Improving the quality of care for stroke survivors in care homes
Research type
Research Study
Full title
Improving the quality of care for stroke survivors in care homes
IRAS ID
232343
Contact name
Charles Wolfe
Contact email
Sponsor organisation
King's College London
Duration of Study in the UK
1 years, 9 months, 31 days
Research summary
Summary of Research
Stroke is a leading cause of disability. A quarter of care home residents are stroke survivors. Their access to specialist care is patchy and a high proportion of them have ongoing health problems that are not well managed. Caring for stroke survivors n care homes presents challenges. Many residents have complex care needs and care homes have few resources compared with acute hospitals. In practice, most care will be provided by staff who lack substantial formal training, and who face high levels of workload pressure.This study aims to understand the current care provided to care home residents who have had a stroke, and how it might be improved in the future. Specifically, we aim to answer the following questions:
-What is the current care provided to care home residents who have previously had a stroke?
-What are the needs of residents after their stroke?
-What impact and importance does a previous stroke have in older people with multiple other health problems?
-How does the care home setting (and in particular, staff workload, staff experience and training) affect resident care after a stroke?This study will use qualitative methods, and the researcher will conduct interviews with residents and staff. The researcher will additionally spend time observing staff with residents. Residents who have had a previous stroke will be asked whether or not they would consent to take part in this study. The researcher will collect information by: observing interactions (or non-interactions) between care staff and residents, conducting interviews with residents, and conducting interviews with care staff. The results from this study will feed into a larger project, which aims to develop an intervention to improve the care of people who have had a stroke and are living in care homes. This study will take place over 18 months, and seeks to recruit 6 varied care homes to take part.
Summary of Results
This study used ethnographic research in care homes. Fieldwork (observations and/or interviews with residents/family members and staff, n=28) was completed in four of the six planned homes before the COVID-19 pandemic prevented access. We analysed data gathered on the following research questions:1. What is the current care provided to care home residents who have previously had a stroke?
2. What are the needs of residents after their stroke?
3. What impact and importance does a previous stroke have in older people with multiple other health problems?
4. How does the care home setting (and in particular, staff workload, staff experience and training) affect resident care after a stroke?
Key findings for each research question included:
Current care
Stroke is not perceived by care home staff to be an important attribute for daily caregiving purposes
Recommended practice, e.g. specialist multi-disciplinary team (MDT) reviews on admission to the home following a stroke and annual medical reviews were not in evidence
Care which meets needs and preferences, particularly in valued activities, is often not achieved for residents with stroke-related physical disability
Needs of residents with stroke
Support or supervision with activities of daily living (ADLs) due to physical and/or cognitive impairment (needs usually met but emphasis sometimes on support/’doing for’ rather than supervision).
Equipment and environment (e.g. adapted cutlery; accessible room layout appropriate for one-sided weakness) appropriate to the individual (this was not always provided/ in place
Support to access personalised social and leisure activities (understood to be valuable by staff, but provision somewhat dependent on individual staff/relationships and impacted by time staff pressures).
Support (including information) to help them understand and adjust to their stroke.
Impact and importance of stroke to residents
In general, residents have moved into the care home because of the cumulative effect of co-morbidities. The stroke event was often several years in the past. Residents are not always aware of their health conditions, whereas family members may be important advocates for their relatives getting the treatment/care they feel is needed
Relevance of the care home setting to resident care
Care home staff (particularly non-nursing staff) have limited access to training and support to care for residents with stroke and respond to stroke-related changes
Staff are sometimes uncertain who they might contact for advice on caring for stroke survivors, outside purely medical matters.
Some of the care practices and equipment use (or lack of) are contrary to evidence-based/consensus-based good practice, do not meet individual needs, and limit residents’ potential to do as much as they can/want to do independently. Reasons include lack of stroke awareness/specialist input (e.g. assessments), time pressures, assumptions about capabilities of older/disabled people and perception of risks to health and safety.
Perceived or actual limited access to NHS services (and/or perception that the service, e.g. therapy, would not benefit the resident) can influence whether staff seek this support on behalf of a resident.
REC name
London - Camberwell St Giles Research Ethics Committee
REC reference
18/LO/0805
Date of REC Opinion
26 Jun 2018
REC opinion
Favourable Opinion