Residential Care Facilities Research Articles

Residency in Long-Term Care Facilities: An Important Risk Factor for RSV Hospitalization.

Older age and comorbid conditions increase risk for severe RSV. Skilled nursing (SNF) and assisted living (AL) facilities represent an intersection of risk factors. In a 3-year prospective study (Rochester, NY) we compared population-based incidence of RSV-associated hospitalization for community-dwelling, SNF and AL adults ≥65 years. Median age was 76, 83 and 86 years, respectively, and dementia and CHF more prevalent among SNF and assisted living residents. Average annual incidence was 117 (95%CI:104-132), 440 (95%CI:307-629) and 740/100,000 persons (95%CI:523-1045) for community-dwelling, SNF and AL adults ≥65 years, respectively, demonstrating need for unequivocal RSV vaccine recommendations in SNF and AL residents.

COVID-19 infection prevention and control program for aged care providers: a quasi-experimental study of Telegram-based training

ABSTRACT Given the high turnover of care workers in residential aged care facilities, continuous training on infection prevention and control (IPC) remains essential even after the COVID-19 pandemic. This study examined the impact of a Telegram-based training on aged care providers’ IPC knowledge, attitudes, self-efficacy. A two-arm, pre-post quasi-experimental study with repeated measures at week 2 (T1) and week 4 (T2) was conducted for seventy-two (72) participants from 14 residential aged care facilities in Malaysia, with 60 completing the study (30 per arm). All instructional activities and data collection for both groups were delivered through Telegram. The intervention group received a 2-day synchronous workshop (3 h/day) alongside e-materials for a 10-unit IPC module. Primary outcomes were measured using a knowledge test, COVID-19 Elderly Caregiver Questionnaire (attitude component), and an adapted General Self-Efficacy Scale. Telegram’s acceptability was also assessed using an adapted Technology Acceptance Model questionnaire. Results showed that the intervention group had a faster knowledge transfer (91.3%–93.5%; T0-T2 = ∆22.9; p ≤ .002;), higher knowledge scores (∆7.2–16; p ≤ .002; large effect sizes 0.9–1.7), and a small-to-modest increments in self-efficacy (∆13.2; p = .002) and attitude (∆5.2; p = .045). Integrating synchronous sessions into an online program improved knowledge transfer, enhanced self-efficacy and promoted positive attitudes by enabling real-time interpersonal communication and instant feedback. Telegram proved effective for mobile learning in aged care settings with limited resources.

Feasibility of a Novel Lighting System to Reduce Nighttime Falls in Assisted Living Residents With Dementia

ObjectivesTo determine the feasibility of conducting a trial of a novel nighttime lighting system designed to support postural stability in assisted living (AL) residents, and to estimate intervention effectiveness by comparing the incidence of nighttime falls during the novel lighting condition to that in a control condition featuring a standard nightlight. DesignRandomized crossover trial. The intervention consisted of 3 custom-designed linear arrays of amber light-emitting diodes (LEDs) arranged in strips: 1 strip aligned horizontally across the top of the bathroom/entry doorframe containing 68 LEDs and 2 strips of 140 LEDs each aligned vertically down the sides of the doorframe. The control condition was 1 standard nightlight in the bedroom and 1 in the bathroom. Residents were randomized to treatment sequences, receiving each condition for 1-2 quarters. Setting and ParticipantsFive AL communities serving exclusively residents with dementia or having separate units for residents with dementia, with at least 30 beds and at least 5 residents in private rooms. Residents were eligible if they had dementia, were ambulatory, did not share a bedroom, were not on hospice or expected to die within the year, and were not expected to transfer to another setting within the year. MethodsOutcomes included recruitment, retention, incident falls, and satisfaction. ResultsThirty-eight residents of the 5 communities participated (56% recruitment rate), and 24 family members completed surveys about their satisfaction with the lighting system. Cameras captured falls data for 92% of 8591 resident nights. The incidence density for falls was 34% lower in the intervention condition than the control condition (incidence density ratio 0.66, 95% CI 0.35, 1.22), which did not reach statistical significance (P = .18). Conclusions and ImplicationsThis low-cost intervention was feasible with high satisfaction. Building on these results, the intervention is being evaluated in a larger clinical trial. A novel lighting system to reduce falls could ultimately benefit millions of older adults across all settings.

