‘The issue of identity is a thorn in the flesh’: challenges in obtaining identity documents for children in residential care facilities in Harare, Zimbabwe


 Background: In British Columbia, community care facility is a broad term that covers many different type of facilities including residential care and child care facilities. These facilities are inspected and audited by the BC regional health authorities to ensure that they are operating in compliance with the BC Community Care and Facilities Act and its respective regulations. These facilities house population groups that are at higher risk of injury or illness due to their physiology and behaviour. Therefore, it is crucial that these facilities are operating in compliance with the prescribed legislation to minimize the risk of illness and injury to the users of these facilities. Objective: The purpose of this study was to determine if there were any differences in the number of violations in residential care and child care facilities between the different health authorities in BC. Methods: Inspection data were randomly selected and extracted from each of BC’s five health authority’s websites and assessed for the number of violations found in these inspections. Violations were tallied and an ANOVA analysis was performed to identify if there were any differences in the number of violations between the health authority regions. Results: Statistical analysis was performed using Microsoft Excel 2013 and NCSS. There was a statistically significant difference of violations between child care and residential care facilities located in the Interior Health Authority region and Northern Health Authority region. Interior Health Authority child care and residential care facilities have more violations than Northern Health Authority child care and residential care facilities. Conclusion: Violations in child care and residential care facilities varied among the five BC HA region. The IHA facilities were found to have the overall highest number of violations for both child care and residential care facilities whereas the NHA facilities were found to have the lowest number of violations. This suggests that patrons of child/residential care facilities in IHA have a higher potential of getting injured or ill compared to patrons in facilities located in NHA.

Role of Nursing & Residential Care Facilities in the Pennsylvania Economy

Adherence to antiretroviral therapy in HIV patients with psychiatric comorbidity.

ContextPatients in residential aged care facilities (RACF) are frequently admitted to hospital since the RACF often lack adequate medical resources. Different economic agents, whose missions and funding may conflict, provide care for RACF residents: residential facility, primary care physicians, and hospital. In this article, I estimate the economic impact of employing a mobile hospital team (MHT) in RACF, which modifies the relationship between these three agents by providing care directly in RACF.MethodA national, patient level database on RACF from 2014 to 2017 is used to calculate RACF outcome indicators. I analyse the difference between RACFs, that use MHT for the first time during the period (treatment group), and those that did not use MHT at all in the same period using a difference in difference (DID) model.ResultsThe MHT had a significant impact on health care quality in treated RACFs and reduced the number of patients transferred to hospital and the number of emergency department visits, and increased palliative care utilisation at the end-of-life, without increasing total hospital expenditure.ConclusionMHT appear improve care quality in RACFs by filling the gap in care needs including better end of life care, without increasing health expenditure. Given the high number of hospital transfers especially towards the end of life, securing the right level and mix of social and medical resources in RACFs is essential. Transferring some competencies of MHT teams to residential facilities may improve the quality of life of residents while improving allocative efficiency of public resources.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10198-022-01522-1.

Social workers are seen as a key resource in addressing the needs of South African society (Department of Social Development, 2009:7). The Department of Social Development (DSD) employs the bulk of social workers in the country to implement policies and programmes targeting, for example, poverty, unemployment and HIV/AIDS. However, the government is faced with an overwhelming demand for services and the inability of social workers to cope with these demands. According to the Recruitment and Retention Strategy for Social Workers (Department of Social Development, 2009:7), this lack of capacity is the result of a critical problem with the recruitment of social workers and the fact that recruited social workers cannot be retained either in the government or within the profession in general. Social workers move between the government, NGOs, and the private and corporate sectors. Social workers also migrate to other fields or other countries because of better job opportunities. The Department of Social Development (2009:7) acknowledges the role of the poor working conditions of social workers: “The inability of the sector to retain social workers is further exacerbated by lack of support and the poor working conditions that social workers are subjected to, which often lead to burnout and inability to render effective services.”

Objective: The literature suggests that approximately 90% of residents in aged care facilities have communication difficulties and between 40 and 60% of residents experience dysphasia. The ability of residents to attend outpatient clinics or private consultation, especially in a rural setting, is severely restricted. In an attempt to address this service gap a speech pathology service for residents in rural aged care facilities was developed and trialed over a 12‐month period. Method: Thirty aged care facilities in the Northern Rivers Area of New South Wales (NSW) agreed to participate in the trial. Results and Conclusion: An analysis of the first 9 months of data collected showed 331 resident consultations, 94 general practitioner (GP) consultations, and 111 education sessions showed that the quality of life of residents was greatly improved. As well, the skills, knowledge and the overall provision of service provided by GPs, nursing and allied health staff to residents of aged care facilities was greatly enhanced. The speech pathology service also proved to be financially self‐sustainable and was able to generate income for: (i) GPs through improved access to Enhanced Primary Care (EPC) funding; and (ii) aged care facilities through significant movements within the Resident Classification Scale.

