Nurse Perceptions of End-of-Life Care Quality Across Long-Term Care, Home, and Social Model Hospice Home Settings: A Qualitative Descriptive Study.

Need Is Urgent for Better Dementia Care

Uncovering the Devaluation of Nursing Home Staff During COVID-19: Are We Fuelling the Next Health Care Crisis?

Objective: Little attention is paid to understand Generation Y’s views about institutional placement. This study investigated the Y generation’s intentions to use long-term institutional care services. Methods: This study employed a cross-sectional descriptive survey design. The proportionate sampling method was applied. A questionnaire including a scale of attitudes toward long-term care (LTC) institutions, an item of perceived norms toward LTC institutions, and an item of intentions to use LTC institutions when aging was developed. A total of 609 university senior students returned the questionnaires (90% response rate). Descriptive statistics were applied to all variables. Predictor variables were analyzed by a multiple regression. Results: The respondents had moderate levels of intention to use LTC institutions when they age. Based on the regression, attitudes toward LTC institutions (P < .001) and perceived norms toward LTC institutions (P < .001) were predictors of intention to use LTC institutions when they age. The variance in intentions to use LTC institutions when they age explained by attitudes toward LTC institutions and perceived norms toward LTC institutions was about 24%. Conclusion: Study findings imply that it is vital to investigate attitudes and perceptions about institutional care services utilization among people of all ages as the society rapidly changes.

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

In long-term care (LTC) facilities, nursing staff are important contributors to resident care and well-being. Despite this, the relationships between nursing staff coverage, care hours, and quality of resident care in LTC facilities are not well understood and have implications for policy-makers. This systematic review summarizes current evidence on the relationship between nursing staff coverage, care hours, and quality of resident care in LTC facilities. A structured literature search was conducted using four bibliographic databases and gray literature sources. Abstracts were screened by two independent reviewers using Covidence software. Data from the included studies were summarized using a pretested extraction form. The studies were critically appraised, and their results were synthesized narratively. The systematic searched yielded 15,842 citations, of which 54 studies (all observational) were included for synthesis. Most studies (n = 53, 98%) investigated the effect of nursing staff time on resident care. Eleven studies addressed minimum care hours and quality of care. One study examined the association between different nursing staff coverage models and resident outcomes. Overall, the quality of the included studies was poor. Because the evidence was inconsistent and of low quality, there is uncertainty about the direction and magnitude of the association between nursing staff time and type of coverage on quality of care. More rigorously designed studies are needed to test the effects of different cutoffs of care hours and different nursing coverage models on the quality of resident care in LTC facilities.

410 - A Systematic Review on Digital Health Interventions (DHIs) supporting the administration of Comprehensive Geriatric Assessments (CGAs) use in long-term and home care settings

E Health Records and Information Exchange

Nursing Home Reform in the Context of National Long-Term Care Services and Policy: The Devil in the Details of the National Academies Report.

Exploring Place of Death among Individuals with Huntington's Disease in the United States

Mental health service delivery in long-term care homes.

While debate over the appropriate scope and goals of COVID‐19 lockdowns has raged, all public health agencies have been clear on one matter: older adults have the highest rates of mortality (Comas‐Herrera et al., 2020) and should be isolated (Public Health Agency of Canada, 2020). Older adults and individuals with complex health conditions are most vulnerable to the virus. Yet, social isolation contributes to the onset and intensifies depression, feelings of despair and, in older adults with dementia, further cognitive decline.

Demands and resources significantly influence burnout and work ability, which are critical outcomes in nursing workforce health research. Burnout is a multidimensional construct comprising emotional exhaustion, depersonalization, and reduced personal accomplishment due to prolonged work-related stress, while work ability describes a worker's capacity to meet job demands given their health, skills, and mental resources. Evidence suggests that the extent of burnout and work ability varies across different care settings. However, research on the relationships between demands, resources, burnout dimensions, and work ability in the context of long-term care remains limited. To test a modified version of the Job Demands-Resources model by assessing measurement invariance and examining the relationships between demands, resources, burnout dimensions, and work ability, as well as comparing these relationships across residential long-term care and home care settings. A Multi-group Structural Equation Modelling approach. 301 employees working in German residential long-term care and home care facilities. Data from two cross-sectional studies conducted in residential care (November-December 2019) and home care (September-October 2020) were analyzed using a multi-group structural equation model. Measurement invariance testing was applied to validate the model across both settings and to identify setting-specific differences. The modified Job Demands-Resources model demonstrated measurement invariance across residential and home care settings, confirming its applicability in both long-term care settings. High demands were linked to increased emotional exhaustion and depersonalisation, while resources were positively related to personal accomplishment in both settings. Statistically significant group differences were observed: emotional exhaustion was negatively associated with work ability only in home care (β=-0.58, p=.016), and paths from depersonalisation (p<.001) and personal accomplishment (p<.001) to work ability differed between settings. Demands and resources shape burnout dimensions among long-term care employees. Similarities point to the potential of generic interventions, whereas differences in the relationships between burnout dimensions and work ability across settings underscore the need for setting-specific approaches. Further research should identify additional demands and resources and confirm these findings through longitudinal studies.

409 - Psychometric features of Comprehensive Geriatric Assessments (CGAs) in long-term and community care settings: A Systematic Review

The use of data for process and quality improvement in long term care and home care: a systematic review of the literature.

ObjectivesThe first wave of the COVID‐19 pandemic necessitated extensive infection control measures in long‐term care (LTC) and had a significant impact on staffing and services. Anecdotal reports indicate that this negatively affected LTC residents' quality of care and wellbeing, but there is scarce evidence on the effects of COVID‐19 on quality of dementia care in LTC.MethodsFrom December 2020 to March 2021, we conducted a cross‐sectional online survey among staff who worked in LTC homes in Ontario, Canada. Survey questions examined staffs' perceptions of the impact of COVID‐19 on dementia quality of care during the initial wave of the COVID‐19 pandemic (beginning 1 March 2020).ResultsThere were a total of 227 survey respondents; more than half reported both worsened overall quality of care (51.3%) and worsening of a majority of specific quality of care measures (55.5%). Measures of cognitive functioning, mobility and behavioural symptoms were most frequently described as worsened. Medical and allied/support staff had the highest odds of reporting overall worsened quality of care, while specialized behavioural care staff and those with more experience in LTC were less likely to. LTC home factors including rural location and smaller size, staffing challenges, higher number of outbreaks and less COVID‐19 preparedness were associated with increased odds of perceived worsening of quality of dementia care outcomes.ConclusionsThese findings suggest that COVID‐19 pandemic restrictions and related effects such as inadequate staffing may have contributed to poor quality of care and outcomes for those with dementia in LTC.