{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T10:22:03Z","timestamp":1747218123517,"version":"3.40.5"},"reference-count":165,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002001","name":"Health and Social Care Delivery Research (HSDR) Programme","doi-asserted-by":"publisher","award":["NIHR132541"],"award-info":[{"award-number":["NIHR132541"]}],"id":[{"id":"10.13039\/501100002001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Soc Care Deliv Res"],"abstract":"<jats:sec id=\"abs1-1\"><jats:title>Background<\/jats:title>\n<jats:p>Older people living in care homes are at high risk of poor health outcomes and mortality if they contract coronavirus disease 2019. Protective measures include social distancing and isolation, although implementation is challenging.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-2\"><jats:title>Objectives<\/jats:title>\n<jats:p>To explore the real-life experiences of social distancing and isolation in care homes for older people, and to develop a toolkit of guidance and resources.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-3\"><jats:title>Design<\/jats:title>\n<jats:p>A mixed-methods, phased design.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-4\"><jats:title>Setting<\/jats:title>\n<jats:p>Six care homes in England caring for older adults.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-5\"><jats:title>Participants<\/jats:title>\n<jats:p>Care home staff (<jats:italic>n<\/jats:italic> = 31), residents (<jats:italic>n<\/jats:italic> = 17), family members (<jats:italic>n<\/jats:italic> = 17), senior health and care leaders (<jats:italic>n<\/jats:italic> = 13).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-6\"><jats:title>Methods<\/jats:title>\n<jats:p>A rapid review to assess the social distancing and isolation measures used by care homes to control the transmission of coronavirus disease 2019 and other infectious diseases (phase 1), in-depth case studies of six care homes, involving remote individual interviews with staff, residents and families, collection of policies, protocols and routinely collected care home data, remote focus groups with senior health and care leaders (phase 2) and stakeholder workshops to co-design the toolkit (phase 3). Interview and focus group data and care home documents were analysed using thematic analysis and care home data using descriptive statistics.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-7\"><jats:title>Results<\/jats:title>\n<jats:p>The rapid review of 103 records demonstrated limited empirical evidence and the limited nature of policy documentation around social distancing and isolation measures in care homes. The case studies found that social distancing and isolation measures presented moral dilemmas for staff and often were difficult, and sometimes impossible to implement. Social distancing and isolation measures made care homes feel like an institution and denied residents, staff and families of physical touch and other forms of non-verbal communication. This was particularly important for residents with cognitive impairment. Care homes developed new visiting modalities to work around social distancing measures. Residents and families valued the work of care homes to keep residents safe and support remote communication. Social distancing, isolation and related restrictions negatively impacted on residents\u2019 physical, psychological, social and cognitive well-being. There were feelings of powerlessness for families whose loved ones had moved into the care home during the pandemic. It was challenging for care homes to capture frequent updates in policy and guidance. Senior health and care leaders shared that the care home sector felt isolated from the National Health Service, communication from government was described as chaotic, and trauma was inflicted on care home staff, residents, families and friends. These multiple data sources have informed the co-design of a toolkit to care for residents, families, friends and care home staff.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-8\"><jats:title>Limitations<\/jats:title>\n<jats:p>The review included papers published in English language only. The six care homes had a Care Quality Commission rating of either \u2018good\u2019 or \u2018outstanding\u2019. There was a lack of ethnic diversity in resident and family participants.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-9\"><jats:title>Conclusions<\/jats:title>\n<jats:p>Care homes implemented innovative approaches to social distancing and isolation with varying degrees of success. A legacy of learning can help rebuild trust at multiple levels and address trauma-informed care for residents, families, friends and staff. Future work can include evaluation of the toolkit, research to develop a trauma-informed approach to caring for the care home sector and co-designing and evaluating an intervention to enable residents with different needs to transition to living well in a care home.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"abs1-10\"><jats:title>Funding<\/jats:title>\n<jats:p>This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132541) and is published in full in <jats:italic>Health and Social Care Delivery Research<\/jats:italic>; Vol. 12, No. 45. See the NIHR Funding and Awards website for further award information.<\/jats:p>\n<\/jats:sec>","DOI":"10.3310\/yntw4569","type":"journal-article","created":{"date-parts":[[2024,11,8]],"date-time":"2024-11-08T16:52:19Z","timestamp":1731084739000},"page":"1-164","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Challenges and guidance for implementing social distancing for COVID-19 in care homes: a mixed methods rapid review"],"prefix":"10.3310","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6285-180X","authenticated-orcid":true,"given":"Joanne M","family":"Fitzpatrick","sequence":"first","affiliation":[{"name":"Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1010-6581","authenticated-orcid":true,"given":"Anne Marie","family":"Rafferty","sequence":"additional","affiliation":[{"name":"Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7946-0717","authenticated-orcid":true,"given":"Shereen","family":"Hussein","sequence":"additional","affiliation":[{"name":"Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8612-9600","authenticated-orcid":true,"given":"Richard","family":"Adams","sequence":"additional","affiliation":[{"name":"Sears Healthcare Ltd, Newbury, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3629-3995","authenticated-orcid":true,"given":"Lindsay","family":"Rees","sequence":"additional","affiliation":[{"name":"Encore Care Homes Management Ltd, Bournemouth, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7918-7485","authenticated-orcid":true,"given":"Sally","family":"Brearley","sequence":"additional","affiliation":[{"name":"Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7494-9030","authenticated-orcid":true,"given":"Sarah","family":"Sims","sequence":"additional","affiliation":[{"name":"Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2234-2872","authenticated-orcid":true,"given":"Amit","family":"Desai","sequence":"additional","affiliation":[{"name":"Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4377-5063","authenticated-orcid":true,"given":"Ruth","family":"Harris","sequence":"additional","affiliation":[{"name":"Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King\u2019s College London, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"6221","published-online":{"date-parts":[[2024,11]]},"reference":[{"key":"key2024110822162100_ref1-bib1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jclinepi.2020.10.007","article-title":"Cochrane Rapid Reviews Methods Group offers evidence-informed guidance to conduct rapid reviews","volume":"130","author":"Garritty","year":"2021","journal-title":"J Clin Epidemiol"},{"key":"key2024110822162100_ref2-bib2","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"key":"key2024110822162100_ref3-bib3","doi-asserted-by":"crossref","first-page":"e050706","DOI":"10.1136\/bmjopen-2021-050706","article-title":"Protecting older people living in care homes from COVID-19: a protocol for a mixed-methods study to understand the challenges and solutions to implementing social distancing and isolation","volume":"11","author":"Fitzpatrick","year":"2021","journal-title":"BMJ Open"},{"volume-title":"A Teaching Care Home Pilot. 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