Most residential aged care facilities support residents to participate in activities and the importance of activities that are suited to individual preferences and abilities is widely acknowledged. Participating in activities, including those considered to be 'meaningful' has the potential to improve residents' quality of life. However, what makes activities meaningful for people living with dementia in residential aged care facilities is unclear. The aim of this study was to understand the key characteristics of 'meaningful activity' in residential aged care facilities and the perceived value of residents participating in these activities. Using a qualitative study design, this study explored 'meaningful activities' from the perspectives of people living with dementia in residential aged care facilities, their family members and staff. Across four residential aged care facilities, residents (n = 19) and family members (n = 17) participated in individual interviews while staff (n = 15) participated in focus group interviews. Interviews were recorded, transcribed and analysed using a qualitative content analysis approach. Participant responses suggest that the meaning of an activity is subjective, varying over time and between individuals. Key characteristics of an activity that makes it meaningful include being enjoyable, social and engaging, aligning with the persons' interests, preferences, and abilities. To be considered meaningful, activities need to do more than occupy the person. The activity needs to be linked to a personally relevant goal and an aspect of the individuals' identity. Participating in 'meaningful activities' was perceived as valuable to encourage participation and socialising, provide a sense of normality for residents and improve their wellbeing. The findings of this study further our understanding of the concept of 'meaningful activity' for people living with dementia in residential aged care facilities. Understanding the key attributes of 'meaningful activity' can also provide practical guidance for those supporting people with dementia to participate in these types of activities.

Objective The objective of this systematic review was to report on the best available evidence relating to oral hygiene for adults with dementia in residential aged care facilities, including: documenting the prevalence and incidence, as well as the experiences and increments, of oral diseases and conditions the use of assessment tools by carers to evaluate oral health oral hygiene care strategies to prevent oral diseases and conditions the provision of dental treatment and the ongoing management of oral diseases and conditions. Inclusion criteria This review considered any randomised or non-randomised controlled studies, cohort studies, case-control studies, multiple time series studies, uncontrolled studies, descriptive studies and opinions of respected authorities (including theses and other publications) related to residents with dementia living in residential aged care facilities in Australia and overseas; community-dwelling adults with dementia; and special needs adult populations (for preventive oral hygiene care strategies and interventions). The review considered studies and publications designed to: quantify the oral health status of older adults living in residential aged care facilities; quantify the oral health status of adults with dementia living in the community and in residential aged care facilities; evaluate tools used to assess the oral health of residents by staff and carers working in residential aged care facilities; evaluate preventive oral hygiene care strategies and interventions used in special needs adult populations (including adults with dementia); and evaluate oral health care training and oral hygiene care provision, staff and carers working in residential aged care facilities. Dental outcome measures of interest were those relating to the prevalence, incidence, experiences and increments of oral diseases and conditions including: denture problems, coronal and root caries, periodontal diseases (plaque accumulation, gingivitis, loss-of-attachment), oral mucosal conditions, xerostomia and salivary gland hypofunction, tooth loss, difficulty chewing, behavioural problems and pain/discomfort. Related characteristics and outcomes of interest included: medical conditions, medications, cognitive status, functional status, nutritional status and sociodemographics. Search strategy The aim of the search was to locate relevant English-language studies and publications appearing between 1980 and 2002. The search utilised a two-step approach, involving an initial search of electronic databases using combinations of key words followed by a second extensive search carried out using the identified key words. This was supplemented with a secondary search of the references cited in the identified studies. Electronic database searched were: Cinahl, Embase, Psycinfo, Medline and Current Contents. Methodological quality All selected studies were critically appraised by two reviewers prior to inclusion in the review. Results In regards to relevance, incidence, experiences, and increments of oral diseases and conditions, possible risk factors identified included: saliva dysfunction, polypharmacy, comorbid medical conditions, swallowing and dietary problems, increased functional dependence, need for assistance with oral hygiene care, and poor access and utilisation of dental care. Evidence on the use of assessment tools by carers to evaluate residents' oral health showed that successful assessment of residents with and without dementia by nursing staff requires appropriate staff training by a dental professional. Coupled with appropriate training, an oral assessment screening tool designed for residents with dementia has been successfully used by nursing and care staff to identify residents requiring further review by dental professionals. Expert opinion in the field indicates that oral assessment screenings by a staff member and then by a dentist would ideally be undertaken upon admission to a facility, and regularly thereafter by staff and/or dentists as required. Clinicians and researchers suggested that oral hygiene care strategies to prevent oral diseases and conditions were found to be effective in preventing oral diseases, and thus are relevant for use in the resident with dementia. In regards to the provision of dental treatment and ongoing management of oral diseases and conditions, the use of adjunctive and preventive aids were found to be effective when introduced in conjunction with a staff training program: Expert opinion suggests that behaviour management techniques will increase the potential of performing oral hygiene care interventions. Conclusions This review suggests that the training of staff in the form of a comprehensive practically oriented program addressing areas such as oral diseases, oral screening assessment, and hands-on demonstration of oral hygiene techniques and products is likely to have a positive impact on the management of oral hygiene care within residential aged care facilities. The review also identified that regular brushing with fluoride toothpaste, use of therapeutic fluoride products and application of therapeutic chlorhexidine gluconate products are validated by research as effective for the general population and some populations with special needs.

