How did home care managers’ resilience contribute to the overall care outcomes in residential care homes?

Abstract

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Overview of research aim / questions.

Overview of methods.

Overview of key findings.

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Key words: Care Managers, Resilience, Strategies, COVID-19, UK

 

Introduction

 

Background

COVID-19 has caused significant direct and indirect implications on the health of people in the UK (Franck et al., 2022). Individuals from the most deprived socioeconomic groups have experienced greater adverse health impacts since the pandemic started, whether in terms of a range of chronic conditions, mortality or inability to access quality health care. For instance, a report by The King’s Fund shows that there were 75,000 excess deaths in 2020 and 42,000 excess deaths in 2021 in England and Wales (Raleigh, 2021). Home care providers early on in the pandemic faced significant challenges from the lack of clear guidance, centralisation of policy, stresses for staff, lack of testing and lack of support (Alzheimer’s UK, 2021). Whereas patients in care homes were the most at risk for COVID-19 complications, workers were just as vulnerable and faced an increased risk of death twice that of the general population (Office of National Statistics, 2020). When policy measures (i.e., isolation, face masks, social distancing, washing hands etc.) were initiated (Franck et al., 2022), care homes had to adapt to them by adjusting to staff ratios and PPE procurement, among others (Gordon et al., 2020). From the existing literature surrounding resilience relative to the care home sector, it appears much of the focus surrounds the first wave. Therefore, given that at the time of writing, England and Wales were facing the fourth wave and the introduction of certain measures that had been identified in Marshall et al.’s (2021) work, as well as early critical supportive factors and strategies discussed by Gordon et al. (2020,), this research sought to explore the wider timeline. The aim is to examine the resilience of home care managers during COVID-19.

Literature Review

This section provides a review of literature that has focused on the challenges that residential care homes faced and how they were able to overcome most of these challenges during COVID-19. The section is divided into four three themes around the mean ing of resilience, challenges faced by residential care homes, resilience demonstrated and initiatives that may have supported response efforts. Each of these themes is examined to guide in answering this research question.

Resilience

Pooley and Cohen (2010) defined resilience as the potential to exhibit resourcefulness by using available resources in response. There are other numerous definitions of resilience, but they all suggest the ability to thrive in difficult situations. Based on this definition, care home staff in the UK were able to continue providing care needs for the residents despite the challenges caused by COVID-19 (Marshall et al., 2021). However, although care homes demonstrated exemplary levels of resilience during COVID-19, it may be critical that the various challenges that were specific to care homes are identified.

Challenges Faced by Residential Care Homes during COVID-19

Gordon et al. (2020) argue that care home residents were at an increased risk for COVID-19 due to their age, prevalent frailty, comorbidities, functional dependency and cognitive impairment. Subsequently, these individuals have compromised immune systems or other chronic conditions that increase their risks of dying when they contract COVID-19. Similarly, Marshall et al.’s (2021) statement may correspond to Gordon et al.’s (2020), whereby being in close contact with other home care residents, the risks of COVID-19 infection among both residents and carers were high. Moreover, Marshall et al. (2021) and Dunn et al. (2021) agree that care homes succeeded in protecting residents from COVID-19, especially during the first wave. However, such reports may be contrary to reports by the Office of National Statistics (2020b), where there were more than 30,500 excess deaths of care home residents, whereas 268 deaths of social care workers were reported by June 2020 (Office of National Statistics, 2020a). These counter findings may insinuate the dire situations home care staff faced despite their commitment to providing better care in the pandemic (Grabowski and Mor, 2020). Although each of these studies has revealed unique challenges that were prevalent amongst home care staff, what is evident from them is the potential for such issues to impact the ability of staff to respond to them. Notably, the nature of the impact of these challenges on their health resonates with the meaning of resilience, which is observed to embody persistence and consistency in performance despite adversities.

Resilience in Residential Care Homes during COVID-19

Despite the above challenges, which had significant negative impacts on nurses, residents and care homes, there were components of resilience observed throughout the pandemic (Marshall et al., 2021; Zhang et al., 2022). For instance, some agencies offered their support to workers by enabling them to have flexible schedules that allowed them family time, while extensive adoption of PPE became requisite for their safety (Marshall et al., 2021). However, significant challenges were also observed in obtaining PPEs, but this did not deter their commitment to providing care to home care residents (Carter, 2020). Furthermore, some policies rolled out by the UK government, such as the adoption of telehealth and other virtual tools, enabled home care staff to provide services devoid of compromising their safety and that of clients (Nicholas et al., 2021). However, Goldfeld et al. (2022) react to Nicholas et al. (2021) claim stating that not all home care agencies could afford some technologies due to reduced funding and constraint on businesses. Whereas care homes throughout the pandemic experienced work intensification, understaffing, or even dangerous work conditions, which proved their resilience despite the challenges, Anderson et al. (2020) argue that outcomes such as severe moral injury and exhaustion cannot be ignored. These reports highlight the fact that while resident care homes demonstrated significant resilience, numerous challenges that derailed their operations also had negative implications on the resilience of staff and homes.

Policy Initiatives in Healthcare during COVID-19

Marshall et al. (2021) explored issues during the first wave of COVID-19, such as adaptations and changes as well as responses and services that providers adopted in the adversities posed by COVID-19. Marshall et al. (2021) reveal that government responses had a counterproductive effect on the ability of home care managers to carry out their role when legislation and policies focused more on protecting patients rather than healthcare providers. Nonetheless, Baskin and Bartlett (2021) note that despite gaps in policies and legislation to protect healthcare workers, the need for resilience amongst care providers has become more important. Baskin and Bartlett’s (2021) comment coincides with Franck et al. (2022), who reveal the potential buffering role of mental resilience on healthcare staff at the frontline during the COVID-19 outbreak. The studies suggest the fundamental role of resilience in times of crisis and attract significant questions about the government’s ignorance of the impacts of COVID-19 on the health of care providers during the first wave of the pandemic. From the findings, it may therefore be crucial to explicate the scope of resilience, especially in the context of COVID-19 in-home care managers.

Rationale

From the above review, it is apparent that an adequate number of studies have examined the numerous challenges that affected resident care homes. In addition, these studies have also noted the significant contribution of the social workers as well as the care homes overall. Nonetheless, most investigations and contentions have not adequately highlighted the contribution of home care managers to the overall resilience observed in resident care homes at the same level as home care nurses. Considering such a gap in the literature, it is fundamental that the resilience of care home managers is identified and examined to understand how such interacted with the dynamics of the COVID-19 pandemic.

 

Research Aims and Questions

This study aims to contextualise a residential care home manager’s perspective on resilience during COVID-19 and the importance of this resilience on their health and the quality of care that residents receive. The study is guided by several aims, as outlined below.

• To identify different challenges that home care managers faced during COVID-19.
• To identify the strategies that home care managers devised for overcoming challenges during COVID-19.
• To contextualise the resilience of home care managers during crises with a specific focus on COVID-19.
• To provide suggestions on what can be done to enhance home care managers’ resilience during emergencies.

 

 

Primary Research Question

• How did home care managers’ resilience during the COVID-19 pandemic influence care service outcomes in the UK?

Secondary Research Questions

• In what ways did the home care managers demonstrate resilience during COVID-19?
• What are the different support structures that home care managers receive to support them in responding to crises such as COVID-19?
• How did home care managers’ resilience contribute to the overall care outcomes in residential care homes?