Evaluation of an equity, diversity and inclusion program for the healthcare workforce in rural long-term care in Canada.

Care Aides Working Multiple Jobs: Considerations for Staffing Policies in Long-Term Care Homes During and After the COVID-19 Pandemic

This article examines what is known and what we need to know about rural long-term care populations and the formal and informal service systems that support their long-term care needs. The article provides a framework for identifying some of the critical policy and research questions concerning the financing and delivery of rural long-term care that merit the attention of health services researchers and policymakers. It documents differences in the demographic and health characteristics of the rural and urban elderly and in the availability, organization, and use of health and long-term care services in rural areas that have significant implications for long-term care policy and programs. With this background in mind, the author discusses specific topics and questions relevant to long-term care policy and program improvements for rural communities and people: (a) the changing role of the rural nursing home; (b) residential care alternatives in rural areas; (c) health personnel and rural long-term care; (d) the quality of rural long-term care; (e) innovations in long-term care financing and service delivery; (f) use of technology in rural long-term care; and (g) the effects of Medicaid and Medicare policy changes on the rural long-term care system.

BackgroundThe precautions and restrictions imposed by the recent Covid-19 pandemic drew attention to the criticality of quality of care in long-term care facilities internationally, and in Canada. They also underscored the importance of residents’ quality of life. In deference to the risk mitigation measures in Canadian long-term care settings during Covid-19, some person-centred, quality of life policies were paused, unused, or under-utilised. This study aimed to interrogate these existing but latent policies, to capture their potentiality in terms of positively influencing the quality of life of residents in long-term care in Canada.MethodsThe study analysed policies related to quality of life of long-term care residents in four Canadian provinces (British Columbia, Alberta, Ontario, and Nova Scotia). Three policy orientations were framed utilising a comparative approach: situational (environmental conditions), structural (organisational content), and temporal (developmental trajectories). 84 long term care policies were reviewed, relating to different policy jurisdictions, policy types, and quality of life domains.ResultsOverall, the intersection of jurisdiction, policy types, and quality of life domains confirms that some policies, particularly safety, security and order, may be prioritised in different types of policy documents, and over other quality of life domains. Alternatively, the presence of a resident focused quality of life in many policies affirms the cultural shift towards greater person-centredness. These findings are both explicit and implicit, and mediated through the expression of individual policy excerpts.ConclusionThe analysis provides substantive evidence of three key policy levers: situations–providing specific examples of resident focused quality of life policy overshadowing in each jurisdiction; structures–identifying which types of policy and quality of life expressions are more vulnerable to dominance by others; and trajectories–confirming the cultural shift towards more person-centredness in Canadian long-term care related policies over time. It also demonstrates and contextualises examples of policy slippage, differential policy weights, and cultural shifts across existing policies. When applied within a resident focused, quality of life lens, these policies can be leveraged to improve extant resource utilisation. Consequently, the study provides a timely, positive, forward-facing roadmap upon which to enhance and build policies that capitalise and enable person-centredness in the provision of long-term care in Canada.

To explore and understand the sources and experiences of joy in caregiving among formal caregivers in Canadian long-term care (LTC). A qualitative study with interpretative descriptive design. The participants consisted of 20 formal caregivers from a large public LTC home in British Columbia, Canada, focusing on those with at least 6 months of direct caregiving experience. Convenience sampling was conducted to recruit participants. Data were collected through 3 focus groups, with discussions moderated by the primary investigator, and were audio recorded and transcribed. Reflexive thematic analysis was used to identify themes, combining inductive and deductive strategies. To enhance rigor and trustworthiness, the research team engaged in reflective practices, leveraging diverse expertise, and ensuring a rich description of the study context. The study received ethical approval, and participant confidentiality was maintained through pseudonyms. Three interconnected themes of joy in caregiving were identified: (1) Joy in caregiving is a relational and dynamic process that evolves over time and coexists with other emotions, such as sadness and grief. (2) Joy is driven by an attitude shaped by the environment, stemming from an internal attitude, and contributing to a deeper sense of fulfillment despite challenges. (3) Joy in caregiving builds personal team resilience that reduces burnout, fostering compassion and creating a supportive atmosphere through gratitude and shared experiences, benefiting caregivers and residents. This study highlights the relational and evolving nature of joy in caregiving, the influence of internal attitudes and supportive environments, and the impact of joy on resilience and burnout. The findings contribute to characterizing how joy functions within caregiving contexts-specifically for LTC workers-and its broader implications for caregiver well-being and team dynamics.

