Exploring the organisation and delivery of falls management in care homes for older people in England

Background: To explore the organisational context of English care homes in delivering falls management and identify barriers and facilitators to help design future service delivery. Methods: Non-participant observations and semi-structured interviews in one region of England with care home staff, commissioners and individuals involved in the organisation of falls management, care home managers, care home owners and residents. Barriers and facilitators were identified by thematic analysis and mapped against the Consolidated Framework for Implementation Research (CFIR). Results: 17 interviews were undertaken including staff and a resident from three care homes. Delivering falls management in care homes was complex and challenged by difficulties in integration across a disjointed system, workforce challenges and managing complexity of resident needs with multiple competing priorities. Facilitators included consistent and regular multi-disciplinary support, valuing team working within the care home, and between the care home and external agencies, and the ability to retain care home staff who developed and honed skills over time and who valued their advocacy role for residents. Variation in care home environments, and access to healthcare support were highlighted. Conclusions: The delivery of falls management in care homes is complex and involves a number of interacting systems. Implementation strategies to support future delivery need to consider the pressure on care homes and wider systems, workforce challenges and variation between settings.