Care Homes

CARE HOMES

The Quality of Life Study

(Principal Investigator: Professor Peter Huxley)

This study followed a cohort of older people in residential or nursing home care in three areas of North West England, assessing maintenance of physical and mental functioning and quality of life (subjectively and objectively perceived). The study took place between 1997 and 2000 and was funded by the Department of Health.

The study found: there was a low rate of recognition of depression in residents by care staff; a significant number of self-funded residents had low dependency on admission to nursing homes; the majority of residents had evidence of severe cognitive impairment although many of them were able to address questions about their quality of life. Survival generally was strongly associated with dependency level on admission; for residents with less cognitive impairment, likelihood of survival was also associated with greater satisfaction with leisure provided in the home.

Publications

Bagley, H., Cordingley, L., Burns, A., Mozley, C., Sutcliffe, C., Challis, D. and Huxley, P. (2000) Recognition of depression in long term care facilities for older people. Journal of Clinical Nursing, 9, 445-450.

Challis, D., Mozley, C., Sutcliffe, C., Bagley, H., Price, L., Burns, A., Huxley, P. and Cordingley, L. (2000) Dependency in older people recently admitted to care homes. Age and Ageing, 29, 255-260.

Mozley, C., Challis, D., Sutcliffe, C., Bagley, H., Burns, A., Huxley, P. and Cordingley, L. (2000) Psychiatric symptomatology in elderly people admitted to nursing and residential homes, Aging and Mental Health, 4, 136-141.

Mozley, C., Huxley, P., Sutcliffe, C., Bagley, H., Burns, A., Challis, D. and Cordingley, L. (2000) "Not knowing where I am doesn't mean I don't know what I like": Cognitive impairment and quality of life responses in elderly people. International Journal of Geriatric Psychiatry, 14(9), 776-783.

Sutcliffe, C., Cordingley, L., Burns, A., Mozley, C. G., Bagley, H., Huxley, P. and Challis, D. (2000) A new version of the Geriatric Depression Scale for nursing and residential home populations: the Geriatric Depression Scale (Residential) (GDS-12R) International Psychogeriatrics, 12, 173-178.

Mozley, C., Sutcliffe, C., Bagley, H., Cordingley, L., Challis, D., Huxley, P. and Burns, A. (2004) Towards Quality Care: Outcomes for Older People in Care Homes, Gower Publishing, Ltd.

Sutcliffe, C., Burns, A., Challis, D., Godlove Mozley, C., Cordingley, L., Bagley, H. and Huxley, P. (2007) Depressed mood, cognitive impairment and survival in older people admitted to care homes in England. American Journal of Geriatric Psychiatry, 15, 8, 708-715.

Mozley, C., Sutcliffe, C., Bagley, H., Cordingley, L., Challis, D., Huxley, P. and Burns, A. (2017) Towards Quality Care: Outcomes for Older People in Care Homes, London: Routledge.

Assessment Approaches in Residential and Nursing Homes

(Principal Investigator: Angela Worden)

This study involved a survey of homes in North West England (2001 to 2004). It examined assessment tools in use in care homes, and how these were used. An analysis was made of the quality and contents of assessment tools currently in use. The study also examined the relationship between quality of assessment tools and other measures of quality of the home.

Most homes assessed newly admitted residents and repeated this assessment. Specialist doctors and therapists were rarely consulted. Coverage of key 49 assessment domains was low. No homes were using the assessment tools suggested as part of the Single Assessment Process and there was also little evidence of use of any of the proposed standardised scales. The analysis of documentation found that some important general health domains were infrequently covered - pain, oral health and foot care. Coverage of preventative health domains was particularly low and history of falls was covered on only 48 per cent of the forms. Most frequently covered items were the activities of daily living (ADLs) with 94 per cent of the documents mentioning mobility. Nearly one third of assessment documents did not mention either cognition or mood state.

