Relationships between care homes and their residents / local communities

The Context

Social relationships are an important part of all human beings at any stage of their life. They provide a sense of purpose and of belonging, and studies show that they are essential for our physical and mental health. For this reason, it is important to promote the formation and maintenance of social relationships for people living in residential care homes.

In a review conducted for the Care Inspectorate on ‘Meaningful Connection’ for people living in care homes, Dr Palattiyil has explored how different types of relationships, such as friendships with Peers, relationships with family members or with staff, could have different positive effects on the wellbeing of older people. For instance, forming new relationships with peers in care settings can support older people to feel ‘at home’.

The creation of friendly relationships with staff was also identified as a way to help residents in care homes to feel more comfortable in accepting and seeking support. Connections to the wider community was also highlighted in Dr. Palattiyil’s review as central to supporting people’s wellbeing, but sometimes are hard to maintain when people move into a care setting, particularly if it is located in a different area.

Whilst there is a general acknowledgement of the importance of supporting visits by familiars and friends by policies, practitioners and providers, there are some barriers to forming and maintaining social connections for people in care homes.

Covid-19 was an important factor that impacted negatively on visits and relationships of people living in care home settings. Other challenges are difficult partnerships and power dynamics between family carers and providers. Another important issue identified is the physical distance between the care setting and where family and friends may live. Recruitment and retention issues can also affect negatively and make it difficult for people living in care settings to form strong relationships with staff.

An IMPACT network was run to explore this topic and identify potential solutions and good practices to support the maintenance and creation of relationships and involving the community in the care home settings.

Policy Context

In Wales, Scotland, England, and Northern Ireland, there are different policies about ‘visit in home care’:

In Scotland, the ‘Anne’s Law’ campaign by Natasha Hamilton, the daughter of 63-year-old care home resident Anne Duke, led to the announcement by the Scottish Government to introduce legislation to give people in care homes in Scotland the right to safe and supported visits, even in the case of future pandemics. However, Anne’s Law has yet to be introduced into legislation.

In England there is currently no specific legislative requirement for care homes to allow visits into care homes. However, the Care Quality Commission (the regulator of health and care services in England) provided guidance on this matter and care home providers failed to allow residents to see their family and friends could be accused of breaching regulations related to dignity, respect and person-centred care.

In Wales, people living in care homes must have space other than their bedroom to be able to meet with visitors. Visits can be restricted at times when there are infections within the home, but any measures must be proportionate to the level of risk (Older People’s Commissioner for Wales, 2022).

In Northern Ireland, the Department of Health has issued an updated guidance for care homes about visits in 2022: “Visiting with Care -The New Normal”. According to the guidance there should be no restrictions on visiting people in care homes. In case of an outbreak of an illness in a care setting and in the community, visitors should be informed and action should be taken in proportion with the nature of the disease and level of risk to people living and working in the care setting.

Network Coordinators

There are four local coordinators across the four UK nations:

Each Local Network included people with lived experience, carers, commissioners of services, providers, and support services, brought together by a Network Coordinator.

Discussion Materials

Before the first Network meeting, IMPACT produced a short report which summarised an existing review of the evidence produced by Dr George Palattiyil for the Care Inspectorate on ‘Meaningful Connection’ for people living in care homes. The main points of this document were

  • Visit in home care’ is on the agenda of all the 4 UK nations.
  • Social isolation and loneliness can reduce older people’s life expectancy and damage their health and wellbeing, including their quality of life.
  • Forming and maintaining social relationships in care homes is an essential element of supporting the wellbeing of older people living in these settings.
  • Factors that could facilitate the creation and maintenance of relationships in care homes include:
    • The physical environment, e.g. the creation of indoor and outdoor social spaces,
    • Policies, procedures and training developed in co production with residents and their families,
    • Technologies to support social interaction,
    • Group activities and collaborations aimed to facilitate the involvement and engagement of the whole community to the life of the care home

First Network Meeting Discussions

At the first Local Network meeting, Local Network Members discussed the evidence review and their experiences of care home, relationships, and community.

The main message that strongly came out from the first discussion was that “Moving into a care home shouldn’t mean the end of life”. Participants to our local networks shared the feeling that there are a series of misconceptions and prejudices about care homes. Staff working in the care home expressed their frustration about the belief that, once a person is in a care home, their life ends, and this should be delayed as the last resort. Staff, by contrast, expressed their willingness and interest for each of their residents. They would like to know more about their life in order to make the passage to home care the smoothest possible and allow the resident to continue with their life, responsibilities, and their passions.

When talking about the main challenges of working and managing care homes, providers reported recruiting volunteers and languages as important problems. Volunteers have been described as essential to bring life into home care. However, the cost and the complexity of the process to recruit volunteers make this very difficult. Another challenge to provide good and tailored care is linked to having residents speaking other languages. In this sense, volunteers speaking other languages could be an important resource but it is not easy to provide care to an older person, especially with dementia, when it is not possible to communicate with them in their mother language.

During this first meeting, local networks also identified what can support the creation and maintaining of relationships in care home settings. For example, it was reported that inviting schools in the care home is a good strategy to engage with the community. Residents enjoy the company of young people, especially their enthusiasm. Good communication was also recognised as an essential skill for staff working with older people in care homes. It is essential to develop trusting relationships but also to know more about the person and create activities tailored to that person.

All participants in our networks acknowledge the importance of finding new ways to bring the community into care homes. Some examples of good practices identified during the meetings were: inviting people walking their pets to bring them into the care home and inviting other community groups, such a knitting club or choirs, to come to the care home for a one-off session.

Feedback

“It was good being able to hear other stories and experiences of how they had maintained and built relationships.”

IMPACT Co-ordinator

“Moving into a care home shouldn’t mean the end of life”

Shared Network Themes

“This was energising – we need more conversations like this where we are able to come together and talk about issues and think of solutions.”

Network Participant

“Care Homes are forgotten territories – people seem to be scared about them, or worry about their own futures”

IMPACT Co-ordinator