Introduction: Residential Aged Care Facilities (RACFs) play an important role in the care of a group of older Australians who are rapidly increasing in numbers. They are often frail, dependent and are of high acuity. Demand for clinical care of RACF residents has increased, and there has been a shift in the characteristics of staff who care for them. It is now common practice in High Care facilities that the majority of direct care is provided by Assistants in Nursing and/or Personal Carers, who have little formal training. Sydney Local Health District (SLHD) in Sydney Australia has 77 Residential Aged Care Facilities (RACFs), with 4,576 beds. Description: In 2008 a telephone triage service, Aged Care Triage (ACT), was introduced to assist RACF’s to provide care to residents in the most appropriate setting. The service is staffed by experienced registered nurses. During the period July 2009 - June 2010 this service saved 2427 emergency department presentations across the District. The Access Care Team aims to provide the best care for residents of RACFs in the most appropriate setting by offering clinical advice and arranging services to support resident's care within the RACFs. It offers a partnership between RACFs, GPs and services of SLHD, by linking medical specialists and expert hospital nurses with GPs, ACAT/MAC, Sydney District Nursing and Palliative Care, with GPs and RACF staff. The Access Care Team can arrange outreach or outpatient services for clinical issues such as ambulatory care appointments, behavioural issues, continence issues, IV antibiotic therapy, Palliative care, Wound care management. The Access Care Team also has the capacity to facilitate and coordinate transfers to the most appropriate health services, such as appropriate emergency department if required. In 2010, funding was sourced to commence an RACF Outreach service. This compliments the ACT service. The outreach model was developed to improve access to primary health care for older people residing in RACFs and for the provision of face-to-face clinical nursing services to residential aged care facilities (RACFs) during the business hours period. Three senior nurses with extensive aged health experience are employed to provide a rapid and mobile outreach service to RACFs within SLHD catchment. They attend RACFs during business hours to resolve problems and prevent transfers or facilitate transfers to the Emergency Department. Aim, Theory, Targeted Population & Stakeholders: Together with relevant stakeholders the service and promotes an outreach model into residential care that: Builds on the existing ACT Service which is a central point of contact, resource for all RACF within SLHD Utilises an existing care manual for use within facilities to support RACF staff with evidence based algorithms for clinical care Provides regular targeted and group education for RACF staff Provide clinical coaching to RACF staff with all consultations. Promote collaborative work between acute care staff, RACF staff, GPs, Allied Health staff, families and significant others across primary and secondary settings. Establish goals of care and management plan for residents seen by the RACF outreach which facilitated efficiency of review in ED Enable the management of complex residents within the RACF Promote early intervention for highly complex residents Impacts: During the period June 2016 – January 2017 the RACF outreach team provided 777 occasions of service seeing 193 residents. 166 interventions ranging from care planning, medication review, complex wound management, comprehensive geriatric assessment, behaviour management, tube management and end of life planning Facilitation of geriatrician review. These residents would otherwise been transferred to one of the Districts ED’s. This small team of nurses have been able to sustain the model over a number of years while imparting clinical education to RACF staff to empower them to provide high quality care to frail aged residents. The right care, in the right place at the right time.

