Yes / Over half a million people aged 65+ live in care homes (ONS 2011). Yet, sex, sexuality and intimacy and old people remain overlooked in social policy and professional practice (Hafford-Letchfield 2008). We explore narratives from a feasibility study based in Northwest England that consulted on the significance of researching sexuality and intimacy. We draw on narratives generated with two focus groups of professional carers (n = 16) and interviews with three residents, (two male and one female) and four female spouses (n = 7). All three types of stakeholders expressed concern about privacy and environmental impediments to intimacy (e.g. shortage of double rooms). However, distinct concerns were expressed by each group. Residents’ expressed scepticism that the topic was ‘too personal’, that old people were post-sexual or that sex/intimacy were part of range of needs and could be eclipsed by those relating to grand-parenting, avoiding isolation and personalization of care. Spouses emphasized the importance of intimacy over sex/sexuality as an indicator of the depth and longevity of a relationship but were concerned about unmet needs and loss of influence over their partners’ care. Obliged to meet a complex of legal, professional, ethical and interpersonal obligations, care staff articulated a need for guidance to help them support residents and their significant others. We conclude with practical recommendations that address barriers to enabling intimacy.

Yes / Acute hospital admission is distressing for care home residents. Ambulatory care sensitive conditions, such as respiratory and urinary tract infections, are conditions that can cause unplanned hospital admission but may have been avoidable with timely detection and intervention in the community. The Better Health in Residents in Care Homes (BHiRCH) programme has feasibility tested and will pilot a multicomponent intervention to reduce these avoidable hospital admissions. The BHiRCH intervention comprises an early warning tool for noting changes in resident health, a care pathway (clinical guidance and decision support system) and a structured method for communicating with primary care, adapted for use in the care home. We use practice development champions to support implementation and embed changes in care. Methods and analysis: Cluster randomised pilot trial to test study procedures and indicate whether a further definitive trial is warranted. Fourteen care homes with nursing (nursing homes) will be randomly allocated to intervention (delivered at nursing home level) or control groups. Two nurses from each home become Practice Development Champions trained to implement the intervention, supported by a practice development support group. Data will be collected for 3 months preintervention, monthly during the 12-month intervention and 1 month after. Individual-level data includes resident, care partner and staff demographics, resident functional status, service use and quality of life (for health economic analysis) and the extent to which staff perceive the organisation supports person centred care. System-level data includes primary and secondary health services contacts (ie, general practitioner and hospital admissions). Process evaluation assesses intervention acceptability, feasibility, fidelity, ease of implementation in practice and study procedures (ie, consent and recruitment rates). / UK NIHR grant number RP-PG-0612-20010.

Resident-centered care has been the standard philosophy in accredited personal care homes (PCHs) across Canada since 1990. Health care aides (HCAs) are the primary health care providers in PCHs and key to residents' quality of care and quality of life. However, studies have not examined HCA work satisfaction in relation to the four elements of resident-centered care: providing flexible scheduling, following residents' preferences, promoting a home-like environment and offering permanent assignment to promote consistency of care. This cross-sectional, ethnographic study was conducted using face-to-face interviews with nine HCAs working in four PCHs in Winnipeg, Manitoba, Canada. The results indicate that HCAs' work satisfaction was highly related to their caring relationships with residents and their working relationships with other HCAs and staff. The implementation of resident-centered care depended on institutional and managerial support. Lack of this support created stressful situations for HCAs and caused them concern about the quality of care and quality of life of residents. / May 2009

Resident-centered care has been the standard philosophy in accredited personal care homes (PCHs) across Canada since 1990. Health care aides (HCAs) are the primary health care providers in PCHs and key to residents' quality of care and quality of life. However, studies have not examined HCA work satisfaction in relation to the four elements of resident-centered care: providing flexible scheduling, following residents' preferences, promoting a home-like environment and offering permanent assignment to promote consistency of care. This cross-sectional, ethnographic study was conducted using face-to-face interviews with nine HCAs working in four PCHs in Winnipeg, Manitoba, Canada. The results indicate that HCAs' work satisfaction was highly related to their caring relationships with residents and their working relationships with other HCAs and staff. The implementation of resident-centered care depended on institutional and managerial support. Lack of this support created stressful situations for HCAs and caused them concern about the quality of care and quality of life of residents.

Resident-centered care has been the standard philosophy in accredited personal care homes (PCHs) across Canada since 1990. Health care aides (HCAs) are the primary health care providers in PCHs and key to residents' quality of care and quality of life. However, studies have not examined HCA work satisfaction in relation to the four elements of resident-centered care: providing flexible scheduling, following residents' preferences, promoting a home-like environment and offering permanent assignment to promote consistency of care. This cross-sectional, ethnographic study was conducted using face-to-face interviews with nine HCAs working in four PCHs in Winnipeg, Manitoba, Canada. The results indicate that HCAs' work satisfaction was highly related to their caring relationships with residents and their working relationships with other HCAs and staff. The implementation of resident-centered care depended on institutional and managerial support. Lack of this support created stressful situations for HCAs and caused them concern about the quality of care and quality of life of residents.