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Working, living and dying in COVID times: perspectives from frontline adult social care workers in the UK
- Authors:
- BRIGGS Daniel, et al
- Journal article citation:
- Safer Communities, 20(3), 2021, pp.208-222.
- Publisher:
- Emerald
Purpose: This paper aims to explore 15 UK adult social care workers’ experiences during the COVID-19 pandemic. Design/methodology/approach: This paper’s 15 open-ended interviews with adult social care workers are complemented by digital ethnography in COVID-19 social media forums. This data set is taken from a global mixed-methods study, involving over 2,000 participants from 59 different countries. Findings: Workers reported a lack of planning, guidance and basic provisions including personal protective equipment. Work intensification brought stress, workload pressure and mental health problems. Family difficulties and challenges of living through the pandemic, often related to government restrictions, intensified these working conditions with precarious living arrangements. The workers also relayed a myriad of challenges for their residents in which, the circumstances appear to have exacerbated dementia and general health problems including dehydration, delirium and loneliness. Whilst COVID-19 was seen as partially responsible for resident deaths, the sudden disruptions to daily life and prohibitions on family visits were identified as additional contributing factors in rapid and sudden decline. Research limitations/implications: Whilst the paper’s sample cohort is small, given the significance of COVID-19 at this present time the findings shed important light on the care home experience as well as act as a baseline for future study. Social implications: Care homes bore the brunt of illness and death during the first and second COVID-19 waves in the UK, and many of the problems identified here have still yet to be actioned by the government. As people approach the summer months, an urgent review is required of what happened in care homes and this paper could act as some part of that evidence gathering. Originality/value: This paper offers revealing insights from frontline care home workers and thus provides an empirical snapshot during this unique phase in recent history. It also builds upon the preliminary/emerging qualitative research evidence on how the COVID-19 pandemic impacted care homes, care workers and the residents. (Edited publisher abstract)
Living in a care home during COVID-19: a case study of one person living with dementia
- Authors:
- DAVIES-ABBOTT Ian, HEDD Jones Catrin, WINDLE Gill
- Journal article citation:
- Quality in Ageing and Older Adults, 22(3/4), 2021, pp.147-158.
- Publisher:
- Emerald
Purpose: This paper aims to understand the lived experience of a person living with dementia in a care home during the COVID-19 pandemic. It responds to the absence in research of the voices of people with dementia living in care homes during the pandemic. Design/methodology/approach: The paper adopts a single case study design applied thematic analysis to semi-structured interview data to discover the experiences of one person living with dementia in a care home during a period of lockdown. Findings: Five themes reveal how the participant responded to the practical and emotional challenges of the pandemic: autonomy; fears; keeping connected; keeping safe and other people living with dementia. These themes highlight the participant’s ability to adapt, accept and dispute lockdown restrictions, revealing considerable insight into their situation. Research limitations/implications: The pandemic has restricted access to care homes, which informed the single case study design. This approach to the research may restrict the generalisability of the findings. Other researchers are encouraged to include the voices of people with dementia living in care homes in further studies. Practical implications: Implications for practice, presented in this paper, promote quality psychosocial approaches when health-care workers engage with people living with dementia during periods of restricted activity. Originality/value: Unlike other studies about the impact of the pandemic on care homes, this paper explores the experience of the pandemic in care homes from the perspective of a person living with dementia. (Edited publisher abstract)
Human rights and care homes for older people: a typology of approaches from academic literature as a starting point for activist scholarship in human rights and institutional care
- Authors:
- GREEN Caroline Emmer De Albuquerque, TINKER Anthea, MANTHORPE Jill
- Journal article citation:
- International Journal of Human Rights in Healthcare, early cite 4 August 2021,
- Publisher:
- Emerald
Care homes for older people attract human rights discourse. This has intensified during the Covid-19 pandemic, which disproportionately affected care home communities with various human rights ramifications. Activist scholarship in human rights can contribute to the protection and realisation of the rights of people living, working in and visiting care homes through high-quality research. This article reports the findings of an analysis of pre-pandemic scholarship that explored the ways authors approached the topic of human rights of older people in care homes. The aim was to produce a typology of approaches to the topic as a basis for critical reflection and as a starting point for future activist scholarship in gerontology, social policy and law. Reflexive thematic analysis of 23 international English-language peer-reviewed articles published between 1998 and March 2019 was undertaken. Analysis was framed in the context of the health and social care setting of England. The article reports the pertinent and common assumptions that care homes are ‘inherently risky’ places for the protection of the human rights of ‘vulnerable’ care home residents. The article highlights five types of approaches: the anti-institutional, the legalistic, the care quality, the equality approach, and the issue-based approach. (Edited publisher abstract)
Understanding good leadership in the context of English care home inspection reports
- Authors:
- MONGAN Ceara, THOMAS Will
- Journal article citation:
- Leadership in Health Services, 34(2), 2021, pp.167-180.
