NIHR Programme Grants for Applied Research (PGfAR) is seeking to increase the diversity of study type and design submitted for funding. This case study outlines a novel research design to gain better insight into what happens in the wake of care home closures.
Programme details
Programme name: 'Achieving closure?' Improving outcomes when care homes close
Researcher name: Professor Jon Glasby
Institution: University of Birmingham, School of Social Policy
Funding: £1,247,778
Benefits to service users
Care homes for older people are a critical service, supporting some 400,000 people 24 hours a day/365 days a year. However, when care homes close – whether through financial problems, care failings or other factors – the received wisdom is that subsequent relocation can be detrimental to the wellbeing of older residents.
This research is expected to provide better understanding about what happens when care homes close and what works best for supporting the families and the care staff. The overall benefit would be improved outcomes for older people by minimising the risk of harm by ensuring that future closures are planned/conducted in a more evidence-based manner. The following outputs are envisaged by end of this research programme:
- Development of good practice guidance to inform future closures, sharing this with health and social care leaders across the country
- Production of a free video for care staff who might not otherwise have access to training materials
- Preparation of a guide to closures for older people and their families, with a view to reducing some of the inevitable stress and anxiety they may feel
Aims of the programme
This study seeks to explore what happens to older people and care staff when care homes close, how best to manage home closures in a way that minimises distress and negative outcomes for older people and their families, and key lessons for local authorities managing future closures.
In order to achieve these aims, the research questions are:
- What is the pattern of care home closures nationally, how are they undertaken in different Councils and what do Councils consider to be best practice when supporting older people at such potentially stressful times?
- How do older people experience closures, what impact does closure have on health and quality of life, and how can any negative impacts be reduced?
- What impact do closures have on care staff and local care markets, and how can negative impacts be reduced?
- What are the costs and consequences of closures, and the key data required to make this estimation? Can a modelling framework be developed to drive appropriate data collection for future home closure prediction for mitigating adverse outcomes?
- How can future closures be planned and conducted in a more evidence-based manner, so that outcomes for older people are improved and negative impacts reduced?
Programme design
Building on a previous pilot study of care home closures in Birmingham, this study will answer these research questions through five work packages (WPs; see Figure 1).
WP 2 is a particular area of focus, since gaining access to care homes that are closing, and working sensitively and ethically with older people, families and care staff during closures, is the most complex element of this research proposal – and some of the key reasons why previous research into these issues has not been undertaken.
While it replicates key elements of our pilot, other WPs broaden what we were able to do previously, by exploring outcomes for care staff, analysing the cost and benefits of closures, reflecting on the relationship between providers and commissioners in social care markets, and reflecting on the experience of people who fund their own care (not just those funded by their local authority). We also hope to gain insights into emergency closures and well as more planned closure programmes.
Figure 1: Programme work packages
Work package 1: Collect information on the current national picture
This WP will help establish the pattern of care home closures nationally, how closures are undertaken in different Councils and what constitutes best practice when supporting older people.
Methods: A national survey of Directors of Adult Social Care Services will be carried out, supplemented by regional/national data from CQC (2013 onwards) and a review of background literature.
Work package 2: Case study research with older people, families, care staff and social workers
This is the major component of this research aimed at understanding how older people experience closures, what impact it has on health and quality of life and explore potential ways to reduce negative impacts.
Methods: Four sites will be selected for case studies and appropriate stakeholders will be interviewed. WP2 is divided into three elements: (a) qualitative interviews with local stakeholders, (b) qualitative interviews with older people, families, care staff and social workers, and (c) collection of outcomes data at three points (before, during and after relocation).
Work package 3: Understand the impact of closures on care staff/care markets
This WP explores the impact of closures on care staff and care markets, and how can negative impacts be reduced.
Methods: all care staff in closing homes in the four case study sites will be invited to complete the ProQOL well-being survey, before and six months after closure, supplementing this with qualitative interviews to explore staff experiences in more detail. Content analysis of local policy documents will also be undertaken, including examination of local closure protocols, and strategies to support a diverse and viable care market. Interviews will be undertaken with care providers and commissioners to explore how effectively they work together to plan and deliver the care that local people need.
Work package 4: Conduct cost-consequence analysis of closures
In this WP, information will be collected to understand the nature of care costs as well as financial and health and wellbeing consequences of closures on residents, their families care home staff and other stakeholders.
Methods: Using a cost-consequence approach, we will compare the costs and consequences of alternative pathways of care for residents when homes close (including costs for residents, families, staff and local authorities). This is an exciting, but exploratory, part of the research, exploring scope to apply key concepts from health economics to a topic that has not been researched in this way before.
Work package 5: Improving outcomes for older people
The final WP will focus on utilising findings from WPs1-4 to influence policy/practice so as to improve outcomes for all concerned during future closures.
Methods: By working with a national Advisory Board of key/senior partners (including people who themselves draw on care and support), we will develop a national good practice to help shape future closures, free training resources for care workers, and a guide for older and families. We hope that these materials will be jointly badged by members of our Advisory Board, many of whom are senior leaders in key national bodies.