Early warning COVID-19 outbreak in long-term care facilities using wastewater surveillance: correlation, prediction, and interaction with clinical and serological statuses

The unprecedented COVID-19 pandemic has highlighted the strategic value of wastewater-based surveillance (WBS) of SARS-CoV-2. This multisite 28-month-long study focused on WBS for older residents in 12long-term care facilities (LTCFs) in Edmonton (AB, Canada) by assessing relationships between COVID-19, WBS, and serostatus during the pandemic. Wastewater samples collected two to three times per week were tested for SARS-CoV-2 using RT-quantitative PCR. Theserostatus of antibodies was examined using immunoassays. The data of clinical COVID-19 outbreaks based on extensive testing were obtained from local public health officials. Analyses included calculating correlations between 7-day rolling averages for WBS and COVID-19 cases and investigating whether WBS led or lagged confirmed outbreaks using a multinomial test. Wastewater results correlated well with clinical COVID-19 infections and outbreaks at participating LTCFs. 1058 (36·0%) of 2936collected wastewater samples were SARS-CoV-2 positive, compared with 1247people (resident n=671, staff n=572, and unknown n=4) reporting positive test results of 21 673clinical samples assessed (5·8%). WBS led clinical testing in 32 (60·4%) confirmed outbreaks, which was significantly different from WBS lagged (12outbreaks [22·6%, 95% CI 11·3-33·7]). Non-detection of WBS SARS-CoV-2 served as a negative predictor for outbreaks. WBS results attested protective immunity in vaccinated individuals before the omicron wave. Aparallel increase in the proportions of positive WBS SARS-CoV-2 and anti-nucleocapsid antibodies underlined that omicron was an immunity-evading variant despite high seropositivity of neutralising antibodies after multiple doses of vaccine. Implementation of WBS could enable targeted clinical investigations and improve cost-effectiveness of COVID-19 outbreak management in LTCFs. WBS and serostatus provided informed dynamic changes of infections and immunity. Critical evidence was that LTCF WBS is an effective early warning system to support rapid public health outbreak management and protect vulnerable older populations. Canadian Immunity Task Force for COVID-19 and Alberta Health.

Through The Lens – Perceptions and Experiences of Aging in Older Adults Living in Residential Care Facilities

Through The Lens – Perceptions and Experiences of Aging in Older Adults Living in Residential Care Facilities

Pseudomonas aeruginosa population dynamics in a vancomycin-induced murine model of gastrointestinal carriage.

Pseudomonas aeruginosa is a common nosocomial pathogen and a major cause of morbidity and mortality in hospitalized patients. Multiple reports highlight that P. aeruginosa gastrointestinal colonization may precede systemic infections by this pathogen. Gaining a deeper insight into the dynamics of P. aeruginosa gastrointestinal carriage is an essential step in managing gastrointestinal colonization and could contribute to preventing bacterial transmission and progression to systemic infection. Here, we present a clinically relevant mouse model relying on parenteral vancomycin pretreatment and a single orogastric gavage of a controlled dose of P. aeruginosa. Robust carriage was observed with multiple clinical isolates, and carriage persisted for up to 60 days. Histological and microbiological examination of mice indicated that this model indeed represented carriage and not infection. We then used a barcoded P. aeruginosa library along with the sequence tag-based analysis of microbial populations (STAMPR) analytic pipeline to quantify bacterial population dynamics and bottlenecks during the establishment of the gastrointestinal carriage. Analysis indicated that most of the P. aeruginosa population was rapidly eliminated in the stomach, but the few bacteria that moved to the small intestine and the caecum expanded significantly. Hence, the stomach constitutes a significant barrier against gastrointestinal carriage of P. aeruginosa, which may have clinical implications for hospitalized patients.