In rural settings, many healthcare professionals experience intersections of professional and personal relationships, often known as dual roles. Dual roles are traditionally studied in terms of their potential for ethical conflicts or negative effects on care. In the existing scholarship, there is little discussion of dual roles in long-term care (LTC) settings, which present distinct conditions for care. Unlike other forms of health care, LTC work is provided daily, over longer periods, in care recipients' home environments. This article outlines results from a case study of LTC in rural Alberta, Canada and provides evidence of some of the challenges and, more notably, the considerable benefits of dual roles in these settings. The qualitative data discussed in this article come from a multi-site comparative case study of rural LTC that, among other questions, asked, 'How do personal and professional lives intersect in rural LTC settings across the province?' These data were collected through the use of rapid ethnographies at three rural LTC homes across the province of Alberta. The research team conducted semi-structured, in-depth interviews (n=90) and field observations (~200 hours). Participants were asked about care team dynamics, the organization of care work, the role of the LTC home in the community, and the intersections of public and private lives. The results were coded and critically analyzed using thematic analysis. Dual roles were primarily described as beneficial for care provision. In many cases, dual roles provided participants with opportunities for reciprocity, enhanced person-centered care, and increased perceptions of trust and community accountability. Similar to what has been documented in the extant literature, dual roles also presented some challenges regarding personal and professional boundaries for those in leadership. However, the negative examples were outweighed by positive accounts of how dual roles can serve as a potential asset of rural LTC. There is a need for more nuanced conversations around the implications of dual roles. Policies and care approaches need to emphasize and support the use of good judgment and the responsible navigation of dual roles, rather than taking either a permissive or prohibitive approach. Leaders in rural LTC can promote conversations among care providers, with an emphasis on the cultural context of care provision and how dual roles play out in their specific professional practice. Blanket policies or educational approaches that frame dual roles as necessarily problematic are not only insensitive to the unique nature of rural LTC, but prohibitive of relational elements that these results suggest are highly supportive of person-centered care.

This exploratory, mixed-methods study explores how older adults living in Canadian Long-Term Care (LTC) homes experience and perceive LOVOT, an AI-driven social robot from Japan. It is an extended arm of a mixed-methods, three-country study conducted in Singapore, Hong Kong, and Canada. Our Canadian sample consists of 20 older adults and 40 interdisciplinary staff, and 10 leadership team members. The participants join four weekly sessions of interaction with LOVOT. In the quantitative portion of the study, questionnaires are administered before and after interaction with LOVOT to assess participants’ experiences of the LOVOT robot. The qualitative portion consists of individual conversational interviews with older adults and focus groups with the LTC staff and leadership. We use thematic analysis to guide our initial conceptual framework, and later use both Chi-square tests and content analysis for our quantitative and qualitative data. This study demonstrates (1) the experiences and perceptions of older adults and their family members regarding their interactions with the LOVOT robot, and (2) the LTC staff and leadership perceptions on having the LOVOT robot in LTC. The study offers insights into the potential role of social robots in LTC homes across eastern and western countries.

BackgroundWithin the context of Canada’s aging population, the complexities of its long-term care system, and the COVID-19 pandemic, information about long-term care facilities, their residents, and their workers is needed. However, little information exists on long-term care residents as they are rarely included in population surveys, and data on the facility characteristics of long-term care workers’ places of employment are often not available. Objective and ApproachTo effectively monitor changes, improvements, and health outcomes in Canada’s long-term care sector, many data gaps need to be addressed. This paper will present the results of an initiative that sought to examine the potential of integrating existing survey and administrative data sources to fill these gaps. A novel approach was taken which focused on how both facility-level and individual-level data could be integrated, allowing for a more comprehensive understanding of long-term care in Canada. ResultsThis initiative resulted in the development of two data linkage proposals. This presentation will provide an overview of the data sources identified for linkage, the approach taken to examine the feasibility of these linkages, challenges with integrating the data sets, and next steps to move the initiative forward. ImplicationsThe data linkages that will be discussed will help to address data gaps on Canada’s long-term care system. The proposed data linkages may also provide researchers with ideas for using similar data sources to address data gaps in long-term care in their respective countries.

