Thoughts ahead of the Enabling Research in Care Homes forum (12th July)

Hospitals in England are facing unprecedented demand that they are struggling to meet. More people are being admitted to hospital in emergency situations that ever before. The increase in demand has led some people to look for admissions that could be considered avoidable. One group of people who have received particular attention are care home residents. Care home residents are amongst the ‘oldest old’ in society – research suggests that over half of all care home residents aged 85 years or above. What is more, care home residents often have multiple health conditions and a wide range of complex health and social care needs.

For some care home residents, the risks associated with a stay in hospital can outweigh the potential benefits. Care home residents are at risk of further physical decline due to prolonged periods of inactivity and the risk of contracting hospital-acquired infections. A transfer to a busy hospital can also be confusing, stressful and associated with cognitive decline. In particular, people with moderate and advanced dementia may become increasingly agitated and frightened at being placed in unfamiliar surroundings, cared for by unfamiliar people.

In recent years a number of NHS organisations have introduced initiatives to reduce the number of hospital transfers from care homes. Published evaluations of these schemes are lacking and hospital transfers from care homes remain poorly understood. A particular gap in knowledge surrounds the views of care home staff. This is surprising given the pivotal role that care home staff play in managing residents health conditions. Often care home staff are involved in initiating a transfer – for example, when a carer notices a resident is “not quite right”.

The research I am conducting as part of my PhD is seeking to understand the work that goes on in a care home prior to a hospital transfer taking place. This includes the chain of events that precede a transfer and the decision-making processes that staff undertake. I have interviewed 30 members of care home staff across 6 care homes in both the East and West Midlands. The findings that I will present during the ENRICH East Midlands forum on Friday 12th July will outline some of my key findings.

In particular, my talk will cover: how do care home staff feel about transferring residents to hospital, who is involved in the transfer process, how do staff decide when to call for help, what factors influence the decisions that care home staff make? In addition, I will also cover a number of practical take home messages for care home staff about how to improve the care of residents around hospital transfers.

My research takes a new approach towards understanding hospital transfers from care homes, by listening to the views and experiences of care home staff. This approach could provide new insights about how to reduce the number of ‘inappropriate’ transfers and be an important first step in developing high quality alternative services for care home residents.


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EnRICH  (Enabling Research in Care Homes) is a network specifically set up to promote research in care homes and provide the opportunity for care home residents to take part in research . EnRICH supports care home staff and researchers to set up studies and organises 3-4 Forums a year .

Post written by Fawn Harrad ahead of the ENRICH forum. Fawn is an PhD student at the University of Leicester. She has previously worked in both the NHS and social care settings. Fawn’s research focuses on hospital transfers from care homes. In particular, she is interested in the work that goes on in a care home before a transfer takes place, including the actions and decisions that care home staff undertake before a resident is transferred to the hospital.

Contact details: /  @FawnHarrad



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