Challenges and improvements associated with transitions between hospitals and care homes during the COVID-19 pandemic: a qualitative study with care home and healthcare staff in England

Craig Newman; Stephanie Mulrine; Katie Brittain; Pamela Dawson; Celia Mason; Michele Spencer; Kate Sykes; Frazer Underwood; Lesley Young-Murphy; Justin Waring; Jason Scott

doi:10.1093/ageing/afad146

Challenges and improvements associated with transitions between hospitals and care homes during the COVID-19 pandemic: a qualitative study with care home and healthcare staff in England

Age Ageing. 2023 Sep 1;52(9):afad146. doi: 10.1093/ageing/afad146.

Authors

Affiliations

¹ Department of Social Work, Education & Community Wellbeing, Faculty of Health & Life Sciences, Northumbria University, Newcastle-upon-Tyne NE7 7XA, UK.
² Newcastle University, UK.
³ Plymouth Marjon University, UK.
⁴ North Tyneside Community and Health Care Forum, UK.
⁵ Royal Cornwall Hospital NHS Trust, UK.
⁶ University of Birmingham, UK.

Abstract

Background: Care home residents transitioning from hospital are at risk of receiving poor-quality care with their safety being challenged by the SARS-CoV-2 virus (COVID-19) pandemic. Little is known about how care home staff worked with hospital staff and other healthcare professionals to address these challenges and make improvements to increase patient safety.

Objective: To gain insight into how the COVID-19 pandemic influenced the safety of transitions between hospital and care home.

Method: Semi-structured interviews were conducted with care home staff and healthcare professionals involved in hospital to care home transitions including doctors, nurses, paramedics, pharmacists, social workers, and occupational therapists. Commonalities and patterns in the data were identified using thematic analysis.

Results: Seventy participants were interviewed. Three themes were developed, first, 'new challenges', described care homes were pressurised to receive hospital patients amidst issues with COVID-19 testing, changes to working practices and contentious media attention, which all impacted staff negatively. Second, 'dehumanisation' described how care home residents were treated, being isolated from others amounted to feelings of being imprisoned, caused fear and engendered negative reactions from families. Third, 'better ways of working' described how health and social care workers developed relationships that improved integration and confidence and benefited care provision.

Conclusion: The COVID-19 pandemic contributed to and compounded high-risk hospital-to-care home discharges. Government policy failed to support care homes. Rapid discharge objectives exposed a myriad of infection control issues causing inhumane conditions for care home residents. However, staff involved in transitions continued to provide and improve upon care provision.

Keywords: COVID-19; care home; care transitions; hospital discharge; older people; qualitative research.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19 Testing
COVID-19* / epidemiology
England / epidemiology
Hospitals
Humans
Pandemics*
SARS-CoV-2