The uncertainties and questions of care home residents, relatives and staff as a basis for evidence-based improvement and research

Background: Research in long-term residential care settings (or care homes) for older people should address questions and uncertainties that matter most for those receiving and delivering care. Whether research does this effectively is unclear. In part, because the uncertainties and questions of key stakeholders are unmapped. Objective: To capture and prioritise the uncertainties of older people living in care homes, their relatives and staff. Methods: A three-phase mixed-methods study: (i) gathering uncertainties, (ii) data analysis and (iii) prioritisation. Phase 1 used interviews to gather uncertainties from residents (n = 14), relatives (n = 10) and staff (n = 44). In phase 2, uncertainties were coded using thematic inductive analysis, represented as ‘foreground’ (necessitating research) or ‘background’ (not needing research) questions, and a prioritisation tool developed. The tool included optional open-text responses, capturing new questions fitting (and additional detail around) the existing subthemes. During phase 3, the prioritisation tool was completed by residents (n = 95), relatives (n = 85) and staff (n = 158). Results: 319 uncertainties were identified: 274 foreground (research-based) and 45 background (fact-based) questions. Six broad and 38 subthemes were developed. Broad themes included (i) communal living, (ii) health and care services, (iii) resident care, (iv) residents’ health and well-being, (v) residents’ daily life and (vi) care home staff. Priority subthemes included enjoy living with others, dignity and respect, support with emotions, meaningful activities, and staff recruitment and retention. Conclusion: This is the first study of care home prioritised uncertainties informed by residents, relatives and staff. The uncertainty-based questions represent important targets for care home research and practice improvement.