Context: Cleaning, catering, housekeeping and laundry workers (ancillary staff) play a crucial role in care homes through promoting infection control, food preparation, hygiene, and contributing to care home environments, relationships and culture. Their contributions were highlighted during the COVID-19 pandemic in the media in England and internationally. However, this workforce is overlooked in much care home research. Objective: The aim of this study was to understand the experiences of ancillary staff working in English care homes to identify elements of promising practice. Findings: From in-depth qualitative interviews with 63 participants, consisting of 38 ancillary workers (9 cleaners, 14 catering staff, 12 housekeeping staff, 3 ancillary staff supervisors), 8 care home managers, 5 human resources (HR) managers, 5 care home residents and 7 family members, we identified themes that related to promising practice to support ancillary staff wellbeing. Themes were discussed and finalised into principles in five stakeholder workshops with 13 stakeholders. These principles of promising practice were to: (1) promote fair reward and recognition, (2) enhance clear communication through leadership, (3) create effective support systems, (4) provide person-centred staff development opportunities, (5) ensure inclusive and respectful treatment and (6) recognise relationships with residents and relatives. Implications: Consideration should be given to ancillary staff being better recognised as essential workers in care homes through the creation of national training accreditation for this group, attention to their wages in addition to those of other care home staff, and more support for their occupational health.
Context: Between 2015 and 2020, 1,578 care homes in England closed, affecting 48,600 individuals. The financial and economic impact of such closures on various stakeholders remains largely unquantified. Objective: To develop pathways for care home closures from key stakeholders’ perspectives, quantify associated costs, and explore the economic implications to key stakeholders. Methods: A mixed-methods approach was adopted across three stages: qualitative analysis of stakeholder interviews, development of care home closure pathways, and cost analysis, including sensitivity analyses. Findings: The public sector cost for a single care home closure over 12 months was estimated at £30,550 (2021/22 prices) or £34,185 (2023/24 prices). Sensitivity analyses showed costs could range from £4,400 to £66,490 (£4,924 to £74,398 in 2023/24 prices). Qualitative findings indicated various financial implications for residents, families, and care staff, including top-up fees and increased travel costs. Limitations: The study relied on assumptions and proxy costs due to limited data availability, potentially increasing uncertainty in cost estimates. Whilst methods are transferable, findings relate specifically to England. Implications: The findings highlight the need for careful planning and resource allocation in managing care home closures. Future research should explore the association between costs and outcomes through economic evaluation to inform cost-effective strategies for addressing care home closures.
Context: The COVID-19 pandemic presented unprecedented challenges for the adult social care sector, necessitating rapid changes in service delivery. Understanding the factors influencing the well-being of staff beyond the pandemic’s initial crisis response phase is crucial. Objective: The article examines the mental well-being, burnout, and the morally injurious experiences of the adult social care workforce in Greater Manchester during the UK’s ’Living with COVID’ phase, initiated in February 2022. Methods: An online survey collected responses from 251 social care staff. Regression analyses, employing a job-demands and resources framework (JD-R), considered demographic, occupational, and COVID-19-related factors to predict psychological outcomes. Findings: Significant levels of low mental well-being (34%) and burnout (31% likely experiencing burnout, 36% at risk) were observed. Additionally, 40% reported experiencing events that were potentially morally injurious. COVID-19-related factors had a significant impact on these outcomes. Satisfaction with infection control measures and access to sufficient resources were associated with more favourable outcomes. Considerable changes in daily activities and dissatisfaction with infection control measures were associated with increased levels of burnout and exposure to morally injurious experiences. Demographic and occupational factors had a lesser influence. Limitations: The study was conducted in a single geographic region of England with non-probability sampling methods and recruitment, potentially impacting the generalisability of the findings. Implications: The findings highlight the importance of adequate resources and infection control measures in reducing harm in the adult social care workforce and building resilience for future sector pressures.
Background: The UK’s social care sector, employing 1.6 million workers, faces profound challenges exacerbated by the COVID-19 pandemic. This study explores the nuanced factors influencing care workers’ intentions to leave the current employer and sector altogether during this critical period. Methods: Utilising a two-wave online longitudinal survey, data from 1,791 care workers were analysed. The survey included adapted questions from validated workforce surveys and qualitative insights from stakeholders during the pandemic. Findings: There is a complex interplay of factors influencing care workers’ intentions to leave. High job satisfaction is associated with lower intent to leave. Yet, disparities in satisfaction with pay, promotion, and work-life balance persist. The pandemic appeared to impact intention to leave minimally but heightened abuse instances. Visible markers—notably colour—emerged as significant factors, emphasising the need for tailored interventions. Strong job support is associated with increased intent to leave, underscoring the fine employee-manager relationship. The middle-aged group showed the highest intent to leave, warranting further exploration. Implications: Tailored interventions acknowledging the intersectionality of age, gender, and race are crucial for enhancing job retention in the social care sector. A comprehensive long-term care workforce strategy is urgently needed, addressing immediate concerns and deep-rooted challenges to empower the entire workforce. Collaborative efforts are essential for crafting sustainable solutions that support and uplift the social care workforce.
