Care Facilities For Older People Research Articles

IMPACT OF UNIFORMS IN LONG-TERM CARE FACILITIES: SYNTHESIS OF INTERNATIONAL EVIDENCE AND SURVEY OF UK STAFF VIEWS

Abstract Non-uniform-based staff dress codes are beginning to emerge in UK long-term care facilities for older people. However, there is little research evidence on the impact of staff clothing on resident, staff and visitor experiences, wellbeing or quality of life. Uniforms may be reassuring and facilitate identification of staff; a non-uniform approach may create a home-like, relaxed environment. This study aimed to synthesise existing international evidence and explore staff views about work clothing in three not-for-profit long-term care facilities in the UK. Five bibliometric databases were searched from inception. A narrative synthesis of included papers was conducted due to heterogeneity of study designs and outcome reporting. 77 (49%) of 158 staff responded to the survey. 68 staff (88%) did not currently wear a uniform at work. Views about the importance and impact of uniform were mixed: 25 (32%) believed that their role needed a uniform; 60 (78%) thought staff clothing made no difference in resident care quality but 45 (58%) agreed the environment felt more home-like when staff did not wear a uniform. 36 staff (47%) would choose to wear a uniform and 17 staff (22%) reported finding it difficult to afford clothes for work. In the context of limited research evidence, staff clothing is perceived to have little impact on care quality but considerable impact on long-term care facility atmosphere and staff working experiences. There is a need to research the impact of staff clothing to support evidence-based decisions about staff clothing policies in long-term care settings.

Development and initial validation of the staff perception of residential care environments (SPORE) instrument.

The impact of the physical environment on healthcare staff well-being and work performance is well recognised, yet there is a lack of instruments assessing environmental features from the perspective of staff working in residential care facilities (RCFs) for older people. To develop and provide initial validation of the instrument Staff Perceptions Of Residential care facility Environments (SPORE). An instrument development and psychometric evaluation study. Based on material from a British project, items were translated and adapted for Swedish residential care facilities as SPORE. Care staff (N = 200), recruited from 20 Swedish RCFs, completed a questionnaire-based survey containing the SPORE instrument and two other instruments selected as suitable for use in the validation. In addition, an environmental assessment instrument was used for further validation. Analyses were performed at individual (staff) level and home (RCF) level. The SPORE subscales demonstrated good internal consistency reliability and were moderately to strongly correlated at the individual level with the subscales of measures of person-centred care, and strongly correlated with the same measures at the home level. The SPORE subscales were also highly correlated with the total score of the instrument used to assess the quality of the physical environment. The initial validation indicates that the SPORE instrument is promising for measuring care staff perceptions of environmental features in care facilities for older people. SPORE can be a valuable instrument for use in research and in practice to evaluate the environment as part of working towards high-quality care. The design of the physical environment within RCFs can affect the staff's health and work performance. The instrument is useful for evaluating the environment and informing decisions about design solutions that support staff in their important work.

233 Residents’ experiences of COVID-19 pandemic in a Long-Term Care Facility in Ireland: a qualitative study

Abstract Background COVID-19 fundamentally impacted Long-Term Care Facilities (LTCFs) in Ireland and worldwide. The pandemic resulted in a series of restrictions and limited older people in LTCFs in their daily lives. Learning and understanding the impact COVID-19 had on older people in LTCFs is crucial for future care delivery planning, as those in LTCFs are some of the frailest in society. This study aimed to provide a perspective of that understanding. Methods The study’s objective was to capture a description of the residents’ in-depth experience of COVID-19 in a communal long-term care facility for older people. Individual semi-structured interviews with residents who could consent were held between September to November 2021. Results Ten residents participated in the interview study. Their average stay in the LTC facility at the time of the interview was 3.25 years, with the shortest stay being 1.5 years and the longest being seven years. The gender distribution was 50/50 among the ten residents interviewed. Four main themes were concluded from the transcriptions; coping, loss & grief, resilience and social activities. The themes are interlinked and provide insight into residents’ ability to adapt to critical changes in the LTC facility in an extremely challenging period. Conclusion Although residents mentioned loss, not only about people but also the loss in doing activities, being active within the LTC facilities was essential and helped with coping with COVID-19 restrictions. Understanding residents’ experiences of COVID-19 in nursing homes is crucial to implement improvements as well as acknowledging the impact of COVID-19. Older people in LTCFs are already marginalised by their need for care. Further understanding of older people in LTC experience of a pandemic such as COVID-19 is required. This requires innovative solutions to capture the experience of all living in LTC facilities.

Evaluating person-centered care in residential care facilities from the perspective of caregivers in South Korea: a survey

