Care homes, their communities, and resilience in the face of the COVID-19 pandemic: interim findings from a qualitative study

  1. Fiona Marshall
  2. Adam Gordon
  3. John R. F. Gladman
  4. Simon Bishop

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Abstract

Background

From late February 2020, English care homes rapidly adapted their practices in response to the COVID-19 pandemic. In addition to accommodating new guidelines and policies, staff had to adjust to rapid reconfiguration of services external to the home that they would normally depend upon for support. This study examined the complex interdependencies of support as staff responded to COVID-19. The aim was to inform more effective responses to the ongoing pandemic, and to improve understanding of how to work with care home staff and organisations after the pandemic has passed.

Methods

Ten managers of registered care homes in the East Midlands of England were interviewed by videoconference or phone about their experiences of the crisis from a structured organisational perspective. Analysis used an adapted organisational framework analysis approach with a focus on social ties and interdependencies between organisations and individuals.

Results

Three key groups of interdependencies were identified: care processes and practice; resources; and governance. Care home staff had to deliver care in innovative ways, making high stakes decisions in circumstances defined by: fluid ties to organisations outside the care home; multiple, sometimes conflicting, sources of expertise and information; and a sense of deprioritisation by authorities. Organisational responses to the pandemic by central government resulted in resource constraints and additional work, and sometimes impaired the ability of staff and managers to make decisions. Local communities, including businesses, third-sector organisations and individuals, were key in helping care homes overcome challenges. Care homes, rather than competing, were found to work together to provide mutual support. Resilience in the system was a consequence of dedicated and resourceful staff using existing local networks, or forging new ones, to overcome barriers to care.

Conclusions

This study identified how interdependency between care home organisations, the surrounding community, and key statutory and non-statutory organisations beyond their locality, shaped decision making and care delivery during the pandemic. Recognising these interdependencies, and the expertise shown by care home managers and staff as they navigate them, is key to providing effective healthcare in care homes as the pandemic progresses, and as the sector recovers afterwards.

Article activity feed

  1. Version published to 10.1186/s12877-021-02053-9
  2. ScreenIT

    SciScore for 10.1101/2020.11.10.20229013: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has some limitations. Only care home managers were interviewed and not representatives of the NHS, public health organisations or social care. It is only a small sample (n=10). The majority of the study was conducted by one ethnographer and so may only present one worldview. The study continues to recruit and so these findings are interim ones based on ten care homes, all located within the East Midlands of England. There may be regional variation that these results fail to capture. These findings have important implications for how statutory health and social care providers work with care homes during the second and subsequent waves of the pandemic and beyond. They also provide useful insights as improvement work with care homes continues beyond the pandemic and as national government proposes reconfiguration of the care home sector. It is important to recognise the ability of care home staff to identify and solve emerging issues in care homes. Care homes are under-represented at all levels of decision making – this must be rectified. The importance of care homes to their local communities, and the preparedness of communities to support care homes, is an important new finding. This means that stakeholders in decisions about care home provision are potentially wider than previously recognised. This requires that consultation must be broader when changes are implemented, but it also provides potentially novel opportunities for how care home staff can be supported by...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.11.10.20229013v1 on medRxiv