SCWRU Service User and Carer Advisory Group, 2nd November 2017 Katharine Orellana Jo Moriarty Caroline Norrie Valerie Lipman Rekha Elaswarapu Jill Manthorpe RESIDENTS’ AND FAMILIES’ PERSPECTIVES ON SHIFT HANDOVER IN CARE HOMES FOR OLDER PEOPLE: EMERGING FINDINGS Margaret Butterworth Care Home Forum 28th November 2018 katharine.orellana@kcl.ac.uk Health Research Authority, Social Care Research Ethics Committee (Ref no. 18/IEC08/0001)  

Disclaimer and acknowledgements SCWRU Service User and Carer Advisory Group, 2nd November 2017 Disclaimer and acknowledgements We thank the care homes’ owners and managers who helped with this study and the residents and family members who took part. We thank the Study Advisory Group and SCWRU’s Service User and Carer Group for their input to this study. The study was funded by the Abbeyfield Research Foundation and we are most grateful for its support. The views and opinions here are those of the authors and should not be interpreted as those of the funders of their research. Images: www.openclipart.org

SCWRU Service User and Carer Advisory Group, 2nd November 2017 WHY LOOK AT THIS TOPIC? Care Quality Commission says handovers are an important tool for assessing lots of things (e.g. safety) - but no CQC guidance on what is good practice Little attention to care homes and non-nursing staff handovers in research Yet: care homes provide 24 hour care and need workers to work different shifts residents have more complex health conditions Reported from perspective of care home staff (and observations): Content, purpose and effectiveness of handovers between off-going and in-coming staff)

SCWRU Service User and Carer Advisory Group, 2nd November 2017 OUR STUDY Total participants: 31 Exploratory, focused-ethnographic qualitative approach to study care home residents’ and their relatives’ views and experiences of handovers at shift changeover 31 interviews and 47 observations of residents during handover periods (at different times of day) Service user, carer and other expert input

FIVE CARE HOMES - all CQC rated ‘Good’ SCWRU Service User and Carer Advisory Group, 2nd November 2017 FIVE CARE HOMES - all CQC rated ‘Good’ Care home with nursing - large chain, for-profit • Capacity 150 • One unit for residents from an Asian background Care home – small, for-profit business Capacity 33 Care home with nursing - small chain, not-for-profit Capacity 185 Care home – small chain, not-for-profit Capacity 56 Care home with nursing – large chain, for-profit Capacity 65 A B C D Images of care homes from Wikimedia (not the study care homes) E

SCWRU Service User and Carer Advisory Group, 2nd November 2017 SHIFT HANDOVERS Residents’ views mainly influenced by: what they were doing at shift handover times whether they wanted to be doing something different at those times (e.g. getting up/going to bed earlier/later) whether they felt staff were available if they might need them ccc Mix of shift handovers 2, 2 or 3, 4 Mix of handover locations Room-by-room Staff room Reception Office Lounge Nurses’/care workers’ station

AWARENESS OF HANDOVERS AND HANDOVER PRACTICES Residents mainly unaware of handovers / what took place at them Family members aware of handovers but had not seen them Assumption that administrative procedures would operate without input from residents or relatives Least content with handover length: - residents awake and needing or wanting assistance - relatives concerned for vulnerable residents Z Z Z . . . We don’t really, you know we don’t really see much of what they do except when they’re with us. (Resident 6)

VARYING PRE-/POST-/DURING PRACTICES AT HANDOVER TIMES Delivering drinks or doing a room round checking on residents  caring vs checking ‘that you’re still responsive’ (Resident 13) Greeting and bidding farewell I think my mum identifies with “Are you going home now? Have you got far to go?”, she'll ask them. (…) I've been here many a time and she knows the night staff because she'll say “Have you brought my tea?” (Family member 1) Varying formality of discussions, inclusion of residents, woken or left asleep Care related/advice/ information interactions or general conversation … and task-related actions with no interaction Mainly protective of residents’ dignity and privacy

INVOLVEMENT BY RESIDENTS Some residents: are content for no involvement in discussions about them would prefer a certain level of involvement Some residents: value the social opportunity of being involved in pre-/post- /during handover conversations But at 9 o’clock at night I don’t think I’d be terribly interested in what they’re discussing, not in the slightest. (Resident 1) They always say “good morning” and “good night”. I always say “good morning” to them when they come in and I always wish them a good, quiet day. I wish them a safe journey home and a good rest. (Resident 4) … but we don’t know because they don’t tell us anything. If you don’t ask, you don’t know nothing (Resident 4)

HANDOVER PURPOSE AND EFFECTIVENESS Most residents felt safe and known Most family members: - had a good idea of the purpose of handovers - felt they and residents benefited from these - felt their relative was well looked after - were uninterested in handover information As I said, I don’t really know much about it but whatever they’re doing seems to be working okay. As I don’t know much about it, I can’t really answer that too fully. (Family member 3) Very few examples of ineffective passing of information between shifts Most residents and relatives happy with status quo or did not know enough to judge, but some scope for improvement

SCWRU Service User and Carer Advisory Group, 2nd November 2017 No one single model of handover as being desired or considered to be most effective by care home residents and relatives, and which might be replicated  but different perspectives revealed  touches on ‘street-level’ work in care homes What may be the most appropriate ways of approaching pre-/post-/during handover communication with residents? N.B. Low expectations & reluctance to complain or challenge practice Residents are often unable to imagine how care and support may be delivered differently A care home = place of residence + a place of work  Tensions between medicalisation v comfort and relationships  Are there differences between staff attitudes to handovers because they are in a care home not a hospital ward? Do staff regard the nursing unit as a hospital ward or a care home? SOME THOUGHTS

FURTHER RESEARCH? Differences in perspectives and outcomes for residents with varying or changing needs Impact of handover timings on residents What is the gain and loss from electronic handover devices ANY MORE SUGGESTIONS?