Summary of the impact

Quality of care for the increasing numbers of frail older people is an issue of international concern. Led by Professor Meyer at City University London, in partnership with Age UK and Dementia UK, My Home Life (MHL) is a collaborative movement of people involved with care homes for older people. It was established to improve the quality of life of everyone connected with care homes for older people and has become the recognised voice for the sector. The original underpinning research and ensuing projects all focused on knowledge translation, in particular the factors that enhance quality improvement in care homes. MHL actively works with care homes to progress quality improvement and share the lessons learned throughout the system. The programme has had a significant impact on both policy and practice in health and social care, influencing Government policy and supporting practice improvement across national and international borders.

Underpinning research

There are around 18,000 care homes for older people in the UK, providing three times as many beds as the NHS. Older people represent some of the most vulnerable citizens in our society. National policies that focus on ageing in place have led to this group going into care homes later and sicker. Care home residents often have complicated health and social care needs, resulting from multiple long-term conditions, with significant levels of disability and frailty (for instance, around two-thirds of residents have dementia). However, residents are being cared for by a predominantly social care (rather than health care) workforce that is poorly paid, with low level or no educational qualifications. Given this situation, it is widely acknowledged by the Government and the health care sector that care homes need support to improve standards of care. This is the focus of the My Home Life initiative.

Key academics in the MHL team include: Julienne Meyer (Professor of Nursing, Care for Older People: 1999 to date; Executive Director, My Home Life: 2006 to date), Tom Owen (Director of My Home Life: 2007 to date), Dr Zara Ferreira (Volunteer/Administrator/Research Fellow: 2010 to 2011).

The research pathway for MHL is that of knowledge translation and so is designed to deliver impact. MHL is concerned with disseminating and implementing best practice in care homes for older people and the best practice in turn becomes the focus of the investigation. There is a clear pathway from the initial underpinning literature review for the MHL Vision [1] to the more recent Joseph Rowntree Foundation report which synthesises lessons from its implementation [2]. These and other studies focus on some of the factors that enhance quality improvement in care homes: evidence-based practice [1]; relational leadership to enable better voice, choice and control for residents [2]; quality of life indicators to measure quality improvement [3]; better partnership working between health and social care [4]; care home sensitive research [5]; and positive risk-taking for frail older people in care homes [6].

The original research underpinning MHL (Phase 1: Vision: 2005 to 2007) was funded by Help the Aged (£25k) and synthesised the evidence for best practice in care homes [1]. This Vision challenged the narrow focus of policy for older people and highlighted the importance of positive relationships to deliver person-centred care. Phase 2: Dissemination (2007 to 2009) was funded by Bupa Giving (£279,500) and involved sharing the best practice findings with around 18,000 care homes, using a range of creative resources (research briefings, bulletins, posters, DVDs etc.). A website was developed which enabled care homes to access best practice for the first time (www.myhomelife.org.uk). Phase 3: Implementation (2009 to 2013) was funded (over £2 million in total) from several sources (Joseph Rowntree Foundation, Department of Health, Local Authorities and City Bridge Trust) to support care home managers progress quality improvement. This work resulted in the creation with the care home sector of a Leadership Support and Community Development (LSCD) programme that is being successfully implemented in 25 local authorities in England and 9 regions in Scotland, while other MHL initiatives have been developed in Wales and Northern Ireland. LSCD supports care home managers and other key stakeholders to work in better partnership to implement the MHL vision [2].

References to the research

The significance of the findings and the continued support of government and other major funders attest to the quality of the underpinning research.

Details of the impact

Frailty in ageing is a global issue that is predominantly managed by the independent care home sector which is fragmented, isolated and hard to influence. MHL has provided a step change to practice improvement in care homes through its research highlighting issues affecting this marginalised sector through its evidence-based and relationship-centred directives, its piloting and testing of new ways of working, the beneficiaries of its leadership training initiatives and its spread and depth of influence.

Highlighting issues affecting this marginalised sector

The resources section of the MHL website hosts the 6 underpinning research reports which are also shared on research partner websites [7]. The research provoked 2 Early Day Motions to improve practice in care homes, one linked to My Home Life (EDM 1588 in 2007) and the other linked to Quest for Quality (EDM2578 in 2012), for which MHL was a partner [8].

