Care home managers' views on the media coverage of COVID-19 outbreaks in care homes for older adults: A case study in Stockholm.

The COVID-19 pandemic has particularly affected older adults and resulted in high rates of infections and deaths in care homes. We have conducted a case study in which three managers of care homes for older adults in central Stockholm have shared their thoughts on the media coverage of care homes for older adults during the COVID-19 pandemic. We analysed the data using conventional content analysis and identified three themes and five categories. The results show that the managers experienced the media coverage of care homes during the pandemic to be negative and incomplete, causing feelings of sadness and shame amongst themselves and their staff. The negative media coverage further generated added workload as they had to arrange for discussions to answer questions by staff and close relatives of the residents. Informants also thought that there is a lack of knowledge about the role of care homes and subsequently what to expect of them. Finally, informants reported that the pandemic might create an opportunity for system-level policy changes. In light of this, we discuss possible victim blaming of staff and how greater public awareness of the care home sector could facilitate for a debate on policy changes and the low social status of caring for older adults.

What does this research add to existing knowledge in gerontology?

This is one of the first studies on care home managers' views of the media coverage of the COVID‐19 pandemic, which they thought had been negative and incomplete.

The study shows that the media coverage negatively affected their health and wellbeing in the form of feelings of sadness and shame.

The care home managers thought that lack of knowledge onthe role of care homes for older adults and what to expect of them contributed to the harsh media reporting.

What are the implications of this new knowledge for nursing care with older people?

As mentioned by the care home managers, the role of care homes needs to be debated and disseminated in society to address lack of knowledge on the work undertaken in care homes.

The social status of caring for older adults needs to be improved to stop and prevent staff from feeling shame of working in the elderly care sector.

How could the findings be used to influence policy and practice?

Increased awareness of the role of and what one can expect of care homes for older adults could be addressed through education and policy.

Addressing the low social status of caring for older adults and promoting positive aspects of this sector could contribute to long‐term changes in attitudes.

INTRODUCTION

Long‐term care homes for older adults have been disproportionally affected by the SARS‐CoV‐2 (COVID‐19) virus. Statistics show that care home residents account for up to 50% of all deaths in countries such as the United States, England, France, Spain and Sweden (European Centre for Disease Prevention and Control, 2020; Kaiser Family Foundation, 2021; Office for National Statistics, 2021). Sweden's capital, Stockholm, was hit particularly hard by the pandemic. By June 2020, 7% of older adults in Stockholm care homes had died from COVID‐19 compared with 2% of older adults in care homes across the rest of the country (Szebehely, 2020).

In the beginning of the pandemic, mainstream Swedish media primarily reported on the development of the spread of the coronavirus and information on the latest recommendations on how to avoid being infected (Melin, 2020). However, the rapidly increasing number of fatal cases changed the media reporting to focus more on failure in protecting older adults. This resulted in individual care homes being harshly exposed (Andersson, 2020; Baumann et al., 2006; Fjällborg, 2020). An American study has reported similar trends in the United States. Their study shows that the increase in numbers of infected and dead older adults in care homes was followed by a dramatic rise in both the volume of articles and the number of prominently placed articles with a negative tone about care homes (Miller et al., 2021). In their study, the researchers analysed articles from four of the most widely circulated newspapers in the United States: The New York Times, Washington Post, USA Today, and Los Angeles Times, from September 2018 to June 2020. Their findings showed that the COVID‐19 pandemic has uncovered challenges that care homes face on a systemic level. They further concluded that it is highly likely that the general public's view on care homes has become more negative during the pandemic (Miller et al., 2021). For a long time, many Americans have viewed care homes unfavourably and the general public's thoughts on care homes were at a low level even before the pandemic (Jones & Saad, 2019; Kaiser Family Foundation, 2007). A recent study demonstrating that both poor‐quality and high‐quality care homes in Ohio were equally affected by COVID‐19 has suggested that care homes might have been accused purely because media and the general public wanted someone to blame for the tragedy (Bowblis & Applebaum, 2020).

A short open‐ended 4‐item survey about challenges during the pandemic sent to care home staff across multiple American states is one of few studies that has reported on care home workers' perceptions on the media coverage during the COVID‐19 pandemic. In the survey, several respondents expressed lack of recognition by the media, public and government, and reported that the negative media coverage has had a demoralising impact (White et al., 2021). An additional aspect of the media coverage of the COVID‐19 pandemic that has been highlighted include that healthcare professionals at intensive care units often have been praised for their work whereas the work by professionals in social care services have received less attention (Shembavnekar et al., 2021).

