A critical evaluation of the implementation process of a person-centred model of care in a new dementia specific care home

Abstract

This thesis addresses the challenges associated with the implementation of models of person-centred care in newly operational care homes in an English context. This study critically evaluates a model of care produced in house, with academic support named in this thesis as EMBRACELIFE. The implementation of person-centred care in newly opened care settings is yet to be explored. Data collection took place between September and November 2015. An ethnographic approach was taken to fieldwork. Semi-structured interviews and/or unstructured observations were conducted with 20 care workers and 10 people with dementia. Document analysis was also undertaken on 6 personal care plans. A letter from the care provider completed the data set. A thematic approach to data collection was undertaken, informed by principles of discourse analysis. The finding revealed a culture of care organised around task. Overarching themes indicative of task-based practice were the care planning, activity, outdoor space, care worker perceptions, the mealtime experience, leadership and a lack of choice. The model of care was therefore not fully implemented. The research indicated the implementation process was hindered by organisational issues. These were inadequate staff training, unmet staff expectations, low staff satisfaction, a lack of a team ethos, a high agency staff presence, a lack of flexible care delivery. The newly operational status of the home had a uniquely mediating influence on these findings due to the challenge of assembling a new staff team, having a domino effect on the organisational issues described. This thesis concludes by suggesting care providers are in need of more support if they are to overcome organisational barriers, accentuated by the challenges of opening a new care home, to achieve person-centred cultures of care in such settings.