Time spent in bed at night by care-home residents: choice or compromise?

Abstract

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.

Factors affecting residents’ sleep in care homes

“…As well as the obvious issue of noise and light, many care homes use routine practices that involve staff entering the rooms of residents to check on them at regular intervals, sometimes hourly (Kerr et al, 2008;Luff et al, 2011;Eyers et al, 2012). In support of previous findings from Kerr et al (2008), both staff and residents in this study felt that these overnight checks significantly contributed to poorer sleep quality of residents.…”

“…However, as discussed in Luff et al (2011), it was found that the capacity of residents to exercise control over their sleep environment correlated with physical and cognitive impairment, with those most disabled experiencing the least control over their sleep environment. As such it is important to remember that those more frail and cognitively impaired will require even more proactive engagement from staff around their sleep.…”

“…Long hours in bed did not relate to more time asleep and residents on average reported spending more than 2 hours in bed awake each night (Luff et al, 2011). Disabilities and sensory impairments can impact upon a resident's ability to help themselves get to sleep or to pass the time while awake in bed.…”

“…Bed times and getting up times for many residents were influenced primarily by staffing levels and shift patterns, which did not always facilitate staff giving residents a choice over their sleeping times (Luff et al, 2011). This is particularly relevant for people with more severe physical and cognitive disabilities.…”

Striking the balance: night care versus the facilitation of good sleep

“…Good night time sleep enhances cognitive and physical abilities, reduces the risk of falls, and also enhances quality of life (Livingston et al 1993;Leger 1994;Ersser et al 1999;Busto et al 2001;Martin 2002;Stepanski et al 2003). For older adults these are particularly important aspects of everyday life (Luff et al 2011;. However, studies undertaken in both North America and the United Kingdom indicate that the care home environment is not conducive to sleep (Alessi and Schnelle 2000;Kerr et al 2008).…”