CHARM Care Home Research Study: Using research to help improve dementia care

Four care homes participated in the CHARM research project, conducting two mini-research projects each. This blog shares the experiences of Hallmark Care Home’s Anya Court Care Home in Rugby and their whole journey through the CHARM project.

Thanks go especially to Lifestyles Lead, Sue Mitchell, Home Manager Michelle Sides, Dementia Care Manager Cheryl Jones, and Dementia & Wellbeing Lead for Hallmark Care Homes April Dobson for their work as part of the Anya Court Research Working Group.

Stage 1: Find out, plan and prepare

The team at Anya Court was originally very different to the one that ended the project! Sue and April were originally joined by a different home manager, a lead carer, the hospitality lead and a family member. This team planned to implement a project called “home in time for tea” exploring the impact of switching the “big” meal of the day from lunchtime to evening time and introducing food preparation activities for the residents to get them more involved. It was hoped this might improve resident well-being and sleep. The team developed their own measurement tools and ran awareness days to let everyone know what would be happening.

Stage 2: Act and make things happen

In February 2020 they set about implementing the change and collecting data. And then coronavirus hit!

Whilst the home managed to carry on collecting data (which was an amazing feat, well done Sue!) the original plans for the change were affected because the activities to involve the residents (a big part of the switch) were just not possible under social distancing and infection control requirements.

You can read about this project, the team’s progress and some preliminary results here:

Link to project resource

When Anya Court were ready to re-engage with CHARM in late 2020, a lot had changed. They had a new manager, a dementia care manager who was due to start in the new year and only Sue left from the original team who had been waving the flag for CHARM valiantly by herself for several months! Sue, Michelle and April got together and discussed what they would like to do with their remaining CHARM project whilst they waited to be able to restart the mealtimes project when restrictions were lifted.

They were very clear that “we don’t want to hear the C-word!” (COVID) They wanted to focus on something that would help their team move on from the last 8 months. In particular, as a new manager, Michelle had lots of plans for change – particularly in relation to improving dementia care in line with Hallmark’s dementia care strategy and with a new dementia care manager joining the team (Cheryl). We therefore helped them develop a research project that would involve the team in the planned changes and help them keep track of what was working and not working.

The new research was called: “What do you need to carry out your role and improve quality for life for residents living in the dementia community”

Stage 3: Study, watch and listen

The research working group designed an in-depth questionnaire that asked their team members about their thoughts and experiences of the following parts of their work:

• feeling valued at work
• feeling involved and empowered at work
• training and support
• relationship-centred care

The team completed this questionnaire and then the findings from this were analysed to create a picture at the start of the research. The findings were also used to influence the action plan for change which would be implemented over the next 6 months. The survey would then be completed again after 3 months and 6 months to see what had changed for the team, together with some focus groups with the team.

Stage 4: Reflect, think, discuss and change

After 3 months, the project produced A LOT of data and there was a definite feeling that things had changed for the better on the dementia community. As one of the focus group participants said:

When the team compared the findings from the initial picture with the picture after 3 months this was confirmed. Improvements had occurred, but there was still some progress to be made (as they’d expected half way through their 6 month plan).

The headline findings at 3 months were:

• Our action plan has had a modest effect on improving team members’ feelings and experiences of being valued in their work. This is not as dramatic as we hoped, but this perhaps highlights that making sure people feel valued for their work is an ongoing individual issue

• Our action plan has had a modest impact on improving team members feelings and experiences of feeling involved and empowered. This has demonstrated that improving these areas is harder than we hoped, but we are making progress.

• Our action plan has been successful in improving team members’ feelings and experiences of training and support. Informal every day support appears to have been particularly improved, appreciated and impactful.

• Our action plan has been successful in improving relationship centred care, especially with regards to the experiences of residents

The five most popular words chosen by the team to describe care at Anya Court

The team wrote this project up as a final report and designed two “you said, we listened” posters to communicate their progress to the team.

Link to final report

Link to poster 1

Link to poster 2

But they’re not finished!  The research group have developed an action plan for the next 3 months and plan to run the questionnaire and focus groups again at 6 months as planned. They’ve definitely caught the research bug.

Well done everyone at Anya Court!

