Page 29.06.2020

Top Tips for Tricky Times

Working with and for care home staff during a pandemic

When Covid-19 hit care homes there was no guidance on how to care for older people in long term care. It was as if the sector was hiding in plain sight.

To fill the information vacuum some care home managers set up a WhatsApp group, with support from academics, clinicians and a commissioner. They pooled knowledge, responded to questions about accessing PPE, clinical issues, and offered much needed peer support and encouragement. This care home led group grew rapidly. 

A quick overview of the questions highlighted the context specific challenges being faced.

"How do you comfort someone you can’t hug or touch? How do you help someone self-isolate when they don’t understand why? What do you do if you are not sure what is happening to the resident? How can I support staff in dealing with multiple deaths? How do we communicate with worried and grieving families at a distance?"

A group of care home researchers from two NIHR Applied Research Collaborations (ARC) looked at the questions and identified eight topics that might help address some of the questions. Five decisions were made

  • We were only going to review and use research evidence
  • We would share findings with each other for peer review
  • We would develop a list of rules of thumb or top tips
  • We would ask care home staff if they thought the Tips would help
  • We would make them available online and follow up to see if and how they were used, changing and adding to them as new evidence emerged

Everyone knows FAST (Facial drooping, Arm weakness, Speech difficulties and Time to call emergency services). It’s a lifesaving acronym, based on years of research evidence, to help recognise someone having a stroke. Our top tips for tricky times aspired to be that useful but we could only go as far as the research let us.

We found care home research was often better at saying what staff “ought to” do. There was less detail on how to respond. The dementia care research was helpful but for some top tips we had to rely on studies done in other settings. For example, learning from ITU research on how staff talk with families unable to visit.

We asked care home staff from around the country what they thought, and whether these tips were patronising, too easy, useful? Feedback was largely positive especially as a resource for new and inexperienced staff. Some were reassured that they weren’t missing something, others appreciated that it gave them space to reflect. A few thought they were obvious or missed emphasising the importance of person-centred care. These Top Tips are not a short cut or an excuse to not provide the best care. They add to evidence and guidance grounded in good practice and experience. We hope that they provide an additional resource that is grounded in what care home staff were experiencing and wanted answers for.

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Top Tips for Tricky Times NIHR ARC Authors  

  • Kathryn Almack, Frances Bunn, Claire Goodman,  Angela Dickinson, Melanie Handley, Elspeth Mathie, Andrea Mayrhofer University of Hertfordshire
  • Tamara Backhouse, Dianne Bunn, Lee Hooper, Florence Jimoh, Anne Killet University of East Anglia
  • Ann-Marie Towers University of Kent

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