Coding and analytic framework
| Main themes | Subthemes |
|---|---|
| Healthcare issues | Acuity of residents, complex comorbidities |
| Best interests: dementia and capacity | |
| Deterioration or rehabilitation | |
| Emergency care | |
| Access to medical care | |
| Anticipatory care | |
| Frailty | |
| Residential versus nursing status | |
| Professional boundaries as barriers to delivering care | Not calling the GP |
| Deference | |
| Expert vs tacit knowledge | |
| Role and disempowerment | |
| Recognising change | |
| Best interests | |
| Relationships/family | |
| Social care | |
| Risk | Distinguishing between minor and catastrophic symptoms |
| Moral and legal tensions: who takes responsibility for healthcare decisions | |
| Responsibility | Care homes as the last refuge when neither family or NHS can/will take on care |
| An ethic of care (moral ought) | |
| Care staff skill, disempowerment and responsibility | |
| Home or hospital—where should the care be delivered? | Stranger at the bedside—hospital care that inevitably means people who do not know the residents caring for them |
| The absence of end of life planning and care | |
| “Give her a chance” | |
| Substandard care (hospital): the experience of care home residents sometimes returning to the care home more ill than when they went | |
| “We're not short of work” (GPs) | |
| Support for care home staff in caring for ill residents | |
| Expectations and tensions | Normative assumptions of care homes as businesses/poor care (NHS staff) |
| Care homes held at arm's length | |
| Dealing with end of life | |
| “Oh God you know they've got septicaemia” (social care practitioners as healthcare practitioners) | |
| Contradictions | The economy of care: untrained staff in care homes and GP time |
| Ethic of care vs business ethic (both care home managers and GPs refer to the economy of their work) | |
| Deontological ethics vs consequentialist ethics: end of life (moral and legal tensions) | |
| Consequences | Care homes in isolation |
| Formal healthcare at a distance | |
| Care homes as a last resort, “picking up the pieces” | |
| Residents waiting for healthcare | |
| Reactive healthcare | |
| Quality of life? |
GP, general practitioner; NHS, National Health Service.