- Publisher:
- Emerald
Purpose: As part of their inspection of care homes in England, the statutory inspector (the Care Quality Commission [CQC]) makes a judgement on the quality of the home’s leadership. Their view is critical as it is intended to inform consumer choice and because the statutory nature of inspection means these views hold considerable authority. The purpose of this paper is to look at the content of a selection of reports and seek to determine what the CQC understands by the concept of “good leadership”. Design/methodology/approach: A purposive sample of recent CQC inspection reports was selected and subjected to a qualitative content analysis. Inspections are structured around five main questions. The resulting themes describe areas of focus within the section of reports that feature the question “Are they well-led?”. Findings: Inspection reports were found to focus on four main themes: safety and quality of care; day-to-day management of staff; governance and training in the home; and integration and partnership working. In the discussion section, the authors reflect on these themes and suggest that the CQC’s view of leadership is rather limited. In particular, while an emphasis is placed within the literature and policy on the importance of leadership in delivering change and quality improvement, little attention is paid to this within the leadership section of inspection reports. Research limitations/implications: The authors’ research is based on a small-scale sample of inspection reports; nevertheless, it suggests a number of avenues for further research into the way in which leadership and management capabilities are developed and monitored in the sector. Originality/value: The analysis in this report offers a view of how the inspection regime implements its own guidance and how it assesses leadership. The reports, as public-facing documents, are artefacts of the inspection regime and critical not just as evidence of the practice of inspection but as influence on care home operations and the choices of care home residents and their families. (Edited publisher abstract)
Structural discrimination and abuse: COVID-19 and people in care homes in England and Wales
- Author:
- PARKER Jonathan
- Journal article citation:
- Journal of Adult Protection, 23(3), 2021, pp.169-180.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the significant and high death toll of COVID-19 on care home residents and social care staff in England and Wales. These mortality figures, alongside differential treatment of residents and staff during the pandemic, are conceptualized as a form of structural abuse. Arguments are made for the inclusion of structural abuse as a separate category of elder abuse. Design/methodology/approach: This paper is predominantly conceptual but it also draws on available secondary data, such as mortality statistics, media reports and developing research. Findings: The lack of appropriate personal protective equipment, paucity of guidance and high mortality rate among care home staff and residents during the pandemic is indicative of social discourses that, when underpinned by ageism, reflect structural elder abuse. Research limitations/implications: The research is limited by its focus on a specific time period and its recency. It is also limited in not being based on primary empirical research but it remains exploratory and conceptual and provides a base for ongoing research in this area. Social implications: If structural elder abuse was to be included in classifications, it demands a rethink of social and health-care services and the policies and practices associated with them and reinforces the government message that safeguarding is everyone’s business. Originality/value: Research concerning the effects and impact of COVID-19 are still in their early stages. However, the central element of originality in the paper concerns the linking of practices, policies and underlying social assumptions and structural, or societally ingrained, elder abuse. (Edited publisher abstract)
High death rate of older persons from COVID-19 in Quebec (Canada) long-term care facilities: chronology and analysis
- Authors:
- BEAULIEU Marie, GENESSE Julien Cadieux, ST-MARTIN Kevin
- Journal article citation:
- Journal of Adult Protection, 23(2), 2021, pp.110-115.