CHARM Care Home Research Study – A project to find out resident, visitor and staff preferences and suggestions for our new garden space and associated activities

Four care homes participated in the CHARM research project, conducting two mini-research projects each. This blog shares the experiences of Sanctuary Care’s Hastings Residential Care Home in Malvern, Worcestershire and their second mini-research study. Hastings is also part of Sanctuary Group and thanks go especially to Home Manager Sue Milward, Deputy Manager Dan Reeves, Activity Coordinators Kirsty Sinton, Jackie Sadler, April Walwyn, Hannah Barber, Jenny Douglas and Project Manager Elizabeth Johnston of Sanctuary Care for their work as part of the Hastings’ Research Working Group.

Stage 1: Find out, plan and prepare

The direction of the project was decided with the knowledge that landscaping work planned for the garden area was about to start following the build of “the orangery”, a new conservatory area to the care home, which had left the garden in a bit of a state!) In addition, Sanctuary Care – the Organisation that runs Hastings – had a “spring initiative” underway, which was focussed on helping residents access gardens and outside spaces, as a way to enhance their well-being. Both these factors meant that focussing on the garden space seemed appropriate and timely for their second research project within CHARM.

It was decided that the CHARM research could be used innovatively to inform the design and plans for the garden space by consulting with as many interested people as possible. This was with the aim to ensure that the new garden space met people’s wants and needs.

The project aimed to:

1. Enhance the lives of residents at Hastings by providing them with access to good, accessible and safe outdoor space at their home, with the knowledge that the natural world is known to improve well-being.
2. Ensure that everyone’s needs were considered, including residents, family members, visitors and staff.
3. To open up interest and opportunities for everyone to be involved in helping with the changes to the garden space and to make use of the space when it’s finished.

Stage 2: Act and make things happen

This project was an exploratory study to find out how three groups at Hastings (residents, staff and families/visitors) wanted to influence the plans for the garden and related activities. The team decided to use a different approach for consulting each group. The three approaches were:

Staff Group

Staff were invited to take part in a focus group run by two members of the care home research team.

Family/friends Group:

A questionnaire was created for family friends and visitors to complete, to provide Hastings with their preferences and ideas around the design, features and uses of the garden.

Resident Group:

Residents, including those living with dementia took part in a series of consultation groups facilitated by staff. The consultation groups took three different forms:

1. A group activity using ‘planning packs’, in which residents chose where to place certain items on a garden plan.
2. A group discussion about what would make a good garden.
3. A discussion group about favourite plants that prompted the senses of smell, sight and taste.

Planning packs activity

Stage 3: Study, watch and listen

The team at Hastings received:

• 18 responses from the friends, family and visitor questionnaire
• 5 members of staff participating in the staff focus group
• 6 residents took part in group discussions around what would make a good garden
• 6 took part in the garden planning activity pack
• 8 residents took part in selecting favourite plants

Once all the data was gathered it was time to find out what it told the care home and what they could learn from it. With the help of the CHARM researchers-in-residence from the Association for Dementia Studies, the team analysed the data and produced basic descriptive statistics.

You can read the full report of the findings here:

Link to report

See the poster of their findings here:

Link to poster

Findings from the resident consultation activities around landscaping and feature preferences

Stage 4: Reflect, think, discuss and change

Once the data was analysed, it was time to look at the findings and work out how these could influence the decision making about the garden. They came up with a list of common ideas from all three groups and these have been used to create an action plan for the next steps in building the garden.

Landscaping

Aspect	Suggested by
Space to move and walk This should be built-in and paid attention to with placement of furniture etc.	Residents, staff and families
Shaded seating areas Both permanent and portable Also think about some that also doubles as sheltered seating in poorer weather	Residents, staff and families
Interactive and sensory plants Pay attention to how it functions and looks all year round	Residents, staff and families
Accessible pathways with safe, level surfacing Think particularly about providing a pathway to follow around the garden for those who wish to walk	Staff and families
Routine Maintenance Ongoing maintenance should be incorporated into the action plan Cannot rely on staff voluntary work Watering is the most pressing problem, could a sprinkler system solve this?	Staff and families