Osteopathic health care in aged care facilities: The experience of practitioners in an emerging practice setting.

Residential aged care facilities (RACFs) are an emerging practice setting for osteopaths in Australia. This study explored the experiences of osteopaths working in Australian RACFs, reviewed current trends and challenges and considers future developments. Purposive and snowball sampling were used to recruit osteopaths with experience working in RACFs. This was a qualitative descriptive study derived from verbatim interview transcripts. Data were analysed using a six-step thematic analysis. Eight interviews were conducted during January 2023. Thematic analysis identified common experiences between participants. These included positive aspects of aged care, perceived challenges of working in aged care, exposure to age-specific conditions, benefits of working in multidisciplinary teams and perceived gaps in university education curricula in relation to geriatric populations. Employment in RACFs may offer a satisfying employment experience for osteopaths, albeit hindered by policy and funding inadequacy. The respondents suggested enhancing pre- and postgraduate education to better prepare and encourage the profession to engage in this health service.

Factors associated with transfer from assisted living facilities to a nursing home: National Health Aging Trends Study 2011-2019.

Residents of assisted living facilities (ALF) transfer to a nursing home when they require a higher level of care, but limited research has examined risk factors for transfer to a nursing home. The aims of this study were to identify (1) baseline factors associated with transfer to a nursing home and (2) time-varying factors associated with transfer to a nursing home over 8 years, using a national dataset from the National Health Aging Trends Study (NHATS). NHATS participants were included in this study if they: (1) resided in ALF from Round 1 (2011) through Round 8 (2018); (2) completed the sample person (SP) interview at baseline; (3) were admitted to ALF at age 65 years or older. We conducted Cox proportional hazards regression to examine candidate predictors (difficulty with basic activities of daily living (ADL), chronic conditions, hospitalization, sleep disturbances, mental health, physical performance, self-reported health, participation in social and physical activity, and sociodemographic) associated with transfer to a nursing home. Employing backward elimination, we built parsimonious final models for analysis. The analytic sample included 970 participants of whom 143 transferred to nursing homes over 8 years. Those who had a better physical performance at baseline (HR = 0.83, 95% CI = 0.79-0.88) and were college educated (HR = 0.58, 95% CI = 0.36-0.92) demonstrated a significantly lower risk for transfer to a nursing home over 8 years. Residents who maintained physical activity (HR = 0.56, 95% CI = 0.37-0.86), better physical performance (HR = 0.87, 95% CI = 0.80-0.94), and difficulty with fewer basic ADLs (HR = 1.13, 95% CI = 1.02-1.26) were at lower risk for transfer to a nursing home over 8 years. Our findings can be used to identify older adults in ALFs at risk of transfer to a nursing home. Strategies to promote physical function and physical activity could avoid/delay the need to transfer. Helping older residents to age in place will have important health and economic benefits.

Impact of COVID-19 public health restrictions on fall-related hip fracture hospitalizations: An interrupted time series analysis

PurposeThere is limited evidence regarding the impact of public health restrictions on hip fracture hospitalization by place of fracture occurrence. This study aimed to examine the impact of COVID-19 public health restrictions on fall-related hip fracture hospitalization rates by place of occurrence. MethodsThis retrospective cohort study was conducted using hospitalization data in New South Wales, Australia, between January 2014 and June 2022. Older adults aged ≥65 years admitted to hospital following a fall-related hip fracture. An interrupted time-series analysis using autoregressive integrated moving average models evaluated the impact of public health restrictions on fall-related hip fracture hospitalization by place of fracture occurrence (home/residence, residential aged care facility (RACF), or away from usual residence). ResultsThe mean observed fall-related hip fracture hospitalization rate during COVID-19 public health restrictions (36.3 per 100,000 people per month) was 13.4 % lower than the forecasted rate (41.1 per 100,000 people per month). The mean observed hospitalization rates for fall-related hip fractures at home/residence, at a RACF, and away from the usual residence were 3.8 %, 18.5 %, and 40.1 % lower than the forecasted rates, respectively. Level changes in the fall-related hip fracture hospitalization rates at RACFs and away from usual residences were −0.9 per 100,000 people per month (95 % CI −1.6 to −0.2) and −1.7 per 100,000 people per month (95 % CI −2.5 to −0.9), respectively. ConclusionsThere was a decline in fall-related hip fracture hospitalization rates among older adults, where the fracture occurred at RACFs and away from a person's usual residence during COVID-19 public health restrictions.

