Enhanced Care Home Outcomes: A Qualitative Study

There are currently 800 000 people in the United Kingdom (UK) living with dementia and this is predicted to grow to 1 million people by 2021. Studies suggest that 250 000 of people with dementia reside in care homes. Reports such as the National Dementia Strategy and subsequent government initiatives, such as the Dementia Challenge and the Prime Minister's Challenge on Dementia 2020 have helped the nation focus on provision of services for people with dementia. Further, our media remind us that the quality of care being delivered in care homes needs significant improvement. With an ageing population effective, safe, good quality care for our older people is paramount.

A high proportion of people in care homes have dementia and many have co-existing physical health problems and/or additional mental health needs. An integrated Care Home Support Service (CHSS) delivers care and treatment of both physical and mental health problems at an early stage of development. This integrated service combines two approaches which have been shown to be effective in randomised control trials and open studies in a stepped care model. Evidence suggests it is feasible to implement some elements of such approaches into a specialist mental health NHS context. However, no widespread implementation of this combined approach had been undertaken in an NHS context until the integration of this Care Home Support Service.

Evaluating the implementation of health care initiatives is crucial in determining their impact and sustainability in a routine NHS setting. This qualitative evaluation is part of a broader evaluation of the service. Focus groups and service improvement workshops will be conducted with NHS staff and other stakeholders. The data will be analysed using thematic analysis and applied to the RE-AIM framework to:

• Provide valuable information from NHS staff and stakeholders regarding the impact and sustainability of this model.
• Explore key factors to consider when integrating physical and mental health services.
• Increase understanding of the potential barriers and facilitators of integrating evidence-based practice into a routine NHS setting.

On completion of the research the findings of the study will be disseminated to research participants and health professionals to support learning and best practice both locally and nationally.

Inclusion criteria

• Care home staff working in the homes in the top 10% of service use of the 102 participating homes referring to the Care Home Support Service*
• Relatives of residents living in the top 10% of service use of the 102 participating homes referring to the Care Home Support Service*
• GPs supporting residents living in the top 10% of service use of the 102 participating homes referring to the Care Home Support Service*
• Service user representatives from Age UK carer groups
• Note: * Sampling GPs, care staff and relatives through the top 10% of care homes referring to and using services of the care home support service will ensure that they have adequate awareness of the care home support team to contribute to the focus group discussion.

Exclusion criteria

• Not fluent in English