Dear Sir,
A conference on ‘Medical care for residents of care homes: What works?’ on 16 May 2017 highlighted the changes that have occurred in care homes research in the 5 years since the start of ENRICH—the NIHR portal for Enabling Research In Care Homes [1]. The specific challenges to research are becoming clearer and require both sectors to accommodate to each other's needs.
The care home sector is experiencing similar recruitment and retention problems as the NHS, and regulation impacts on research capacity. Nevertheless care homes can be innovative and staff are interested in what other care homes do; in this sense they are ‘research receptive’.
Three characteristics of research teams seem to facilitate care homes’ involvement in research: ensuring protected time to work with care homes; recognising it takes time for NHS and care home staff to learn how to work together; and seeing care homes as partners with and not a problem for the NHS. Interventions designed to reduce the number of care home residents going to A&E, for example, can scapegoat care homes for not responding to NHS priorities [2].
Research tools and methods (such as CGA, Appreciative Inquiry and Quality Improvement) are used differently by different people in care home settings. Similarly, systems that are familiar to NHS staff, such as shift handovers, can be very different in care homes. Attempts to harmonise interventions through collaborative meetings can result in difficult dialogues, in which NHS staff may be more likely to take offence than care home staff [3].
Identifying all care homes relevant to a particular study in a geographical area can still be difficult, recruitment of care homes can be disappointing, and there are signs of ‘innovation saturation’ and ‘improvement inertia’ in the sector.
On the positive side, researchers can identify care home residents with greater accuracy using NHS and other datasets [3]. Well-meaning assumptions sometimes made by ethics committees, researchers and practitioners about what care home residents are willing and able to do may be wrong. For example, the PROVIDE study has demonstrated that cognitive impairment is not necessarily an obstacle to care home residents agreeing to lengthy (1 h) and complicated vision assessments [4]. Researchers can effectively work with care homes by using simple tools, not assuming that tools can be transferred from health to social care without adaptation, utilising oral traditions and in-person meetings, and engaging with all levels of staff [5].
Overall, there seems to be greater familiarity in the NHS with the care home sector—problems are better-recognised and the differences between health and care home settings are valued. ENRICH may have helped in changing healthcare researchers thinking as much as changing the minds of care home staff about research.
Conflict of interest
None declared.
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