Date: 24 July 2017
Category: Care homes
Last week saw the launch of Advancing Care, a new NIHR Themed Review of research with care homes. Researchers, clinical staff and care home providers debated the future of care home research. Below are just some of the points we discussed.
Future care home research needs to address the priorities of residents, relatives and care home staff (owners, managers and frontline staff) as well as health and social care professionals who work in care homes. But how can we understand and balance these diverse research needs?
A recent non-NIHR funded study has identified the priorities of care home staff, but perhaps a James Lind Alliance priority setting partnership could engage a broader range of stakeholders in setting future research agendas.
Much good practice is already happening in care homes, but without an evidence base. We need to share better what we already know, in terms of what works and what conditions make best outcomes most likely. We also need to find better ways of identifying and sharing promising solutions and prototypes for further evaluation.
Given that there is so much variation in the care home sector, the likelihood of any new intervention making a difference will depend on context. New approaches which explore how context affects outcome may often be more useful than randomised controlled trials which try to design out the impact of context. Learning from what goes right, in terms of appreciative enquiry and studying positive deviants, can also be helpful.
The care home environment is complex, making it difficult to develop successful interventions. Residents, relatives and care home staff need to be partners in this design process. They can provide insights on what’s needed, what’s likely to work and define what success looks like to them. More time needs to be invested in this developmental phase and the learning needs to be shared more widely – especially about what doesn’t work.
Taking part in research must not be a burden for care homes, but rather a positive experience that recognises and builds on their skills and expertise. Investment is needed to build the capacity of care homes to be partners in research. This might include enabling care home staff to develop academic qualifications and become co-applicants in funding bids. Research would then become a joint activity and the findings owned by all involved.
This is especially important given a large number of care homes are privately owned. Making the business case for new interventions is an important part of the evidence required to change policy and practice. The costs and benefits for the whole community need to be considered and shared. If a change in the care home benefits the NHS, what returns are there for care homes?
Researchers need to find hooks to engage care homes in research. This might include alignment of study questions with CQC regulation standards, to maximise relevance to care homes.
For research and monitoring purposes it would be helpful for care homes to agree what standard information they will collect about their residents and services. There is a need for a minimum data set and agreed ways of sharing this with others, such as commissioners and service providers.
There is a case for better coordination of care home research, building on the good work of ENRICH and other networks. We need to focus on the topics that matter to staff and residents, to build capacity for co-designed research amongst care-homes, and to improve collaboration and communication. We also need to find better ways to share what we know to advance best care.
At the launch of Advancing Care, clinical staff and care home providers debated the future of care home research.
Working on behalf of the NIHR Dissemination Centre.