Little research has focused on media reporting on COVID‐19 in care homes and no previous study on this topic has been conducted in Sweden. Therefore, we will present and discuss our findings on care home managers' views on the media coverage of COVID‐19 outbreaks in care homes for older adults.

METHODS

For this exploratory study, we obtained data from qualitative interviews with managers of care homes for older adults in the city of Stockholm, Sweden (Ethical approval 2020–04577). Stockholm was targeted as it was particularly hard hit by the pandemic. Thirteen care homes were purposively sampled to obtain some variation in geographical location, number of residents and ownership status. Researcher LM telephoned the managers of the thirteen care homes to inform them about the study and asked them to participate of which nine agreed. Three dropped out due to time constraints. The remaining six informants participated in an interview study about the influence of organisational characteristics on COVID‐19 infection control [Liljas A., Morath L., Burström B., Agerholm J., unpublished data]. During the interviews, three informants spontaneously came to talk about the role of media. The researcher let them speak freely about the topic and only interrupted them for clarification. The interviewer then continued with the topic guide. In this Commentary, we focus solely on the information provided by the three informants about the media coverage of care homes during the COVID‐19 pandemic. Media was neither mentioned in the pilot interview nor part of the aim of the original interview study.

Researcher LM (female) conducted the one‐to‐one interviews by telephone or Zoom between 25th February and 17th March 2021 based on the participant's availability and preference. Each interview took about one hour and was conducted in Swedish. All participants provided informed consent prior to the interview. Researcher LM audio recorded and transcribed the interviews verbatim. She took field notes and anonymised all identifiable information after each interview. Participants have been given the opportunity to read and comment on the manuscript prior to submission.

Researchers LM and AL conducted the data analysis of the transcribed interviews using conventional content analysis. Conventional content analysis is suitable for inductive studies that aim to describe a phenomenon, and appropriate when existing research literature on the phenomenon is minimal. This analysis approach also allows for the research question to be depicted post data collection (Hsieh & Shannon, 2005). AL has several years of experience in ageing research including conducting qualitative studies. LM studies medicine and has a background as a journalist. Individually, we (researchers LM and AL) read the text multiple times to achieve immersion and to identify codes in the data. We highlighted words in the text that captured key thoughts and took notes of our thoughts independently. We then organised our codes into potential categories and themes and compared our categories and themes using MS Excel. We repeatedly discussed and revised the themes and their relationship until they reached consensus. We then translated the categories, themes and quotes into English. We discussed choice of words and synonyms to make the translations as accurate as possible. Our colleague BB who has extensive experience in ageing research contributed to the interpretations of the findings.

RESULTS

Characteristics of participants are presented in Table 1. The participants were all managers of small to medium sized privately operated care homes for older adults located in central Stockholm.

TABLE 1

Characteristics of participants

	Title	Ownership	Number of residents	Number of employees
Informant 1	Manager	Private	50–100	>150
Informant 2	Manager	Private	<50	<100
Informant 3	Manager	Private	<50	<100

Table 2 shows the categories and themes identified in the text: an inadequate picture, adverse consequences of the media coverage and opportunity for change. The themes are presented in the text below.

TABLE 2

Themes and categories

Themes	An inadequate picture	Adverse consequences of the media coverage	Opportunity for change
Categories	Incomplete and negative reporting	Personally negatively affected	The responsibility of politicians
	Lack of knowledge on care homes	Consequences to staff and workplace

An inadequate picture

All participants thought that the media coverage during the COVID‐19 pandemic often consisted of incomplete and negative reporting of care homes.

[Media reported] that the older residents are just dying, that they don’t receive any help. [That there were] no staff by their side etcetera. It was almost nothing [in what the media reported] that we recognized here. Yet it was the picture given to the general public, that it was like this in every care home. (Informant 1)

The informants further thought that there is a lack of knowledge about staff competence and what care homes are like.

