Under embargo until: 00.01 hrs Tuesday 29 April 2008
Night-time practices jeopardise quality of care in residential homes
The quality of night-time care in residential homes is at risk due to a lack of routine inspections and adequate training or supervision of night-time staff. This is according to a new study for the Joseph Rowntree Foundation (JRF) from the Scottish-based Centre for Research on Families and Relationships (CRFR).
Although residential care homes provide a 24-hour service, little is known about what happens at night in these settings. With standards relating to night-time care notably absent from both legislation and policy guidance, Supporting older people in care homes at night is the first study of its kind to shine a spotlight on the night-time care experiences of residents, relatives and staff. It also reflects the views of the Care Commissioners, who are responsible for inspecting care homes in Scotland.
Dr Heather Wilkinson, report co-author and co-director of CRFR, said: "Despite supporting 400,000 elderly people 24 hours a day, residential care and nursing homes are seldom inspected during the night, usually only if there has been a complaint. We found that night-time inspections were carried out with less rigour than day-time inspections."
The study, carried out across three care home sites in Scotland, sought to identify areas of good and poor practice, and ways to make improvements through a series of interventions. Some of these were tested out in the ‘action research’ stage that followed the initial fact-gathering research.
When good quality day-time care is provided, the social, personal and environmental needs of residents are taken into account: residents are assigned key workers, they interact socially with others, and their medical needs are met. This is just as important during the night, although additional issues also need to be considered.
The report found that unacceptable levels of noise and light disturbed and agitated residents during the night; the physical environment was disabling rather enabling, especially for people with dementia; and night staff felt undervalued and isolated from the running of the home. It also found that night staff received less training than day staff – and little or none on responding to people with dementia, supporting continence, recognising and managing pain, or encouraging good hydration and nutrition during the night. In addition, managers in the care homes studied were insufficiently involved in night-time supervision and practice.
During the research process, staff were found carrying out routine and indiscriminate ’checking’ (for breathing, falls and incontinence) through the night, due to a general culture of anxiety. Dependence on unfamiliar agency and bank staff increased the workload of regular staff and jeopardised quality of care for residents.
Wilkinson added: "Night-time care is not just about promoting sleep. Some residents welcome company during nightly checks. It is also an opportunity to promote good nutrition and hydration. In addition, those with dementia who are awake at night would benefit from signage to help orientate them and from the removal of wall mirrors which can confuse them.
"To improve the quality of night-time care, it is essential that night-time staff are supported, trained and valued. We found that night staff missed out on relevant training; felt isolated and anxious due to lack of management and supervision; and had their workloads increased by having to instruct and supervise agency staff."
Wilkinson concluded: "Recommendations that emerged from this research project recognise that night-time care is a key part of a 24-hour care service. Relatively minor changes in practice, such as not turning on bright lights and assigning a key worker to residents to manage individual night-time care plans, can result in considerable improvements to the night-time care experience of both residents and staff."
Notes to Editors:
- The full report, Supporting older people in care homes at night by Dr Heather Wilkinson, Diana Kerr and Colm Cunningham from the Centre for Research on Families and Relationships, is available as a free download.
- The research team carried out the work across three care home sites in Scotland. These were a mixture of voluntary, private and statutory provision. Interviews were conducted with Care Commission Officers, care home residents, direct care night staff, managers and relatives, and observations were undertaken during night shifts in the homes.
- The Joseph Rowntree Foundation is one of the largest social policy research and development charities in the UK. It supports a research and development programme that seeks to understand the causes of social difficulties and explore ways of overcoming them.
Issued by Nasreen Memon, JRF Head of Media Relations: 020 7278 9665 / 01904 615 919 / nasreen.memon@jrf.org.uk
