Background
Domain | Definition |
---|---|
Control over daily life | The service user can choose what to do and when to do it, having control over his/her daily life and activities |
Personal cleanliness and comfort | The service user feels he/she is personally clean and comfortable and looks presentable or, at best, is dressed and groomed in a way that reflects his/her personal preferences |
Food and drink | The service user feels he/she has a nutritious, varied and culturally appropriate diet with enough food and drink he/she enjoys at regular and timely intervals |
Personal safety | The service user feels safe and secure. This means being free from fear of abuse, falling or other physical harm |
Social participation and involvement | The service user is content with their social situation, where social situation is taken to mean the sustenance of meaningful relationships with friends, family and feeling involved or part of a community should this be important to the service user |
Occupation | The service user is sufficiently occupied in a range of meaningful activities whether it be formal employment, unpaid work, caring for others or leisure activities |
Accommodation cleanliness and comfort | The service user feels their home environment, including all the rooms, is clean and comfortable |
Dignity | The negative and positive psychological impact of support and care on the service user’s personal sense of significance |
Outcome state | Definition |
---|---|
No needs | The individual has no or the type of temporary or trivial needs that would be expected in this area of life of someone with no impairments. |
Some needs | Some needs are distinguished from no needs by being sufficiently important or frequent to affect an individual’s qualify of life |
High needs | High needs are distinguished from some needs by having mental or physical health implications if they are not met over a period of time. This may be because of severity or number. |
Aims and objectives
Method
Homes and participants
Data collection
Measures
ICCs Current SCRQoL at T2 | ICCs Expected SCRQoL at T2 | |
---|---|---|
All homes | .76 | .81 |
Nursing homes only | .79 | .84 |
Residential homes only | .76 | .77 |
Residents lacking the capacity to consent | .62 | .75 |
Residents with the capacity to consent | .75 | .81 |
Feedback intervention
Current occupation | ||
---|---|---|
Number of residents | % of residents | |
No needs | 10 | 50 |
Some needs | 8 | 40 |
High needs | 2 | 10 |
Feedback
• Just under half of the residents spent their time doing things they value and enjoy • Reading • Exercise sessions • Just under half did some of the things they enjoyed but not enough • Long periods with no activity but did something later or we were told about other activities they do • A few residents who had high needs – did almost nothing they enjoyed • Resident did no activities during observation and staff confirmed they do not do anything they value or enjoy. Another resident says she feels very bored and clearly states she does nothing. |
Analysis
Results
Residents’ characteristics
Variable | Home 1 | Home 2 | Home 3 | Home 4 | All |
---|---|---|---|---|---|
Home characteristics | |||||
Type | Nursing | Nursing | Residential | Residential | - |
Size | 64 | 39 | 37 | 29 | - |
Provider | National chain | National chain | Small independent | Small independent | - |
Resident characteristics T1 | |||||
N
| 15 | 9 | 20 | 14 | 58 |
N female (%) | 9 (60 %) | 6 (67 %) | 20 (100 %) | 14 (100 %) | 85 |
% White British/Irish | 87 | 100 | 100 | 100 | 97 |
Age range (min-max) | 77–96 | 73–93 | 74–97 | 73–94 | 73–97 |
Mean Age | 87 | 82 | 87 | 86 | 86 |
% lacking capacity | 100 | 44 | 30 | 36 | 53 |
Mean Bathel Index Daily Living | 8.00 | 4.44 | 10.55 | 9.43 | 8.67 |
Mean MDS CPS (0-6) | 3.80 | 3.67 | 3.00 | 3.36 | 3.40 |
Resident characteristics T2 | |||||
N
| 15 | 7a
| 20 | 14 | 56 |
% lacking capacity | 100 | 43 | 30 | 36 | 52 |
Bathel Index Daily Living | 6.20 | 6.00 | 8.80 | 9.29 | 7.88 |
MDS CPS | 3.80 | 3.86 | 3.05 | 3.50 | 3.46 |
Social care-related quality of life
TI Current | T2 Current | T1 Expected | T2 Expected | T1 Gaina
| T2 Gain | |
---|---|---|---|---|---|---|
All homes | ||||||
N
| 58 | 49a
| 58 | 49a
| 58 | 49a
|
Mean | .71 | .66 | .17 | .06 | .57 | .60 |
SD | .21 | .23 | .25 | .15 | .23 | .17 |
Min | .06 | .06 | -.11 | -.11 | .01 | .11 |
Max | 1 | 1 | .88 | .45 | 1.05 | 1.05 |
Home 1 (dementia nursing) | ||||||
N
| 15 | 15 | 15 | 15 | 15 | 15 |
Mean | .62 | .54 | .10 | .03 | .52 | .51 |
SD | .27 | .25 | .22 | .14 | .24 | .19 |
