‘Managing down’: ‘pioneering’ practice and professional discretion in the South-West of England care homes during the pandemic

ABSTRACT This qualitative study investigates how care homes in South-West England managed and responded to the everyday challenges of the COVID-19 pandemic. While many studies explore the impact of the pandemic on care home staff, residents and families, limited research addresses care homes’ experiences with filtering top-down rules and guidelines during ‘uncertain times’. Drawing on the concept of ‘street-level bureaucracy’, this study examines how professionalism operates under crisis conditions and how it impacts discretion and organisational response within care homes. Based on 14 semi-structured interviews with care home staff, including managers, analysis highlights that care homes engaged in effective response mechanisms and developed innovative practices in response to the needs of staff, residents and their families by moving beyond the scope of established guidelines. The mobilisation of professional discretion under crisis conditions by both care workers and managers centre around four key categories: strengthening infection control and prevention, promoting socialisation, enhancing communication and fostering intra- and inter-professional teamwork. Pioneering, which emerges as a common element across these categories, shapes professional discretionary responses of care home workers and managers in relation to policy mediation and implementation during the pandemic. This study, thus, emphasises the ability of care home staff to take action and their resilience in facing pandemic-induced challenges.