A total of 400 survey questionnaires were returned from staff working in 74 care homes across England.
Characteristics of care home and respondents
Due to some respondents not completing the postcode free text question accurately, only 66 of the 74 responding care homes could be identified and their CQC rating found; 15 required improvement (22.7%), 44 were reported as good (66.6%), and seven were outstanding (10.6%). The responses of staff from each home were collated to determine the number of respondents from each care home, this ranged from one person to 36 people, with 26 care homes having five or more respondents.
Analysis found that many respondents from the same care home reported different care home types for their home. Due to these disparities, all care home classifications were then checked against the care home manager’s response and for those who provided a valid postcode the care home website was reviewed to provide a more accurate and standardised record of what type of care home it was.
Survey respondents were most commonly working in nursing homes (180/ 45%), followed by residential care homes (144/ 36%). Some respondents also noted they worked in a care home caring especially for those living with dementia (16/ 4%). Two dual-registered groups were also formed as some respondents commonly reported their home had both nursing and residential units (44/ 11%), or that their home was a residential unit but specifically caring for those living with dementia (12/ 3%). In addition, some noted their work place as ‘other’ (4/ 1%), which were settings that the respondent felt did not fit into any of these other categories.
Respondents job roles included health care assistants (who provide personal cares/assistance to residents) (210/ 52.5%), care home managers (65/ 16.25%), qualified nurses (56/ 14%), activities coordinators (14/ 3.5%) and ‘other’ for those who did not consider that they were in any of the other role options (55/ 13.8%). Elaboration on other job roles was enabled through a free text option. The role ‘other’ mainly included those classifying themselves as senior health care assistants, but also included catering staff.
Size of the care home was based on the amount of residents the care home could accommodate, and therefore related to resident capacity. Smaller care homes were considered to be those with less than 30 residents (118/ 29.5%), medium sized care homes as those with a resident capacity of between 31 and 60 (142/ 35.5%) and larger care homes being able to accommodate over 60 residents (140/ 35%). Information on the length of time the respondent had worked in care homes was also collected; less than two years (78/ 19.5%), 2-5 years (122/ 30.5%), 5-10 years (62/15.5%), and over 10 years (138/ 34.5%).
There was a significant correlation between job role and length of time that respondents had worked in care homes (P=0.000), with care home managers reporting the longest length of service and health care assistants the least. A significant relationship was also found between care home type and job role (P=0.000), with a greater proportion of respondents from nursing homes being qualified nurses, and a greater proportion of those classifying themselves as ‘other’ being from residential homes.
The figures below show the number of responses for the different types of care home the respondent stated that they worked in (Figure 1), the size of the care home (Figure 2), their reported job role (Figure 3), and the length of the time they had worked in care homes (Figure 4).
Care home practices and staff knowledge
Table 1 shows the percentage of responses regarding assessment and treatment of hearing loss and vision loss. The majority of participants reported that both hearing (91.3%) and vision impairments (93.5%) are recorded in residents’ care plans, and that hearing aids (84%) and glasses (91.8%) are checked/cleaned regularly by staff. In addition, a majority reported that their care home has made suitable environment adaptations such as quiet places for residents (79.5%), that the care home they work in is well lit (88.3%), and that specific adaptions to the environment (such as contrasting colours for signs) exist (67.8%). In addition, the majority said that annual vision check-ups by optometrists are conducted in the home (85.3%).
However, some hearing and vision practices were less commonly implemented. A total of 46% of participants stated that they did not use screening tools for hearing assessment; and 43.8% not using vision screening tools. Assistive devices for hearing were only reported by 16%; and only 23.8% of care homes provided other assistive devices for vision part from prescribed glasses (i.e. magnifying glasses). Less than half stated that annual hearing check-ups are conducted by audiologists (46.8%), and that all residents’ glasses are labelled (48.8%).
Just over a quarter (103 out of the 400 respondents) reported that all of their residents are willing to use their hearing aids (25.8%), and only 83 stated that their residents are able to take care of their own aids (20.8%). Furthermore, the majority of all respondents reported that some assistance in caring for residents’ hearing problems is provided by family members (96%). Only 118 out of the 400 respondents reported that all residents are willing to use their glasses (29.5%), with 359 stating that family members provide assistance with this (89.8%).
A free text question asked about other practices used in the care home to assist with the identification and management of hearing and vision difficulties apart from those that had been listed. Additional hearing practices included using sign language professionals, nurses carrying out ear syringing, creating links with relevant charities, use of communications devices such as IPads, and staff training. Examples given of additional vision practices were contacts with relevant charities, input from a variety of outside professionals, volunteers, one on one care, visits from professional services that provide eye care, and staff assistance and training.
Table 2 shows the percentage of respondents who considered themselves to be confident in their knowledge of different aspects of hearing and vision care. For all questions about staff knowledge, over 50% reported being confident to some extent in their knowledge of a particular aspect of hearing and vision care. The majority of respondents strongly agreed that they were confident in cleaning glasses (57.5%) and communicating with the hearing (63.5%) or visually impaired residents (70.5%). However, less than 25% strongly agreed that they were confident in recognising various hearing (17.5%) and vision conditions (8.3%), assessing whether a resident has a hearing (24.8%) or vision impairment (14%), assessing hearing (21.5%) or vision impairment in the cognitively impaired (14.5%) and cleaning hearing aids (23.8%).
