Title: Protecting older people living in care homes from COVID-19: challenges and solutions to implementing social distancing and isolation.
Funder: Department of Health and Social Care

Abstract: What is the problem?_x000D_ Older people living in care homes (i.e. homes that provide residential and/ or nursing care) often have complex needs and are at high risk of poor health outcomes and mortality especially if they contract the coronavirus. To protect older people from the coronavirus, care homes use measures such as social distancing and isolating of residents. The care home sector has stated that implementing social distancing and isolation when caring for residents is a significant challenge. Currently, we do not have a good understanding of this challenge and how best to address it. _x000D_ Aim of our research_x000D_ The aim of our research is to explore and understand the real-life experiences of implementing social distancing and isolation of residents in care homes for older people from the perspective of residents, their families/friends, staff working in and with care homes, and to develop a toolkit of resources for health and care delivery now and to support further outbreaks of the coronavirus. _x000D_ What we will do_x000D_ To achieve this our study has 3 phases:_x000D_ Phase 1: We will search the literature to describe how care homes and long-term facilities previously have physically distanced older people to control the spread of other infectious and contagious diseases. _x000D_ Phase 2: _x000D_ a) We will recruit six care homes in England. _x000D_ For each care home we will conduct individual remote interviews with care home managers/deputies, registered nurses, and care staff that will be video- and audio-recorded with permission. Interviews will be conducted with individual residents and families/friends and with permission will be video- and audio-recorded. We will gather local policies and protocols related to managing social distancing and isolation of residents. We will gather care home information such as resident occupancy, staffing, and COVID-19 infection rates._x000D_ b) We will carry out a focus group(s) with external stakeholders who have knowledge and expertise at a wider level relevant to the pandemic for the care home sector, e.g. local authority providers, clinical commissioning groups, hospital discharge teams, representative bodies for care home providers. _x000D_ Phase 3:_x000D_ Our analysis of the data will help us to co-design a toolkit of resources for residents, families/friends, and care homes. The resources will share which interventions and strategies for social distancing and isolation for residents work well and which do not. These resources will support decision making about health and care delivery in care homes and help build resilience. Content will be presented in different ways to maximise accessibility and impact. e.g. using flow charts to present evidence-informed guidance, and film to narrate the stories of older people, their families/friends and care home staff. Throughout and on completion of the project we will share the findings of our research in different ways and with different audiences. We have discussed and consulted on the topic widely and there is a consensus that this research is important and is needed now. Our team includes experienced professionals who work in the care home sector. Our proposed Project monitoring and advisory group includes representatives of older people living in care homes and their families/friends, experts representing the care home sector, care home nursing, and infection control and prevention. The knowledge, expertise, and perspectives of these service user and public representatives and those with a professional role in health and social care services will help us achieve the objectives of this research.

Lay abstract: Background: Care homes provide care for some of the vulnerable population of older people. They are at high risk of poor health outcomes and mortality if they contract COVID-19. The risk of contracting COVID-19 is compounded by difficulties in implementing infection control measures such as social distancing and isolation of residents. It is critical that care home services remain safe and provide high quality care during the pandemic and for further surges. Our research will provide a unique contribution to helping protect older people living in care homes from COVID-19._x000D_ Research aim: to explore and understand the real-life experiences of social distancing and isolation in care homes for older people from the perspective of multiple stakeholders, and to develop a toolkit of evidence-informed guidance and resources to support health and care delivery now and for further outbreaks. Design: This tripartite 12-month study involves a rapid evidence review, in-depth case studies, and toolkit development. Methods: Phase 1: An update of existing reviews of evidence to collate knowledge on the mechanisms and measures used by care homes and long-term facilities previously to socially distance and isolate older people or control the spread of other infectious and contagious diseases. Phase 2: a) In-depth case studies of 6 purposively selected care homes to identify the real-life challenges and consequences of providing safe care incorporating social distancing and isolation measures and to identify novel solutions being used to implement these measures in a person-centred way. Data collection: Within each care home case study: Interviews with a purposive sample of 3 residents and 3 family/friends to examine their experiences while residents are social distancing and isolating. Interviews with a purposive sample of 5 staff to examine how they adapt and manage care delivery for residents with different needs whilst maintaining social distancing and isolation of residents. Interview with the care home manager/deputy to examine how they develop, manage, and adapt policies, procedures, and protocols to achieve these measures. Collection of relevant documents and routinely recorded care home data to understand contextual factors. 2b) A focus group with a purposive sample of 8 external key informants with macro-level knowledge and experience relevant to the pandemic for the care home sector. Data analysis: Interviews will be transcribed and analysed using thematic analysis. Documentary data will be analysed using thematic analysis. Concurrent data collection and analysis will inform decisions about the need for further data collection. Analysis for each case site and across case sites will be conducted. Descriptive summary statistics will be used to describe quantitative data. Phase 3: Synthesis of findings from Phases 1 and 2 will culminate in a co-produced toolkit comprising evidence-informed guidance and resources. The content of the toolkit will be presented in different ways e.g. using flow charts to present evidence-informed guidance, and film to help narrate the stories of older people, their families/friends and care home staff. We will work with care home practitioners, our co-applicants from the care home sector, our PPI group, and Project monitoring and advisory group to co-produce a final version that is meaningful, accessible and will be used in practice. Dissemination: project website; publication in peer-reviewed, professional journals, and sector press; social media; presentations to different audiences.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: INFECTION;GENERIC HEALTH RELEVANCE