Persisting gaps in dementia carer wellbeing and education: A qualitative exploration of dementia carer experiences.

To explore the emotional wellbeing of dementia carers in the lead up to and during transition of a person living with dementia to a residential aged care facility. An interpretative qualitative study. Semi-structured interviews were conducted with informal carers of person living with dementia between February and June 2023. Data were analysed using an inductive thematic approach and resulted in three themes. The majority of carers were adult children (n = 19) and six were wives. Carers lived across metropolitan (n = 20) and regional settings (n = 5) in the most populous state of Australia. Three themes were identified which were attributed to different aspects of the carer role: (1) Carer emotional journey as dementia progresses - impacted by knowledge and lack of support; (2) Questioning decision making-underpinned by knowledge and confidence; and (3) Challenges in re-establishing identity - impacted by ongoing concerns. As dementia progresses carers of person living with dementia consistently reported gaps in knowledge including how to access support. Specifically, this study identified the need for more to be done to help carers to develop the skills needed for their role, including participation in care planning and identifying care preferences for the future. Nurses can play a key role in promoting referral to services that support carers. Findings offer practical solutions to ameliorate carer stress and promote shared decision making. This research was guided by the Consolidated Criteria for Reporting Qualitative Research.

Hospital referrals, exclusions from hospital care, and deaths among long-term care residents in the Community of Madrid during the March–April 2020 COVID-19 epidemic period: a multivariate time series analysis

BackgroundFrom March 7 to April 7, 2020, the Community of Madrid (CoM), Spain, issued interventions in response to the COVID-19 epidemic, including hospital referral triage protocols for long-term care facility (LTCF) residents (March 18–25). Those with moderate to severe physical disability and cognitive impairment were excluded from hospital referral. This research assesses changes in the association between daily hospital referrals and the deaths of LTCF residents attributable to the triage protocols.MethodsDaily hospital referrals and all-cause mortality from January to June 2020 among LTCF residents and the CoM population aged 65 + were obtained. Significant changes in LTCF resident daily hospital referrals time series, and in-LTCF and in-hospital daily deaths, were examined with tests for breaks and regimes in time series. Multivariate time series analyses were conducted to test changes in the associations between LTCF resident hospital referrals with daily deaths in-hospital and in-LTCF, and in the CoM population aged 65 + when the triage protocols were implemented.ResultsAmong LTCF residents, hospital referrals declined sharply from March 6 to March 23, 2020. Increases in LTCF residents' daily deaths occurred from March 7 to April 1, followed by a decrease reaching pre-epidemic levels after April 28. The daily ratio of in-hospital deaths to in-LTCF deaths reached its lowest values from March 9 to April 19, 2020. The four versions of the triage protocol, published from March 18 to March 25 had no impact on further changes in the association of hospital referrals with daily deaths of LTCF residents in-hospital or in-LTCF.ConclusionsWhile LTCF residents’ deaths increased, hospital referrals of LTCF residents decreased with the introduction of the CoM governmental interventions on March 7. They were implemented before the enactment of the triage protocols, protecting hospitals from collapse while overlooking the need for standards of care within LTCFs. The CoM triage protocols sanctioned the existing restrictions on hospital referrals of LTCF residents.