Publications

Stewart, K., Worden, A. and Challis, D. (2003) Assessing the needs of older people in care homes, Nursing and Residential Care, 5, 1, 22-25.

Worden, A., Challis, D. and Pedersen, I. (2006) The assessment of older people's needs in care homes, Aging and Mental Health, 10, 5, 549-557.

Worden, A. and Challis, D. (2006) Assessing Care Home Quality using Routine Regulatory Information, Quality in Ageing, 7, 3, 33-44.

Worden, A. and Challis, D. (2007) Factors associated with higher quality assessment tools in care homes, Journal of Care Services Management, 2, 1, 79-91.

Challis, D. (2008) Assessment of needs of older people in care homes, Journal of Care Services Management, 2, 2, 108-112.

Towards a National Standard Assessment Instrument in Continuing Care Homes: Translation of the MDS/RAI into a Manual for Use by Staff in the UK.

(Principal Investigator: Professor David Challis)

This study examined the possibility of developing a standard assessment instrument for residents in care homes, to assess care needs, assist in care planning and provide information to permit costing of the level of care provided. It involved a pilot study in eight care homes to address issues of staff training, the instrument format, staff time and the use of the data. A version of the MDS/RAI was then developed suitable for use in the UK context.

Further work involved examining the capacity of the MDS to identify the registered nursing care contribution. In their response to the Royal Commission on Long Term Care the Government committed itself to funding nursing care provided in nursing homes. This study examined the feasibility of using the MDS to identify the level of nursing care contribution. The results suggested that use of a systematic assessment tool could improve the reliability of these assessments. The work was funded by the Joseph Rowntree Foundation and took place between 1998 and 2000.

Publications

Challis, D., Stewart, K., Sturdy, D. and Worden, A. (2000) UK Long Term Care Resident Assessment Instrument User's Manual, MDS/RAI UK. InterRAI UK: York.

Stewart, K., Worden, A. and Challis, D. (2003) Assessing the needs of older people in care homes. Nursing and Residential Care. 5; 1:22-25.

Carpenter, I., Perry, M., Challis, D. and Hope, K. (2002) Identification of registered nursing care of residents in UK nursing homes using the MDS/RAI and Resource Utilisation Groups Version III (RUG 111), Age and Ageing, 32, 279-285.

Perry, M., Carpenter, I., Challis, D. and Hope, K. (2003) Understanding the roles of registered general nurses and care assistants in UK nursing homes, Journal of Advanced Nursing, 47, 497-505.

A Randomised Controlled Study to Meet the Needs of Older People with Dementia in Residential Care

[Principal Investigator: Professor Martin Orrell]

Shortcomings in the care of older people with dementia in residential or nursing home care were identified by the Audit Commission which recommended that specialist mental health professionals provide additional expertise for residents. This study was designed to assess and address the met and unmet health and social care needs of older people with dementia resident in care homes, using the Camberwell Assessment of Need tool. The study was funded by the Wellcome Trust between 2001 and 2004.

Publications

Hancock, G. A., Woods, B., Challis, D. and Orrell, M. (2006) The needs of older people with dementia in residential care, International Journal of Geriatric Psychiatry, 21, 43-49.

Orrell, M., Hancock, G., Hoe, J., Woods, B., Livingston, G. and Challis, D. (2007) A cluster randomised controlled trial to reduce the unmet needs of people with dementia living in residential care, International Journal of Geriatric Psychiatry, 22, 1127-1134.

Orrell M, Hancock G, K. C. Galboda Liyanage, Woods B, Challis DJ, Hoe J. (2008). The Needs of People with Dementia in Care homes: The perspectives of users, staff, and family care givers. International Psychogeriatrics, 20, 941-951.

Worden A, Challis DJ, Hancock G, Woods R, Orrell M. (2008). Identifying need in care homes for people with dementia: The relationship between two standard assessment tools. Aging and Mental Health, 12, 719-728.

