Impact case study database

The impact of our research ( R1, R2, R3, R4) on care home culture as described in this case study refers to the impact of Ulster University’s My Home Life (MHL) Leadership Support and Quality Improvement Programme (hereafter referred to as the MHL programme). This 10-month programme commenced in 2013 and continues to be used as a conduit for changing care home culture through the translation of our research into practice.

In planning our impact strategy, Ulster University was one of the original partners in My Home Life, an international initiative and registered charity (No. 1187498) which promotes quality of life and delivers positive change in care homes. Each partner organisation works independently, and research findings and resources are shared with the care home sector and with other partners and stakeholders through the MHL website.

I1: Impact on policy

In 2018, the Permanent Secretary, DOH (NI) referenced our research when he outlined measures to address “unacceptable failings” in safeguarding and restore public confidence in care homes by supporting the “ implementation of initiatives aimed at improving the quality of life for people living in care homes such as the My Home Life initiative” ( C1). The significance of our policy impact is further evidenced by extra funding from DOH (NI) in 2020, to support care homes to participate in the MHL programme during the COVID-19 pandemic and to appoint a Project Manager to engage with 100 new care homes as part of the regional implementation of the MHL programme across NI (C1).

The reach and significance of our research impact ( R1, R2, R3) is evidenced by buy-in from the care home sector and partnership funding from its umbrella organisation Independent Health and Care Providers. This resulted in an increase in the uptake of the MHL programme from 15 managers in 2013 to 67 managers in 2020 from a diverse range of care homes (urban, rural, residential, nursing), representing approximately 1 in 7 care homes in NI (C1). The MHL programme was cited as an example of best practice in the Report of the Expert Advisory Panel on Adult Care and Support (DOH NI, 2017) and was recommended as a catalyst for remedial change in adult safeguarding in the report of the Independent Review Team commissioned by the DOH (NI) to investigate care home abuse and neglect in the region. “The HSCTs should explore … how change programmes demonstrate approaches to care and support which reflect human rights … and projects such as My Home Life at the University of Ulster would enhance this work” ( C2). Our research ( R1, R2, R3) has directly influenced DOH (NI)’s Reform of Adult Care and Support policy resulting in a request from DOH (NI) to submit a funding bid (GBP2.6m) for the regional implementation of Ulster’s MHL programme across all 484 care homes in Northern Ireland (C2). In 2017, our research on the concept of a nursing home as ‘home’ received extensive media coverage and was commended by the Irish Minister for Health and raised during parliamentary questions leading to an increased focus on the need to create a more ‘homely environment’ in care homes ( C3). Since 2013, the MHL programme ( R4) has received unwavering support from AgeNI who provided partnership funding for our programme and whose CEO described it as making “ a positive impact on the quality of care experienced by residents in care homes” ( C4). The impact of our research ( R2, R3, R4) has also been recognised by the Chair of Northern Ireland Regulation and Quality Improvement Authority (RQIA) who described the MHL programme as “ a great fit with RQIA’s aspirations for excellence in the care of older people” ( C4) and by Care Home Advice and Support (a voluntary organisation in NI) who stated, “ We want the DOH to use these findings to make the necessary improvements” ( C2) .

I2: Impact on culture in dementia care

Results of questionnaires completed by participating managers since 2013 showed a significant positive change in 89% of the responses measuring the impact of the MHL programme on care home residents, relatives and staff ( C5). Significantly, there were marked improvements in the quality of interaction between staff and relatives (54% of respondents agreed), quality of management and leadership (51%) and satisfaction with practice (49%) in care homes caring for 2,268 residents ( C1, C5). One participating manager commented: “I’ve been a care home manager for 20 years and this has been the most rewarding programme for me as a manager. I would do it all over again!” ( C4) . Another commented “I think the My Home Life programme should be the standard. I think all managers should take the opportunity to do it. In fact, I think it should be part of the process of becoming a registered manager” ( C6). Others spoke of how the MHL programme led them to change the focus of their work to more meaningful engagement, positive risk-taking and a recognition of the importance of relationships with older people and their families. “ It was… the best training I ever had for managing, leading and working in a care home, it was about relationships, and rights of older people, it was not just about health but about quality of lives, importance of family relationships and leading the team using these approaches has improved the staff and more importantly the care and support offered to older people” ( C2) .

The reach and significance of the impact of our research on culture is evidenced by the introduction of a range of research-based quality improvement initiatives ( R1, R2, R3) across the 67 care homes which implemented the MHL programme between 2013 and 2020 ( C7). These include the development of new pre-admission assessment protocols, the production of a short film on the transition to life in a care home, a new approach (‘This is Me Now’) to maintaining the dignity and identity of residents with advanced dementia, and the introduction of a ‘Decision Tree’ to facilitate the involvement of care home residents and relatives in decisions about life in their care home ( C7). Based on Ulster’s research, participating managers worked with residents and their families to co-create an information booklet on the transition to life in a care home which reached approximately 17,000 individuals and organisations in the wider care home sector across Northern Ireland and provided much needed guidance as part of the implementation of the Northern Ireland Dementia Strategy ( C7). In 2017 Sarah Penney (MHL Project Manager) was awarded the RCN Nurse of the Year, Learning in Practice award for the impact of the MHL programme on care home culture ( C7).

I3: Impact on understanding of dementia

Our reminiscence research provided significant evidence to the NHS of the viability of mobile device apps for people living with dementia, in terms of uptake and sustained engagement ( R5, R6). This led to additional funding to develop the InspireD reminiscence app which is now freely available on the Apple App and Google Play stores and in the HSC Apps4Dementia library, soft launch December 2020 ( C8). One person living with dementia said of the app, “It helped me find myself again, so it did” ( R6). The HSC Innovation & Digital Eco-system Lead highlighted the reach and significance of our work, and stated that the benefits described in Ulster’s research “ convinced us that the app should be widely deployed across Northern Ireland and beyond” as part of a wider digital transformation programme in health and social care, which is being led by Digital Health & Care NI with the support of the DOH (NI) ( C8).

Recognising the power of the arts to reflect the experiences of people living with dementia, we collaborated with a local theatre company to create a play ‘The Songbirds’ and share the findings of our reminiscence research ( R5, R6). Between 2019 and 2020, the play reached an audience of approximately 2,000 people in theatres and other venues across the island of Ireland ( C9). A questionnaire administered before and after the play showed a significant improvement in public understanding of dementia across 100% of the evaluation statements. Before seeing the play, 76% of audience members agreed that people living with dementia can learn new skills and 77% understood that long term memories are often intact for people with early to moderate dementia. Significantly, these figures increased to 91% and 97% respectively after seeing the play ( C10). Qualitative feedback on the play was collected via questionnaires, emails and social media tweets. A person living with dementia described the play as “ *just like watching myself… It gives a 100% perfect representation of a person with dementia, that is the truth. Families need to see this; they will know then what we feel, and experience and they will understand us better”. * Another posted a message on Dementia NI’s Facebook page saying, “It was fantastic. I would advise anyone to watch the play. What a brilliant way of getting the dementia message out to people”. The play has been described as “ superb” by the Alzheimer’s Society. It sold out within a matter of days at the ESRC Festival of Social Science, from where the Commissioner for Older People for Northern Ireland tweeted “ very powerful performance of #ThesongbirDs in AccidentalT tonight. Great portrayal of people’s journey with #Dementia. Well done to all who pulled it together” ( C10).