Moving our care home: A qualitative study of the views and experiences of residents, relatives and staff

Abstract Introduction Involuntary relocation when care homes close can be detrimental to residents’ health and well‐being and is associated with increased mortality. There is little formal evidence to support whether planning can mitigate the impact of such moves. This study aimed to understand the experiences of a whole care home relocation where staff and residents relocated together using existing published guidance. Methods A longitudinal qualitative research study using individual face‐to‐face semi‐structured interviews was conducted between August 2018 and August 2019. Baseline interviews were conducted 6–8 weeks after relocation with follow‐up interviews 10–12 months later. Interviews were recorded, transcribed and analysed using framework analysis. Results 27 interviews were conducted; 19 baseline interviews (4 residents, 7 family members, 8 staff) and 8 follow‐up interviews (2 residents, 2 family members, 4 staff). Participants’ feelings about the relocation were mixed: some reported apprehension before the move but others excitement. Residents and families felt variably involved in planning the move, whereas staff expressed lack of involvement. Time, family support and continuity of care helped participants settle in. The new environment shaped participants’ experiences and abilities to adjust, especially the lack of a homely feeling with the new home, the larger size and changes in staff organisation and management. Conclusions Despite implementation of existing guidance, relocation was still challenging for residents, staff and family members. Future relocations should increase involvement of staff in the planning and design of the home; offer continuous support to those involved; and ensure continuity of care and management style.


| Study design and sample
Relocation is considered a process rather than a single event; therefore,alongitudinalfollow-upqualitativeresearchstudyusingsemistructured interviews was conducted (Holland, 2007). Baseline interviewswereconductedbetweenSeptemberandOctober2018 (6-8 weeks after relocation) with follow-up interviews between June and August 2019 (10-12 months after the move

| Recruitment and data collection
The care home management team was asked to identify eligible residents and identified 12 residents who met the eligibility criteria.Residentswereconsideredineligibleforinterviewsiftheywere very unwell or cognitively unable to engage in a conversation. All potentiallyeligibleresidents(n =12)werethenapproachedbythe researchteamwhoexplainedthestudyandansweredanyquestion, and they were given at least 48 h to think, talk to family and then decidewhethertotakepartornot.Fouroutof12(33%)approached agreed to take part in the study (three females and one male). Reasonsfornottakingpartincludedthefollowing:residents'unwill-

| Reflexivity and Trustworthiness
The research team consists of female academics with different levels of seniority (medical students, a postdoctoral researcher andprofessors).Twooftheseacademicsweretrusteesofthecare homecharitablefoundation.Theirexperienceandexpertisewere valuabletothedesignofthestudy.Tominimisetheirbiases,they were not involved directly in data collection and analysis. Three othermembersoftheteamwithdifferentseniorityandagelevels (a medical student, a postdoctoral researcher and a professor in healthscience)wereinvolvedindatacollectionandanalysis.They were all familiar with the care home sector with some personal experienceeitherfromworkinginacarehomeorvisitingfriends and relatives in care homes. This helped them relate to the residents,enabledthemtoreadbodylanguagealongsideresponses.
Thisexperiencealsoassistedintheidentificationofparticipants who may have been unable to consent and helped prompt furtherdiscussionwithstaffastotheireligibilityforthestudy.The involvement of the three researchers in the process of data collection and interpretation was key to minimise any personal bias and to ensure the trustworthiness of the findings. Researchers keptindividualreflexivejournalsduringdatacollectionandanalysis,andthesewerediscussedandsharedwithotherresearchers during the regular research team meetings. In addition, we used data triangulation (i.e. collecting data from different group of participants-relatives, residents and staff-to ensure the whole picture of experiences of relocation was captured. In addition, a report of the main findings and recommendations for future relocations were shared with the care home organisation and the feedbackfromtheirseniormanagementteamconfirmedthatthey recognisedthevalidityofourfindings.Wealsoknowthatthecare homeorganisationhasrewrittentheirprotocolforcarehomerelocationinlightofthesefindings.

| Communication and involvement
All participants in the baseline interviews reported that they had

| Theimpactofsizeanddesign
In the baseline interviews, many participants described the new homeasa'hotel',ratherthanahome,basedonthelargesizeofthe building and the design features. The size and layout of the buildingwasmainlyseentoimpactbothresidentsandstaffnegatively, althoughonestaffmemberfeltitwaspositivebecausetheresidents had more space.

| Staff organisation and management
In the baseline interviews, staff and family members commented on the management restructuring that occurred after the relocation,withachangeinthemanagerandadditionaldeputymangers.
Management style was also perceived to have changed and some  Further,thedifficultyofprovidingequityofcareandaccessto facilities such as outings and activities was highlighted-by some staffandfamilymembers-becauseofthesizeofthenewhomeand the numbers of staff needed to fetch, chaperone or support residents.Forexample,activityco-ordinatorswereattemptingtoprovide such opportunities for much larger numbers of residents and werethus'having to spread themselves thinly'. There's no continuity with the carers here whatsoever; they are moved around constantly. Two days is maximum here anywhere, any household, so they
-Provide counselling opportunities for individual residents, family members and staff to discuss and come to terms with the experience.

Facilitateasafeenvironmentinwhichresidents,familymembersandstaffcanexpresstheirworriesandpreferencesfreelytoinform
actions and changes. Wehavedevelopedrecommendationstosupportfuturewholecare home relocations to help guide current policy and practice.

CO N FLI C T O F I NTE R E S T
KI,JL,SBandNMdeclarenoconflictsofinterest.HRandJBwere trusteesofthecharitablefoundationresponsibleforthecarehomes when the data were gathered.