Person-centred quality indicators for Australian aged care assessment services: a mixed methods study

BackgroundAged Care Assessment Teams are the assessment component of the Australian aged care system. Their purpose is to undertake needs-based assessments to determine an older person’s eligibility for, and access to Commonwealth-funded aged care services. There are no measures that tell us if the aged care assessment service is of high quality from the perspective of the person being assessed. Quality measures have been developed and introduced in Australian residential aged care facilities. These however, have not considered the perspectives of those living in this setting. Quality measures for home care services have also been recommended.This research aims to address the gap in person-centred quality measures by asking current and future service users of aged care assessment services to vote on the importance of 24 person-centred quality indicators (PC-QIs), that were developed in a previous study using a modified Delphi method approach supported by engagement with a consumer led Advisory Board.MethodsThis mixed methods study used the RAND/UCLA Appropriateness Method to reach consensus on a final set of PC-QIs. Twenty-five community-dwelling older people in Brisbane, Australia, voted on the importance of 24 PC-QIs using a five-point Likert scale. A consensus statement for PC-QI elimination was determined prior to participants voting. Voting was undertaken with participants individually either face-to-face or via telephone, in their homes. To capture any narrative provided by participants regarding each PC-QI, participant voting sessions were audio-recorded and subsequently transcribed verbatim.Quantitative data from participant votes for each PC-QI were calculated and statistically described by median, interquartile range, consensus met, percentile, percentile rank, rank order, median and standard deviation. PC-QIs were then assessed against the consensus statement for elimination and rank ordered according to importance to participants. Content analysis of qualitative data from audio transcriptions was conducted to determine the presence of certain words supporting participant votes for each PC-QI.ResultsNo PC-QIs were eliminated during voting. Variation existed among participants’ ratings of importance for each PC-QI. Final quality domains, their respective title, quality indicator descriptor and supporting qualitative data are presented. Five PC-QIs had a median of five, no votes recorded below four, an interquartile range of zero, and a rank order score of one, two and four, out of a possible ten, indicating they were of highest importance to participants.ConclusionParticipants reached consensus on 24 evidence-based PC-QIs that represent measures of quality of aged care assessment services from the perspectives of current and future service users.

Impact of the Southeast Melbourne Virtual Emergency Department on reducing transfers from residential aged care facilities.

To evaluate the impact of the Southeast Melbourne Virtual Emergency Department (SEMVED) on transfers from residential aged care facilities (RACFs) to traditional EDs. A cohort study of residents requesting transfer to the ED via ambulance within participating health networks' catchments from April to June 2022. Two hundred thirty-eight VED consultations occurred with 79% (188/238) avoiding transfer. This represented an avoidance of 12% (188/1511) of all requests for transfer during operating hours. SEMVED prevented unnecessary transfers and enabled in-facility care. Integration into community outreach programmes could enhance care delivery. Patient safety outcomes were not formally assessed by our methodology.

The Role of Clientelism in Facilitating Orphanage Trafficking

ABSTRACT Orphanage trafficking involves the recruitment and/or transfer of a child into a residential care facility for a purpose of exploitation, including labor, sexual exploitation and servitude, or child institutionalization for profit. Orphanage trafficking has been recognized as a form of child trafficking under international law and has been increasingly reported in a range of countries, including Cambodia and Myanmar. Despite the growing academic focus on this subject, the specifics of how children are targeted, recruited, and transferred into these unregulated orphanages for exploitation remain largely unclear, as do the precise social mechanisms employed. Drawing on qualitative research, this article delves into the significant role that patron-client relationships play in the recruitment, transfer, exploitation, and concealment of child exploitation within unregulated residential care facilities established for exploitative or profit motives in Cambodia and Myanmar. It reveals how orphanage directors exploit clientelism to circumvent regulations, manipulate and undermine bureaucratic systems meant to protect vulnerable groups, and legitimize illegal activities through a process of formalization. The article explores the implications of the use of clientelism in orphanage trafficking for prevention efforts, child protection governance reforms, and rehabilitation of children whose perception of exploitation and victimization has been shaped by their socialization to clientelism norms.

Analysis of Longitudinal Patterns and Predictors of Medicine Use in Residential Aged Care Using Group-Based Trajectory Modeling: The "MEDTRAC-Cardiovascular" Longitudinal Cohort Study.