Executive summaryObjective The objective of this systematic review was to report on the best available evidence relating to oral hygiene for adults with dementia in residential aged care facilities, including: documenting the prevalence and incidence, as well as the experiences and increments, of oral diseases and conditions the use of assessment tools by carers to evaluate oral health oral hygiene care strategies to prevent oral diseases and conditions the provision of dental treatment and the ongoing management of oral diseases and conditions. Inclusion criteria This review considered any randomised or non‐randomised controlled studies, cohort studies, case‐control studies, multiple time series studies, uncontrolled studies, descriptive studies and opinions of respected authorities (including theses and other publications) related to residents with dementia living in residential aged care facilities in Australia and overseas; community‐dwelling adults with dementia; and special needs adult populations (for preventive oral hygiene care strategies and interventions).The review considered studies and publications designed to: quantify the oral health status of older adults living in residential aged care facilities; quantify the oral health status of adults with dementia living in the community and in residential aged care facilities; evaluate tools used to assess the oral health of residents by staff and carers working in residential aged care facilities; evaluate preventive oral hygiene care strategies and interventions used in special needs adult populations (including adults with dementia); and evaluate oral health care training and oral hygiene care provision, staff and carers working in residential aged care facilities. Dental outcome measures of interest were those relating to the prevalence, incidence, experiences and increments of oral diseases and conditions including: denture problems, coronal and root caries, periodontal diseases (plaque accumulation, gingivitis, loss‐of‐attachment), oral mucosal conditions, xerostomia and salivary gland hypofunction, tooth loss, difficulty chewing, behavioural problems and pain/discomfort. Related characteristics and outcomes of interest included: medical conditions, medications, cognitive status, functional status, nutritional status and sociodemographics.Search strategy The aim of the search was to locate relevant English‐language studies and publications appearing between 1980 and 2002. The search utilised a two‐step approach, involving an initial search of electronic databases using combinations of key words followed by a second extensive search carried out using the identified key words. This was supplemented with a secondary search of the references cited in the identified studies. Electronic database searched were: Cinahl, Embase, Psycinfo, Medline and Current Contents.Methodological quality All selected studies were critically appraised by two reviewers prior to inclusion in the review.Results In regards to relevance, incidence, experiences, and increments of oral diseases and conditions, possible risk factors identified included: saliva dysfunction, polypharmacy, comorbid medical conditions, swallowing and dietary problems, increased functional dependence, need for assistance with oral hygiene care, and poor access and utilisation of dental care.Evidence on the use of assessment tools by carers to evaluate residents’ oral health showed that successful assessment of residents with and without dementia by nursing staff requires appropriate staff training by a dental professional. Coupled with appropriate training, an oral assessment screening tool designed for residents with dementia has been successfully used by nursing and care staff to identify residents requiring further review by dental professionals. Expert opinion in the field indicates that oral assessment screenings by a staff member and then by a dentist would ideally be undertaken upon admission to a facility, and regularly thereafter by staff and/or dentists as required.Clinicians and researchers suggested that oral hygiene care strategies to prevent oral diseases and conditions were found to be effective in preventing oral diseases, and thus are relevant for use in the resident with dementia.In regards to the provision of dental treatment and ongoing management of oral diseases and conditions, the use of adjunctive and preventive aids were found to be effective when introduced in conjunction with a staff training program:Expert opinion suggests that behaviour management techniques will increase the potential of performing oral hygiene care interventions.Conclusions This review suggests that the training of staff in the form of a comprehensive practically oriented program addressing areas such as oral diseases, oral screening assessment, and hands‐on demonstration of oral hygiene techniques and products is likely to have a positive impact on the management of oral hygiene care within residential aged care facilities. The review also identified that regular brushing with fluoride toothpaste, use of therapeutic fluoride products and application of therapeutic chlorhexidine gluconate products are validated by research as effective for the general population and some populations with special needs.

It's time: Delivering optimal emergency care of residents of aged care facilities in the era of COVID-19.

Drug-related problems (DRPs) are common in aged care facilities and few studies have been conducted to determine the impact of the pharmacist-conducted medication review services. Studies determining the prevalence of chronic kidney disease (CKD) and data regarding inappropriate prescribing of renally cleared medications in aged care facilities in Australia are also lacking. To investigate the number and nature of DRPs identified and recommendations made by pharmacists in residents of aged care facilities. To determine the prevalence of CKD and estimate the magnitude of inappropriate prescribing of renally cleared medications in residents of aged care facilities. DRPs identified and recommendations made by pharmacists were classified using the adapted version of the DOCUMENT classification system. The modification of diet in renal disease formula was used to estimate the prevalence of CKD, and the Cockcroft-Gault formula was used to estimate the magnitude of inappropriate prescribing of renally cleared medications. Over 98 % of residents of aged care facilities had at least one DRP. Most (83.8 %) recommendations made by accredited pharmacists to resolve DRPs were accepted by general practitioners. CKD was prevalent in 48 % of residents, and inappropriate prescribing of renally cleared medications was identified in 28 (16 %) residents with CKD. DRPs are common in aged care facilities and the impact of medication review services appears to be high. CKD is also common among residents of aged care facilities, and inappropriate prescribing of renally cleared medications was also prevalent, warranting attention to regular renal function monitoring and appropriate drug and dose selection in residents of aged care facilities.

