Preparedness for future health pandemics: A mixed methods study of the use of national policies and guidance to prevent the spread of respiratory viruses in care homes

Background Public health policies and guidance played a crucial role in controlling the spread of the COVID-19 virus. They addressed multiple aspects of daily life and were updated at pace as knowledge about the virus evolved. The COVID-19 pandemic was a particularly challenging time for care homes for older people. Objective To investigate how English policies and guidance supported care homes to implement social distancing and isolation measures for older care home residents, their family members, and care home communities. Methods In-depth case studies of six purposively sampled care homes across England comprising i) review of documents relevant to guidance, policies, and protocols related to social distancing and isolation measures, ii) individual interviews with residents (n = 17), family members (n = 17), care home staff n = 25), care home managers (n = 6), and iii) focus groups with senior leaders and external stakeholders (n = 13) within adult social care. Results Four themes were identified: significant variation in the content, length and level of detail in policies and guidance documents; rapid government updates to policies and guidance, often repetitive and unclear; challenges in implementing social distancing and isolation measures in complex environments with limited resources; and lack of policies and guidance about staff education, development and capacity building. Conclusions Government policies and guidance were poorly timed, complex and insufficiently tailored to care homes and their residents, undermining trust and consistent implementation. Limited training and support exacerbated implementation challenges, contributing to staff moral distress. This paper contributes significant understanding to inform future pandemic readiness.