Cardiovascular diseases are the leading cause of death globally. Ensuring ongoing use of medicines-medication persistence-is crucial, yet no prior studies have examined this in residential aged care facilities (RACFs). We aimed to identify long-term trajectories of persistence with cardiovascular medicines and determine predictors of persistence trajectories. A longitudinal cohort study of 2837 newly admitted permanent residents from 30 RACFs in New South Wales, Australia. We monitored weekly exposure to six cardiovascular medicine classes-lipid modifiers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs), beta-blockers, diuretics, calcium channel blockers (CCB), and cardiac therapy-over 3 years. Group-based trajectory modeling was employed to determine persistence trajectories for each class. At baseline, 76.6% (n = 2172) received at least one cardiovascular medicine with 41.2% receiving lipid modifiers, 31.4% ACEI/ARBs, 30.2% beta-blockers, 24.4% diuretics, 18.7% CCBs, and 14.8% cardiac therapy. The model identified two persistence trajectories for CCBs and three trajectories for all other classes. Sustained high persistence rates ranged from 68.4% (ACEI/ARBs) to 79.8% (beta-blockers) while early decline in persistence and subsequent discontinuation rates ranged from 7.6% (cardiac therapy) to 25.3% (CCBs). Logistic regressions identified 11 predictors of a declining persistence across the six medicine classes. Our study revealed varied patterns of cardiovascular medicine use in RACFs, with 2-3 distinctive medicine use trajectories across different classes, each exhibiting a unique clinical profile, and up to a quarter of residents discontinuing a medicine class. Future studies should explore the underlying reasons and appropriateness of nonpersistence to aid in identifying areas for improvement.

Risk factors for older people re-presenting to the emergency department with falls: A case-control analysis.

Falls are a leading cause for ED presentations among older adults. Existing secondary falls prevention interventions have not been shown to decrease fall-related ED re-presentation, indicating a need to better understand contributing factors. Our aim was to evaluate risk factors for fall re-presentations among the older patient population presenting to the ED. This is a single-centre case-control study. Cases were patients aged ≥65 years with two falls-related ED presentations within 6 months. Age- and sex-matched controls had a corresponding index, but no subsequent ED fall presentation. Data collected included falls risk factors and clinical features of the index presentation. Univariate and multivariate analyses were conducted to assess the relationship between potential exposures and fall re-presentation. A total of 300 patients (mean age 83.8 years) were studied. On univariate analysis, factors significantly associated with ED fall re-presentation included increasing multimorbidity (P < 0.0001), increasing number of medications (P < 0.0001) and residing in residential aged care facility (RACF) (odds ratio [OR] 3.06, P < 0.001). No factors remained significant on multivariate analysis. Post-hoc analyses for the RACF subgroup showed that psychotropic medication use (OR 1.65, P = 0.04) and prior fall within 12 months (OR 2.68, P < 0.001) were significantly associated with re-presentation. Initial presentation with serious musculoskeletal injury was a significant protective factor (OR 0.21, P = 0.02). The present study failed to identify factors independently associated with ED fall re-presentation, suggesting that the factors are complex and inter-related. Two high-risk populations were identified - those from RACF and those initially presenting with falls not resulting in serious injury.

Trajectories of mental health problems in unaccompanied young refugees in Germany and the impact of post-migration factors - a longitudinal study.

