Care homes resilience during the pandemic: changing to adapt.

Introduction: The unfolding of the pandemic in 2020 led to an unprecedented level of stress in care homes, including adjustments and changes within this pivotal service to the community in coping with the increased pressures on and need of support for the National Health Service (NHS). Care homes (CH) were crucial in providing healthcare services, but the support given to them was limited and lacked strategic information that enabled them to experience better outcomes. It was important to understand the CHs views and strategies and how these endured during the pandemic. Methods: A total of 220 CH from the Care Home Research Network (CHRN) were invited to take part in an on-line survey, where 51 CH completed the survey. The survey comprised demographic- and open-ended questions concerning the service and adaptations/adjustments made within CH during the pandemic. Results: CH staff reported an increase in the level of stress in their roles, including their workload, due to COVID-19, which made it difficult to cope with their tasks. CH also reported the fear of uncertainty, with some CH saying there was a lack of information. Loneliness and depression were reported as colossally increasing for residents. CH made changes to their working ways and spaces, adopting a more frequent use of technology platforms to meet residents needs. Conclusion: CH were resilient and adaptable to highly stressful challenges, ensuring residents need were met. CH felt a huge pressure to support wider health services, whilst having to deal with uncertainty, staff and supply shortages as well as cope with the loss of residents. Nevertheless, CH reinvented themselves, promoted more teamwork and used supporting channels, including investment in technology to facilitate communication between residents and families but also with supporting services such as general practitioners (GPs). Despite these changes, loneliness and depression amongst residents was reported as high. Highlighting the need to assess the long-term impacts of this on residents includes the development of interventions or strategies that will reduce depression/loneliness. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical Clearance was obtained from Kings College London Research Ethics Office Ethical Clearance Reference Number LRS-19/20-19657 I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.