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Researchers Cynthia Wyld, Patricia Duff, Sara Arber and Kate Davidson report on their study examining the reactions of residents, relatives and staff to changes caused by temporary relocation when residential homes have to be rebuilt or refurbished.

Moving home at any age can be a stressful and sometimes traumatic experience, and older people who have already moved from their individual homes into a residential home usually hope not to have to move again. How should those responsible for residential homes manage a necessary refurbishment programme in a way that causes the least stress and distress to elderly residents?

The research¹ considers issues resulting from temporary relocation of residents in most of the 17 homes that Anchor Homes took over from Surrey Council in 1998. It finds that staffing, communication and timescale were the three main issues connected with relocations.

All staff were guaranteed daily transport to and from their new place of work and encouraged to remain in employment. This was an important issue for all homes in ensuring continuity of care. Some staff were unhappy about moving to work in a new home, often five to 10 miles from their previous place of work, while others took the change as an opportunity to retire or change jobs. Senior staff were more accepting and perceived the benefits of the change.

Communication with residents, staff and relatives was undertaken during the 12-month preparation period at each home, in accordance with plans agreed by Anchor Homes. Information packs, meetings, and bulletins were used. Residents were also consulted on the decor and furnishings of their new room. Staff played a crucial role through their daily contact with residents.

The decision about when and how to communicate information to residents raises important issues relating to choice, autonomy and rights. Interviews with staff, residents and relatives suggest that these have to be balanced with a concern for avoiding stress and ensuring a continuity of familiar patterns. It was suggested by residents, relatives and staff that the consultation process was too long. Despite planning, consultation and reassurances, and in some cases because of it, some residents became anxious about their future in relation to friends, social life, familiarity of surroundings, staffing and continuity of visits.

Some residents and relatives said they were content with the existing surroundings and were unable to comprehend the long-term benefits of change. Staff also expressed the view that residents would have been better prepared by one-to-one sessions when they would be more likely to express their anxieties.

There were delays of at least a couple of months to the planned date of the move at each home. Such delays were a common cause of anxiety for all and constant updates were necessary.

There were also a number of specific issues. The study found that there were four models of relocation: two homes moved into one empty refurbished building (model 1); one home split between two homes with existing residents (model 2); one home moving to a newly built home (model 3); and staying put during the refurbishment of their home (model 4).

- In the case of two homes into one previously refurbished home there were two separate sets of staff and residents, each with their own established practices and cultures, moved to co-reside in one refurbished home. The timing for the move was critical and collaboration between each of the home's managers helped avoid conflict of interests during the move.

One home had a much higher number of mentally frail residents than the other. Each home was relocated in different wings of the building; the two homes retained separate care practices and staff and residents did not mix.

- Where one home was moved into two existing operational homes residents were relocated into two homes that were geographically close and could accommodate the "incomers" alongside their existing residents.

Fewer residents needed relocating than was originally anticipated; no new admissions had been made leading up to the move and there were a higher number of deaths than predicted.

Staff at each of the two homes had different views on staff integration. At one home the two sets of staff reported that there had been no difficulties working together - the staff mixed well and shared information. The other home appeared to have many more difficulties; existing staff reported that their jobs were more demanding and tiring. The incoming residents had much higher levels of dementia than the existing residents at both receiving homes. The existing residents at one home complained that "temporary" residents caused disruption within the home, particularly in the lounge area. There were different cultures in each of the homes brought together that meant that staff and residents had to adjust to a number of issues. For example, there were different charges and prizes for bingo at two homes that caused dissension among residents.

- In model 3 residents in one home were moved temporarily into a newly built residential home. The new location was seen positively by some residents because they had pleasant memories of the site, where there had once been an army barracks. The new home was spacious with a different layout from the original home. Staff found it difficult to transfer their skills and procedures easily into the new setting and took time to establish new patterns of social activity. Staff observed that residents with mental health difficulties fared better following the move than the residents whose health problems were physically related. This contrasts with the finding at one of the receiving homes in the 1 to 2 model.

- The main advantages of model 4 are that residents are able to stay on in the same location and thus maintain familiarity, and established patterns of visiting. The refurbishment was planned in five stages with a number of rooms being refurbished in each stage. Residents were moved around within the residential home in order to facilitate the necessary works. Perhaps surprisingly, the constant presence of builders and noise appear not to have been too disruptive.

A number of core issues can be identified across all four models of relocation: the timing involved in preparation for the move, communication methods, the need to preserve residents' autonomy and rights, emphasis on providing continuity of care and the preservation of a social life. The retention of existing staff was rated as highly desirable across all homes. The mixing of residents with different levels of mental and physical frailty can create discontent, anxiety and resentment, particularly among those who have to accept incomers potentially disrupting their established lifestyles. Established cultures exist within homes and changes in location, staffing and social contacts may remove much that has provided security and comfort.

In this study, the two relocation models 1 and 2, which involved the temporary mixing of staff and residents, were more problematic than model 3, which allowed single home relocation to an empty residential home. The least problematic was model 4, refurbished on site that permitted the residents to stay in the home, albeit changing rooms within it. Nevertheless, lessons can be learned from each of these experiences of temporary moving.

Cynthia Wyld is research fellow, Patricia Duff is research assistant, Sara Arber is professor of sociology, and Kate Davidson joint director, all at the Centre for Research on Ageing and Gender, University of Surrey. The authors would like to thank Anchor Homes for funding the research. The article represents the views of the authors and not those of Anchor Homes.

References

¹ Cynthia Wyld, Patricia Duff, Sara Arber, Kate Davidson, Managing Change During The Rebuilding and Refurbishment of Residential Homes, University of Surrey. For more information e-mail: C.Wyld@surrey.ac.uk