Care of the ageing veteran population: developing an evidence base for the Royal Hospital Chelsea model of care

It the midst of a globally ageing population, where and how we live as we get older, matters. The Royal Hospital Chelsea has provided a home, support, and care, for retired British Army veterans since 1692. However, until now there has been an absence of evidence on the impact this provision has on its residents, the Chelsea Pensioner (or, ‘In-Pensioner’). This project had two main aims: to explore the Royal Hospital Chelsea model of care and the impact it has on the lives of In-Pensioner’s, and to inform future service provision. A literature review considered theories relating to ageing, specifically ageing ‘well’ and ageing in [the right] place. The UK residential landscape for those aged 65 years and over, and a Systematic Narrative Review were carried out to explore existing residential care options for veterans and identify what impact this residential care had on health and social care outcomes. A mixed method, non-traditional convergent design facilitated the collection of qualitative data from 19 Key Staff (Part A), and 25 In-Pensioner participants (Part B), in the form of semi-structured interviews, which allowed participants the flexibility to provide in-depth responses to interview questions. Quality-of-life questionnaires were completed by all In-Pensioners (Part C), and 17 New In-Pensioner (Part D) participants. Qualitative and quantitative data sets were simultaneously analysed using Reflexive Thematic Analysis to facilitate a comprehensive understanding of the findings. Integrated analysis identified four mutually dependent areas that were fundamental to the Royal Hospital Chelsea model of care. The quasi-military environment provided a familiar setting that revived the attachment In-Pensioners experienced whilst serving in the British Army, as many considered the Royal Hospital Chelsea to be home. The changing demographics of the Armed Forces prompted suggestions of the inclusion of other branches of the military, which was met with acceptance and resistance. In-Pensioner identity was multidimensional as many primarily identified as Chelsea Pensioners, whilst maintaining strong connections to their individual identities. The blend of accommodation options made the Royal Hospital Chelsea challenging to describe succinctly. This did not impact on service provision but may present challenges for those outside of the Armed Forces Community and less familiar with its identity. By staying active, In-Pensioners maintained their independence, created a sense of purpose, and remained visible, as they engaged in informal hobbies and interests, or took part in more formal civic engagement-style events. Staying healthy was facilitated by an integrated medical centre, a social care team, and a collective commitment by all staff to place In-Pensioner wellbeing at the heart of everything they did. This commitment was also evident in residents who, through active peer-support, ensured fellow In-Pensioners were cared for. However, evidence of In-Pensioner stoicism and a reluctance to accept support presented challenges in service delivery. Collectively, these areas positively influenced an In-Pensioners health and social care outcomes, and overall life satisfaction. The findings from this project generated several recommendations for the Royal Hospital Chelsea, including further research into the changing demographics of future veterans; building on the quality-of-life evidence base created by this project; and sharing best practice with other veteran-specific residential establishments. Recommendations for service providers include exploring the provision, and impact, of civic engagement for those living in residential establishments; and exploring the impact an onsite medical centre may have on resident outcomes. Further research recommendations include identifying a potentially ‘hidden’ veteran community within residential establishments to explore the potential need for relocation to veteran-specific residential establishments; to consider the impact employing ex-military staff in quasi-military roles has on the staff member; and to explore ways to facilitate place attachment within residential establishments, to mitigate the impact of moving into higher needs care