Unaccompanied young refugees (UYRs) are at an elevated risk of continuing psychological distress, including posttraumatic stress symptoms (PTSS), depression, and anxiety. The post-arrival situation in a host country plays an important role in increasing or reducing mental health risks for UYRs. This study aimed to examine the trajectory of psychological distress and post-migration factors experienced by UYRs in Germany with five assessments every six months over a two-year period.Standardised self-report questionnaires were used to assess PTSS (CATS-2), depression (PHQ-9), and anxiety (GAD-7) symptoms. Material and social stressors (DSSYR), sociocultural adjustment (BSAS), frequency of contact with family members, and distress regarding asylum status were included as post-migration factors. N = 131 UYRs (Mage = 17.04; SDage = 1.46; 81.1% male) living in residential care facilities in Germany were included in this study. There was a significant loss to follow up with n = 77 after 12 months at T2 (59% attrition), and n = 37 after 24 months at T4 (28% attrition).At baseline, clinically relevant symptom scores were found in 48.1% for PTSS, 42.0% for depression, and 22.9% for anxiety. Analysis of latent growth curve models revealed that the symptom severity of depression and anxiety did not change substantially over one year, but PTSS showed a significant decline. The number of traumatic events affected initial levels of mental health problems but not their trajectory over time. The impact of post-migration factors varied between measurement points and outcome measures and did not result in a homogeneous pattern.Despite limitations, this study demonstrated the persistence of high levels of psychological distress in UYRs. Effective interventions are required at an early stage to prevent chronic trajectories and support systems should adapt to constantly changing circumstances.Trial registration number/date of registration: DRKS00017453/11th December 2019.

Realising Person-Centredness: Transitioning to a Clustered Domestic Model of Aged Residential Care for People With and Without Dementia.

Many older people who cannot live independently live in aged residential care facilities to obtain support with social and healthcare needs. Despite old age being a precious time for people to live well, many facility residents have limited access to activities that promote their well-being and connectedness. In New Zealand, one provider of aged residential care developed a village inspired by de Hogeweyk in the Netherlands, where resident engagement in valued activities supports continuing lifelong identities. The study aimed to explain the transition from a traditional Aged Residential Care facility to a clustered domestic model of care. A critical realist theoretical perspective underpinned case study research. Data comprised transcripts of interviews with key informants, facility staff, residents and their families, records of observation of residents' daily lives, organisational documents, photographs and the first author's study journal. The intersection of philosophical workplace change to support delivery of person-centred care and a change in the physical environment enabled realisation of the organisational vision of residents living normal lives. Policy makers and practitioners must be aware that while a domestic-scale environment provides cues to normal living, staff who know residents and what is important to them enable participation in community and valued activities. Innovative living arrangements are a synthesis of philosophical aspirations, architectural and design vision, dedicated leadership and committed teamwork.

Revolutionizing Patient Surveillance in Assisted Living Facilities: Insights from AUGi Technology Implementation.

In the face of escalating non-fatal fall-related expenses and an aging population, innovative solutions in assisted living facilities (ALFs) are imperative. This study evaluates the implementation of a remote-surveillance technology (AUGi) across three diverse ALFs, emphasizing its impact on falls and falls with injury across sites. Utilizing comprehensive data collection, AUGi facilitated an average reduction of 64% in falls (p < 0.01) and falls with injury (p = 0.05), a statistically and clinically significant difference. The technology's success in enhancing nurse surveillance, providing prompt notifications, and reducing falls underscores its potential to transform ALF care dynamics. This pioneering approach not only fosters better staff-patient interactions but also provides a foundation for future advancements in clinical decision support systems, offering hope for mitigating falls in ALFs.

Improving urinary incontinence management and sleep quality with wetness sensing technology in absorbent products.

Using absorbent products to manage the urinary incontinence (UI) of dependent residents in care facilities (such as nursing homes, and hospitals) requires frequent routine checks throughout the day and night to see if products need changing. Timely changes of saturated products are necessary to avoid long-lasting skin exposure to wet absorbent products, unpleasant odor, leaking of such products and embarrassing moments for the users. Limited staffing, high workload, and peaks on the demand for caregiving are challenges that hamper swift support for the care dependent population. This paper describes novel sensing technology that has been developed for monitoring the wet state of absorbent products remotely. The Orizon system by Ontex enables caregivers to prioritize care routines, avoid sleep disturbance at night and achieve effective leakage prevention. Moreover, the monitoring data can be used to understand the individual product usage and incontinence pattern of individuals, helping incontinence specialists to choose the optimal product and implement appropriate toilet training for each user.