New research reveals six ways that care homes support older people to thrive

Despite the many known challenges that vulnerable older people can face when living in their own homes, moving into long-term residential care is often considered to be a last resort, and care homes are certainly not seen as places where older people are expected to flourish.

At My Home Life England (part of City St George’s, University of London) we carried out a wide-scale qualitative research project exploring the experiences of residential care, from the perspectives of older people and those who care for them. Through this we aimed to better understand the challenges and benefits of living in a care home.

We spoke to 125 individuals (older people, care team members and families) in 16 care homes across the UK.  We visited a broad range of residential care homes in terms of location, inspection ratings, size, and type of home. We captured the voices of a diverse range of older people, with an average age of 85 and who had been living in a care home for an average of two years. The research was funded by Hallmark Foundation and independently engaged a range of different care homes and different care home providers.

The research findings, published in the report ‘Thriving in Residential Care’, shine a light on what is working well, and how, when conditions are right, care homes can support older people to really thrive.

The findings cluster into six emerging themes: Thrive Relationally, Thrive Actively, Thrive Inclusively, Thrive Securely, Thrive with Dignity, and Thrive Healthily.  

Thrive Relationally

Far from care homes being places of mere survival, the older people we spoke were flourishing in many different ways. Many were ‘thriving relationally’ and had formed meaningful friendships with each other and with staff, which was a lifeline for those experiencing isolation. Indian-born Kash acted as an ‘ambassador’ and supported people to settling in to his care home, telling us; “Whenever someone come new over here, they used to introduce with me. And if possible, they put me on the same table. So that person get used to it…. So that person will be happy. And they don’t feel they are on their own.”

Moving to a care home had also helped restore strained family relationships; families generally felt reassured, welcomed and able to stay actively involved in their older relative’s life.

Thrive Actively

Older people living in care homes were actively participating in activities that gave their lives renewed purpose and helped them to feel valued. For example, 82-year-old Irene had a long career working for a fabric company and this was a critical part of her identity. She told us: “I can’t do my sewing anymore, which was part of my life working for {a textile company} for 27 years. So, I decided to knit…I knit scarves for the staff. I think I’ve knitted 13 since I’ve been in here”. Irene also found a new sense of purpose through volunteering in her care home, laying tables and attending to others at mealtimes.

Thrive Securely

A significant finding was the overwhelming sense of security that care homes can provide. Before moving into residential care, some of the older people were experiencing poor housing, insecurity and even violence. Others felt anxious about being alone in their own homes, especially at night. We found that living in a care home provided older people with reassurance and safety, as well as alleviating the strain and worry for families. This was true for 94 year-old Harriet who had become increasingly frail and had fallen in her own home on a number of occasions. She now “felt really safe” after moving to her care home. Whereas, before, she was “getting scared all the time.”

Thrive with Dignity

Many older people had also found it increasingly difficult to keep on top of household tasks, including laundry, before they moved to a care home. They really valued having assistance with chores such as cooking and cleaning. Others had previously struggled with personal care and continence, but now had support from care staff with things like bathing and using the toilet. This helped to restore and maintain dignity.

Thrive Healthily

Proactive support with nutrition and healthcare meant many older people shared that their health had actually improved since moving into residential care. This may be surprising to envisage, but we found this to be the case on multiple occasions. Since moving to a care home, Lesley’s 93-year-old mum was “no longer breathless” and “no longer needed to use a scooter”. Lorraine said: “She was so frail and so weak when she was in hospital. So, it’s amazing, you know, what this level of care has done for her. Previously she could barely walk from one room to another, but now “takes herself out every day, twice a day, for walks”.

Care team members who had previously worked in domiciliary care also highlighted that working in a care home made it much easier and quicker to notice when things weren’t quite right, because they spent longer time with an individual.

Thrive Inclusively

Finally, we found that care homes can be inclusive environments where diversity is valued and respected. The report shares examples of older people being supported to embrace their faith, culture, ethnicity, sexuality and gender identity. Jay, a care home manager, recounted that; “We have made an environment where somebody feels so safe that at age 82… he’s been able to come out [as gay]… I thought my job is done…if this environment is safe enough that somebody feels that they can do that, this environment is correct.”

Inclusive environments also helped families feel confident that their older relative would be well-supported and that the move was the right choice.

Conclusion

Our research reveals that, whilst care homes may not be right for everyone, they can be everything for some. It has shone a light on how the provision of high quality, proactive, relationship-centred care, inclusion in a social environment with meaningful activities and nutritious meals, and fostering a strong sense of safety and security has, in some cases, been truly transformative and has supported many older people to really thrive.

Visit myhomelife.org.uk/thriving to watch an animation and see the report’s key findings.

Bethany Morgan-Brett,

Research Fellow, My Home Life England, City St George’s University of London