Context: At the time of the study, hospitals in England had 24,029 patients who no longer met the criteria to reside (as of 1 April 2022). Objective: This qualitative study examined the availability of short-term beds in long-term care facilities to support the discharge process, alongside the opportunities and challenges managers faced. Method: Managers in long-term care facilities were interviewed between October 2021 and April 2022. The framework approach underpinned the analysis, which used thematic analysis. Findings: Managers perceived that short-term beds enable the transfer of patients from a hospital for assessment and potential rehabilitation before returning home or to a further care setting. Three main themes emerged: supply and demand, service pressure, and the impact of the COVID-19 pandemic. Limitations: The study was conducted during the COVID-19 pandemic, when the government’s guidance to long-term care facilities underwent significant changes. The study was limited to a small sample of managers from long-term care facilities, and therefore, the views may not be representative. Finally, we acknowledge that the preferences among patients and families were not represented in the study, and that the discharge process could not be fully explored. Implications: This study found that communication and planning within and between health and social care providers are crucial for ensuring the timely discharge of patients into long-term care facilities. These findings are consistent with post-pandemic research (Naick and Jones (in development)), highlighting the potential to inform the government policies focusing on the hospital discharge process.
Context: The COVID-19 pandemic presented unprecedented challenges for the adult social care sector, necessitating rapid changes in service delivery. Understanding the factors influencing the well-being of staff beyond the pandemic’s initial crisis response phase is crucial. Objective: The article examines the mental well-being, burnout, and the morally injurious experiences of the adult social care workforce in Greater Manchester during the UK’s ’Living with COVID’ phase, initiated in February 2022. Methods: An online survey collected responses from 251 social care staff. Regression analyses, employing a job-demands and resources framework (JD-R), considered demographic, occupational, and COVID-19-related factors to predict psychological outcomes. Findings: Significant levels of low mental well-being (34%) and burnout (31% likely experiencing burnout, 36% at risk) were observed. Additionally, 40% reported experiencing events that were potentially morally injurious. COVID-19-related factors had a significant impact on these outcomes. Satisfaction with infection control measures and access to sufficient resources were associated with more favourable outcomes. Considerable changes in daily activities and dissatisfaction with infection control measures were associated with increased levels of burnout and exposure to morally injurious experiences. Demographic and occupational factors had a lesser influence. Limitations: The study was conducted in a single geographic region of England with non-probability sampling methods and recruitment, potentially impacting the generalisability of the findings. Implications: The findings highlight the importance of adequate resources and infection control measures in reducing harm in the adult social care workforce and building resilience for future sector pressures.
Using evidence to improve public services is a key aspiration, but also a significant challenge internationally, with a number of key national investments in breaking down traditional barriers between research, policy and practice. This paper brings together the experiences of three European centres of excellence working in social and health care: Vilans (the national centre of expertise for long-term care in the Netherlands); Nka (the Swedish national centre of excellence in the field of unpaid carers); and IMPACT (the UK centre for implementing evidence in adult social care). The paper describes the background, structure and approach of each centre, and draws out key lessons from each. It then explores potential differences as well as key similarities. In particular, each centre seeks to move beyond more traditional, top-down forms of dissemination through their commitment to bridging policy, practice and research; valuing different voices and different types of evidence; co-production and lived experience and being a more active participant in policy debates and the change process.
Context: Australia and Canada are both currently working to improve their long-term care systems to, respectively, meet the growing needs of their ageing populations. Perspective: International long-term care system comparisons between similar countries can provide insights relevant to the development of long-term care policies and reforms that may improve the lives of older persons. From September 2022 to May 2023, we conducted an environmental scan of publicly available literature, comparing key elements of the long-term care systems in Australia and Canada. While both countries offer similar universal, publicly funded long-term care services, their organisational and governance structures differ significantly. Australia relies more heavily on residential care, whereas Canada has a stronger emphasis on in-home care services. Both countries face ongoing challenges related to the sustainability of their long-term care workforces and support for carers. Implications: The implications of this analysis suggest that both Australia and Canada can learn from each other’s best practices to enhance their long-term care systems. These insights have significant implications for long-term care practice, policy and future research, emphasising the need for sustainable workforce strategies, improved in-home care services and better support systems for carers.