Evidence-based and relationship-centred directives

The MHL findings have been creatively shared in user-friendly formats with around 18,000 care homes across the UK and are freely available on the MHL website. The Government has highlighted MHL as a "recognised quality scheme" alongside the new National Institute for Health and Care Excellence (NICE) social care quality standards and the Dementia Care and Support Compact for the Provider Quality Profiles launched as part of the Caring for our future White Paper (http://caringforourfuture.dh.gov.uk/2012/08/08/provider-quality-profile).

Piloting and testing new ways of working

Internationally MHL has influenced the development of a shared set of evidence-based indicators for quality of life in care homes that were developed and agreed by 7 EU Member States (Austria, England, Germany, Italy, Luxembourg, Netherlands and Slovenia). The indicators have been translated into four languages (English, German, Dutch and Spanish) and downloaded over 1,000 times [9].

Beneficiaries of leadership training initiatives

Over 500 care home managers in 25 local authorities in England and 9 regions of Scotland have been through the MHL LSCD programme. Significant change over time has been reported from this work which has potentially enhanced the lives of 13,450 residents. Findings from 132 care home managers at the end of the LSCD, generated from a before and after self-report questionnaire survey (Perceptions of Workplace Change Schedule), demonstrate improvements in: quality of leadership and management (88%); better engagement with staff (83%); increased time to offer residents (78%); feeling less stressed (59%); greater job satisfaction (59%); enhanced engagement between residents, relatives and staff (87%); more confidence for managers (90%); enhanced quality of life for residents (89%); and more positive interactions between staff, residents and relatives (82%). [10]. Funding has been raised to start roll-out of LSCD in Northern Ireland and the Welsh Assembly Government extended funding (originally 3-5 years, now 6 years) for a MHL initiative in Wales to work with 38 care homes there (http://www.ageuk.org.uk/cymru/home-and-care/my-home-life-cymru-home). Several local authorities are now basing their care home strategy on the MHL LSCD programme and one has developed its own MHL website (www.myhomelifeessex.org.uk).

Spread and depth of influence

MHL serves as a quality charter mark for best practice in care homes. It is endorsed by the Relatives and Residents Association and all the provider organisations that represent care homes across the UK (National Care Forum, English Community Care Association, Registered Nursing Home Association, National Care Association, Care Forum Wales, Scottish Care and Independent Health and Care Providers in Northern Ireland). Over 5000 care homes have joined the MHL Network to share best practice. Internationally, MHL has also attracted substantial interest. In Australia, funds were awarded from the Department of Health and Ageing for a MHL-linked initiative in Hepburn Health Service (Ballarat) [11]. In addition, Professor Meyer has spoken about MHL by invitation in Australia, Canada, China, Japan, Malta, Spain and the USA. She is also on the Board of the International Association of Homes and Services for the Ageing (www.iahsa.net) with special remit to help establish a global network of researchers interested in working collaboratively with the sector to improve quality of life in care homes.

In England, MHL has gained substantial traction. It is mentioned positively three times in the Caring for our future White Paper [12] that sets out the Government's vision for a reformed care and support system (p21, p24, p40). It was cited as an example of best practice in the Commission on Dignity in Care for Older People (Recommendation 24: p22 and Case Study: p37) [13] and in a policy report by the Older Age Working Group for the Centre for Social Justice (Case Study: p33) [14]. The focus on positive relationships between residents, relatives and staff and the care homes and the outside world is thought to be key.

MHL is held in similar high regard by the Welsh Government. In December 2012, the report of the Welsh Health and Social Care Committee into its Inquiry into Residential Care for Older People stated: "The Committee commends the work of the My Home Life project which we believe makes a valuable contribution to improving quality of life in residential care" [15]. In Scotland, the themes of My Home Life were used to structure the educational resources on an on-line Shared Space (Improving Care for Older People) developed by NHS Education for Scotland and e-Library Scotland Life [16]. In Northern Ireland, the Public Health Agency have just funded a MHL initiative, following one care home manager (Sunnymead Residential Care Home) downloading materials from the MHL website and claiming to have consequently transformed her care home, winning awards for doing so and being given a special invitation to talk about MHL to Members of the Legislative Assembly at Stormont [17].

