Exploring the experiences of adults, their care partners and care home staff around moving into care home settings and identifying interventions which support the move: a mixed methods systematic review

Background: Moving into a care home is a life-changing experience for the adult involved, and also for those who are involved in supporting them, personally and professionally. It is associated with significant financial costs, typically shared by individuals and health and care systems. Feedback obtained from members of the public, family members and older adults facing the need for long-term care placement has consistently highlighted the lack of support and significant scope to improve the experience for those making the move. Thus, there is a gap in our understanding about those moving into care homes, including the diversity of characteristics of those moving, their needs and diagnoses. Understanding the people involved and their relationships is a critical first step in determining supportive interventions to improve transitions into care homes. Review questions: (1) What are the views and experiences of adults moving into a care home setting and how can their care partners and care home staff support this transition? (2) What interventions have been tested to support the process of moving into a care home and how effective are they? (3) What are the components of interventions used to support move into care homes, and what are the outcomes used to assess their effects? Methods: We will undertake two distinct reviews to address these questions. Firstly, a review of qualitative studies on the experiences of adults, their care partners and care home staff about moving into care home settings including the barriers and facilitators of successful transitions of care. Secondly, a review of interventions which have been tested with the aim of supporting those moving into care homes and other enhanced care settings. Our reviews are interested in mapping who is and is not included in the current evidence. This relates to the characteristics of the adults moving (in terms of age, diagnoses and long-term conditions), where they move from (e.g. hospital or community), the relationship with their care partner (e.g. spousal, child, friend) and which staff groups are included (e.g. nurses, carers, managers). Risk of bias will be assessed using the CAMELOT tool for review 1 and Cochrane ROB1 for randomised intervention studies and ROBINS-I for non-randomised designs. Analysis: Data will be presented using a mix of data visualisation, tabulation and narrative description. For review one, we will use the technique of meta-ethnography to synthesise identified qualitative studies. For review two, if identified studies have used comparable outcome measures and it is clinically appropriate to combine data, quantitative synthesis will be undertaken. This will take the form of pairwise meta-analyses. From both reviews we will also generate a visual summary map about who is included in the research evidence – in terms of resident populations, care partner relationships and staff groups. Involvement: These review questions arise directly from those with personal and professional experience of care home transitions. It is supported by members of our evidence synthesis PPI group and by a wider network of interest-holders. They will support in making sense of findings, identifying gaps and producing accessible materials for dissemination and impact.