Care of the Ageing Veteran Population: Developing an Evidence Base for the Royal Hospital Chelsea Model of Care

Royal Hospital Chelsea (RHC) has provided a sheltered housing environment alongside integrated health and social care and comradeship for British Army veterans since 1692, following a decree by King Charles II to aid the "relief of veterans broken by age and war" (RHC, 2018). Today approximately 300 In-Pensioners, known globally as 'Chelsea Pensioners' live at RHC. They also have access to an on-site infirmary providing nursing or personal care for up to 68 people (CQC, 2019).

RHC is in central London (UK) and comprises of several historical buildings, protected by the organisations Mission Statement to "...safeguard their historic home for the veterans of tomorrow". In-Pensioner's must have served in the British Army as a non-commissioned officer (or have served at least 12 years 'in the ranks' prior to becoming a commissioned officer), be aged 65 or over, be free of any financial obligations to dependents, and at the time of admission be able to live independently. Traditionally a male-only residence, RHC welcomed its first female Army veteran in 2009.

There is an absence of evidence to support the impact of care delivery and the Chelsea Pensioner experience, with the only evidence being RHC Annual and Care Quality Commission (CQC) reports which focus on strategic and operational matters rather than the impact of the wider social care or environment.

This lack of evidence presents a unique opportunity to evaluate RHC's current service provision, inform future direction and address the hiatus in evidence-based research to quantify the impact of its model of care.

The research will seek to address two main aims:

1. To gain an understanding of the current Royal Hospital Chelsea (RHC) model of care by:

   1. Evidencing the influence the model of care has on In-Pensioner health outcomes
   2. Understanding the influence the model of care has on wider social care provision
   3. Reflecting on the contribution the environment has on the In-Pensioner experience, their health outcomes, and quality of life
2. To inform future RHC care provision by:

   1. Mapping current services, future need and sustainability of the model
   2. Projecting findings to inform the growth of existing services for future generations of ageing veterans

The findings will inform RHC strategic direction as it continues to deliver care provision to current and future generations of veteran, identify the value of RHC interventions, and explore any development of service provision in the form of potential outreach care. Further, the findings will look to inform wider social care provision which may contribute to national health and social care policy.

The findings of the study may be applicable to the wider care provision within similar residential care establishments as they will seek to present service delivery findings from both a staff (care provider) and resident (care recipient) perspective and evidence best practice.

The findings may contribute to national health and social care policy (UK).

Key staff and Royal Hospital Chelsea 'In-Pensioner' residents will be interviewed for this study. New In-Pensioner residents will be invited to complete two Quality of Life Questionnaires (one on arrival and one six months later).

Eligibility Criteria:
Inclusion Criteria:

• Participants identified as Key Staff, In-Pensioner residents and new In-Pensioners at Royal Hospital Chelsea will be eligible to be included in the study.

Exclusion Criteria:

* Anyone who is not employed by Royal Hospital Chelsea and identified as a Key Member of staff, or is not an In-Pensioner resident at Royal Hospital Chelsea will be excluded from the study.
* Any potential participant who does not complete a consent form will be excluded from the study.