Understanding the factors that shape care homes’ responses to Government COVID-19 guidance on visiting arrangements

Background While effective in limiting Covid-19 transmission, restrictions on family visits to care homes for older people can negatively impact residents emotional, cognitive and physical health and cause distress for families.1,2 Government has published guidance for care homes on establishing visiting policies that balance these risks, subject to local-area risk assessments from Public Health Directors.3 The guidance states, the first priority must remain preventing infections and visiting policy should still be restricted with alternatives sought wherever possible.

However, it guides homes to develop a policy for limited visits which is made available and/or communicated to residents and families.

This is challenging and potentially sensitive, with significant lobbying for increased access on compassionate and human rights grounds.4,5,6 Experience is evolving and care homes will manage these challenges differently.7,8,9,10 Research aims and objectives We will identify: range and diversity in care homes interpretation and implementation of guidance how scope for personalisation afforded by the guidance is reflected in policies need for, and use of, support (guidance, tools, assistance) to develop and implement policies perspectives on how policies are working; including feasibility, acceptability, equity and other impacts consultation with families and other stakeholders, including challenges, achievements and influence on policies how policies are communicated to residents, families and others; perspectives on how well this worked and why whether family members find policies understandable, fair and proportionate, and why how characteristics and circumstances of care homes, and contextual factors, influence all of the above The evidence generated by our study is intended to inform ongoing policy and practice during the current pandemic and be of relevance in the event of future epidemics and pandemics.

Methods Stage one (months 1-6): To understand range and diversity and generate theory, we will administer a semi-structured questionnaire to care home managers or nominated senior staff (20 minutes; online or telephone) and review policy documents across 200 care homes, purposively-sampled. This provides sufficient breadth and depth and a sampling pool for later stages.

Stage two (months 6-12): We will further develop explanatory analyses using twenty cases theoretically-sampled from the participating homes, involving 1-3 in-depth interviews with care home managers and nominated senior staff.

Stage three (months 6-15): Thirty to thirty-five in-depth interviews with family carers, purposively-sampled to reflect diversity, will be conducted to explore understanding and views of care home policies.

In all stages, data from will be thematically-analysed using NVivo; range and diversity will be fully described and patterns in the data identified and articulated.16,17,18 Findings will be refined and interpreted, and policy implications considered in consultation with our expert advisors and experts-by-experience.

Supported by LSE and Care England s media and communications teams, we will monitor updates to Government guidance and key developments throughout to inform data-collection, analysis and interpretation.

Three policy briefings and three peer-reviewed journal articles will be produced and promoted through our websites, professional networks, social media and public platforms. We will run joint webinars, give presentations and produce lay summaries.