Features

Aspect	Suggested by
Raised flower beds Providing opportunities for participation	Residents, staff and families
Focus on sensory planting Suggestions made: grasses for movement; lavender, herb garden, strong scents and colour Resident preferences as listed above	Residents, staff and families
Comfortable seating With shade and allowing group dining and socialising	Residents, staff and families
Water feature As a talking point Think about sound of water on stones/waterfall	Staff and residents
A greenhouse Accessible by residents to help with potting, planting and watching things grow	Staff and residents
Bird feeding stations, table and bird bath	Families

Activities

Aspect	Suggested by
Potting, planting and watching things grow Interacting with plants is really important	Residents, staff and families
Sensory engagement Smelling, tasting, touching as prompts for reminiscence and conversation	Residents, staff and families
Adding to the garden features Building wildlife area, bug/bee hotels Perhaps an area could be saved to be readily changeable or added to at a later date	Residents and staff
The use of the garden is what makes it special Helping with routine tasks Spending time outside and socialising	Residents and staff
Encourage families to socialise and use it Signage Events Invitations to participate in activities	Staff and families
Launch the new garden with an open day! To encourage use and possible volunteering from visitors	Overall
Listen and encourage residents to share their own ideas The consultations with residents created positive and enjoyable environments so that residents could take part. This is important for all activities	Overall

In addition, by sharing their project findings with others in the CHARM group, a care home with a specially designed dementia garden has been identified and the team at Hastings will be visiting to help with their own design: A great example of sharing learning across our CHARM care homes and one of the key intended outcomes of the CHARM project!

CHARM Care Home Research Study – Covid in a Care Home

Four care homes participated in the CHARM research project, conducting two mini-research projects each. This blog shares the experiences of Care UK’s Perry Manor Care Home in Worcester and their whole journey through the CHARM project.

Thanks go especially to Home Manager Katherine Matthews, Dementia Care Manager Donna White, Lifestyles Lead Tiffany Thompson and Dementia & Nursing Lead for Care UK Suzanne Mumford for their work as part of the Perry Manor Research Working Group.

Stage 1: Find out, plan and prepare

The team at Perry Manor originally planned and started a project exploring the best way to support their staff to use the PAL Tool (Pool Activity Level, 2011) to deliver dementia care. They went through all the planning stages, intending to compare the ‘usual’ use of the tool with a ‘bespoke’ version. They developed their own measurement tools and completed the extensive ethics steps because they wanted to involve people living with dementia. You can read about this project in the following booklet.

Project booklet

Stage 2: Act and make things happen

However, COVID hit just before they got a chance to move onto stage 2 of the research process! It was impossible to carry out the staff training or collect the data in the way they planned, because of the stresses and changes required by COVID protocols. Therefore, we had to “shelve” the original project (we’ve saved all the tools and work completed, so that the home can do the research in the future if they want to). At this point I will hand over to Tiffany Thompson, co-researcher extraordinaire, to tell the story on behalf of the Perry Manor research team.

“We originally planned on basing our CHARM project on the effects of using the tool with the residents on our Dementia suite. However, due to the world-wide pandemic and spread of Covid-19 our world was turned upside down. We had to pause our involvement in CHARM and we weren’t able to get restarted until the middle of 2021. We had to completely rethink what we would be able to do as a piece of research and how we would be able to do it, because our resident and staff group had changed so much in the intervening months, and we had only a limited timeframe left

The only thing that was consistently on our minds was coronavirus. That was when we realised that the most important thing that we could possibly do some research on was the virus. Perry Manor Care Home, like many other homes throughout the pandemic has had a very difficult time and this has had an effect on the staff, residents and their relatives. Sadly, our home experienced an outbreak which took the lives of many residents. These experiences have profound effects on us all, which is why we wanted to do our research project on this. We hoped that our research project could help share our experiences with the wider community but also help the staff, residents and relatives find some closure too.

The title of our research was: “COVID in a care home” The experience and impact of COVID-19 and the home’s recovery from a staff perspective

At first, we did not know if this project would be too difficult for staff to get involved with and so we didn’t know if we would be able to get the data needed for our project to work. We were blown away by the amount of staff who not only got involved but, in some cases, poured their hearts out sharing their experiences. 43 out of 60 staff returned their anonymous surveys and a further 12 staff volunteered to take part in interviews!