I think it's outrageous to blame the elderly care, [to claim] that the elderly care would have more or less killed it's residents. That is, I'm awfully biased, but I think it is dreadful because, it [the elderly care] is not prepared for anything like this, it just isn’t. … I think people believe that care homes are like hospitals, and they aren't. And they shouldn’t be. Clarity in what care homes involve and what to expect of them is missing. (Informant 2)

Insight into what it is like to reside and work in a care home [is missing]. … The biggest misunderstanding is probably the competence required by staff to look after someone with dementia. People think that anyone can do the job but that just wouldn't work. (Informant 3)

Adverse consequences of the media coverage

Two of the informants reported that the media coverage had negatively affected them personally.

It [the media reporting] makes me very sad, and it also provokes me to turn on the TV. Those of us who work in care homes don't find it [the media reporting] particularly uplifting, to say the least. All that negative criticism. It really hurts as our care home is a wonderful place where both residents and their close relatives are very satisfied. It feels like we're battling against a headwind. (Informant 3)

Two informants further reported that the media coverage had had negative consequences to staff and workplace.

Some [staff] felt that this wasn't okay. They repeatedly said that reading about it made them feel ashamed of telling people that they work in elderly care. Reporting that no one looks after older adults [with COVID‐19] was the most damaging [to us] and affected all staff. Actually, it made staff feel unwell at times. There have been many times when we have had to reflect and discuss this sort of stuff, discuss what has been reported by the media, what they had written. (Informant 1)

Anything that has been reported about care homes and COVID‐19 in the evening news generates ten phone calls from close relatives the following morning. [For many people] the elderly care is an unknown area and so one single story on TV can cause a great deal of issues to us who work in the field.” (Informant 3).

Opportunity for change

Two of them thought that the COVID‐19 pandemic might put the care for older adults on the political agenda, which would create opportunities for policy changes to care homes on a system level.

It [the negative reporting on care homes] might help to get politicians to invest in the elderly care, though it has not been uplifting for us who work in the field. (Informant 3)

I understand that increasing taxes won't create landslides in the elections but they [politicians] have to be able to debate [the role of care homes], I think. And such debate might happen now. (Informant 2)

DISCUSSION

Our findings show that care home managers experienced the media coverage of the COVID‐19 pandemic to be negative and incomplete. They expressed that this was worsened by lack of knowledge of the role of care homes and subsequently what to be expected of them. The findings further show that the media coverage has negatively affected care home managers, their staff and the care home they manage in the form of feelings of sadness and shame. It also increased their workload as they had to arrange for discussions to answer questions by staff and close relatives of the residents. The informants hoped that the pandemic might create an opportunity for system‐level changes to care homes.

The care home managers' perceptions on negative media coverage on care homes support previous findings from the U.S. where a dramatic rise in articles with a negative tone about care homes has been observed (Miller et al., 2021). The large number of COVID‐19 related deaths that occurred in care homes for older adults might justify the intense media coverage. However, hospital‐based frontline staff have mainly been portrayed positively in the media and considered heroes by the general public despite many fatalities in hospitals too (Bauchner & Easley, 2020; Manthorpe et al., 2021; Shembavnekar et al., 2021). Such lack of appreciation for hard work reported by the care home managers is in line with previous research. For instance, the need of feeling valued was demonstrated in a recent survey about health and social care staff's reflections on the weekly clapping for carers by the UK general public. According to the survey findings, several social care workers made favourable mention of being classified as frontline staff worthy of appreciation (Manthorpe et al., 2021). It is possible that the pre‐existing negative picture of care homes described by the informants in the present study and elsewhere (Shembavnekar et al., 2021) might have made the elderly care ‘a sitting duck’ in the search for someone to blame (Bowblis & Applebaum, 2020). Indeed, caring for older adults has for a long time been undervalued (Koskinen et al., 2015), underfunded (Pelling, 2021) and politically neglected (Pelling, 2021; Shembavnekar et al., 2021).

The large proportion of women working in this sector in combination with low salaries and precarious work conditions have been reported to contribute to its low social status (Pelling, 2021). Additionally, apart from considering elderly care low status, many nurse students have for a long time thought that caring for older adults does not require specialised knowledge or skills (Dahlke et al., 2021; Kydd et al., 2014). The underfunding of the elderly care could be explained by cuts in the public expenditure of the elderly care as a consequence of the global financial crisis in 2007–2008 (Pelling, 2021). At the same time, the growing number of for‐profit‐providers has pushed for higher productivity (Pelling, 2021). Together, these factors have resulted in high vacancy and high staff turnover rates, allowing for little flexibility when exposed to new challenges such as the COVID‐19 pandemic (Shembavnekar et al., 2021). Worse still, the already high turnover and job burnout among care workers (Willard‐Grace et al., 2019) have increased during the pandemic due to long working hours and more work‐related stress (Jang et al., 2021; Teo et al., 2021). Our research reports that the wellbeing of care home workers was negatively affected by the COVID‐19 media coverage. However, the possibility cannot be excluded that negative media coverage on COVID‐19 has had undesirable impact on other aspects of health closely linked to the social work environment such as burnout, retention and turnover, too.

