Despite the many known challenges that vulnerable older people can face when living in their own homes, moving into long-term residential care is often considered to be a last resort, and care homes are certainly not seen as places where older people are expected to flourish. Dr Bethany Morgan Brett, a Research Fellow for My Home Life England at City St George’s, University of London, shares her reflections on the research with UK Care Week readers.

 

At My Home Life England (part of City St George’s, University of London) we carried out a wide-scale qualitative research project exploring the experiences of residential care, from the perspectives of older people and those who care for them. Through this we aimed to better understand the challenges and benefits of living in a care home. 

 

We spoke to 125 individuals (older people, care team members and families) in 16 care homes across the UK.  We visited a broad range of residential care homes in terms of location, inspection ratings, size, and type of home. We captured the voices of a diverse range of older people, with an average age of 85 and who had been living in a care home for an average of two years. The research was funded by Hallmark Foundation and independently engaged a range of different care homes and different care home providers.

The research findings, published in the report ‘Thriving in Residential Care’, shine a light on what is working well, and how, when conditions are right, care homes can support older people to really thrive. 

 

The findings cluster into six emerging themes: Thrive Relationally, Thrive Actively, Thrive Inclusively, Thrive Securely, Thrive with Dignity, and Thrive Healthily.  

 

Thrive Relationally

 

Far from care homes being places of mere survival, the older people we spoke were flourishing in many different ways. Many were ‘thriving relationally’ and had formed meaningful friendships with each other and with staff, which was a lifeline for those experiencing isolation. When asked what the benefit of living in a care home was, 74-year-old Brian replied, “Well, being here by having company. The one thing I like is company”. Moving to a care home had also helped restore strained family relationships; families generally felt reassured, welcomed and able to stay actively involved in their older relative’s life.

 

Thrive Actively

 

Older people were actively participating in activities that gave their lives renewed purpose and helped them to feel valued. For example, 82-year-old Irene had had a long career working for a fabric company and this was a critical part of her identity. She told us, “I can’t do my sewing anymore, which was part of my life working for {a textile company} for 27 years. So, I decided to knit…I knit scarves for the staff. I think I’ve knitted 13 since I’ve been in here”. Irene also found a new sense of purpose through volunteering in her care home, to lay tables and through attending to others at mealtimes.

 

Thrive Securely 

 

A significant finding was the overwhelming sense of security that care homes can provide. Before moving into a care home, some of the older people were experiencing poor housing, insecurity and even violence. Others felt anxious about being alone in their own homes, especially at night. We found that living in a care home provided older people with reassurance and safety, as well as alleviating the strain and worry for families. This was true for 94-year-old Harriet who had become increasingly unwell, frail and had fallen in her own home on a number of occasions. She now “felt really safe” after moving to her care home, whereas before she was “getting scared all the time”.

 

Thrive with Dignity 

 

Many older people also found it increasingly difficult to keep on top of household tasks including laundry before they moved to a care home. They really valued having assistance with chores such as cooking and cleaning. Others had previously struggled with personal care and continence, but now had support from care staff with things like bathing and using the toilet. This helped to restore and maintain dignity. 

 

Thrive Healthily 

 

Proactive support with nutrition and healthcare meant many older people shared that their health had actually improved since moving into residential care. This may be surprising to envisage, but we found this to be the case on multiple occasions.  Care team member Caitlin spoke of a lady who arrived with a “grade five pressure sore” across the whole of her back. She said, “she wasn’t eating. She wasn’t drinking. They expected her to be gone within weeks”. With the right support the lady is now eating well, and the pressure sore is healed, “she’s amazing, she’s thriving, she’s not going anywhere”.

 

Care team members who had previously worked in domiciliary care also highlighted that working in a care home made it much easier and quicker to notice when things weren’t quite right, because they spent longer with an individual.

 

Thrive Inclusively

 

Finally, we found that care homes can be inclusive environments where diversity is valued and respected. The report shares examples of older people being supported to embrace their faith, culture, ethnicity, sexuality and gender identity. Jay, a care home manager, recounted that; “We have made an environment where somebody feels so safe that at age 82… he’s been able to come out [as gay]… I thought my job is done…if this environment is safe enough that somebody feels that they can do that, this environment is correct.” Inclusive environments also helped families feel confident that their older relative would be well-supported and that the move was the right choice.

 

Conclusion

 

Our research reveals that, whilst care homes may not be right for everyone, they can be everything for some. It has shone a light on how the provision of high quality, proactive, relationship-centred care, inclusion in a social environment with meaningful activities and nutritious meals, and fostering a strong sense of safety and security has, in some cases, been truly transformative and has supported many older people to really thrive.

Visit myhomelife.org.uk/thriving to watch an animation and see the report’s key findings.

 

 

About the author 

Dr Bethany Morgan Brett is a Research Fellow for My Home Life England at City St George’s, University of London. Her academic background includes 19 years’ experience of lecturing in Psychosocial and Psychoanalytic Studies, Sociology, and Social Psychology and she is a senior fellow of the Higher Education Academy. She is an experienced evaluation specialist and archivist, with expertise in data management and research methods and ethics. She has published extensively including the monograph The Child-Parent Caregiving Relationship in Later Life: Psychosocial Experiences (Policy Press, 2023) and co-authored a methods textbook How to Do Qualitative Interviewing (SAGE, 2022). She is also a registered psychotherapist accredited by The British Psychotherapy Foundation and a charity director. Her research expertise lies in the experiences of ageing across the life course, social care, therapeutic communication, end of life care, mental health, transitions, and grief, loss and bereavement.