This paper examines the amount of time that care-home residents spend in bed at night, focusing on how residents' bedtimes and getting-up times are managed. Using a mixedmethods approach, diary data were collected over 14 days from 125 residents in ten care homes in South East England. The findings indicate that residents spent, on average, nearly 11 hours in bed at night, significantly more time than was spent sleeping. There was greater variance in the amount of time residents who needed assistance spent in bed than there was for independent residents. Detailed investigation of six care homes, each with 8 pm to 8 am night shifts, showed that bedtimes and getting-up times for dependent residents were influenced by staff shift patterns. Analysis of qualitative interviews with 38 residents highlighted a lack of resident choice about bedtimes and many compromises by the residents to fit in with the care home shift and staffing patterns. The social norm of early bedtimes in care homes also influenced the independent residents. It is argued that the current system in care homes of approximately 12-hour night shifts, during which staff ratios are far lower than in the daytime, promotes an overly long 'night-time' and curbs residents' choices about the times at which they go to bed and get up, particularly for the most dependent residents.

In divergent ways, both government policy and care home practices influence the everyday life of older people living in English care homes. The rhetoric of choice for care home residents may be in conflict with the reality of government policy-driven service delivery. The aim of the article is to examine the role of organised activities in facilitating choice and active ageing among care home residents. Findings from a study of ten care homes in South East England exemplify the conflict between government policy rhetoric and the reality of care home life. The indication is that the formality of the ''activities of daily living'' support procedures restricts residents' involvement in the organised social activities. Within the general provision of services, the organised ''social activities'' offered failed to meet the interest, cognitive and physical abilities of residents. The reality

Sources of support:The authors are grateful for funding from the New Dynamics of Ageing initiative, a multidisciplinary research programme supported by AHRC, BBSRC, EPSRC, ESRC and MRC (RES-339- 25-0009).Key Words: actigraphy, non parametric circadian rhythm analysis, care home residents, community dwelling 2 AbstractSleep disturbances are a common problem among institutionalised older people. Studies have shown that this population experiences prolonged sleep latency, increased fragmentation and wake after sleep onset, more disturbed circadian rhythms and night-day reversal. However, studies have not examined the extent to which this is because of individual factors known to influence sleep (such as age) or because of the institutional environment. This paper compares actigraphic data collected for 14 days from 122 non demented institutional care residents (across 10 care facilities) with 52 community dwelling poor sleepers aged over 65. Four dependent variables are analysed: i) the 'interdaily stability' (IS); ii) the 'intradaily variability' (IV); iii) the relative amplitude (RA) of the activity rhythm; and iv) the mean level of activity during the 24 hour day. Data are analysed using a fixed effects, single level, model (using MLwiN). This model enables comparisons between community and institutional care groups to be made whilst conditioning out possible 'individual' effects of 'age', 'gender', 'level of dependency', 'level of incontinence care', and 'number of regular daily/prescribed medications'. After controlling for the effects of a range of individual level factors, and after controlling for unequal variance across groups (heteroscedascity), there is little difference between community dwelling older adults and institutional care residents in IS score; suggesting that the stability of day to day patterns (such as bed times, get up times, lunch times etc) is similar within these two resident groups. However, institutional care residents do experience more fragmented rest/wake patterns (having significantly higher IV scores and significantly lower mean activity values). Our findings strongly suggest that the institutional care environment itself has a negative association with older people's rest/wake patterns; although longitudinal studies are required to fully understand any causal relationships.

Aims To understand sleep as part of the 24 hour provision of resident care by viewing it in the wider social context within the care home, exploring both the subjective experience of residents and the perceptions of staff. Methods Qualitative research in four care homes for older people consisting of semi-structured interviews and ethnographic observations. Interviews were conducted with 38 residents and 39 staff, and were analysed using a grounded theory approach. Findings The findings have highlighted some challenges and opportunities for developing practice in care homes to improve residents' sleep. In addition to pain and physical disabilities, both the physical environment and practices in care homes can affect residents’ sleep and night-time experience. Conclusion Improving our understanding of residents’ and staff experiences at night in care homes can inform the development of good practice in night-time care and contribute to a positive culture of person-centred care

This article presents the key findings from an extensive research project aiming to identify the determinants of poor sleep in care homes. A mixed methods study was conducted in 10 care homes in South East England, which included 2 week daily diaries completed with 145 older residents, observations and interviews with 50 care home staff. The research found that the regular surveillance by qualified nurses and care assistants at night seriously impedes the quality of sleep experienced by older people living in care homes. However, nurses and social care workers have a duty of care and would not be fulfilling their duty if regular checks were not undertaken at night. There is a need for a balance to be struck between enabling older people living in care homes to have a good night's sleep and care home staff adhering to their professional duty of care.