Award Title: Understanding the factors that shape care homes’ responses to Government COVID-19 guidance on visiting arrangements
Funder: Department of Health and Social Care

Abstract: Background   While effective in limiting Covid-19 transmission, restrictions on family visits to care homes for older people can negatively impact residents  emotional, cognitive and physical health and cause distress for families.1,2 Government has published guidance for care homes on establishing visiting policies that balance these risks, subject to local-area risk assessments from Public Health Directors.3  The guidance states,  the first priority must remain preventing infections  and  visiting policy should still be restricted with alternatives sought wherever possible.  However, it guides homes to develop  a policy for limited visits  which is  made available and/or communicated to residents and families.  This is challenging and potentially sensitive, with significant lobbying for increased access on compassionate and human rights grounds.4,5,6 Experience is evolving and care homes will manage these challenges differently.7,8,9,10      Research aims and objectives    We will identify:    range and diversity in care homes  interpretation and implementation of guidance  how scope for personalisation afforded by the guidance is reflected in policies  need for, and use of, support (guidance, tools, assistance) to develop and implement policies    perspectives on how policies are working; including feasibility, acceptability, equity and other impacts  consultation with families and other stakeholders, including challenges, achievements and influence on policies  how policies are communicated to residents, families and others; perspectives on how well this worked and why  whether family members find policies understandable, fair and proportionate, and why  how characteristics and circumstances of care homes, and contextual factors, influence all of the above   The evidence generated by our study is intended to inform ongoing policy and practice during the current pandemic and be of relevance in the event of future epidemics and pandemics.       Methods   Stage one (months 1-6): To understand range and diversity and generate theory, we will administer a semi-structured questionnaire to care home managers or nominated senior staff (20 minutes; online or telephone) and review policy documents across 200 care homes, purposively-sampled. This provides sufficient breadth and depth and a sampling pool for later stages.   Stage two (months 6-12): We will further develop explanatory analyses using twenty  cases  theoretically-sampled from the participating homes, involving 1-3 in-depth interviews with care home managers and nominated senior staff.   Stage three (months 6-15): Thirty to thirty-five in-depth interviews with family carers, purposively-sampled to reflect diversity, will be conducted to explore understanding and views of care home policies.   In all stages, data from will be thematically-analysed using NVivo; range and diversity will be fully described and patterns in the data identified and articulated.16,17,18  Findings will be refined and interpreted, and policy implications considered in consultation with our expert advisors and experts-by-experience.      Supported by LSE and Care England s media and communications teams, we will monitor updates to Government guidance and key developments throughout to inform data-collection, analysis and interpretation. Three policy briefings and three peer-reviewed journal articles will be produced and promoted through our websites, professional networks, social media and public platforms. We will run joint webinars, give presentations and produce lay summaries.

Lay Abstract: During the pandemic, many families have been unable to visit relatives living in care homes. This is to prevent the spread of Covid-19 but can be harmful for care home residents  emotional, mental and physical health and distressing for families. Government has recently published guidance for care homes. This states, the first priority must remain preventing infections  and  visits should still be restricted with alternatives sought wherever possible,  but recommends care homes develop  a policy for limited visits,  to be  made available and/or communicated to residents and families.         Care homes must follow advice from their local Public Health Director and the guidance tells them what factors to consider but care homes otherwise choose their own policies. It is extremely difficult to strike the right balance, and many carers and organisations are arguing for more in-person visiting on compassionate and human rights grounds.      Our study will find out:    how care homes have applied the guidance to develop their policies  how personalisation, encouraged in the guidance, is reflected in policies  what help, other than the guidance, care homes have used or needed  whether managers and staff think their policies are workable, acceptable and fair  what consultation has been carried out with residents, families and others, and how this has influenced policies  how policies are communicated, how well this has worked and why  whether family members find policies understandable, fair and proportionate, and why  the most important factors that influence all of the above   We will select 200 diverse care homes, review and compare their written policies and, using a questionnaire (completed online or by telephone), ask care home managers (or a senior staff member) about using the guidance and their policies. Based on what we find out, we will choose twenty of the homes and speak in more depth with the care home manager and other staff. We will also interview 30 family carers to find out about their views and experiences. We will consult an expert advisory group and a group of five experts-by-experience (two of whom input into this proposal) at three stages in the project to help us refine and better understand the implications of emerging findings.      Two of our research team are experts-by-experience. Margaret is an ex-carer for her husband who had dementia, a trustee and volunteer with carers  support organisations. She will support the experts-by-experience group. Sarah is a family carer for her mother who lives in a nursing home and will work as a researcher on all aspects of the study.      Study outputs (briefings, summaries and timely journal papers) will be promoted through our websites, professional networks, social media and public platforms. We will run joint webinars, give presentations and produce lay summaries.

Research Activity Codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health Categories: GENERIC HEALTH RELEVANCE