MHL has had a significant and wide-reaching impact on both policy and practice to help support quality improvement in care homes. Professor Meyer is a member of `The Commission on Residential Care', hosted by Britain's leading cross-party think-tank Demos and chaired by Paul Burstow MP, former Minister for Care Services (http://www.demos.co.uk/projects/corc). Its purpose is to develop a vision for residential care for the 21^st century. Professor Meyer has also influenced the development and continuing evaluation of new roles in care homes to progress quality improvement. For instance, the Orders of St John's Care Trust with 72 care homes have appointed several Admiral Nurses to help implement the MHL vision (http://www.nursingtimes.net/nursing-practice/clinical-zones/older-people/care-home-provider-appoints-admiral-nurse/5027527.article) and another care home organisation (REGAL) with 17 care homes claims that "engaging in the My Home Life programme has brought many benefits: giving staff increased resilience, meaning they are less burnt out. All of this enables reduced staff turnover and sickness with care home staff driving forward their own quality agenda resulting in improved relationships with external agencies" (www.odcg.org/app/download/5793166208/Regal+Case+study.pdf).

Sources to corroborate the impact

[7] For MHL research reports, dissemination products, stories of good practice and other testimonials, see MHL website (www.myhomelife.org.uk).

[8] For EDMs 1588 and 2578 — www.parliament.uk/edm/2006-07/1588 and www.parliament.uk/edm/2010-12/2578.

[9] European Centre for Social Welfare Policy and Research (Coordinator) (2010). Measuring Progress: Indicators for Care Homes. Vienna/Bad Schallerbach/Utrecht/London /Dortmund/Essen/Düsseldorf: European Centre/E-Qalin/Vilans/City University London/University Dortmund/MDS/MGEPA NRW. (available at:
www.euro.centre.org/data/progress/PROGRESS_ENGLISH.pdf; and policy brief available at: www.euro.centre.org/data/1306242771_99752.pdf).

[10] For more details, see MHL website.

[11] Penney W, Clinnick L, Martin L (2013) Improving Quality of Life for Older People Living in Residential Aged Care Homes: An Action Learning Approach to Education, University of Ballarat & Hepburn Health Service Partnership Project Final Report submitted to the Commonwealth Government Department of Health and Ageing — Rural Health Continuing Education Grant Stream 2.

[12] HM Government (2012) Caring for our future: reforming care and support, White Paper presented to Parliament by the Secretary of State for Health and by Command of Her Majesty, The Stationery Office Limited (available at:
www.gov.uk/government/publications/caring-for-our-future-reforming-care-and-support

[13] Commission on Dignity in Care for Older People (2012) Delivering Dignity: Securing dignity in care for older people in hospitals and care homes. A report for consultation. London: Local Government Association, NHS Confederation, Age UK (available at:
www.nhsconfed.org/Publications/reports/Pages/Delivering-Dignity.aspx)

[14] CSJ (2011) Age of Opportunity Transforming the lives of older people in poverty. A policy report by the Older Age Working Group (Chaired by Sara McKee), London: Centre for Social Justice (available at:
www.centreforsocialjustice.org.uk/UserStorage/pdf/Pdf%20reports/20110629_AgeofOpportunity.pdf),

[15] Report available at: www.assemblywales.org/bus-home/bus-business-fourth-assembly-laid-docs/cr-ld9138-e.pdf?langoption=3&ttl=CR-LD9138%20-%20Health%20and%20Social%20Care%20Committee%20Report%3A%20Residential%20care%20for%20older%20people%20in%20Wales (page 61)

[16] Website for sharing resources between the Care Commission Care Home Learning Network, My Home Life and Connect in Care, Scotland:
www.elib.scot.nhs.uk/SharedSpace/icopn/Pages/login.aspx?ContainerID=194307&ret=http%3a%2f%2fwww.elib.scot.nhs.uk%2fSharedSpace%2fICOPN%2fPages%2fIndex.aspx%3fcontainerID%3d194307.

Further information to corroborate claims can be provided by:
MP for Sutton, Cheam and Worcester, Liberal Democrats and Coalition Government; Quality Innovations Lead, Essex County Council; Care Home Manager, Sunnymead Residential Home; Chief Executive Officer, National Care Forum.