Protecting older people living in care homes from COVID-19: challenges and solutions to implementing social distancing and isolation.

Research for Social Care Programme Care homes (CHs) provide care for some of the vulnerable population of older people. They are at high risk of poor health outcomes and mortality if they contract COVID-19. The risk of contracting COVID-19 is compounded by difficulties in implementing infection control measures such as social distancing and isolation of residents. It is critical that CH services remain safe and provide high quality care during the pandemic and for further surges. Our research will provide a unique contribution to helping protect older people living in CHs from COVID-19. Research aim: to explore and understand the real-life experiences of social distancing and isolation in CHs for older people from the perspective of multiple stakeholders, and to develop a toolkit of evidence-informed guidance and resources to support health and care delivery now and for further outbreaks. Design: This tripartite 12-month study involves a rapid evidence review, in-depth case studies, and toolkit development. Methods: Phase 1: A rapid review of evidence to collate knowledge on the mechanisms and measures used by CHs and long-term facilities previously to socially distance and isolate older people or control the spread of other infectious and contagious diseases. Phase 2: a) In-depth case studies of 6 purposively selected CHs to identify the real-life challenges and consequences of providing safe care incorporating social distancing and isolation measures and to identify novel solutions being used to implement these measures in a person-centred way. Data collection: Within each CH case study: Interviews with a purposive sample of 3 residents and 3 family/friends to examine their experiences while residents are social distancing and isolating. Interviews with a purposive sample of 5 staff to examine how they adapt and manage care delivery for residents with different needs whilst maintaining social distancing and isolation of residents. Interview with the CH manager/deputy to examine how they develop, manage, and adapt policies, procedures, and protocols to achieve these measures. Collection of relevant documents and routinely recorded CH data to understand contextual factors. 2b) A focus group with a purposive sample of 8 external key informants with macro-level knowledge and experience relevant to the pandemic for the CH sector. Data analysis: Interviews will be transcribed and analysed using thematic analysis. Documentary data will be analysed using thematic analysis. Concurrent data collection and analysis will inform decisions about the need for further data collection. Analysis for each case site and across case sites will be conducted. Descriptive summary statistics will be used to describe quantitative data. Phase 3: Synthesis of findings from Phases 1 and 2 will culminate in a co-produced toolkit comprising evidence-informed guidance and resources. The content of the toolkit will be presented in different ways e.g. using flow charts to present evidence-informed guidance, and film to help narrate the stories of older people, their families/friends and CH staff. We will work with CH practitioners, our CH co-applicants, our PPI group, and Project monitoring and advisory group to co-produce a final version that is meaningful, accessible and will be used in practice. Dissemination: project website; publication in peer-reviewed, professional journals, and sector press; social media; presentations to different audiences.