- Publisher:
- Emerald
Purpose: Among the ten Canadian provinces, Quebec has experienced the most significant excess mortality of older persons during COVID-19. This practice paper aims to present the chronology of events leading to this excess mortality in long-term care facilities (LTCFs) and a comprehensive analysis of the phenomenon. Design/methodology/approach: Documented content from three official sources: daily briefings by the Quebec Premier, a report from the Canadian Armed Forces and a report produced by Royal Society of Canada experts were analysed. Findings: Two findings emerge: the lack of preparation in LTCFs and a critical shortage of staff. Indeed, the massive transfer of older persons from hospitals to LTCFs, combined with human resources management and a critical shortage of permanent staff before and during the crisis, generates unhealthy living conditions in LTCFs. Originality/value: To our knowledge, this paper is the first to analyse official Quebec and Canadian statements concerning COVID-19 from the angle of quality of life and protection of older adults in LTCFs. (Edited publisher abstract)
Modelling the comparative costs of Namaste Care: results from the namaste care intervention UK study
- Authors:
- BRAY Jennifer, et al
- Journal article citation:
- Working with Older People, 25(2), 2021, pp.131-140.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to populate a theoretical cost model with real-world data, calculating staffing, resource and consumable costs of delivering Namaste Care Intervention UK (NCI-UK) sessions versus “usual care” for care home residents with advanced dementia. Design/methodology/approach: Data from five care homes delivering NCI-UK sessions populated the cost model to generate session- and resident-level costs. Comparator usual care costs were calculated based on expert opinion and observational data. Outcome data for residents assessed the impact of NCI-UK sessions and aligned with the resident-level costs of NCI-UK. Findings: NCI-UK had a positive impact on residents’ physical, social and emotional well-being. An average NCI-UK group session cost £220.53, 22% more than usual care, and ran for 1.5–2 h per day for 4–9 residents. No additional staff were employed to deliver NCI-UK, but staff-resident ratios were higher during Namaste Care. Usual care costs were calculated for the same time period when no group activity was organised. The average cost per resident, per NCI-UK session was £38.01, £7.24 more than usual care. In reality, costs were offset by consumables and resources being available from stock within a home. Originality/value: Activity costs are rarely calculated as the focus tends to be on impact and outcomes. This paper shows that, although not cost neutral as previously thought, NCI-UK is a low-cost way of improving the lives of people living with advanced dementia in care homes. (Edited publisher abstract)
Improving care in care homes: what can Primary Care Networks learn from the Vanguards?
- Authors:
- COLEMAN Anna, CROKE Sarah, CHECKLAND Kath
- Journal article citation:
- Journal of Integrated Care, 29(1), 2021, pp.85-96.