Context: This article fills a gap in the literature on long-term care by focusing on the role of local elected officials. The balance between local and national influence over long-term care varies by country. We here focus on England, where local elected councillors make key decisions on the design and delivery of support for frail older people and disabled people. Objectives: The article draws on new empirical data to highlight the different ways in which executive councillors, i.e. those in Cabinet positions, can exercise collaborative leadership in adult social care. Method: Structured literature review and 55 semi-structured interviews with national stakeholders and local case site interviewees. Findings: Drawing on the work of Ansell and Gash (2012) we use empirical data to identify how executive councillors operate as both organic and political leaders in the collaborative governance setting of adult social care in England. In particular we distinguish between councillors as stewards, mediators and catalysts. Limitations: Case study drop-outs limited the scope of our research. The sample size is small. The findings would need testing to explore their applicability outside England given the different balance of national and local roles in long-term care elsewhere. Implications: Councillors in care leadership roles need to better understand the difference they can make and be supported in skills acquisition to be more effective.
Context: Facing unprecedented barriers to providing adequate care, along with a lack of recognition from the public, long-term residential care (LTRC) workers were at risk for mental health concerns, particularly moral distress, during the COVID-19 pandemic. Objective and Methods: This analysis of 30 interviews with LTRC workers aimed to describe how workers were affected by the public during the COVID-19 pandemic. Guided by recognition theory, our thematic analysis identified patterned meanings of worker experiences with the interface between LTRC facilities and the public. Findings: LTRC workers’ interactions with the public often reflected a lack of recognition for workers, as workers, and their workplaces, were publicly criticised while attempting to manage new and difficult responsibilities to members of the public. Yet, instances of recognition from the public had the potential to support workers’ self-confidence, self-respect and self-esteem. LTRC workers’ experiences pointed to a need for better understanding from members of the public as part of alleviating their stress. Limitations: The interviews were not originally conducted to examine the specific research question of this analysis, and we do not imply a diagnosis of participants’ mental health. The findings may be limited by self-selection bias. Implications: This study highlights the importance of having workers’ stories shared as part of increasing public awareness of their experiences and reducing the public’s negative perceptions of their work.
Personalising a new space by bringing furniture and photographs from home can promote a sense of belonging, self-identity and ease a challenging transition from independent living to a care home for older adults. Personalising a mobility device by adding coloured lights or hanging keychains from past travels has found similar benefits for some older adults. To date, research on device personalisation has focussed on community-based older adults, and we know very little about if, and how, this might work for older adults living in long-term care (LTC). The objectives of this study were to: (a) determine interest and support for an assistive device personalisation programme in LTC; (b) understand current processes in device selection, prescription and care; and (c) generate suggestions for implementing a device personalisation programme. Using a qualitative research design, 15 participants (staff, residents and families) from two care homes were interviewed for the study. Findings show support for a device personalisation programme, highlight a system where function is prioritised and personal choice and self-expression are limited and identify challenges and recommendations for implementation. A limitation of the study is that participants were all volunteers and therefore findings may not reflect the full range of perspectives of staff, residents and family members. There are several important implications of this research including identifying the potential benefits of a device personalisation programme and how this might ‘work’ in a care home and providing insight into what may be lost in current systems where the function and efficiency of mobility device prescription are prioritised.
Context: The use of community support groups and peer support are expanding across mental health and older people’s services, however, there is a lack of evidence on how such support may be beneficial to older men who might struggle with aspects of traditional mental health help seeking due to male identity, ageing and isolation. Objective: This article explores older men’s experiences of using community support groups to manage their mental health and wellbeing, and (re)establish constructions of masculinities in later life. Method: Using a qualitative approach, 21 in-depth semi-structured interviews with older men (65+) who attended a community support group for their mental health and wellbeing were conducted during 2022. Findings: Thematic analysis revealed three overarching themes which explored how men benefited from the groups and the ways in which they supported them to navigate their mental health and sense of self. Community support groups enabled men to seek out social connections with similar others, fostering belonging and a sense of self, which was crucial to their mental wellbeing. These groups provided a safe space that legitimised emotional vulnerability and allowed for the re-establishment of positive self-identity and masculine roles. Limitations: The cross-sectional design and small number of participants do not capture older men’s long-term engagement in mental health and social care support over time. The sample lacks ethnic diversity and misses the isolated and disabled older men’s voices. Conclusions: The findings offer insights into how older men engage in mental health-specific support and highlight a need for considering age and masculinities in community support group provision.