Stage 3: Study, watch and listen

When it came to reviewing the data collected, it opened a range of emotions. Some of the findings was so true and raw, that it was difficult to read, while others were so shockingly positive that I couldn’t help but smile. My and my colleagues’ main take away from this project, was just how much the staff are committed to the residents of Perry Manor. That their passion for enriching their lives and ensuring that their life continued to the best of its ability throughout the pandemic was vital.

Stage 4: Reflect, think, discuss and change

We wrote these findings up as a final report and designed a short booklet and poster to help share the findings in an eye-catching way:

Final report

Short booklet

Poster

The whole point of our project was to help our staff tell their COVID story in the hope that it would help Perry Manor, its staff residents and relatives, to move forwards. As part of our conclusions, we made the following action plan:

• Share the findings with the Perry Manor staff team to demonstrate that their story has been heard
• Consider ways that we can share these findings with residents and families and support them to tell their parts of the story as well.
• Consider how we can share findings and what we have learned across Care UK – whilst being sensitive to staff confidentiality and anonymity.
• Write this research up for publication in a journal (such as the journal of dementia care and the royal colleague of nursing journal) – again being sensitive to confidentiality and anonymity.
• Continue the aspects of pandemic life that we have identified as positive (e.g. Namaste Care, activity trollies)
• Maintain the teamwork, unity and support that existed though the pandemic.
• Celebrate the milestones of return to normal (first trip, first café visit, first activity)
• Understand that individuals will have a differentiated path to recovery
• Remind ourselves that grieving and healing can be a long journey and that everyone’s experience will be different
• Complete our memorial garden as a way to remember the residents we lost and the challenges we faced.

My experience of taking part in CHARM

Doing this research project has been an amazing experience for myself personally, as I have learnt so much! I have always been excited when it comes to learning anything new, so when I was asked if I would like to get involved with CHARM, I jumped at the opportunity. Throughout the project I have learn so many new skills and ways of working. I now understand how to make an ethics form, complete questionnaires, conduct interviews, complete data analysis and even put the data into a word cloud. I am very grateful for this experience and hope to get involved with more research in the future!”

Thanks for telling us about your project, Tiff! – The CHARM team

Involvement in CHARM from the perspective of Provider Lead

Four care homes participated in the CHARM research project, conducting 2 mini-research projects each. This blog shares the experiences of Anya Court Care Home in Rugby, from the perspective of their Provider Lead, April Dobson. April is Head of Dementia Care and Wellbeing at Hallmark Care Homes and has played an active part in CHARM from the very beginning: from helping design the model and bid for funding, to supporting the research team at Anya Court to conduct their own research projects.

Thanks especially also goes to Sue Mitchell, Cheryl Jones, Sally Mahon and Michelle Sides of Hallmark Care Homes for their work as part of the Anya Court Research Working Group. Over to April:

“I had been aware for some time of the various different research and service evaluation projects conducted by ADS and was introduced to CHARM by Isabelle Latham. Isabelle had been the course lead of the module I participated in.

A large part of my role involves supporting our teams in the homes to continuously develop their own dementia care practice; that might be through identifying training needs and opportunities, advising on the physical environment, or sharing innovative ideas and projects. I’m always really keen for ideas to come from the people who are delivering hands-on care, and know the residents best, so CHARM sounded like an ideal opportunity to develop some of their ideas more fully.

I also know that taking part in research can often feel daunting for care homes, and worries about the pressures of time, resources and usefulness can put care homes off taking part. However, we also know that care homes want to deliver the best practice for their residents, are interested in trying out new things, and that within the team, residents and their families, there are lots of untapped skills and experiences.

I initially put a proposal forward to our board to ask for their approval for Hallmark to be involved. Anya Court seemed the ideal home for the project, given its location and accessibility for the research team. I particularly liked the hands-on coaching and mentoring elements that the proposed researcher-in-residence model included and wanted to ensure that these could be fully integrated.

The home manager at Anya was relatively new to the organisation and I felt that the project would help get everyone working together. I met with her to discuss the project.  She was really enthusiastic and keen to be involved, and so I subsequently invited Izzie and Faith (the researchers-in-residence) along to talk to all heads of departments, and team members in the home.

