1. Family members’ involvement in health care
for their relatives in care homes
C Powell, A Blighe & M Downs
Background
A lot of residents go to hospital for illnesses that could have been treated in the care home (with nursing) if detected earlier. Hospital can be distressing to the person and their family [1].
Family members differ both in terms of the intensity and types of involvement in their relatives care [2-3]. There is a lack of research about how family could be involved in early detection of changes in their relatives’ health, and of the effect that interventions to improve staff-family relationships have on residents’ care [4].
The Better Health in Residents in Care Homes (BHiRCH) research programme aims to develop and test a complex intervention to ensure early detection in order to reduce rates of hospital admissions from care homes.
Intervention components include:
An Early Warning Tool
A Care Pathway
Method
We interviewed 16 relatives of care home residents aged over 65. All
were adult children.
Findings
Family members are involved in their relatives’ health in a variety of ways.
Roles can include:
Noticing changes in relative’s health
Informing staff of anything significant
Filling in care gaps
Advocating for their relative and other residents
Making decisions
Surveillance of care
Knowledge and skills potentially needed include:
Knowledge of their relatives’ health
Ability to communicate or negotiate with staff
Some knowledge of how the care home is organised e.g. when does the doctor visit
Ability to observe changes in health
Optimal communication:
Ensure that responsibilities are clearly defined, but can also change over time
Ensuring family members know what is going on
Staff communicating sensitively with family
Creating suitable and timely opportunities to communicate
Copyright: Cathy Greenblat
Next steps
The findings have informed the development of the BHiRCH complex intervention such that nurse within the care home will:
Explain the Early Warning Tool and Care Pathway, and their application in the care home
Establish the roles that family members would like to have in the intervention
Record preferences in the resident’s care record
Aim
To clarify family members’ preferred role in early detection.
To identify the knowledge and skills they need in order to fulfil this role.
How to optimise communication between family and staff.
To integrate this into the complex intervention.
References
1. Bardsley M, Blunt I, Davies S, et al. Is secondary preventive care improving? Observational study of 10-year trends in emergency admissions for conditions amenable to ambulatory care. BMJ Open 2013;3(1).
2. Bowers, B.J., Family perceptions of care in a nursing home. The Gerontologist, 28(3), pp
3. Baumbusch, J. and Phinney, A., Invisible Hands The Role of Highly Involved Families in Long-Term Residential Care. Journal of family nursing, 20(1), pp
4. Haesler, E., Bauer, M. and Nay, R., Recent evidence on the development and maintenance of constructive staff–family relationships in the care of older people–a report on a systematic review update. International Journal of Evidence‐Based Healthcare, 8(2), pp
BHiRCH PI: Professor Murna Downs, Researchers: Dr Alan Blighe (Research Programme Manager, University of Bradford), Dr Catherine Powell (Research Fellow, University
of Bradford), Alexandra Feast (Research Associate, University College London), Co-applicants: Dr Liz Sampson (University College London), Prof Katherine Froggatt
(Lancaster University), Prof Brendan McCormack (Queen Margaret University), Mrs Shirley Nurock (Alzheimer's Society, PPI), Dr Greta Rait (PRIMENT/University College London), Prof Louise Robinson (University of Newcastle), Dr Barbara Woodward-Carlton (Alzheimer's Society, PPI), Prof John Young (Bradford Institute for Health Research), Collaborators:Ms Caroline Baker (Barchester HealthCare), Prof Clive Ballard (Kings College London), Prof Heather Gage (University of Surrey)
This presentation is an outcome of independent research funded by a National Institute for Health Research Programme Grant for Applied Research – “Reducing rates of avoidable hospital admissions: Optimising an evidence-based intervention to improve care for Ambulatory Care Sensitive conditions in nursing homes” (RP-PG ). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.