EFFECTIVE HEALTHCARE SUPPORT TO CARE HOMES STUDY
Researchers at the University of Manchester have been exploring how best to provide healthcare support in care homes across the UK. The researchers wish to thank all the care home managers in ENRICH Cymru who participated in this research by completing a questionnaire. A fantastic 89 care homes were recruited across the UK, including a very valuable 10 from Wales. The study report is pending for the end of 2019 and will be shared here and with care homes in the network.
PERCH: PRELIMINARY EXPLORATION OF THE ROLE OF PARAMEDICS IN CARE HOMES
Problem: Almost half a million people live in care homes in the UK. General practices have a duty to delliver primary care for residents, but many struggle due to high demand and staff shortages. Meanwhile, ambulance services are seeing an increase in 999 calls from care homes. In addressing these challenges, one emerging approach is to involve paramedics in proactive support to care homes, as part of a larger scale shift towards paramedics undertaking non-emergency primary care and community based work. Yet such major workforce changes require urgent evaluation to understand implications for care home residents and staff, and for health services. Care homes are an under-researched environment, despite high health and social care needs of residents. We aimed to explore the role of paramedics in non-emergency care in care homes to support the design and delivery of portfolio research in this emerging and important area.
Approach: We convened a Research Development Group of care home, ambulance service, Health Board, primary care, public and academic representatives, and:
- conducted fact finding visits and calls to sites where paramedics already provide non-emergency care to care home residents;
- examined data on 999 calls to the Welsh Ambulance Service Trust (WAST) from care homes;
- surveyed ENRICH (Enabling Research in Care Homes) network care homes in Wales and the West Midlands to seek views on the potential role of paramedics working proactively in care homes;
- held a stakeholder workshop to identify and explore the issues that stakeholders deemed important in this work.
Results: We identified multiple sites in England and Wales where paramedics provide planned and proactive, rather than emergency, care in care homes. Operating models varied with paramedics employed by ambulance services, Health Boards or general practices. Data on 999 calls from over 300 care homes in Wales confirmed call rates of up to 20 per month per home and high conveyance rates (over 60%). Our survey, with responses from 50 managers, confirmed interest in the approach. Managers thought paramedic skills were well suited to assessing residents, identifying issues, improving care and avoiding admissions. They foresaw benefits to inter-professional working, clinical support and person-centred care. However, they raised concerns over professional boundaries and clarity of roles and policies. These messages were reinforced in our stakeholder workshop, where the value of timely rapid assessment was highlighted, along with challenges of funding and governance.
Implications: The role of paramedics is shifting rapidly into dedicated primary and community work, including care home settings. It is imperative that research is aligned and informs evidence based practice. Further funding has been applied for to develop a feasibility study evaluating the impact of paramedics working in this way (PERCH 2).
ASSESSING THE NON-INVASIVE GLUCOSE MONITOR - GLUCOBEAM IN NURSING HOMES IN THE UK
The management of diabetes in care homes and monitoring of glucose in elderly residents can be difficult and time consuming for care personnel. RSP System is developing an easy to use non-invasive glucose monitor with no need to draw blood. It will be a safe and hygienic option for care personnel to use with no risk of sharps injuries and a pain free solution for elderly residents. RSP has investigated the market potential for its non-invasive glucose monitor in care homes in the UK. A team from RSP Systems visited five nursing homes (including two in North Wales) to conduct questionnaire-led interviews with nurses and carers. Overall, the involved nursing homes were very positive towards the GlucoBeam device and see a great need for a non-invasive device. As a next step, RSP Systems is planning to distribute a survey targeted at nursing homes in the UK to get more opinion from a larger number of participants and will initiate meetings with different stakeholders, including the NHS. Please contact Dorte Pamperin dorte@rspsystems.com for more details.
ORAL HEALTH RESEARCH PROJECTS - TOPIC; SENIOR; DECADE; FDI and VOICE
Five funded projects are currently underway from researchers from Bangor University, Queens University Belfast and University College London, many of which are being undertaken across Wales and supported by the ENRICH network. One project (called TOPIC) is looking at how care homes understand and use NICE guidelines for oral healthcare in care homes, focusing on oral health assessment and daily assisted tooth-brushing. In another study (SENIOR), the team are looking at undertaking a trial to determine whether dental care professionals can manage the dental needs of residents, compared to dentists, who are often difficult to access. Dental care professionals are another class of dental professional, who can provide much of the treatment that care home residents commonly need, building on an existing Welsh project called Gwen am Byth. The team are actively looking for care homes across Wales who might be interested in being involved in the study in 2020. Please contact Paul Brocklehurst p.brocklehurst@bangor.ac.uk for more details.
Older people are also being actively involved in another study (DECADE) to understand the types of outcome measures that should be used by researchers in future work. This study is using a consensual approach to understand what matters to older people to ensure that researchers and residents are on the "same page" when designing interventions to promote oral health. The team are also about to start a fourth project (FDI) that looks at how to improve the oral health of people living in their own homes.
The fifth and final project that the team have on-going (VOICE) explores the potential of using art to represent and understand the meaning and importance of oral health to dependent older people residing in a care home environment. Adopting a "practitioner-researcher" model, authentic voices of older people will be explored by an "artist-as-researcher" to articulate cultural meanings of oral health for residents in care homes. In this study, visual images alone will act as the vehicle to help break down barriers and create a path for people to reveal their thoughts and feelings about their experiences of oral health. In similarity to SENIOR, interested care homes across the ENRICH network are being sought.
PhD STUDY - WHAT POTENTIAL DO VIRTUAL ASSISTANTS HAVE TO IMPROVE OLDER ADULTS' WELLBEING?
Technology has the potential to promote older adults' wellbeing, reducing feelings of loneliness and support psychological wellbeing. Yet the interaction between older adults and technology is a largely under-researched area. Indeed, very little attention has been paid to the relationship between technology and wellbeing. This PhD study seeks to amplify the voices of often digitally excluded older adults to the fore, whilst contributing robust co-produced evidence to inform meaningful developments in gerontechnology.
Adopting a mixed methods research design through a transformative paradigmatic lens, this PhD research primarily aims to shed light on the impact virtual assistants have on the wellbeing of older adults residing in several ENRICH care homes.
Using co-production, virtual assistants will be tailored to meaningful outcomes led by participants. Older adults and practitioners will be provided with the opportunity to use and provide their views on virtual assistants shaping the development of a co-produced digital toolkit and application of skill specification for virtual assistants requested by older adults. Practitioner involvement and their position as enablers will be explored, to develop best practice guidelines for the effective introduction of virtual assistants into care settings.
Laura Sheerman, Swansea University: 924355@swansea.ac.uk