The challenges and opportunities of COVID-19 for research in care homes

Krystal Warmoth PhD is a Research Fellow of Ageing and Multi-morbidity in Applied Research Collaboration East of England and based at the University of Hertfordshire. She tweets @KWarmoth

When my team received National Institute for Health Research funding for ‘Understanding stakeholders’ perspectives on implementing deprescribing in care homes’ (or STOPPING) study in 2019, we were looking forward to 2020. The study aimed to develop an approach to patient-centred optimisation of some medicines for care home residents. The original study protocol was published and is available online¹. By March 2020, we had received all necessary approvals and were having site initiation visits with care homes to start recruitment. We were looking forward to doing interviews and focus groups with care home staff and residents, family members, and health care providers along with making observations in the care homes. However, COVID-19 brought a complete halt to the study as access to care homes was no longer possible.

Research ⎯ especially with older adults in care homes ⎯ has encountered considerable challenges during the COVID‐19 pandemic. Researchers, like myself, were uncertain about how and whether to modify studies. They asked themselves questions like, ‘is it better to collect a socially distanced version of this measure or not collect it?’ and ‘should we end the study early?’ Many have shifted their focus to COVID‐19 related research, which is of course much needed.

As a chief investigator and the lead researcher on the STOPPING study, I had to prioritise the safety of the participants, research team, collaborators, and myself. Therefore, the study was paused and the last year has been a test of resilience. However, we recognise that COVID-19 is not going anywhere anytime soon and are working with care homes to plan how to move forward and restart the study. Staff are keen to contribute their experiences and views to research. We are having to be more creative and resourceful to perform socially distanced data collection.

There is no guidance about how to conduct research in care homes during the pandemic. Most advice is not to do it or, if you must, use remote or virtual methods (such as telephone or video-conferencing technology). However, these methods can be difficult for residents with hearing or communication impairments and rely on care homes to have technical capacity and support. Yet many staff and residents have learned to use technology for consultations and communication between residents and their families. Currently, the challenge for the STOPPING research team is to modify our methods so that we capture the data we need in a way that is feasible and acceptable to the care home residents and staff whilst following national and regional COVID-19 guidance.

One outcome of the pandemic is the light that it has shed on care homes. While not all of it has been positive (such as the high death rate from COVID, the underfunding and lack of integration across health and social care)², it has shown how crucial care homes and their staff are in the care of the most frail and vulnerable. The skills, dedication, and compassion of care home staff not only shape care but can greatly contribute to research. Accordingly, there has been a growing interest in involving them in care policy and implementation. Aptly, this is what the STOPPING study had set out to do before the pandemic, and with flexibility and imagination, we are determined to achieve the involvement of those at the centre of our research.

Has your research in care home settings been affected by the pandemic? If so, how? If possible, what actions have you taken in order to continue the study? Please share your experiences and get in touch by emailing k [dot] warmoth [at] herts [dot] ac [dot] uk