28 April 2022
Dr Jon Banks is a qualitative research fellow at NIHR ARC West. During the pandemic, he did research interviews with care home staff and residents as part of our evaluation of the Recommended Summary plan for Emergency Care and Treatment (ReSPECT). He is also working on our project on COVID outcomes in care homes in Bath and North East Somerset. Here he reflects on the experience, and how it differs from the NHS-based research he usually does.
I recently did some qualitative research with care home staff and residents. As a healthcare researcher, I was struck by how different the experience was from working with the NHS and the other healthcare organisations I typically work with.
I should preface this by saying that all my contact with the care homes was remote due to the pandemic which may have exaggerated any differences. So, what were those differences?
The NHS has a well-developed infrastructure to support research in primary and secondary care. This includes the NIHR Clinical Research Networks (CRNs) which help researchers identify research sites and recruit to studies.
There are moves to develop the reach of CRNs into care homes with the ENRICH network, but this is at an early stage. This means that researchers have to develop relationships with care homes from scratch.
We were able to draw on some GPs who worked with care homes to introduce us. We were also able to present our research at local forums where care home managers and staff met which was a great way to overcome initial barriers.
Care home managers and staff are not used to people from universities being interested in what they do, so there’s perhaps a higher threshold of trust to cross to enable access for research.
The language of research does not have the same resonance in the care home sector as it does in the NHS, where for many it has become an accepted part of the landscape.
We also should remember that care homes are often privately owned and run organisations. Having researchers talk to staff and residents could be seen as potentially threatening to their commercial interests. Though I should add that this wasn’t something I came across on my encounters with the care homes I worked with.
The lack of infrastructure is reflected in the governance arrangements for conducting research. In the NHS there are established procedures and documented processes for conducting healthcare research. There isn’t the same level of clarity in the care home sector.
To satisfy data protection legislation we had to get care homes to sign a data sharing agreement. This document was 17 pages long and full of legalistic text which, we think, alienated a number of potential participants. This is not meant as a criticism of the document creators, rather than as an indicator of where we are in the relationship between researchers and care homes.
I believe that we will be able to improve our documentation and processes as we engage more with this sector.
On the plus side, given the opportunity, care home staff valued being given a voice to express their experiences and views in a way that they have not been able to do previously.
They care for people who are in the later stages of life, many of whom have high care needs. They also operate and mediate between different healthcare sectors including primary, community and secondary care and the paramedic service, along with residents and their families. They play a crucial role in shaping the experiences of people during the later phases of their lives and it’s important that we capture their voices to shape and improve care home policies.
Working with care homes has been an enlightening and rewarding experience and we should continue to develop the infrastructure that can support future research in this sector.