Roundtable report: what should be done to improve mental health and wellbeing in UK care homes?

• Care Homes

• Data

• roundtable report

Our latest IPPO roundtable looked at the situation in care homes – and, in particular, what’s happened to the mental wellbeing of both residents and staff, and what can be done to help them bounce back. Geoff Mulgan and Rachel France present a summary of our discussion

A high price paid

This roundtable discussion drew on an excellent summary of evidence from Dr Kellyn Lee, Research Fellow in Ageing and Dementia at the University of Southampton, as well as a global scan of policy and interviews with some frontline care home staff.

There is no doubt that care homes have been on the front line of the pandemic. Some 30%-40% of COVID-19 deaths in the UK have been among care home residents – a terrible trauma for residents and staff alike.

But a high price has also been paid for the measures put in place to protect residents’ health, which has had clear knock-on effects on their mental health and wellbeing. Most social activities were curtailed or severely restricted – including visits from family and friends, light activities, and even the chance to socialise among themselves. This matters for a sector that is increasingly concerned with the rights of its residents, and giving them more say over how they are supported and treated. Both Wales and Northern Ireland, for example, now have Older People’s Commissioners.

How did care homes respond?

Care homes are often depicted in the media as miserable places. In contrast, although levels of depression are higher than for people living in their own homes, the IPPO roundtable emphasised that care homes are often lively places, with plenty of positive initiatives being taken to keep residents’ spirits up during the peak of the COVID-19 crisis. Just some of the examples raised include:

• Many homes worked hard to keep residents connected, providing them with iPads and other ways to stay in touch with their friends and family.
• A pen-pal scheme in Wales has linked care home residents with schoolchildren, helping both generations understand each other better, and providing residents with contact with the outside world.
• During the pandemic, one care home supported residents in a storytelling initiative that led them to publish a book of their memories, which was found to have a hugely positive effect on their mental wellbeing.

What are the key issues that need addressing?

The IPPO roundtable highlighted a number of key short- and longer-term issues:

1. Visiting: the constraints designed to protect physical health need to be loosened to make visiting easier, now that most residents and staff are vaccinated. Almost all the public debate has been in terms of restrictions rather than opportunities – but now we need to look at how to reignite socialisation, fun and activity.
2. The importance of staff wellbeing – some of the initiatives designed to support staff, many of whom have experienced symptoms associated with post-traumatic stress disorder (PTSD), were not not easily accessible by staff.
3. A culture which sometimes prioritises avoiding litigation over seeking better outcomes for residents.
4. The remarkably weak organisation of data on all aspects of care homes, including mental wellbeing, which contrasts with the much richer and more joined-up data in the NHS. This is in part a problem of how care home data are collected, but just as much a problem of lack of sharing and common standards. These issues won’t be fixed overnight but are vital in the longer term.
5. The much weaker infrastructures around evidence and its use, in stark comparison to the NHS. Again, this is not easy to fix immediately but will be crucial in the longer term.
6. The relatively poor understanding in government about how the care sector currently works, which has contributed to mistakes being made during the pandemic. Social care is seen mainly in relation to its interaction with healthcare, but staff have a different skillset to healthcare workers and this needs to be acknowledged.
7. Many longer-term issues also need addressing, such as the UK’s relatively poor record in adapting housing provision to older people’s needs – one factor making it harder for them to stay longer in their own homes.

The care policy gap

The problems faced by care homes have re-emphasised just how much care remains a policy gap. Although health and care are statutorily integrated in Northern Ireland, elsewhere in the UK they are run separately, and in any case the care sector remains fragmented between many, mainly private providers. There are still few signs of progress in sorting out the longer-term funding of care – as was promised by Boris Johnson when he became Prime Minister. In Whitehall, there appears to be far weaker policy machinery compared with health, and perhaps a weaker capability in comparison with the devolved governments in Cardiff, Edinburgh and Belfast.

As a sector, care organisations have far less influence and voice than their equivalents in health – and care home residents have far less voice too. In Northern Ireland, a report based on learning from the first lockdown showed how strategies were needed to support wellbeing. The more joined-up approach in the province meant its care sector had support from the regulator to help set up clinical support from GPs. Social workers helped to engage with families.

Hopefully, the care home sector has come through the worst of the crisis and now can start to plan for life beyond COVID-19.  But the huge pressures experienced by its workforce, who have undergone a great deal of stress while typically being afforded both low pay and low status, need to be acknowledged and addressed. Hopefully the crisis may speed up this long-overdue reset.

We at IPPO will continue to focus on evidence around care – including, in the near future, looking at what can be done to sort out some of the issues around data:

• What care data are collected;
• how this could be better shared and standardised; and
• how to ensure the data are analysed to spot patterns and emerging issues.

If you work on these issues and would be interested in taking part, please email us at ippo@ucl.ac.uk, adding the subject line care data.

Resources shared by our roundtable attendees

Research with staff and/or care home residents: 

The Older People’s Commissioner for Wales: Report based on views of families, friends, and older people living in care homes.

Age Cymru: report on conversations with care home residents around their wellbeing, plus tools to enable meaningful and creative conversations, to be published next week here.

Scottish Care: Impactful report about the mental health strain on care home staff:

LTC covid: Video of a webinar looking at international experiences with care home visiting during the pandemic.

Research on supporting staff: 

Rapid Research in Covid-19 Programme (two studies): 

Avoiding Burn Out of Care Home Workforce: Academic study looking at what support was available during the past year and what was helpful:

Online Supportive Conversations and Reflection Sessions (OSCaRS): Feasibility study with care home staff during the pandemic. Academic study into the feasibility of providing online emotional support and practice-based learning on death/dying and end of life care during the pandemic for staff in care homes for older people:

Johnston et.al: Supporting the resilience and retention of frontline care workers in care homes for older people: A scoping review and thematic synthesis. Academic study on supporting staff resilience and retention (pre-COVID data)

Dementia:

The Guardian: This article shows how care staff morale was boosted by training delivered remotely  during the pandemic.

BPS and Newcastle University: Video specifically developed to consider the needs of people with dementia in care homes.

Impact on people with learning disabilities:

hft: Annual report which looks at both the impact on the mental health of the workforce, as well as concerns around the digital barriers preventing people with learning disabilities from staying in touch with family and friends.

Collecting data on care homes and residents:

Care Home Innovation Partnership, Lothian: The Development of a Care Home Data Platform in Scotland. Academic study looking at what is currently collected and how (pre-print, not yet peer-reviewed).

NHS Lothian: Short video on the current SBRI Data Challenge: foundations of a care home data platform in Scotland.