At My Home Life England, we have conducted wide-scale qualitative research exploring residential care experiences, 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 UK care homes. We visited a range of care homes in terms of location, inspection ratings, size and type. 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.
Our research, Thriving in Residential Care, shines a light on what is working well, and how, when conditions are right, care homes can support older people to really thrive. Here, we share six emerging themes.
Thrive relationally
Company was a lifeline for many older people, who felt lonely and isolated when living alone. Many had formed friendships with others and relationships with their care team. 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 residential care also helped restore family relationships. Now that their relative had moved to a care home, families generally felt reassured, welcomed and able to stay actively involved in their relative’s life. Christine told us, ‘They not only care for my mum, and they care for my mum very well, but we’re included in that, you know. It’s given me my mum back for how long or short time I’ve got with her.’
One barrier to building friendships was older people feeling disturbed by those displaying behaviours related to distress in dementia. A perceived lack of shared interests was also a hindrance. However, we saw great efforts from care team members to facilitate connections and help new people settle in, including schemes such as the ambassador’s role to help build friendships.
Thrive actively
When living at home, some older people could no longer do things they enjoyed. Whereas, once living in a care home with the right support, people could adapt their interests to their capabilities. 82-year-old Irene had a long career with a fabric company, which was critical to her identity. She always enjoyed hand-sewing but found it more difficult now, ‘because of my hands’.
She told us, ‘I can’t do my sewing anymore, which was part of my life for 27 years. So, I decided to knit […] I knit scarves for the staff.’ Irene also found renewed purpose through volunteering in her care home, laying tables and attending to others at mealtimes.
We found that well-conceived, person-centred activities and community connections were important for older people’s self-expression, confidence and autonomy, also providing opportunities to ‘give back’. This helped older people to find purpose and feel valued and respected.
The challenges identified around activities included people feeling inhibited by health conditions, especially incontinence. Another centred around resourcing, particularly if a home did not have their own transportation. Some older people chose not to engage with communal activities, preferring to pursue personal interests. Having choice about what they wanted to do mattered most.
Thrive inclusively
Inclusivity involves making someone feel welcome, safe, valued and respected, regardless of characteristic or background. We saw wonderful examples of support enabling older people to connect with their identity through embracing faith or culture.
One care team member said, ‘They can have a bit of their community being brought in.’ Our study also included care homes offering specialist provision for specific cultures and faiths, with culturally appropriate activities and foods, language support for those of whom English was not their first language and multi-faith chapels.
We also recognised the importance of fostering an inclusive environment where older people could express their sexual or gender identity. We heard moving stories, including that of 96-year-old Joanie, who identified as gay.
The manager of Joanie’s care home shared, ‘She was 96 and had never held a newborn baby – she thought, because all of her family had told her, her “condition” could be transferred to newborn babies.’ Joanie held the manager’s newborn baby and felt comfortable enough to share that she had a female life partner, reflecting that, ‘We lived as friends’, due to discrimination.
Thrive securely
Older people, families and care teams expressed that safety and security were amongst the greatest benefits of living in residential care. Care homes offered older people reassurance, and also alleviated the strain and worry for families. 94-year-old Harriet, who was becoming increasingly frail, ‘felt really safe’ after moving to her care home, whereas before she was ‘getting scared all the time’ and had fallen on several occasions.
Before moving into residential care, some of the older people experienced poor housing, insecurity and even violence. 75-year-old Pauline said that, previously, her life was ‘horrible’. She was living with her daughter and her son-in-law, who ‘was a drinker’.
She told us, ‘I didn’t like him. He used to throw bottles, so I was glad that I came out of there and that I’m in here now. Everything’s got better for me.’ Others, like 92-year-old Delith, felt anxious being alone at home, especially at night. But now, ‘When I go to bed at night, I don’t have told worry about whether anybody breaks in. If there’s any fire or anything, I feel safe at night.’
One challenge we recognised was that some care homes may lean towards being overly risk averse for safety reasons, which can stifle meaningful engagement. What we found to be most important was care teams finding creative ways to support people to do the things they enjoyed, even if there were risks involved.
Thrive with dignity
Care home manager Lynette recognised ‘some degree of self-neglect’ in some of the older people who previously lived alone. Many older people also found it increasingly difficult to keep on top of household chores. They really valued that these things were taken care of in residential care.
Others previously struggled with personal care, but now had support with things like bathing and using the toilet. Having an ensuite bathroom in their care home was very important to some, including 84-year-old Rainee who said that getting to the bathroom by herself supported her independence.
84-year-old Fifi recognised the level of dependence she had on others to manage her incontinence. When asked what good care meant to her, she replied, ‘The carers are a wonderful bunch, and you can see how dependent I am on them. Unfortunately, I have to wear pads. So, they’re a big part of me wearing pads, which I didn’t want to wear, so I am very dependent on the carers, who, here, I must say do a wonderful job.’
The greatest challenge to supporting dignity was for staff to remain person-centred working in a busy care home with routines and often depleted resources. Some older people spoke about there not always being enough staff to facilitate the routines they would like. For example, having to get up earlier or not being helped to shower at their preferred time. This was carefully negotiated in care homes as a matter of ‘compromise’.
Thrive healthily
An important benefit of residential care was that older people could be supported to maintain or even improve their health. Care team member Caitlin spoke of a lady who arrived with a ‘grade five pressure sore’. She said, ‘She wasn’t eating. She wasn’t drinking. They expected her to be gone within weeks.’ With the right support, she is now eating well, and the pressure sore is healed; ‘She’s amazing, she’s thriving, she’s not going anywhere.’
Care homes were shown to provide proactive and pre-emptive medical care, having easier access to other health professionals than if living in the community. As manager Jay shared, ‘In a care home setting, you can be very proactive. You have a lot more time [than in domiciliary care] and you can pre-empt things, plan, be strategic.’
Older people also valued having regular and good-quality meals and drinks. 98-year-old Suzanne shared, ‘When I was at home… [and] feeling really bad, I had to get myself something to eat. It used to take me an hour and a half to get a cup of tea, and I lived for a fortnight on brown bread, Marmite and oranges, I was lacking good food.’
Finally, we heard examples of care homes ensuring older people can live their best lives, even in the last chapter of life. It was important to recognise that wellbeing extends through all stages of life and that end of life is no exception.
The best of care
Our research has revealed that, whilst care homes may not be right for everyone, they can be everything for some. It has shown how high-quality, proactive, relationship-centred care, inclusion in a social environment with meaningful activities, nutritious meals and a strong sense of safety and security has, in some cases, been truly transformative and supported many older people to really thrive.
This research was funded by Hallmark Foundation and independently engaged a range of care homes and care home providers. Click here to see the report’s findings in a short animation.
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Dr Bethany Morgan Brett is a Research Fellow at My Home Life England.
Email: [email protected] X @MyHomeLifeUK
Amy Simpkins is Communications and Marketing Lead at My Home Life England.
Email: [email protected] X @MyHomeLifeUK