Exploring the meaning of and barriers to quality of care for people living with dementia through the perspective of care home staff: A qualitative study

AIMS: The prevalence of dementia diagnoses means the demand for quality social care services is growing. This paper is an exploratory study of the larger project 'Music4theMind.' 'Music4theMind' is an intervention trial looking at the feasibility of music therapy in care homes to enhance care quality through the needs and symptom management of people living with dementia. This paper aims to understand the meaning of and barriers to delivering high-quality standards of care from the perspective of care home staff. Insights provided by staff will help to develop effective interventions in care homes for both residents and staff. METHODS: We conducted semi-structured interviews with fourteen care home staff (M age = 35, SD = 14) working on dementia specialist units at a not-for-profit care organisation across five care homes. The care homes were in the North and South of England and located in urban and rural areas. Interviews were carried out either in person or on Microsoft Teams between July 2022 and January 2023. RESULTS: An inductive thematic approach was used to identify themes from the data. Eight overarching themes and four sub-themes emerged. How care staff understand and practice quality care was (1) Caring for the health and well-being of residents' needs (1.1 physical care, 1.2 psychosocial care, 1.3 person-centred care), (2) Enabling residents to make choices and (3) Carer qualities. Staff reported that the help needed to deliver good quality care was (4) Information, learning opportunities and wider support, (5) Having enough staff on shift and (6) Resources for activities. The barriers to delivering high-quality care were (7) Behavioural and Psychological Symptoms of Dementia and (8) Time constraints (8.1 staffing factors). CONCLUSIONS: This research provides insights into how care home staff understand and deliver quality care for residents living with dementia. It highlights factors needed to help staff deliver good quality care for residents and the frequent challenges faced during care practice. Care organisations, policymakers, stakeholders, and researchers should address the needs of care staff to ensure that high standards of quality care are delivered sustainably to residents living with dementia. The findings can be incorporated into future care home interventions to enhance care quality delivery.