Improving the quality of care in care homes: What does the evidence tell us?

In this guest blog Candace Imison, from the NIHR Centre for Engagement and Dissemination, speaks about a recently published Collection that brings together NIHR-funded research in care homes and asks how this research could be used to improve the quality of care. Candace Tweets at @cimison.

Care homes look after some of the most vulnerable people in our society. In 2020, there were 419,000 people living in care homes. Three in four residents are over the age of 75; almost as many (70%) have dementia. Many people in the UK have friends and relatives being cared for in care homes. My great aunt, now heading towards her 100th birthday, receives wonderful care in the home where she lives. The staff provide care sensitive to her needs, and have helped the family stay in touch during the pandemic when they couldn’t visit in person.

Although my great aunt has benefited hugely from dedicated care, there are many challenges facing care homes, for example growing difficulties recruiting staff. Most care staff are paid on or just above the minimum wage and around one in three leave every year. In addition, the COVID-19 pandemic has put more pressure on this already stretched workforce.

The NIHR funds research on the quality of care in care homes, and how it can be improved. I recently authored an NIHR Evidence Collection bringing together the latest evidence in this area. The findings from the Collection are important for those commissioning, regulating, working and living in care homes.

The importance of leadership in care homes

The MiCareHQ study suggests that care can be improved with strong leadership, a focus on continued quality improvement and a culture that gives staff time to listen to residents and meet their needs with compassion. This message is supported by the conclusion of an earlier NIHR evidence review, which highlighted the pivotal role of care home managers in creating a culture in homes that enables change.

Tools and techniques to help people with dementia

In addition to these general lessons about leadership and culture, there is growing evidence about what works in care homes, particularly for people with dementia. The WHELD programme (Well-being and Health for People Living with Dementia) and the MARQUE scheme both provide a framework for high quality care for people with dementia, and we explore both further in the Collection.

Links with the wider health and care system

Work in the OPTIMAL study underlined the importance to care homes of support from GPs and the wider healthcare system. Strong relationships and systematic input, such as training for care home staff, make a critical difference. They improve the experience of both residents and staff, and reduce crisis admissions to hospital.

Exploiting new technologies

Finally, a more recent study showed how simple low-cost video technology allowed residents in different care homes to enjoy taking part in virtual quizzes. Residents felt more connected with each other, and with other care homes. They re-gained a sense of self and purpose and felt less lonely. Care home staff were eager to continue with the sessions, but they outlined barriers such as lack of staff support or time.

A real-world perspective

In addition to collating research findings, we were also keen to understand the impact this evidence could have on the people who might be able to use or act on it. So, we asked a number of people who had professional or lived experience of care homes for their thoughts.

Our contributors were positive about many of the findings and approaches, but echoed many of the challenges care home staff are facing. For example, this comment from Care Worker, Sarah Gray:

As a carer, I find not having the time to care and get to know my residents frustrating. How can I deliver the care they deserve if I can’t give them the time they need? At the end of the day, the more staff you have, the more time they have with residents."

Final thoughts

Care homes are responsible for a vulnerable group of people with complex health and social care needs. This presents a considerable leadership and care challenge. Care homes need proactive support and engagement from the wider health and care system. And within each home, a well-trained, stable workforce is the key to making improvements.

Care homes need to invest in their staff in order to deliver person-centred care, tailored to each individual. Once in place, the evidence from our Collection shows that this approach can improve the experience of both residents and staff.

If you’d like to find out more about NIHR care home research, and the perspectives of our contributors, you can read the full Collection here.