Browsing by Author "Devi, Reena"

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    The COVID-19 Pandemic in UK Care Homes - Revealing the Cracks in the System
    (Journal of Nursing Home Research, 2020-07-09) Hinsliff-Smith, K.; Gordon, Adam; Devi, Reena; Goodman, Claire
    There are around 420,000 residents living in UK care homes. The majority are over 85, have multiple health conditions, live with frailty and are nearing the end of their lives. Up to 80% of residents live with dementia. Care homes are not part of the National Health Service (NHS). Care home places are funded through a complex mix of self-funding, means-tested support from local authorities, and continuous healthcare funding from the NHS. They are run by independent organisations. A third of providers are large for-profit chains, the remainder comprising not-for-profit third-sector organisations, or small private companies with only a small number of homes. The level of government reimbursement for long-term care homes in the UK is low by international standards, an issue highlighted by multiple public commissions3,4 but which has gone unaddressed by successive UK governments. Medical care to UK care homes is highly variable. In some areas, the NHS Care Home Vanguards have established dedicated General Practitioners with responsibility for each home and direct access to specialist multidisciplinary teams, with evidence that such approaches may minimise unnecessary admission to hospital5. But often, care is based on residents’ individual relationships with family doctors, with the result that access to medical care is variable and uncoordinated6. As the COVID -19 pandemic started, arrangements for medical care in English care homes were in the early stages of being standardised as part of the NHS England Enhanced Health in Care Homes project. There is a social dread surrounding care homes, perceived as places to avoid because of concerns about care quality and resistance to having to pay for social care when health care is free. Most of the coverage of care homes in mainstream media prior to COVID was negative, focussing on isolated scandalous cases of negligence or abuse, and rarely reporting on the exceptional work done by the sector daily. The workforce is not valued. There is no national accreditation for care home staff, opportunities for career progression are limited, staff are poorly paid and positions in care homes are often referred to as unskilled work.
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    Engaging in research with care homes
    (NIHR-ARC, 2023-02-10) Hinsliff-Smith, K.; Devi, Reena; Chadborn, Neil; Horne, Jane; Gordon, Adam
    Care homes are a key part of health and social care provision within the UK, and research is needed to help develop solutions to challenges faced in practice. Care homes might want to get involved in research but might not know where to start, and likewise, researchers might not know how best to engage care homes in their work. A team of academics with first-hand experience of conducting research and working with care homes have produced a tool, with public and patient input, to help care homes get more involved in research, and researchers wanting to involve care homes in research. The tool is freely available and is a 2-sided infographic hand out which aims to help guide discussions about engaging in research from the perspectives of both the research community and the care homes.
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    How Quality Improvement Collaboratives Work to Improve Healthcare in Care Homes: A Realist Evaluation
    (Oxford University Press, 2021-02-16) Hinsliff-Smith, K.; Devi, Reena; Gordon, Adam; Chadborn, Neil; Goodman, Claire; Meyer, Julienne; Dening, Tom; Housley, Gemma; Long, Annabelle; Lewis, Sarah; Banerjee, J.; Gladman, J.R.F.; Long, A.; Usman, A.; Housley, G.; Glover, M.; Gage, H.; Logan, P.A.; Martin, F.C.; Gordon, Adam Lee
    Background Quality Improvement Collaboratives (QICs) bring together multidisciplinary teams in a structured process to improve care quality. How QICs can be used to support healthcare improvement in care homes is not fully understood. Methods A realist evaluation to develop and test a programme theory of how QICs work to improve healthcare in care homes. A multiple case study design considered implementation across 4 sites and 29 care homes. Observations, interviews and focus groups captured contexts and mechanisms operating within QICs. Data analysis classified emerging themes using context-mechanism-outcome configurations to explain how NHS and care home staff work together to design and implement improvement. Results QICs will be able to implement and iterate improvements in care homes where they: have a broad and easily understandable remit; recruit staff with established partnership working between the NHS and care homes; use strategies to build relationships and minimise hierarchy; protect and pay for staff time; enable staff to implement improvements aligned with existing work; help members develop plans in manageable chunks through QI coaching; encourage QIC members to recruit multidisciplinary support through existing networks; facilitate meetings in care homes; and use shared learning events to build multidisciplinary interventions stepwise. Teams did not use measurement for change, citing difficulties integrating this into pre-existing and QI-related workload. Conclusions These findings outline what needs to be in place for health and social care staff to work together to effect change. Further research needs to consider ways to work alongside staff to incorporate measurement for change into QI.
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    Quality improvement in long term care settings: a scoping review of effective strategies used in care homes
    (Springer, 2020) Hinsliff-Smith, K.; Chadborn, Neil; Devi, Reena; Gordon, Adam; Banerjee, Jay
    Purpose We conducted a scoping review of quality improvement in care homes. We aimed to identify participating occupational groups and methods for evaluation. Secondly, we aimed to describe resident-level interventions and which outcomes were measured. Methods Following extended PRISMA guideline for scoping reviews, we conducted systematic searches of Medline, CINAHL, Psychinfo, ASSIA (2000-2019). Furthermore, we searched systematic reviews databases including Cochrane Library and JBI, and the grey literature database, Greylit. Four co-authors contributed to selection and data extraction. Results 65 studies were included, 6 of which had multiple publications (75 articles overall). A range of quality improvement strategies were implemented, including audit-feedback and quality improvement collaboratives. Methods consisted of controlled trials, quantitative time series and qualitative interview and observational studies. Process evaluations, involving staff of various occupational groups, described experiences and implementation measures. Many studies measured resident-level outputs and health outcomes. 14 studies reported improvements to a clinical measure, however four of these articles were of low quality. Larger randomized controlled studies did not show statistically significant benefits to resident health outcomes. Conclusion In care homes, quality improvement has been applied with several different strategies, being evaluated by a variety of measures. In terms of measuring benefits to residents, process outputs and health outcomes have been reported. There was no pattern of which quality improvement strategy was used for which clinical problem. Further development of reporting of quality improvement projects and outcomes could facilitate implementation.
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    Safe visiting is essential for nursing home residents during the COVID-19 pandemic: an international perspective
    (Elsevier, 2021-02-26) Hinsliff-Smith, K.; Low, Lee-Fay; Devi, Reena; Spilsbury, Karen; Brown, Jayne; Sinhu, Samir; Stall, Nathan; Dow, Briony; Griffiths, Alys; Bergman, Christina; Verbeek, H.; Siette, J.; Backhaus, R.; Comas-Herrera, A.
    Blanket and total bans of nursing home visitors were widespread at the beginning of the COVID-19 pandemic when governments and homes were unprepared to prevent and manage outbreaks. However, these visitor restrictions have been prolonged and often reinstated after having been lifted, despite increased home and health system readiness and mounting evidence of harms to residents. Further, in most nursing homes, visitor bans were introduced without discussion or consent from residents or their advocates, constituting a violation of the resident’s rights to have visitors.