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10 September 2022

Creating successful partnerships between science and care to enhance quality for older people living in long-term care environments

Karen Spilsbury, University of Leeds, United Kingdom
Reena Devi, University of Leeds, United Kingdom
Carl Thompson, University of Leeds, United Kingdom
Hilde Verbeek, Maastricht University, The Netherlands

Abstract

Older people living in, and staff working in, long-term care environments, should experience quality of care, life, and work. Partnership working between science and care organisations offers a unique opportunity to support this ambition and to offer sustainable solutions to address areas that matter most.

This session is focused on two partnerships; one based in the UK (Leeds), and one based in the Netherlands (Maastricht). The Nurturing Innovation in Care Homes in Leeds (NICHE-Leeds) and the Living Lab in Ageing and Long-Term Care (based in Maastricht) partnerships work towards enhancing the lives of people living or working in (or visiting) care homes. The NICHE-Leeds partnership commenced in 2018 and replicates the Dutch ‘Living Lab’ model first developed in the Netherlands 25 years ago. There are three organising principles in both partnerships: (1) A focus on residents (2) Harnessing interdisciplinary collaboration and (3) Using scientific and practice-based Linking Pins who hold joint appointments at university and long-term care organisations.

The model is gaining international recognition and adoption.

Carrying out high quality research is particularly important in long-term care given the growing number of older people. In our partnerships, we use participatory and appreciative approaches to surface questions that matter and then use robust methods to generate evidence-informed solutions, using methods to promote translation, relevance and uptake.

Partnership working in this sector is innovative and successful, but there are challenges. In this symposium we will:
• Consider the necessary ingredients for science and care partnerships
• Describe the opportunities and challenges inherent in the role of the Scientific Linking Pin
• Expand on two research areas identified by long-term care: (1) CONTACT trial (Leeds) and (2) Innovative long-term care environments

Presentation 1: The recipe for partnership success

Karen Spilsbury, University of Leeds

Introduction: Building partnerships that are successful in their ambition to improve life, care and work in care homes is a complex undertaking. Partnerships by nature are interdisciplinary. Key partners include researchers, frontline clinical and care staff, care organisation senior management teams, local health and care service commissioners, and people work live in or visit care homes. Building and sustaining interdisciplinary collaborative working across this wide range of people, and ensuring they work well together to develop and embed evidence-based solutions into care homes is an ongoing process. Many different components and structures are needed for partners to work together effectively and ensure those at the heart of the partnership benefit from enhanced life, care, and work in care homes. Given the definitional and methodological complexity surrounding partnership working we recently explored the key indicators of success in partnership working, and core principles and features that enable care and academic partnerships to be successful.

Methods: In May 2022 members of the NICHE-Leeds and the Living Lab in Ageing and Long-Term Care partnerships met and discussed:
1. How is success in our partnership models defined?
2. What are the key ingredients needed to enable partnerships to be successful?

The meeting delegates (n=14) included care home senior staff, clinicians, a family representative, researchers, and care home operational management staff.

Results: Partnership working success outcomes included the following: having a shared vision, sharing common values, open communication, mutual respect, collective decision making, inclusive representative amongst partnership members, using a shared language, and bridging the gap between evidence and practice.

Key ingredients for success were described at organisational and individual levels. At an organisational level the following key ingredients were described as important: job descriptions to promote role clarity, formalised time dedicated for working on partnership activities, and regular opportunities for partners to reflect and support each other. Managers and senior staff within the partnership are key to ensuring organisational level key ingredients are in place.

At an individual level the group described the importance of appointing trusted, respected, and influential team members who endorse partnership working models, boost morale and encourage teams to value what they do. These team members are passionate, confident, and motivated, and are key for promoting collaboration.

Discussion: Our findings provide invaluable insight into what makes a partnership successful, and these insights are important for others wishing to replicate partnership models between care and science.

Presentation 2: Partnership working between care and science: the role of the Scientific Linking Pin

Reena Devi, University of Leeds

Introduction: Working effectively in a care and science partnership is important. The NICHE-Leeds and Living Lab in Ageing and Long-Term Care partnerships are diverse, comprising a wide range of interdisciplinary partners. One key role in these partnerships is a Scientific Linking Pin (SLP): a senior researcher who is employed one day per week for one of the care home organisations that is part of the partnership. The SLP has a pivotal role influencing the success of the model. The nature of the SLP role has not yet been captured in the evidence domain. The aim of this study was to identify and describe the goals and activities of SLP researchers and explore the barriers and enablers to working in this role.