Preliminary results of Vitamin D supplementation in residents of aged care facilities

The proportion of people over 65 in Australia is predicted to double by 2050 and the number of people moving into residential aged care facilities has increased by 31% (1) with 50% of Australians aged 85 years and over dying in residential aged care facilities (2). Only 18% of people residing in aged care facilities have access to specialist palliative care (2). An expert reference group (ERG) was established in 2020 to guide the Specialist Palliative Care in Aged Care project team to co-design an integrated model of care that brings together, primary, secondary and community care to improve end of life care in residential aged care facilities and increase choice for older people over where they die. The ERG membership included representatives from specialist palliative care services, a non-government palliative care community service, residential aged care facilities, Queensland Ambulance Service, General Practice, Primary Health Network, consumers, West Moreton Care at End of Life Collaborative and University of Southern Queensland. The ERG utilised clinical redesign methodology to design, implement and monitor the development of the SPACE (Specialist Palliative Care in Aged Care) model. The diagnostics indicated that older people wanted better access to specialist palliative care in their aged care facilities and choice over where they died. The co-designed model consists of a secondary specialist palliative care service (funded through the Queensland Government) and a non-government community palliative care service (funded through the Primary Health Network) working across organisational boundaries as one service to deliver palliative care consultations, palliative care needs rounds and palliative care education within residential aged care facilities in the West Moreton Region. The model has escalating layers of access to specialist palliative care including a palliative care hospital in the home program allowing residents in aged care facilities to access hospital level palliative care in their home and an after-hours support service. The model relies on partnerships with residential aged care facilities, general practitioners and Queensland Ambulance Service to ensure residents have access to the clinical expertise and medications they need to have a quality death in their preferred place of death. The model has been implemented in 17 residential aged care facilities since 2020. In this time 97.73% of patients referred to the service have died in their preferred place of death. Patient reported outcomes for residents who are cared for in the Palliative Care Hospital in the Home are comparable to those being cared for in a specialist palliative care unit in a hospital. The key learnings from the development of this model are that integrated care models require co-design in both design and implementation phases, consumer are central to building models that meet the needs and values of those that will receive the service and flexible delivery of the model ensures scalability. 1.Australian Government Productivity Commission. Report on Government Services 2018 Canberra; 2018. 2.Australian Institute of Health and Welfare. Interfaces between the aged care and health systems in Australia-where do older Australians die? Canberra AIWH; 2021.

The COVID-19 pandemic reduced physical activity levels and increased sedentary behavior among older adults in residential care facilities. Another effect of this crisis was that facilitating a sense of social belonging through in-person social activities, such as group exercises or communal meals, became difficult. This study examines the relationship between physical activity, sedentary behavior, and sense of social belonging in older adults. This longitudinal study, which lasted 10 months, involved 57 older adults in residential care facilities. Participants completed the Échelle de mesure du Sentiment d'Appartenance Sociale (ESAS) questionnaire three times and wore an accelerometer on their waists for 1 week each time to measure sedentary time and physical activity levels. The ESAS questionnaire, a validated tool for evaluating social belonging in older adults, measures social belonging through a series of questions that assess an individual's feelings of acceptance and intimacy within their social group. Participants were predominantly sedentary (7.30 h/day) and engaged in low-intensity physical activities (2.9 h/day). They did not meet the recommended 150 min/week of moderate-to-vigorous physical activity. The sense of social belonging was high, with mean scores of 6.75 (ESAS), 7.08 (Acceptance), and 6.43 (Intimacy). Light physical activity was negatively associated with sedentary time. The sense of social belonging was positively associated with light physical activity and negatively correlated to sedentary time. This study underscores the importance of light physical activity and a sense of social belonging in reducing sedentary behavior among older adults in residential care facilities. By promoting social interactions and light physical activity, we can enhance the well-being of this population, especially during pandemic conditions. The study's findings should inspire future interventions to focus on these aspects, thereby improving health outcomes in residential care facilities for older adults.