Fortunately, there are some natural leaders at Anya Court – one of those being Sue Mitchell, the lifestyles lead, who immediately stepped up to the plate. The great thing about CHARM is that the ideas for research and service evaluations come from the team, and Sue and the team were immediately able to identify areas of practice that they all wanted to improve and change.

At the start of the CHARM project we also persuaded a family member to become involved in the project, and his impact added a different, and very welcome perspective to our thinking and planning.

For project 1, the team wanted to change the meal-time experience for people living with dementia as they had noticed that having a large, 3-course meal at lunchtime was proving unsatisfactory for some on a number of levels, and wanted to see if a larger meal at the end of the day would work better for them.

They identified that the gap between breakfast and lunch, for some, wasn’t that long, and as a consequence some people did not eat much at lunchtime. With only a light teatime/evening meal, some were hungry during the night and may not have slept well as a result. Those who did eat a large meal at lunchtime were often sleepy and inactive during the afternoons.

The team also felt that having longer to engage people in the preparation of food would provide additional opportunities for involvement in a wider variety of activities of daily living, such as chopping vegetables, making soup, preparing sandwiches, etc. bringing with it a renewed sense of purpose, achievement, and belonging. This coupled with the added aroma of baking and cooking throughout the day, could act as sensory stimulus. Having a lighter meal at lunchtime which took up less time might also enable residents to take part in activities that would otherwise be interrupted by the long lunch-time service.

For project 2, the team considered the many changes that had happened in the home and on the dementia community. There had been a change of manager, and the COVID-19 pandemic had negatively impacted residents, relatives and team members. The team decided to focus on how they could support the home and team members to rebuild the morale and skills needed to help people living with dementia in the best possible way. They felt that focussing on communication and training would really help move things in the right direction.

Involvement with in-person meetings during the project was great – we had some at the home, and the wider group met to share their projects and learn more about the research methods and CHARM approach. All of the meetings were incredibly positive and supportive – we all learnt a huge amount. The most valuable aspect was being together with other care home providers, sharing good practice and ideas, and also supporting each other with the various challenges we identified. The on-line meetings were also helpful in keeping the momentum going, although this became increasingly difficult as the pandemic progressed.

The CHARM researchers were pivotal in helping us all stay focussed, and providing a friendly safety net. Their knowledge, flexibility, understanding of the care home environment, and support ensured that the project moved forward at a pace that was comfortable and realistic for everyone.”

Watch this space to read the reports from Anya Court’s specific research projects, which will feature in our blogs in the next few weeks!

CHARM Care Home Research Studies – Park Farm Lodge

4 care homes participated in the CHARM research project, conducting 2 mini-research projects each. This blog shares the experiences of Park Farm Lodge in Tamworth, providing an overview of their mini research project called, “What is the best way to gather life history about our residents? A survey of family members, friends and visitors”

Thanks especially also goes to Beci Paul, Activities co-ordinator and Donna Sealey, Home Manager from Liberty Healthcare, for their work as part of the Park Farm Lodge Research Working Group.

Stage 1: Find out, plan and prepare

The team at Park Farm Lodge decided to focus their research around life history. They recognised it was an important topic for improvement in the home. The team also highlighted that it was necessary for them to make the best use out of the technology they had invested in: The interactive Omni table, and this could be done innovatively through life history work. The Research Working Group at Park Farm Lodge felt this project would provide a strong starting point to steer their future life history work and provide them with the momentum to keep this work going.

Unfortunately, due to the pandemic, this project was initially put on hold. But with lots of hard work, Park Farm Lodge managed to pick it back up once things were a little more settled in the home. They outlined that by concentrating on this it may help them with some of the following things:

1. Progress on an area of the home that needs improvement.  
2. Deliver person-centred care and the best possible service  
3. Understand our residents better- it’s important for staff to know residents on a greater level  
4. Tailor activities according to people’s life history to see the impact of the interactive table  
5. Encourage new interactions between the care home community based on people’s interests 
6. Make residents feel more valued  
7. Create more of a “home/family feeling” (Our home is a very big one with 80 residents) 
8. Shift away from being task orientated  