When asked whether the respondent would like more information regarding how to effectively identify and manage hearing and vision loss, 89.5% agreed that they would like more information on hearing loss, and 85.3% agreed they would like to receive this for vision loss.
For all homes with five or more staff who responded (n=26), a range of responses were provided about the practices the care home was implementing. Whilst some working in the same home agreed that certain practices took place in their care home, others from that same care home were unsure or disagreed; This highlights uncertainty amongst staff regarding the practices the care homes they worked in were actually implementing.
Relationship between hearing and vision care and participant characteristics (n=400)
Potential associations between the answers given to questions about hearing and vision care and the respondents’ job role, their length of time working in care homes, the type of care home they worked in and also the size of the home were examined by applying the Chi Square test. Table 3 shows which of these care home/staff factors were significantly related to the responses to questions about hearing and vision care. Fourteen of the 31 questions about hearing and vision were significantly related (p=0.000) to one or more of the questions regarding staff characteristics as shown in table 3. Detailed data, including absolute numbers and relative frequencies, pertaining to all chi-square results are included in Additional file 2.
Key: *significant relationships were found
Four questions about practices related to hearing and four questions about vision practices were significantly associated with job role. As shown in table 3, whether the care home used screening tools to assess both hearing (P=0.000) and vision difficulties (P=0.000), had access to other hearing (P=0.000) or vision (P=0.000) assistive devices or provided annual hearing (P=0.000) or vision (P=0.000) professional assessments significantly related to job role. A greater number of health care assistants and those classified as ‘other’ stated they were ‘not sure’ regarding whether these three practices for either hearing or vision took place in their employing care home. This was in comparison to care home managers and nurses who tended to state certainty (yes or no responses). However, responses to all other practices identified in the survey; namely, environment adaptations, the checking of assistive aids by staff and reporting of hearing and vision difficulties in care plans, were not found to be significantly related to the job role of the person completing it.
A significant association was found between staff knowledge of different vision problems and their job role (P=0.000). A greater number of care home managers and nurses reported that they had good knowledge of how to identify the different vision problems in their residents in comparison to health care assistants, activities coordinators and those identifying as ‘other’. Furthermore, a greater number of care home managers, compared to other job roles, reported that they believed their residents unable to take care of their own hearing aid (P=0.000).
Despite these significant results found, job role did not have effect on many of the factors assessed. For instance, all respondents despite job role, responded similarly to views on the environment, including the lighting and accessibility to quiet rooms. Their knowledge was also reported as similar despite job role, including their confidence in cleaning aids, assessing hearing and vision difficulties in residents and confidence in communicating with residents with hearing and vision difficulties.
Length of time working in care homes
Significant associations were found between length of work and the three particular practices also affected by job role; namely use of screening tools, professional assessments by ear and eye care experts, and access to other assistive devices. A different level of certainty was again found in the reporting of hearing (P=0.000) and vision (0.000) screening tools, professional hearing (0.000) and vision assessments (P=0.000), and also whether residents have access to other additional vision assistive devices (P=0.000), dependent on length of time the participant reported as working in the care home. Those who had worked in cate homes less than two years were most likely to be uncertain about whether these practices were implemented in their care home, whereas those working in the care home for over 10 years were the most certain of the practices being used in their care home.
Significant associations were also found in the reporting of whether hearing aids are checked regularly (P=0.000) and whether the care home has quiet rooms available to residents with hearing difficulties (P=0.000), with greater uncertainty reported by those who had worked in the care home for less than two years in comparison to those with greater experience (2-5 years, 6-10 years, 10+ years). The heightened level of uncertainty among those with the least length of service is also evident in the reporting of whether residents’ glasses are labelled (P=0.000).
Whilst some associations were found, knowledge again seemed not to be affected by the respondents’ length of time working in care homes, instead only affecting their knowledge of what practices are available to them and their residents which is evident by the frequency of “not sure” responses. They all also similarly viewed the capabilities and willingness of their residents to wear and take care of their own assistive aids.
Type of care home
Care home type was shown to be significantly related to five questions about hearing and two about vision. Respondents from care homes specifically for people with dementia reported that their residents were more likely not to use their prescribed hearing aids (P=0.000) and glasses (P=0.000) in comparison to all other care home types. A greater percentage of respondents from these homes caring specifically for people with dementia also reported that their residents were unable to take care of their own prescribed hearing aids (P=0.000) and were more likely to have their glasses labeled (P=0.000) in comparison to all other care home types.
Respondents from homes noted as caring specifically for those with dementia or as ‘other’ were the least likely to state that they were ‘unsure’ regarding whether residents hearing aids were checked regularly by staff (P=0.000). Staff working in those care homes identifying as ‘other’ were also less likely to be confident in their ability to communicate with residents with hearing difficulties in comparison to respondents from all other care home types (P=0.000).
Care home type however, was not associated with care practices provided to residents, including the use of screening tools, access to other assistive devices, the environment, recording of impairments in care plans, and the accessibility to professional vision assessments. Knowledge again was not associated with care home type, with similar reporting of knowledge of the different conditions, how to assess hearing and vision, how to take care of the different assistive devices and communicate with those with vision difficulties.
Size of the care home
Size of care home was not found to be significantly related to any question, and therefore responses were not affected by how many residents resided in the respondents’ care home.