Min | .06 | .06 | -.11 | -.11 | .11 | .11 |
Max | 1 | 1 | .41 | .26 | 1.05 | .82 |
Home 2 (nursing) | ||||||
N
| 9 | 0 | 9 | 0 | 9 | 0 |
Mean | .54 | NA | .05 | NA | .50 | NA |
SD | .19 | NA | .12 | NA | .28 | NA |
Min | .27 | NA | -.07 | NA | .07 | NA |
Max | .82 | NA | .29 | NA | .84 | NA |
Home 3 (residential) | ||||||
N
| 20 | 20 | 20 | 20 | 20 | 20 |
Mean | .77 | .74 | .20 | .11 | .57 | .63 |
SD | .17 | .17 | .29 | .17 | .25 | .11 |
Min | .42 | .33 | -.11 | -.11 | .01 | .44 |
Max | 1 | .93 | .88 | .45 | .91 | .77 |
Home 4 (residential) | ||||||
N
| 14 | 14 | 14 | 14 | 14 | 14 |
Mean | .72 | .68 | .05 | .01 | .66 | .67 |
SD | .20 | .24 | .20 | .12 | .14 | .19 |
Min | .44 | .36 | -.11 | -.11 | .42 | .40 |
Max | 1 | 1 | .46 | .22 | 1.05 | 1.05 |
Acceptability of the feedback intervention and reported changes to practice
“There was no disruption to the home at all, [The fieldworkers] just went off, found their residents that they needed to observe, and just basically just took hold of it all and got on with it. It didn’t cause any disruption to us whatsoever.” (Manager Nursing Home National Chain)
“The staff were actually fine because the staff are used to people coming in and out…. everybody seemed to be very discreet. I mean, you know, so if they were aware they forgot that you were there.” (Manager Care Home Independent)
Interviewer: “I just wondered how useful you found this feedback?…”Staff 4: “I think it is actually ‘cause we.. where we are, so I’m like constantly from one job to the next job,… sometimes it takes outside eyes … to see that” (feedback session Nursing home national chain)
Staff 1: “Well everything you said about the activities is completely right, it’s not enough” (feedback session nursing home, national chain).
Staff 4: “Unfortunately, you know, unless or until [provider] ups their [staffing] levels where--, ‘cause at the minute--, I mean as it stands at the moment we are five residents per one member of staff”
Staff 2: “They always say, don’t they, when you go to a care home you always see residents in the lounge asleep? It’s not because they’re tired, it’s ‘cause they’re bored, it’s boredom I think a lot of the time.”Staff 1: “There’s nothing keeping their mind going.”Staff 2: “Exactly, what do you do? You sleep when you’re bored.” (feedback session, nursing home, national chain)
Staff 2: “Will it go past regional management?”Interviewer: “I don’t know.”Staff 2: “I hope so, I hope so.”
“I completely changed the whole setup of the working day. So I looked at smaller groups of residents, because the staff were coming back to me and saying, ’We haven’t got time to complete all of our tasks with so many residents.’.... They now have more time to spend with the residents in terms of social care; the little things, painting nails, and so on and so forth, and the lipstick and it’s all very, very important. So that took the onus off of a task-orientated workload.” (Care Home Manager Nursing National Chain)
Interviewer: “Have you noticed any changes in residents from those changes?Manager: “It’s difficult to say with the residents. I mean there are a few that are happier now that they have got their time set for them in the morning.” (Care Home Manager Nursing National Chain)
“they’re doing some training here. It is interesting. It’s broken up into different--, a whole series of different modules from kind of meet and greet, icebreaker type things to physical activities, to singing, to storytelling, erm, and it’s all themed and it kind of allows the--, it allows the residents to sort of take things off in a particular direction.” (manager, residential care, independent provider)
Interviewer: “How about relatives and residents? Did they have any comments to make about it [the research]?”Manager: “… from the very onset, once they had their letters explaining to them what was going to happen, they were quite enthralled by it and they were looking forward to actually having an outside person come and look at what it is that we do here at [the nursing home]. So they were on our side from start to end.” (Nursing Home Manager National Chain)
“I mean although there was a tiny minority of relatives that didn’t want their relatives being in the research there was no concern about you being there and they actually felt the research itself was of value… they just didn’t want their own--, they didn’t want you questioning or asking their relatives ‘cause they thought it might cause them distress, but there was no concern about you being there to do it “ (Care Home Manager Independent)