They worked collaboratively with the researchers-in-residence from the Association for Dementia Studies to think of what they needed to find out and ask from families, visitors and friends to enhance the life history work at Park Farm Lodge. Discussions lead to the research working group finalising the research title of: “What is the best way to gather life history about our residents? A survey of family members, friends and visitors”

Stage 2: Act and make things happen

Initially the team had more in-depth plans for the data collection for this project, however, as a result of the pandemic their capacity was unfortunately reduced, especially in terms of staff’s ability to contribute to research activity. The team recognised that they had had great success in maintaining (and strengthening) their communication with visitors, family members and friends during this time. Therefore, they decided to explore their research through a questionnaire distributed to family, friends and visitors around life history.

The questionnaire asked people to answer questions, some around how important life history was to them, whether they had been involved in life history work before and to give preferences for life history collection methods (such as attending workshops, structured documents and photo-stories).

Promotion of the questionnaire was done online, through the Park Farm Lodge family and friends Facebook group. This online group has proven to be particularly important and successful since the COVID pandemic and is something that the home aims to continue into the future.

Example of questionnaire responses

Stage 3: Study, watch and listen

The team at Park Farm Lodge received 20 individual responses to the questionnaire from family, friends and visitors. This was a fantastic result for them and really shows how willing and enthusiastic family, friends and visitors are to get involved in research in the home.

Once all the data was gathered it was time to find out what it told the care home and what they could learn from it. With the help of the CHARM researchers-in-residence from the Association for Dementia Studies, the team analysed the data and produced basic descriptive statistics.

You can read the full report of the findings here:

Link to reportDownload

See the poster of their findings here:

Link to posterDownload

Stage 4: Reflect, think, discuss and change

After analysing the data, the home was provided with the key findings from the study. An action plan was developed (see below) to ensure Park Farm Lodge had a clear direction to move forward with.

Action Plan:

• Use a structured document to gather information from family and friends

We have already begun to use a structured document with family and friends to gather life history information that relates to activities. So far these are proving popular and being completed enthusiastically

The survey showed a preference for being given documents and having conversations with staff, although a number of other options were also appreciated, so a range of different routes may be needed to reach everyone. In addition, the Facebook group has been proven to be a very successful group way to communication with families and friends.

• Identify a style of life history book that the home wishes to use

This was the most popular method of presentation and also one that can be used in conjunction with other favoured options such as creating a photo story, playlist, memory box and one-page profile.

Initially, whilst this decision is being made, it may make sense to begin to capture and share information in the form of a one-page profile as this will create some immediate results and a useful format for staff (including agency staff)

• Engage with staff to raise profile and understanding of life history work

This could be done in a number of ways: through running a survey similar to this one with staff or organising training/workshops on life history work. This will need to be done in order to complete the care home’s aim of completing life history work for every resident as this will need to be a whole-home effort not just a few members of staff. 

• Create an action plan/timetable for how and when life story work will be completed

It is clear that we have support from family/friends to undertake this work. However, it is a big endeavour and as such will require leadership and planning to make sure we capitalise on this momentum. An action plan will need to include which staff members will be responsible and how they will be supported by others to complete this big task. Time and resources should not be underestimated in order to guarantee success.

CHARM Care Home Research Study – Communication during COVID

4 care homes participated in the CHARM research project, conducting 2 mini-research projects each. This blog shares the experiences of Sanctuary Care’s Hastings Residential Care Home in Malvern, Worcestershire and their first mini-research study.

Hastings is also part of Sanctuary Group and thanks go especially to Home Manager Sue Milward, Deputy Manager Dan Reeves and Senior Care Assistant Sarah Wiggett of Sanctuary Care for their work as part of the Hastings’ Research Working Group.

CHARM Care Home Research Study

“How well has our care home used technology to adapt to the changes created by the COVID pandemic?”

Four care homes participated in the CHARM research project, conducting two mini-research projects each. This blog shares the experiences of Park Farm Lodge Care Home in Tamworth and their second mini-research study.

Park Farm Lodge is part of Liberty Healthcare and thanks go especially to Donna Sealey and Beci Paul for their work as part of the Park Farm Lodge Research Working Group.