Hoe, J., Hancock, G., Livingston, G., Woods, B., Challis, D., Orrell, M. (2009). Changes in the Quality of Life of People With Dementia Living in Care Homes. Alzheimers Disease and Associated Disorders, 23, 285-290.

Wenborn J, Challis DJ, Pool J, Burgess J, Elliott N, Orrell M. (2008). Assessing the validity and reliability of the Pool Activity Level (PAL) Checklist for use with older people with dementia. Aging Ment Health, 12( 2), 202-11.

National Trends and Local Delivery in Old Age Mental Health Services: Mental Health Outreach to Care Homes

(Principal Investigator: Professor David Challis)

This study was undertaken between 2007 and 2012 and was part of a 5-year NIHR funded Programme Grant National trends and local delivery in old age mental health services: Towards an evidence base. Numerous studies have demonstrated the range of psychiatric morbidity in care homes for older people. Support for residents and staff is often provided by old age psychiatry services. This work examined this outreach work by old age psychiatry services in care homes to identify the different approaches used to provide specialist mental health support.

Final Report

Challis, D., Tucker, S., Wilberforce, M., Brand, C., Abendstern, M., Stewart, K., Jasper, R., Harrington, V., Verbeek, H., Jolley, D., Fernandez, J-L, Dunn, G, Knapp, M. and Bowns, I. (2014) National trends and local delivery in old age mental health services: Towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes. Programme Grants for Applied Research, 2(4).

Publication

Stewart, K, Hargreaves, C, Jasper, R, Challis, D, Tucker, S. and Wilberforce, M. (2018). Provision and perceived quality of mental health services for older care home residents in England: a national survey. International Journal of Geriatric Psychiatry. 33(2), 364-370.

Effective Healthcare Support to Care Homes

(Principal Investigator: Professor David Challis)

Since the 1980s as the number of long stay hospital beds has declined increasing numbers of the most vulnerable older people live in care homes. Given the complexity of needs and frequent co-morbidities, concern has been expressed about whether such residents have sufficient access to appropriate healthcare services including specialist healthcare for older people. A series of studies were undertaken in PSSRU, funded initially by BUPA (2010 to 2013) and subsequently by the NIHR SSCR (November 2016 to April 2019), examined the structure and delivery of healthcare support to care homes and their costs, the aspects of such services that are valued most, and their impact on the care of long-term residents. More information is available on the NIHR SSCR website project page.

Poster

Healthcare Support Services for Older Residents of Care Homes: What? Where? How?

Publications

Hays, R., Clarkson, P., Tucker, S. and Challis, D. (2012). Healthcare support services for care home residents. Nursing Older People, 24(10), 26-30.

Clarkson, P, Hays, R, Tucker, S, Paddock, K. and Challis, D. (2018). Healthcare support to older residents of care homes: a systematic review of specialist services Quality in Ageing and Older Adults. 19(1), 54-84.

Tucker S, Buck D, Roe B, Hughes J, Challis D. (2019). Hospital admissions and place of death of residents of care homes receiving specialist healthcare services: Protocol for a systematic review. Journal of Advanced Nursing, 75(2), 443-451.

Hargreaves, C, Tucker, S, Hughes, J, Hays, R. and Challis, D. (2019). Specialist healthcare services for UK care home residents: a latent class analysis. Primary Health Care Research and Development. 20, e132 https://doi.org/10.1017/S1463423619000586

Buck, D., Tucker, S., Roe, B., Hughes, J. and Challis, D. (2021). Hospital admissions and place of death of residents of care homes receiving specialist healthcare services: A systematic review without meta-analysis Journal of Advanced Nursing. https://doi.org/10.1111/jan.15043

Hays, R, Clarkson, P, Tucker, S. and Challis, D. (2014.) Examining models of specialist healthcare support to care homes. Age and Ageing. 43, 31-31. https://academic.oup.com/ageing/article/43/suppl_1/i31/88575