Challenges in Research and Practice in Residential Long-Term Care.

Abstract

As the number of care-dependent older people is projected to grow drastically, the number of individuals depending on long-term care services will increase significantly over the next 50 years, while the number of informal caregivers and healthcare professionals is decreasing (European Commission, Economic Policy Committee, 2012). One of the key challenges for healthcare systems therefore is to develop and implement effective long-term care programs that provide person-centered, efficient, safe, and sustainable care and living environments, as well as a corresponding work environment for healthcare workers. Although the majority of care-dependent older people are cared for in their own homes, about one fifth receive care in residential care facilities (Colombo, Llena-Nozal, Mercier, & Tjadens, 2011). Future long-term residential care needs to be able to adapt to older people's needs rather than coerce older people to adapt to the system. Moreover, long-term residential care cannot do without combining both health and social care, putting the evidence into practice to support older persons' best possible quality of life.While many initiatives and innovations have been launched and tested to optimize long-term care in recent years (Leichsenring, Billings, & Nies, 2013), four major challenges remain to ensure that healthcare workers are able to provide the best possible care at all times in safe and positive work environments. In tackling each of these challenges, residents' well-being should be kept on the forefront, focusing on residents' capacities, personal preferences, interpersonal relationships, involvement, and social needs.First, despite the great number of initiatives taken to improve long-term care, the actual implementation of evidence-based long-term care models has been scarce. The INTERLINKS research initiative listing European long-term care projects illustrated which elements have to be in place to construct an integrated long-term care system. However, from the 59 identified projects, only 8 had undergone a systematic mixed-method evaluation of processes and outcomes. Half of the project had no, minimal, or uncompleted evaluations and therefore failed to truly impact clinical practice and health policy, because the interventions aspects having the most or no impact could not be identified (Leichsenring et al., 2013). Successful implementation of effective and sustainable interventions in long-term care requires a systematic approach. Implementation research, which is intended to aid our understanding of what, why, and how interventions work in the real world setting, is therefore what is truly and urgently needed (Peters, Adam, Alonge, Ageypong, & Tran, 2013).Second, person-centered outcomes, such as improving quality of life or strengthening partnerships between resident and healthcare providers on the one hand, and system outcomes, such as reducing avoidable hospitalizations or costs on the other hand, should be equally important in evaluating the effectiveness of new models of long-term care. This is in line with the Institute for Healthcare Improvement triple aim of improving patient's experience of care and health while reducing costs (Berwick, Nolan, & Whittington, 2008). Ideally, the long-term care environment strives to create a living environment mirroring home as much as possible, while strengthening the residents and their relatives as active and empowered service users and not as passive recipients of care (Wagner, Austin, Davis, Hindmarsh, Schaefer, & Bonomi, 2001). Moreover, the development of new models should also address the building of supportive work environments for healthcare professionals that provide the basis to achieve excellence in care.Third, optimal coordination of care and well-founded care transitions between long-term care settings and healthcare providers are pivotal. Although multiple healthcare professions are involved in the care of older people, nurses are in a key position to ensure continuity of care. …