A Case for Community and Hospital-Based Long-Term Care Facilities in Saudi Arabia

This article examines provincial policy influence on long-term care (LTC) professionals' advice-seeking networks in Canada's Maritime provinces. The effects of facility ownership, geography, and region-specific political landscapes on LTC best-practice dissemination are examined. We used sociometric statistics and network sociograms, calculated from surveys with 169 senior leaders in LTC facilities, to identify advice-seeking network structures and to select 11 follow-up interview participants.Network structures were distinguished by density, sub-group number, opinion leader, and boundary spanner distribution. Network structure was affected by ownership model in Nova Scotia and Prince Edward Island, and by regional geography in New Brunswick. Political instability within each province's LTC system negatively affected network actors' capabilities to enact innovation. Moreover, provincial policy variations influence advice-seeking network structures, facilitating and constraining relationship development and networking. Consequently, local policy context is essential to informing dissemination strategy design or implementation.

BackgroundPain among long-term care (LTC) residents, and especially residents with dementia, is often underassessed and this underassessment has been attributed, in part, to gaps in front-line staff education. Furthermore, although evidence-based clinical guidelines for pain assessment in LTC are available, pain assessment protocols are often inconsistently implemented and, when they are implemented, it is usually within urban LTC facilities located in large metropolitan centers. Implementation science methodologies are needed so that changes in pain assessment practices can be integrated in rural facilities. Thus, our purpose was to evaluate an online pain assessment training program and implement a standardized pain assessment protocol in rural LTC environments.MethodsDuring the baseline and implementation periods, we obtained facility-wide pain-related quality indicators from seven rural LTC homes. Prior to implementing the protocol, front-line staff completed the online training program. Front-line staff also completed a set of self-report questionnaires and semi-structured interviews prior to and following completion of the online training program.ResultsResults indicated that knowledge about pain assessment significantly increased following completion of the online training program. Implementation of the standardized protocol resulted in more frequent pain assessments on admission and on a weekly basis, although improvements in the timeliness of follow-up assessments for those identified as having moderate to severe pain were not as consistent. Directed content analysis of semi-structured interviews revealed that the online training program and standardized protocol were well-received despite a few barriers to effective implementation.ConclusionsIn conclusion, we demonstrated the feasibility of the remote delivery of an online training program and implementation of a standardized protocol to address the underassessment of pain in rural LTC facilities.

Context: Since the 1990s, Alberta, Canada has seen considerable restructuring to health and long-term care (LTC) services. Most LTC research is conducted in urban centres. As a result, little is known about the effects that restructuring has had on rural LTC homes. Objective(s): In this article, we outline our findings related to autonomy and capacity for action in rural LTC homes. Method(s): We conducted a multi-site comparative case study. Using rapid ethnography, we conducted weeklong site visits at three rural LTC homes. This involved two types of data collection: semi-structured qualitative interviews and field observations. We used a feminist political economy lens to analyze the data. Findings: Our findings offer insights into how rural LTC staff are empowered to create change and/or constrained from doing so. We outline these findings at macro, meso, and micro levels of analysis and conclude that a combination of site-level and systemic factors contribute to a LTC home’s level of autonomy and capacity for action. Limitations: Our findings reflect experiences and observations at three LTC homes at three distinct points in time. Though the data provide rich descriptions, they do not provide an exhaustive account of the strengths and challenges of rural LTC. Implications: Community resources, local industries, and other socioeconomic and organizational factors contribute to a community’s response to LTC restructuring and their ability to make change and ruralize their LTC provision. These factors, and the heterogeneity of rural communities, should be taken into consideration during decision-making about rural health policy and service provision.

Needs for non-medical residential care services, long-term care (LTC), will increase over the next 30 years as Canada's population ages. Adams and Vanin (2016) explore four options for raising the public and private monies required to meet LTC needs. In this commentary, I raise a fifth option for finding the resources to meet emerging LTC needs. An alternative approach is to divert resources from Canada's well-resourced, but inefficient, medical treatment system. The dividend of provinces pursuing long overdue reforms to medicare is the liberation of public funds to finance emerging priorities for Canadians like LTC.

