If care homes wore shoes: understanding the care home research environment from the perspective of residents, relatives and staff
The second in a series of lessons from the Proactive Health Care of Older People in Care Homes (PEACH) study about how to do improvement work around healthcare with care homes.
Kathryn Hinsliff-Smith is Senior Research Fellow at De Montfort University, she tweets as @HinsliffK
Annabelle Long is a Research Assistant of the at the University of Nottingham in the Division of Rehabilitation and Ageing and is a qualified physiotherapist.
Recruiting and supporting research participants is always challenging. Understanding how participants view the world and the difficulties and opportunities which research presents them with is important.
When we started work on the Proactive Healthcare for Care Homes (PEACH) study, with an aim of collecting routine data on how residents used health and social care services, we had a pretty clear idea of what to do. We would speak with patient and public involvement representatives on our study steering group, and with care home managers. We would seek to put ourselves in “care homes’ shoes”.
It was only when we started these discussions that we realised, care homes don’t wear shoes. Or, if they do, they wear shoes in all different shapes, styles and sizes. They’re complex organisations and doing effective research in the setting means that you have to understand not just the priorities of residents, families, staff and managers, but also the organisational structures within which they live and work.
We were working directly within care homes, recruiting both residents and family carers to our study. A lot has been written about how to do research in care homes. But, even taking account of this background reading, we found we learned a lot as we went along.
We would like to share with you some of the lessons we’ve learned through 18 months of research work in the sector.
Lesson 1 – Allow time to engage with the care home staff, they are busy and research is not always their first priority
An important challenge in care home research is the need to engage with staff before you can recruit residents to research. Anyone who has visited a care home will recognise that they are busy places, open 24/7, receiving many visitors including relatives, healthcare professionals, inspectors and, occasionally, researchers! Staff don’t always prioritise emails in the way that academics do and they may not have much time to talk on the telephone. Approaching staff at forums away from the care home, where they have time to think about involvement in research away from care responsibilities, is an important way to get a first visit. Otherwise, multiple short conversations may be required before a researcher is invited in. Once through the door, ensuring that staff feel respected and valued is important. They care about their residents and want to help them. Enabling staff to understand how research will do this is key to winning their support.
Lesson/Tip 2 – Work out what you need care home staff to do and then ask them to do it in an appreciative way
In the PEACH study we recruited residents from 24 different care homes, ranging from 3 bedded facilities to homes with over 90 residents. We had to collect quite complex data to measure health-related quality of life and service use. We needed support from the care home staff to be able to do this.
To understand the work required, we worked with Patient and Public Involvement (PPI) Groups. We chose PPI representatives who understood care homes from their own experience so that we could work out what it would be reasonable to ask residents to do and where we would need help from staff. We also worked closely with care home staff on our study team to understand how they would be able to help.
From the above, we developed a rough idea of what would be required of care home staff but we also recognised that each home we worked with had different protocols and practices. For each new home, we met with the staff, explained the information we needed to collect, described what we thought they would have to do to help us, and then gathered their thoughts on how to proceed. By doing so, we were able to anticipate any difficulties peculiar to each home and use the expertise of the staff to overcome these. Engaging staff as active members of the research team, and acknowledging the commitment they were making by doing so, was central to effective planning.
Lesson/Tip 3 – Be prepared to amend and revise your data collection tools
Part of this shared approach with care home staff involved adapting data collection tools to their needs. Whilst engaging with care home staff it became apparent that the tools we used would have to be effective in collecting the necessary data but had to make sense, be quick and easy to fill in, and be meaningful.
The Client Services Receipt Inventory (CSRI) was an important tool for collecting data on service use but, working with the care home staff it became clear that it was fiddly to complete and not, entirely, self-explanatory. With their input we amended the original 4 page form to a more user friendly single sided sheet, with large text and explanatory pictures. The care home staff told us that they found this much more straightforward and we found our training discussions with them much easier with the edited version.
Lesson/Tip 4 – Enjoy working in the care home environment – it’s enormous fun!
Care homes are busy and exciting places. They mean different things to different people. Above all, though, it is important to remember that they are home to their residents. It’s important always to wait to be invited into a space – particularly if that space is a resident’s room. We wouldn’t think to cold call and invite ourselves into someone’s home and a care home should be treated no differently.
But the time spent waiting around for residents to be ready for you needn’t be dull. It can’t be many researchers who have had to wait patiently to speak to study participants because a snake was visiting! Yes, a snake! The home in question was holding an activity afternoon where residents were encouraged to see and hold small reptiles. The residents proved to be much braver than our research team!
Research is at its most useful when it contributes positively to the lives of participants. It’s important, therefore, for researchers to make time in their busy calendars not just to work around the bingo caller, the film afternoon or musical concerts – but occasionally to join in and have fun.
To hear more about the project, please do come to our 2019 annual lecture where Adam Gordon will be presenting the findings.