Abstract
BackgroundThe current profile of residents living in Canadian nursing homes includes elder persons with complex physical and social needs. High resident acuity can result in increased staff workload and decreased quality of work life.AimsSafer Care for Older Persons [in residential] Environments is a two year (2010 to 2012) proof-of-principle pilot study conducted in seven nursing homes in western Canada. The purpose of the study is to evaluate the feasibility of engaging front line staff to use quality improvement methods to integrate best practices into resident care. The goals of the study are to improve the quality of work life for staff, in particular healthcare aides, and to improve residents' quality of life.Methods/designThe study has parallel research and quality improvement intervention arms. It includes an education and support intervention for direct caregivers to improve the safety and quality of their care delivery. We hypothesize that this intervention will improve not only the care provided to residents but also the quality of work life for healthcare aides. The study employs tools adapted from the Institute for Healthcare Improvement's Breakthrough Series: Collaborative Model and Canada's Safer Healthcare Now! improvement campaign. Local improvement teams in each nursing home (1 to 2 per facility) are led by healthcare aides (non-regulated caregivers) and focus on the management of specific areas of resident care. Critical elements of the program include local measurement, virtual and face-to-face learning sessions involving change management, quality improvement methods and clinical expertise, ongoing virtual and in person support, and networking.DiscussionThere are two sustainability challenges in this study: ongoing staff and leadership engagement, and organizational infrastructure. Addressing these challenges will require strategic planning with input from key stakeholders for sustaining quality improvement initiatives in the long-term care sector.
Highlights
The current profile of residents living in Canadian nursing homes includes elder persons with complex physical and social needs
Approximately 70% of people with dementia will die in a residential long-term care (LTC) facility [1], commonly referred to as a nursing home
Measures We describe the measures in two sections: quality improvement (QI) measures and research measures
Summary
The current profile of residents living in Canadian nursing homes includes elder persons with complex physical and social needs. 70% of people with dementia will die in a residential long-term care (LTC) facility [1], commonly referred to as a nursing home. People with dementia have complex care needs and a high dependency on their providers, during end-stage dementia. High resident acuity can result in increased staff workload and decreased quality of work life [5]. The growing number of residents in nursing homes with dementia increases job strain [16] and job-related stress [17] of healthcare providers, leading to reduced job satisfaction [17] and staff turnover. Healthcare aides (HCAs), who provide 70 to 80% of direct resident care, often leave nursing homes within months of employment [19]
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