Informants of this study further highlighted that the role of care homes needs to be debated and disseminated in society. For example, housing services provided vary between care homes and countries. However, care homes have neither specialised medical equipment nor specialised medical staff. This restricts the possibilities to provide advanced care and to isolate certain sections of the care home (Szczerbińska, 2020). At the time of the first COVID‐19 outbreaks, care homes in many societies were not only poorly prepared for outbreaks (Abbasi, 2020; Kaelen et al., 2021) but also ‘abandoned’ as the shortage of personal protective equipment and testing often resulted in intensive healthcare settings being prioritised (Abbasi, 2020). Unquestionably, working under conditions that pose substantial risks to their own health and wellbeing demonstrate remarkable altruism and self‐sacrifice (Morley et al., 2020). Under such circumstances, a lack of appreciation and low social status might be particularly demoralising. This emphasises the importance to listening to staff when making changes to, and in the development of, policy (Morley et al., 2020). Recently, an increased focus on care home policy has been observed in the U.S. Future care home policy is predicted to be shaped by the breadth of reporting on care homes for older adults in media during the COVID‐19 pandemic (Miller et al., 2021). Incorporating the perspectives of those affected is therefore essential to make future care home policy inclusive and sustainable.

In this Commentary, we have presented and discussed our findings on an understudied topic. Our research is also one of the first studies to explore care home managers' views on the media coverage of care homes for older adults during the COVID‐19 pandemic. A strength of this case study is the use of conventional content analysis as it is appropriate when there is little existing research on the topic. This analysis approach has the advantages of allowing the research question to be depicted post data collection and gaining direct information from study participants without imposing preconceived categories. This further allows for the analysis to be grounded in the actual data (Hsieh & Shannon, 2005). Limitations include difficulty in generalising the findings as the number of informants is small and all of them operate private care homes in Stockholm. However, according to the concept of information power in qualitative research, even a small number of interviews might be sufficient if the research topic is almost unexplored (Malterud et al., 2016). Additionally, the study is difficult to replicate as the participants spontaneously shared their views of the media coverage. Further, the small sample makes it difficult to demonstrate data saturation and consistency between the data presented and the summary of the findings. Yet, earlier studies reporting similar findings is an indicator of qualitative validity of the study. Also, the researchers have reflected upon and acknowledge their subjectivity. Attempts to address limitations related to the subjectivity of the researchers and establish credibility and reliability throughout the research process include two researchers coding the data, providing detailed information about the research process, and letting participants read and comment on the manuscript. Though most Swedes speak English, it is unknown to what extent the informants were able to assess the accuracy of the translation. Furthermore, the informants were all managers which might have provided a one‐sided story as perceptions on care are likely to differ depending on the occupational hierarchy (Sandholm Hellner, 2020). Hence, their views might differ from the views of care home staff who predominantly are women, of whom many are of foreign background and have limited education, and thus, might consume different media (Baumann et al., 2006; Fjällborg, 2020).

CONCLUSIONS

In conclusion, we have found that care home managers expressed that the media coverage of the COVID‐19 pandemic has been negative and incomplete, and negatively affected themselves, their staff and the elderly care home setting. This raises concern about victim blaming of staff. Greater public awareness of the care home sector could facilitate for a debate on policy changes and the low social status of caring for older adults. Larger studies are needed to examine the perceptions of the impact of the media coverage of the COVID‐19 pandemic amongst care home personnel including permanent and temporary staff. Further research should also capture the perspectives of residents and their close relatives and examine the potential impact of the negative media coverage on the general public's attitudes towards care homes for older adults.

IMPLICATIONS FOR PRACTICE

The lack of knowledge on the work undertaken in care homes needs to be debated and disseminated in society.

Improving the low social status of caring for older adults could stop and prevent staff from feeling shame of their work.

CONFLICT OF INTEREST

The authors declare no conflicts of interest.