Nursing Home Research – It Isn’t Easy
The importance of improving the quality of long-term care increases as life expectancy rises; however, research in long-term care (LTC) still proves challenging. In a recent systematic review, Lam et al. reviewed studies that revealed a multitude of obstacles to research in long-term care.
The authors searched several databases through 2017 and included any primary research that mentioned challenges or barriers experienced during the course of LTC research. Of 1723 references, 80 articles were screened and 39 were included in the review. Those 39 articles were then categorized by eight themes, one of which addressed obstacles to research at the facility level.
The authors found that 46% of studies reported major obstacles in the realm of facility administration. Specifically, some facilities, like those in large nursing home chains, could not participate due to corporate policies governing the decision, while some independent facilities lacked the resources to participate. High staff and resident turnover rates were an issue. Other facilities declined taking part in research, citing fear or suspicion about additional inspections, scrutiny, and unflattering findings.
Additionally, facility staff had diverse educational and experiential backgrounds and, as a result, had mixed opinions about research. Some staff members were "suspicious of the investigators' motives" for being on-site at the facility to conduct study activities. Others were disinterested in having their facilities participate because they did not see the value in the research. For some, participating in research could seem daunting and time-consuming to staff. In addition, recruitment was lengthy, and took a reported 8 months to more than a year.
Other obstacles identified included complicated logistics based on the setting of the nursing home. Researchers in some of the studies reported "logistical challenges" such as not having medical records for participants easily accessible and being unable to find a private environment to conduct confidential interviews.
In our experience at Insight Therapeutics, staff in nursing homes are busy, sometimes overburdened by care tasks. They also don’t often have the time to dedicate to helping with study procedures, particularly witnessing consent or assisting with interventions, much less respond to communications from research staff.
The good news? Many of these challenges can be addressed through rapport and strong relationships. Lam et al.'s table of “Suggested Solutions to Research Challenges” outlines suggestions for overcoming the obstacles in this growing field of research. For starters, research staff should build lasting relationships with the nursing home and their staff. In our experience, being mindful of which method of communication a facility staff member prefers, as well as knowing their preferred time to communicate (e.g., not calling during staff meetings or med passes), makes a long-term difference in retention of a nursing home research site.