Context: There is a view in England that collective forms of day care for older adults are ‘out-dated’. However, recent studies in the UK and internationally suggest that these services have the potential to address contemporary policy aspirations. Objective(s): This paper reports findings from a study that explored the role of collective day care in England in order to consider a reimagining of services. Method(s): The paper draws on qualitative data collected from 8 case-studies in which 120 interviews were held with older people, their carers, staff and managers of services and local stakeholders. Interviews with managers included questions about the costs and resources used in running services. The reimagined models of care were refined in workshops with research partners. Findings: Analysis of the data revealed three themes underpinning day care provision: the importance of space, place and transport; inclusive and person-centred practice; and the need for purposeful activities. Three models of reimagined day care were developed: 1) small scale collective care for low to moderate needs, 2) larger scale preventative and social provision and, 3) collective care for people with complex and personal care needs. Limitations: Recruitment of sites began after Covid-19 restrictions were lifted in 2021, some sites had not reopened or declined to take part, consequently the study may not reflect the full range of day care services that exist. Implications: The findings illustrate the potential of different models of collective day care services to work together as part of an ecosystem that addresses contemporary policy aspirations.
Context: The social care needs of young adults with neuromuscular conditions (NMCs) are poorly evidenced. To address the paucity in research, it is first necessary to consolidate current understanding of social care and its presence/absence in the lives of young adults with NMCs. Objectives: To undertake a co-produced systematic scoping review to scope evidence on the presence of social care in the lives of young adults with NMCs. Specific objectives were to establish the extent of existing evidence, map key characteristics, identify evidence gaps and outline the most salient components of social care (e.g. housing) that exist in the evidence. Methods: A systematic scoping review was co-produced alongside a group of five young adults with NMCs. Review methods followed published guidelines. Searches were conducted in relevant databases. Findings: Findings from 25 studies were included representing 599 people with NMCs, 253 informal caregivers, 7 siblings and 11 professionals. The scope of available evidence exists across seven identified components. Namely, informal care, personal assistance, independence, interaction with the social care system, adaptations and equipment to support everyday living, opportunities to socialise and relationships and intimacy. Considerable variance in care quality and availability was identified. Limitations: Despite a comprehensive literature search, only 25 studies were identified internationally, representative of the health-oriented nature of evidence on this population. Professional perspectives were also lacking. Implications: Findings highlight where current evidence is situated and where gaps exist. As such, the review provides a foundation to direct vital research in this area.
Background and objectives: Population-based planning targets have been a feature of the Australian aged care policy landscape for decades. Changes in the way places are allocated are being introduced that could put at risk equitable access to residential aged places. This study sets out the regional distribution of places and shows how this might worsen under new policy arrangements. Research design and methods: Population estimates and projections are combined with the locations of current and in-development aged care places to test six planning populations and two levels of supply across 336 small areas. Results: Over the next 10 years, virtually all regions will see an increase in the number of older people and an increase in the 85+ population as a share of the 70+ population. In 2023, there was a shortfall against the target of nearly 25,000 places nationally; with no new allocations and the lower interim target, this could be as high as 55,000 places in 2033. The 85+ planning population presents the most inequitable scenario. Discussion and implications:These results inform aged care planning by quantifying the effect of policy parameters on the regional distribution of residential aged care services. Policy imperatives suggested by the findings include strong regional stewardship of residential care supply, robust monitoring of equity objectives, and regular evaluation of other program objectives.
Context: The COVID-19 pandemic presented unprecedented challenges for the adult social care sector, necessitating rapid changes in service delivery. Understanding the factors influencing the well-being of staff beyond the pandemic’s initial crisis response phase is crucial. Objective: The article examines the mental well-being, burnout, and the morally injurious experiences of the adult social care workforce in Greater Manchester during the UK’s ’Living with COVID’ phase, initiated in February 2022. Methods: An online survey collected responses from 251 social care staff. Regression analyses, employing a job-demands and resources framework (JD-R), considered demographic, occupational, and COVID-19-related factors to predict psychological outcomes. Findings: Significant levels of low mental well-being (34%) and burnout (31% likely experiencing burnout, 36% at risk) were observed. Additionally, 40% reported experiencing events that were potentially morally injurious. COVID-19-related factors had a significant impact on these outcomes. Satisfaction with infection control measures and access to sufficient resources were associated with more favourable outcomes. Considerable changes in daily activities and dissatisfaction with infection control measures were associated with increased levels of burnout and exposure to morally injurious experiences. Demographic and occupational factors had a lesser influence. Limitations: The study was conducted in a single geographic region of England with non-probability sampling methods and recruitment, potentially impacting the generalisability of the findings. Implications: The findings highlight the importance of adequate resources and infection control measures in reducing harm in the adult social care workforce and building resilience for future sector pressures.