- Publisher:
- Emerald
Purpose: We trace the evolution of a new integrated care policy in the English NHS (enhanced health in care homes, EHCH) from pilot model to wider roll out, over a 4-year period, into the circumstances of COVID-19. Design/methodology/approach: Using published evidence and official documentation we compared and contrasted the original EHCH model/framework, subsequent draft specifications and the final proposals, ahead of implementation. Findings: The Primary Care Network EHCH service specification has clearly arisen from the Vanguard programme; however, problems related to GP contracts and COVID-19 means, at least initially, there is likely to be some variability over who will be responsible for delivery. It is unknown whether this service, delivered at pace in the current circumstances, will achieve or affect the outcomes envisaged by the pilots. Research limitations/implications: This is our interpretation of the developing policy for enhanced health in care homes, which requires further follow-up research. We are beginning our final fieldwork phase in Summer 2020, to report on the Vanguard legacy. Practical implications: Evaluations of policy success/failure should consider the context and the differing power relations that are present and may impact subsequent take-up and roll-out across the system. We recommend a longitudinal approach to enable a holistic view of policy implementation. Originality/value: This paper reveals the fragility of health and care policymaking in the current climate. From initial concept, through development and testing, into forced early roll out, our observations reflect the unique impact of a global pandemic shock. (Edited publisher abstract)
Shining a light on care homes during the COVID 19 pandemic in the UK 2020
- Author:
- STEVENSON Annie
- Journal article citation:
- Quality in Ageing and Older Adults, 21(4), 2020, pp.217-228.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the link between age discrimination and the injustices that have taken place in our care homes during the COVID-19 pandemic in this country. It seeks to show how destructive age discrimination is to those who live in our care homes and attempts to shake up our attitudes to older people, as the pandemic continues. It is hoped that shifts in attitude would lead to a societal revolution in care and support for older people as the pandemic shows us how the current system is breaking down. Design/methodology/approach: This is a personal insight into the plight of the care home sector during the COVID-19 pandemic in the UK. The writer has worked in the field of social care and older people’s services for many years and felt compelled to share her learning and observations. This led to venturing more deeply into understanding why those who live, work and visit care homes have been so neglected and “cast into the shadows” in the face of such desperate danger. Whilst tracking the media narrative during the first wave, she attempts to apply her knowledge, in particular gained from working for Help the Aged (now Age UK) as a policy manager for Quality Care, but also draws on experiences as a social worker, commissioner and care provider from the 1980’s to the present. By “shining a light” on care homes, revealing that the darker practices that have taken place contravene the Human Rights Act 1998, it is hoped that the recognition of age discrimination will happen at every level and become better known in its application. The paper observes how deeply rooted it is in us all. Findings: Having highlighted some shocking examples of bad practice from the authorities relating to care homes, the article concludes that Government policy on care homes from March to July 2020 was discriminatory and questions how far lessons have been learned. The legislation is in place in the form of the Human Rights Act 1998 to protect older people in care homes but is not being widely implemented at regional policy level. Government rhetoric remains far from reality Instead of redressing the gap and admitting mistakes, there is evidence at a high level of continued denial and the projection of blame on to the care homes themselves. Originality/value: The author’s professional background includes meeting the founder of the Gray Panthers, Maggie Kuhn, in the United States in the 1988. This was a defining moment that gave her an original insight into age discrimination and influenced her entire career. It eventually led to her working in national policy for one of the most influential charities for older people at the turn of the millennium, Help the Aged. Here, she co-founded the My Home Life Programme (promoting quality of life in care homes). The paper offers a unique insight into why it is so challenging to achieve quality of life for older people needing care and should be of interest to policymakers, clinical commissioning groups, local authorities, older people’s care providers and carer and user organisations. (Edited publisher abstract)
Building relational research capacity in care homes in the COVID-19 era: applying recognition theory to the research agenda
- Authors:
- TOMS Gill, et al
- Journal article citation:
- Quality in Ageing and Older Adults, 21(4), 2020, pp.229-239.
- Publisher:
- Emerald
Purpose: Research can be an influential driver in raising care home standards and the well-being and human rights of residents. This paper aims to present a case for how a relational research capacity building programme could advance this agenda. Design/methodology/approach: This study uses Axel Honneth’s Recognition Theory as a lens through which to explore organisational and institutional factors (such as research capacity and investment) that can either enable or limit “recognition” in the context of research in care homes. This paper draws on recent evidence from the COVID-19 pandemic in the UK and worldwide, to argue that such a relational capacity building agenda is even more pressing in the current context, and that it resonates with evidence from existing relational capacity building initiatives. Findings: A lack of relevant research arguably contributed to the crisis experienced by the care home sector early in the pandemic, and there are only tentative signs that residents, care home providers and staff are now informing the COVID-19 research agenda. Evidence from pre COVID-19 and insights from Honneth’s Recognition Theory suggest that relational approaches to building research capacity within the care home sector can better generate evidence to inform practice. Originality/value: This is a novel application of recognition theory to research in the care home sector. Drawing on theory, as well as evidence, has enabled the authors to provide a rationale as to why relationship-based research capacity building in care homes warrants further investment. (Edited publisher abstract)