The Lived Experience of Implementing Infection Control Measures in Care Homes during Two Waves of the COVID-19 Pandemic. A Mixed-Methods Study

Abstract

Context: During COVID-19 care-homes had to implement strict Infection Control Measures (ICMs), ­impacting on care and staff morale. Objectives: To explore the lived experiences of care-home staff in ­implementing ICMs. Methods: Mixed-methods study comprising 238 online survey responses and 15 in-depth interviews with care-home staff, November 2020-January 2021 in England. Results: Three themes were ­identified: ‘Integrating COVID-19 ICMs with caring’, ‘Conveying knowledge and ­information’, ‘­Professional and ­personal impacts of care-work during the pandemic’. Reported adherence to ICMs was high but ­fatalistic ­attitudes towards COVID-19 infection were present. Challenges of providing care using ­personal ­protective ­equipment (PPE), especially for residents with dementia, were highlighted. ­Interviewees reported ­dilemmas between strictly implementing ICMs and conflicts with providing best care to ­residents and preserving personal space. Nine months into COVID-19, official guidance was reported as ­confusing, constantly changing and poorly suited to care-homes. Care-home staff ­appreciated ­opportunities to work with other care-homes and experts to interpret and implement guidance. ICM training was ­undertaken using multiple techniques but with little evaluation of these or how to sustain behaviour change. Limitations: Results may not be generalizable to other countries. Implications COVID-19 has had a profound effect on well-being of care-home staff. Despite challenges, participants reported broadly good morale, potentially a ­consequence of supportive colleagues and management. Nevertheless, clear, concise and care-home focussed ICM guidance is still needed. This should include evidence-based assessments on implementing and sustaining adherence. Groups of care-home staff and ICM experts working together to co-create, interpret and implement guidance were viewed positively.