In England, 4,170 older people with substance dependence lived in a care home in 2022/23—a 32% increase from the previous year—yet care homes lack the knowledge and skills to support them properly. This matters because care homes are struggling with a growing population they were not designed for. There is evidence of avoidable harm, preventable hospital admissions, delayed discharges from hospital, and routine denial of admission to care homes. The Care Quality Commission has flagged this as a concern. The research team will interview people with substance dependence, their families, care home staff, inspectors, and other professionals, and analyse existing CQC data to understand what good care looks like and what gets in the way. If this research succeeds, it will produce a good practice guide for care staff, a guide for families, learning materials for inspectors, and case studies of innovative care homes. The goal is to reduce inequalities in access to care and cut preventable hospital admissions, saving money while improving lives. The findings will be disseminated through webinars, social media, and briefings tailored to each audience.
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Research question: What is the best way to support People with Substance Dependence (PWSD) in care homes? Background: The number of PWSD who require support in a care home is increasing rapidly in the UK and other countries. In England, 4,170 older people with substance dependence were supported in a care home in 2022/23, an increase of 32% on the previous year. Supporting PWSD in care homes presents complex practical, ethical and legal issues, yet very little is known how to support PWSD in this setting. Our previous research suggests that care homes are struggling to provide good care to this group, mostly because of a lack of knowledge and skills. There is evidence of avoidable harm, preventable hospital admission, delayed discharge from hospital and routine denial of admission to care homes. These findings are a concern for the Care Quality Commission (CQC) who will be our partners in this research. Aim: The study has two aims (a) to understand how PSWD experience care and identify areas for improvement (b) create a circle of dialogue among experts (including experts-by-experience) to develop a consensus on best practice and competencies required to deliver high quality care. Objectives: (1) explore how PWSD experience care, their support needs and which outcomes are important to them (2) identify the barriers/facilitators to achieving these outcomes (3) develop consensus on what good/innovative care looks like and the competencies care home workers require to achieve high quality care. Methods: Five key stakeholder groups – PWSD, families/advocates, care workers, inspectors and other care professionals, will be included and involved at every stage. Stage 1: A hermeneutic systematic review of literature on different models of care and strategies to support PWSD in congregate living care settings. Stage 2: In-depth interviews/focus groups with a diverse sample of PWSD, family members, CQC inspectors, care home staff and other professionals. Case studies of homes providing good/innovative care. Analysis of existing CQC data. Stage 3: Informed by insight from Stages 1 and 2, an online Delphi survey to develop consensus recommendations for best practice and the competencies required to deliver high quality care. Timeline for delivery: 27 months (April 2025 – July 2027). Anticipated impact and dissemination: This study is likely to reduce inequalities in access to care, experience and outcomes for PWSD and lead to cost savings, for example, a reduction in preventable hospital admissions. Evidence generated will be used to produce a good practice guide for care staff, a guide for PWSD/families, learning materials for care home inspectors, case studies of good and innovative practice, briefings tailored for target audiences, an online webinar and presentations. We will use our links with organisations representing care homes and care home staff, social media, newspapers, radio, research briefings and presentations to disseminate the findings and guidance.
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