Methods: Semi-structured interviews were carried out with academic researchers either currently employed as a SLP, or who have previously worked as a SLP. Participants were recruited from Maastricht and Leeds. Data were analysed using thematic analysis.

Results: 15 participants took part in semi-structured interviews (11 female and 4 male). Data analysis resulted in three overarching themes: i) general experience of working as a SLP researcher, ii) the goals and activities, iii) barriers and enablers.

The general experience of working as a SLP researcher theme includes 4 sub-themes. Working as a SLP meant researchers have close connections to and deep insights into care home practice, and this enriched their academic activities (research and teaching activities). Participants also described working as a SLP researcher in an innovative care and science partnership as a unique position and one which they considered a privilege. This role also offered the researchers opportunities for professional and career growth. Participants also described the impact they were able to have in their roles whilst working on internationally relevant topics.

Within the goals and activities overarching theme, participants described the overall aim of their role as being to enhance life and care and work in care homes. Data analysis resulted in 8 sub-themes themes outlining the distinct ways SLPs work with care organisations to achieve this: 1) relationship building, 2) identifying priorities, 3) co-developing research projects, 4) creating a research and innovation culture; 5) supporting care homes with implementing and guiding the implementation of evidence into practice, 6) knowledge brokering, 7) building links across the partnership network, and 8) disseminating evidence.

The barriers and enablers overarching theme provides insight into the barriers which hindered progress when working as a SLP, and the way to overcome these barriers. This theme includes 6 sub-themes: 1) building SLP capability, 2) multiple, mismatched or rapidly changing priorities; 3) managing care organisation expectations, 4) building trust, relationships and engagement; 5) navigating differences between SLP and care home staff, 6) care home staff turnover.

Conclusion: Our findings provide invaluable insight into navigating and being successful in a SLP role. The partnership model is being replicated around the world and so these findings will be of interest to wider science and practice communities developing and embedding research in long term care.

Presentation 3: Addressing topics that matter: contact tracing, quality and COVID19 in care homes

Carl Thompson, University of Leeds

Contact tracing is a key line of defence in infection control and prevention (ICP). The high numbers of residents in homes with memory problems and the nature and quantity of caring work means that traditional approaches to contact tracing are both underutilised in homes and likely ineffective. Contact between residents and between residents and staff is also fundamental to care delivery – it is the key mechanism for facilitating quality of care; an absence of human contact can also detract from life in a home. Traditional research methods of describing these contacts (such as non-participant observation) are intrusive, expensive, and alter the behaviours (and therefore nature and frequency) of contacts.

The CONTACT study was a UK NIHR-funded feasibility study and planned definitive cluster RCT of digital wearable devices that use Bluetooth and LoRoWan technology to capture and describe the social networks of resident, staff and visitor contacts in homes unobtrusively and on a 24/7 basis. Once analysed and translated, CONTACT’s information can be used by managers to make informed IPC choices and – crucially – to contribute to a picture of “quality” in the home.

In this presentation we will describe the technology and associated research design and methods, show the results of our analysis based on >4m data points in 6 homes over a year, discuss the theory-informed implementation of the technology and why it failed, and describe how – despite the changing nature of the COVID19 pandemic and a less than optimal implementation approach – wearable technology has enormous potential to enhance the quality of life, care and experience of care home residents, staff and families.

Presentation 4: Addressing topics that matter: Innovative dementia care environments as alternatives for traditional nursing homes - evidence and experiences from the Netherlands

Hilde Verbeek, Maastricht University

Key goals of the dementia care environment focus on increasing autonomy, supporting independence and trying to enable the lifestyles for as long as possible. To meet these goals, innovative, small-scale and homelike care environments have been developed that have radically changed the physical, social and organizational aspects in the Netherlands.

This presentation discusses various Dutch models that have implemented small-scale and homelike care environments, including green care farms, dementia villages and citizen initiatives. The models reflect a common care concept, focusing on residents’ remaining strengths, providing opportunity for choice and aiming to sustain a sense of self and control. A small number of residents (usually 6 to 8) live together in a homelike environment and nursing staff are part of the household. Residents are encouraged to participate in daily household activities, emphasizing normalization of daily life with person-centred care. The physical environment resembles an archetypal home.

This talk presents the scientific evidence on the impact and effects of these small-scale, homelike models on residents, their family caregivers and staff. Furthermore, the presentation will highlight working mechanisms and how these initiatives have influenced regular care within the long-term care spectrum.


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