anxiety and depression using a mixed-methods approach. We also explored the relationship between care home quality, residents’ outcomes, and the skill mix and employment conditions of the workforce who support them.
Objectives
The objectives were to develop and test measures of pain, anxiety and depression for residents unable to self-report; to assess the extent to which regulator quality ratings reflect residents’ care-related quality of life; and to assess the relationship between aspects of the staffing of care homes and the quality of care homes.
Design
This was a mixed-methods study.
Setting
The setting was care homes for older adults in England.
Participants
Care home residents participated.
Results
Three measures of pain, anxiety and low mood were developed and tested, using a mixed-methods approach, with 182 care home residents in 20 care homes (nursing and residential). Psychometric testing found that the measures had good construct validity. The mixed-methods approach was both feasible and necessary with this population, as the majority of residents could not self-report. Using a combined data set (n = 475 residents in 54 homes) from this study and the Measuring Outcomes in Care Homes study (Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents’ quality of life in England. Health Qual Life Outcomes 2019;17:22) we found a significant positive association between residents’ social care-related quality of life and regulator (i.e. Care Quality Commission) quality ratings. Multivariate regression revealed that homes rated ‘good/outstanding’ are associated with a 12% improvement in mean current social care-related quality of life among residents who have higher levels of dependency. Secondary data analysis of a large, national sample of care homes over time assessed the impact of staffing and employment conditions on Care Quality Commission quality ratings. Higher wages and a higher prevalence of training in both dementia and dignity-/person-centred care were positively associated with care quality, whereas high staff turnover and job vacancy rates had a significant negative association. A 10% increase in the average care worker wage increased the likelihood of a ‘good/outstanding’ rating by 7%.
Limitations
No care homes rated as inadequate were recruited to the study.
Conclusions
The most dependent residents gain the most from homes rated ‘good/outstanding’. However, measuring the needs and outcomes of these residents is challenging, as many cannot self-report. A mixed-methods approach can reduce methodological exclusion and an over-reliance on proxies. Improving working conditions and reducing staff turnover may be associated with better outcomes for residents.
Future work
Further work is required to explore the relationship between pain, anxiety and low mood and other indicators of care homes quality and to examine the relationship between wages, training and social care outcomes.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 19. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ann-Marie Towers
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Nick Smith
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Stephen Allan
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Florin Vadean
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Grace Collins
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Stacey Rand
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | | | | | - Julien Forder
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
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Smith N, Towers AM, Collins G, Palmer S, Allan S, Beecham J. Encouraging managers of care homes for older adults to participate in research. QUALITY IN AGEING AND OLDER ADULTS 2019. [DOI: 10.1108/qaoa-04-2019-0017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Research in care homes requires the co-operation of care home managers. Noting the challenges faced by the care home sector, the purpose of this paper is to consider ways in which research studies can encourage care home managers and their homes to participate in research.
Design/methodology/approach
The discussion is informed by two research projects which are used to explore methods of encouraging managers of care homes to participate in research. One of the studies included interviews with care home managers to understand their reasons for taking part in research.
Findings
This paper outlines and assesses three strategies for encouraging care home managers to participate in research: working in partnership, providing payment and providing personalised feedback on findings. Whereas all the strategies have the potential to encourage care home managers’ participation in research, partnership working in particular was found to be fraught with difficulties.
Research limitations/implications
This paper suggests that the research projects could employ any of these strategies to encourage managers of care homes to participate in research. It also suggests that proactive measures could help ameliorate the pitfalls of partnership working.
Originality/value
This paper shows the advantages and disadvantages of using a combination of strategies for encouraging the participation of care home managers in research.
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Vearing R, Casey S, Zaremba C, Bowden S, Ferguson A, Goodisson C, Potter J, Evry N, Charlton K. Evaluation of the impact of a post‐hospital discharge Transitional Aged Care Service on frailty, malnutrition and functional ability. Nutr Diet 2019; 76:472-479. [DOI: 10.1111/1747-0080.12511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 11/04/2018] [Accepted: 11/29/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Rebecca Vearing
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
| | - Shelly Casey
- Department of Nutrition and DieteticsIllawarra Shoalhaven Local Health District Wollongong New South Wales Australia
| | - Carly Zaremba
- Department of Nutrition and DieteticsIllawarra Shoalhaven Local Health District Wollongong New South Wales Australia
| | - Steven Bowden
- Department of Nutrition and DieteticsIllawarra Shoalhaven Local Health District Wollongong New South Wales Australia
| | - Allison Ferguson
- Department of Nutrition and DieteticsIllawarra Shoalhaven Local Health District Wollongong New South Wales Australia
| | - Christie Goodisson
- Illawarra Transitional Aged Care ServiceIllawarra Shoalhaven Local Health District Wollongong New South Wales Australia
| | - Jan Potter
- Division of Aged CareIllawarra Shoalhaven Local Health District Wollongong New South Wales Australia
| | - Narelle Evry
- Division of Aged CareIllawarra Shoalhaven Local Health District Wollongong New South Wales Australia
| | - Karen Charlton
- Illawarra Health and Medical Research Institute, Rehabilitation & Palliative CareIllawarra Shoalhaven Local Health District Wollongong New South Wales Australia
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Young AM, Mudge AM, Banks MD, Rogers L, Demedio K, Isenring E. Improving nutritional discharge planning and follow up in older medical inpatients: Hospital to Home Outreach for Malnourished Elders. Nutr Diet 2018; 75:283-290. [DOI: 10.1111/1747-0080.12408] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/07/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Adrienne M. Young
- Department of Nutrition and Dietetics; Royal Brisbane and Women’s Hospital; Brisbane Queensland Australia
| | - Alison M. Mudge
- Department of Internal Medicine and Aged Care; Royal Brisbane and Women’s Hospital; Brisbane Queensland Australia
| | - Merrilyn D. Banks
- Department of Nutrition and Dietetics; Royal Brisbane and Women’s Hospital; Brisbane Queensland Australia
| | - Lauren Rogers
- Department of Nutrition and Dietetics; Royal Brisbane and Women’s Hospital; Brisbane Queensland Australia
| | - Kristen Demedio
- Department of Nutrition and Dietetics; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Elisabeth Isenring
- Faculty of Health Science and Medicine; Bond University; Brisbane Queensland Australia
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Salamon KM, Lambert K. Oral nutritional supplementation in patients undergoing peritoneal dialysis: a randomised, crossover pilot study. J Ren Care 2017; 44:73-81. [DOI: 10.1111/jorc.12224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
| | - Kelly Lambert
- MSc (Nutr& Diet); Advanced Accredited Practising Dietitian, Illawarra Shoalhaven Local Health District; Wollongong NSW Australia
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