“Crack on”: a qualitative study of care home managers experiences and responses to system-led setbacks during the crisis of the COVID-19 Pandemic in England

Abstract

Objectives To explore care home managers’ experiences of systems working with various organisations, including statutory, third sector and private, during the second wave of the COVID-19 pandemic from Sept 2020 to April 2021 Design An exploratory qualitative interview study using a systems theory approach focussing on the intersections of relationship interdependencies with other organisations. Setting Conducted remotely with care home managers and key advisors who had worked since the start of the pandemic in/with care homes for older people across the East Midlands, UK. Participants 8 care home managers and 2 end-of-life advisors who participated during the second wave of the pandemic from Sept 2020. A total of 18 care home managers participated in the wider study from April 2020 to April 2021 Results Four organisational relationship interdependencies were identified: care practices, resources governance and wise working. Managers identified changes in their care practices as a shift towards the normalisation of care, with an emphasis on navigating pandemic restrictions to fit the context. Resources such as staffing, clinical reviews, pharmaceutical and equipment supplies were challenged, leading to a sense of precarity and tension. National polices and local guidance were fragmented, complex and disconnected from the reality of managing a care home. As a response a highly pragmatic reflexive style of management was identified which encompassed the use of mastery to navigate and in some cases circumvent official systems and mandates. Managers’ experience of persistent and multiple setbacks were viewed as negative and confirmed their views that care homes as a sector ere marginalised by policy makers and statutory bodies. Conclusions Interactions with various organisations shaped the ways in which care home managers responded to and sought to maximise residents and staff well-being. Some relationships dissolved over time, such as when local business and schools returned to normal obligations. Other newly formed relationships became more robust including those with other care home managers, families, and hospices. Significantly, most managers viewed their relationship with local authority and national statutory bodies as detrimental to effective working, leading to a sense of increased mistrust and ambiguity. Respect, recognition and meaningful collaboration with the care home sector should underpin any future attempts to introduce practice change in the sector.

Minding the gaps: Recognising ancillary staff contributions in care homes during the COVID-19 pandemic

“…8 The crucial role of care home managers in mobilizing responses, implementing early lockdowns, and sharing knowledge highlights the need for timely and evidence-based support. 4,5 However, the lack of sustained PPE supplies, inevitable reliance on agency staff and the pressured acceptance of untested hospital discharged residents brought significant challenges, emphasising the need for robust policies and practices in pandemic preparedness. The DA-CHA (Developing research resources And minimum data set for Care Homes' Adoption) study, initiated in 2020, offers promise with its system-wide prototype to maintain a minimum data set for care homes.…”

“…Despite facing challenges, ancillary staff demonstrated unwavering dedication, often taking on extended roles and responsibilities beyond their pay grade. 3,4 Working in uncertain disruptive times led to valid fears about their own health and wellbeing. Support and team working with sound leadership by the care home managers mitigated some of those fears.…”

Managers' perceptions of the factors affecting resident and patient safety work in residential settings and nursing homes: A qualitative systematic review

“…In addition, the accessibility of physicians and managers and their role in facilitating communication have been emphasized (Engle et al, 2023). Moreover, managers have identified special problems during emergency conditions, such as a pandemic (Dixon et al, 2023;Marshall et al, 2023). In summary, previous research reveals the need to consider many factors when trying to ensure resident safety in residential settings and nursing homes.…”