BackgroundThe COVID-19 pandemic is a significant public health emergency that impacts all sectors of healthcare. The negative health outcomes for the COVID-19 infection have been most severe in the frail elderly dwelling in Canadian long-term care (LTC) homes.MethodsAn online cross-sectional survey of Ontario LTC Clinicians working in LTC homes in Ontario Canada was conducted to provide the clinician perspective on the preparedness and engagement of the LTC sector during the COVID-19 pandemic. The survey questionnaire was developed in collaboration with the Ontario Long-Term Care Clinicians organization (OLTCC) and was distributed between March 30, 2020 to May 25, 2020. All registered members of the OLTCC and Nurse-led LTC Outreach Teams were invited to participate. The primary outcomes were: 1) the descriptive report of the screening measures implemented, communication and information received, and the preparation of the respondent’s LTC home to a potential COVID-19 outbreak; and 2) the level of agreement, as reported using a five-point Likert scale), to COVID-19 preparedness statements for the respondent’s LTC home was also assessed.ResultsThe overall response rate was 54% (160/294). LTC homes implemented a wide range of important interventions (e.g. instituting established respiratory isolation protocols, active screening of new LTC admissions, increasing education on infection control processes, encouraging sick staff to take time off, etc). Ample communications pertinent to the pandemic were received from provincial LTC organizations, the government and public health officials. However, the feasibility of implementing public health recommendations, as well as the engagement of the LTC sector in pandemic planning were identified as areas of concern. Medical director status was associated with an increased knowledge of local implementation of interventions to mitigate COVID-19, as well as endorsing increased access to reliable COVID-19 information and resources to manage a potential COVID-19 outbreak in their LTC home.ConclusionsThis study highlights the communication and implementation of recommendations in the Ontario LTC sector, despite some concerns regarding feasibility. Importantly, LTC clinician respondents clearly indicated that better engagement with LTC leaders is needed to plan a coordinated pandemic response.

AN INVESTIGATION OF A NON-INVASIVE JUGULAR VENOUS PRESSURE POINT OF CARE DEVICE TO DIAGNOSE AND ASSESS HEART FAILURE IN LONG TERM AND PRIMARY CARE: A MIXED METHOD APPROACH

Chapter 1: Long-term care services in Norway - a historical sociological perspective (Karen Christensen and Kari Waerness) Chapter 2: Revisiting the public care model - the Danish case of free choice in home care (Tine Rostgaard) Chapter 3: Organizational trends impacting on everyday realities: the case of Swedish eldercare (Anneli Stranz and Marta Szebehely) Chapter 4: Long-term care reforms in the Netherlands: care work at stake (Barbara Da Roit) Chapter 5: The English social care workforce: the vexed question of low wages and stress (Shereen Hussein) Chapter 6: The personalization and marketization of home care services for older people in England (Kate Baxter) Chapter 7: The development of an ambiguous care work sector in France. Between professionalization and fragmentation (Blanche Le Bihan and Alis Sopadzhiyan) Chapter 8: Care provision inside and outside the professional care system: the case of long-term care insurance in Germany (Hildegard Theobald) Chapter 9: Employing migrant care workers for 24-hour care in private households in Austria: benefits and risks for the long-term care system (August OEsterle) Chapter 10: Migrant care workers in Italian households: recent trends and future perspectives (Mirko Di Rosa, Francesco Barbabella, Arianna Poli, Sara Santini and Giovanni Lamura) Chapter 11: Post-socialist eldercare in the Czech Republic: institutions, families, and the market (Adela Souralova and Eva Slesingerova) Chapter 12: Imbalance between demand and supply of long-term care - the case of post-communist Poland (Stanislawa Golinowska and Agnieszka Sowa-Kofta) Chapter 13: Long-term care in Turkey: challenges and opportunities (Sema Oglak) Chapter 14: The emergence of eldercare industry in China - progress and challenges (Xiying Fan, Heying Jenny Zhan and Qi Wang) Chapter 15: Challenges of care work under the new long-term care insurance for elderly people in South Korea (Yongho Chon) Chapter 16: Migrant live-in care workers in Taiwan: multiple roles, cultural functions, and the new division of care labour (Li-Fang Liang) Chapter 17: Has the long-term care insurance contributed to de-familialisation? Familialisation and marketization of eldercare in Japan (Yayoi Saito) Chapter 18: Care robots in Japanese elderly care: cultural values in focus (Nobu Ishiguro) Chapter 19: Long-term services and supports for the elderly in the United States: a complex system of perverse incentives (Candace Howes) Chapter 20: Complexities, tensions, and promising practices: work in Canadian long-term residential care (Pat Armstrong and Tamara Daly) Chapter 21: Reforms to long-term care in Australia: a changing and challenging landscape (Jane Mears) Chapter 22: Facing the challenges of population longevity but not being ready - the case of Argentina (Nelida Redondo) Index