At My Home Life England, we have conducted one of the largest qualitative research studies on older people’s experiences of living in residential care. We spoke to 125 people (older people, care team members and families) in 16 care homes across Great Britain. The homes varied in terms of their size, type, location and inspection rating. We captured the voices of a diverse range of older people who had been living in a care home for an average of two years, with an average age of 85.

Our resulting research ‘Thriving in Residential Care’ shines a light on how, when conditions are right, care homes can support older people to really thrive. It revealed six key themes:

Thrive relationally

When asked what the benefit of living in a care home was, 74-year-old Brian replied: “Well, being here by having company. The one thing I like is company.” Brian’s response was echoed by many older people, who told us that they had previously felt isolated when living on their own, and that now being around others was a lifeline. Many had formed friendships with other people and relationships with their care team.

Moving to residential care also helped restore family relationships that were previously under strain. Now that their relative had moved to a care home, the families we spoke to generally felt reassured, welcomed and able to stay actively involved in their relative’s life. As Christine told us: “They not only care for my mum, and they care for my mum very well, but we’re included in that. It’s given me my mum back for how long or short time I’ve got with her.”

Thrive actively

Meaningful activity in a care home is vital. As 93-year-old Wally said: “Instead of being miserable at home and nothing to do... plenty of things to do here... occupy my mind.”

Similarly, when living at home, some older people found they could no longer do the things they previously enjoyed. But once living in a care home with the right support, people could adapt their interests to their capabilities. This included Irene, aged 82, who had a long career with a fabric company, which was critical to her identity. Now living in a care home, she was knitting scarves for the staff. She also found renewed purpose through laying tables and attending to others at mealtimes.

​We observed that well-conceived, person-centred activities and community connections were important for older people's self-expression, confidence and autonomy, and also provided opportunities to ‘give back’. This helps older people feel valued and respected.

Thrive inclusively

Inclusivity involves making someone feel welcome, safe, valued and respected, regardless of characteristic or background. We saw wonderful examples of support across the homes we visited, enabling older people to connect with their identity through embracing faith or culture, or through validating the experience of those living with dementia.

Our study also included care homes offering specialist provision for specific cultures and faiths, with culturally appropriate activities and foods, language support for those of whom English was not their first language and multi-faith chapels.

We also recognised the importance of care homes fostering an inclusive environment in which older people could express their sexual or gender identity. We heard very powerful stories, including that from care manager Jay, who recounted how his care home’s open and inclusive environment supported a gentleman to express his sexuality: “We have made an environment where somebody feels so safe that at age 82… he’s been able to come out [as gay]. At age 82! A secret that you’ve kept for all those years. I thought my job is done… if this environment is safe enough that somebody feels that they can do that, this environment is correct.”

Thrive securely

Older people, families and care teams all expressed that feeling safe and secure was one of the greatest benefits to living in residential care. Care homes offered older people reassurance, and also alleviated the strain and worry for families. 92-year-old Delith told us she had previously felt anxious living at home alone. But now: “When I go to bed at night, I don’t have told worry about whether anybody breaks in. If there’s any fire or anything, I feel safe at night.”

Before moving into residential care, other older people had experienced poor housing, insecurity and even violence. 75-year-old Pauline said that, previously, her life was “horrible”. She was living with her daughter and her son-in-law who “was a drinker”. She told us: “I didn’t like him. He used to throw bottles, so I was glad that I come out of there and that I’m in [my care home] now. Everything’s got better for me.”

Thrive with dignity

Care home manager Lynette recognised a “degree of self-neglect” in some of the older people who had previously lived alone. Many had been struggling with personal care and continence, but now had support with things like bathing and using the lavatory. Having an en suite bathroom was very important to some, including 84-year-old Rainee who said that getting to the bathroom by herself supported her independence.

Older people told us about the importance of having support with tasks which were becoming increasingly difficult to do themselves, including household chores. They really valued that these things were now taken care of. Others emphasised the importance of physical appearance to their self-esteem, and the benefit of having easy access to services such as a hairdresser.

Thrive healthily

Our study revealed an important benefit of residential care was that older people could be supported to maintain or even improve their health. Care homes were shown to provide proactive and pre-emptive medical care and also had easier access to other health professionals than if living in the community. 

Care team member Caitlin spoke of a lady who arrived with a “grade five pressure sore”, who “wasn’t eating or drinking – they expected her to be gone within weeks.” With the right support, she is now eating well and the pressure sore is healed; “She’s amazing, she’s thriving, she’s not going anywhere.”

Older people also valued having regular and good-quality meals and drinks. This included 98-year-old Suzanne, who shared that: “When I was at home… I lived for a fortnight on brown bread, Marmite and oranges… I was lacking good food.”

Finally, we were reminded that wellbeing should extend right through all chapters of life, and heard moving examples of care homes ensuring older people could live their best lives, even at the end of life.

Transformative

Our research has revealed how high-quality, proactive, relationship-centred care, inclusion in a social environment with meaningful activities, nutritious meals and a strong sense of safety and security has, in some cases, been truly transformative for many older people living in care homes and supported them to really thrive. It demonstrates that, while care homes may not be right for everyone, they can be everything for some.

The research was funded by Hallmark Foundation and independently engaged a range of care homes and care home providers.