BackgroundAs many older people spend their time in residential care facilities, the demand for person-centered care (PCC), which affects their quality of life, is increasing. Many residential care facility residents have cognitive problems, such as dementia and strokes. Providing quality care upholds their rights as human beings. Currently, the PCC tools used in South Korea are only translations of foreign tools into Korean, so it is necessary to develop tools for older adult care facilities that reflect the reality of Korean care facilities for older adults. This study aims to develop a tool for measuring PCC in residential care facilities for older people from the perspectives of care givers.MethodsThe draft of 34 questions was developed through literature reviews, interviews with LTC practitioners and researchers. This developed questionnaire was then administered to 402 direct caregivers working in the residential care facilities because many of the residents had cognitive problems. By measuring the interrater reliability, the items with high levels of agreement were selected and the validity of the construct was checked through factor analysis. To determine whether the domains adequately measured each concept, we calculated correlation coefficients and Cronbach’s α.ResultsFour domains and 32 items concerning service conditions, resident’s right to self-determination, a comfortable living environment for all residents, and resident and staff satisfaction are derived, thus explaining 24.7%, 23.6%, 14.6%, and 8.00% of the total variance, respectively. Cronbach’s alphas for each domain are 0.965, 0.948, 0.652, and 0.525, respectively, thus demonstrating internal consistency. The inter-rater agreement is high (66.7%~100.0%). The correlation between service conditions and resident’s right to self-determination (r = 0.643, p < 0.001), a comfortable living environment for all residents, resident and staff satisfaction (r = 0.674, p < 0.001), and resident’s right to self-determination and comfortable living environment (r = 0.695, p < 0.001) is strong.ConclusionsIt is important that caregivers recognize PCC and provide services. When evaluating the residential care services, measuring the degree of PCC should be made compulsory. If the facility becomes more person-centered, it will be possible to promote quality of life for older people.Trial registrationNot applicable.

Brazilian National Front for strengthening long-term care facilities for older people: a necessary and efficient social movement

Brazilian National Front for strengthening long-term care facilities for older people: a necessary and efficient social movement

The relationship between participation and space in residential care facilities for older people

Participation has been akey issue in gerontology, geriatric care policy and practice for several years now. The relationship between participation and space plays arole in the discussion about community orientation. So far, little attention has been paid to the relationship between participation and space within residential care facilities for older people. Qualitative data from two studies on residential care facilities for older people were secondarily analyzed by a"supra-analysis" and using qualitative content analysis with respect to participation in relation to space and space in relation to participation. Almost all levels of the participation ladder considered can be found with respect to the co-design of spaces, although residents with dementia are granted fewer opportunities for participation. In addition, spaces can create conditions for participation through their arrangement. Reciprocal relationships are condensed in processes of space appropriation, design and planning. If there is no access to these processes, self-determined everyday life is limited. The results contribute to aspatially related development of participation concepts because they show in which spatial contexts participation is produced in institutional settings through the interaction of different actors and how it is distributed spatially. In order to promote participation in institutions, it is important to reflect on existing possibilities for spatial appropriation, design and planning against the background of institutional framework conditions.

Strategies to combat COVID-19 in long -term care facilities for older people.

To describe the strategies to combat COVID-19 in Long-Term Care Facilities for older people in Bahia state. This is a qualitative study based on documentary analysis of the collection produced by the Intersectoral Committee on Monitoring Long-Term Care for older people in the state of Bahia, from April 2020 to June 2021. Data analysis was based on Bardin's content analysis. The commission produced seven documents in the period analyzed. Two thematic categories emerged: Intersectoral Networks and Telemonitoring of Long-Term Care Facilities for the Elderly. The coordination in an intersector network and the telemonitoring carried out by the Intersector Committee on Monitoring Long-Term Care Facilities were the main strategies to fight COVID-19 in these institutions. The need to implement effective public policies to support long-term care facilities for older people is highlighted.

Long-term care facilities for older people and the COVID-19 pandemic: epidemiological data and preventive measures

Objectives: The COVID 19 pandemic has challenged society, especially residents of long term care facilities (LTCF). This study investigated rates of infection, hospitalization, and death due to COVID 19 among LTCF residents and staff in Minas Gerais, Brazil and identified strategies to control the spread of the disease. Methods: This cross sectional study collected data from 164 LTCF (6017 older adults). The owners or managers were invited to answer an electronic questionnaire. The questionnaire included 55 items, divided into 3 sections. Results: Of the participating LTCF, 48.7%, 39.6%, and 32.3% reported COVID 19 infections, hospitalizations, and deaths, respectively, among residents, while 68.9%, 7.3%, and 1.2% reported COVID 19 infections, hospitalizations, and deaths, respectively, among staff. Preventive measures were identified and classified as organizational, infrastructural, hygiene items/personal protective equipment, and staff training. Conclusion: The strategies used in the daily routines of LTCF during the pandemic were classified. The challenges experienced in Brazilian facilities were similar to those observed worldwide. The results highlight the importance of continuity and the need to improve protective measures for LTCF residents, especially in low- and middle-income countries

Strategies to combat COVID-19 in long -term care facilities for older people

RESUMO Objetivo Descrever as estratégias de enfrentamento à COVID-19 em Instituições de Longa Permanência para Idosos no estado da Bahia. Metodologia Trata-se de uma pesquisa retrospectiva, por meio de uma análise documental do acervo produzido pela Comissão Intersetorial de Monitoramento de Instituições de Longa Permanência para Idosos no Estado da Bahia, no período de abril/2020 a junho/2021. O tratamento dos dados baseou-se na análise de conteúdo de Bardin. Resultados Emergiram duas categorias temáticas: Articulação em rede Intersetorial e telemonitoramento de instituições de longa permanência para idosos. Conclusão Concluiu-se que o conjunto de ações de articulação em rede intersetorial e telemonitoramento realizadas pela Comissão Intersetorial de Monitoramento de Longa Permanência foram estratégias fundamentais para mitigar o impacto da COVID-19 nas instituições. Destaca-se a necessidade de implementação de políticas públicas efetivas de apoio às instituições de longa permanência para idosos, repensando criticamente sobre a tipologia destes equipamentos.

Nursing care in a long-term care facility for older people in the context of COVID-19: scoping review

Resumo Objetivo Identificar as evidências científicas sobre os cuidados de enfermagem à pessoa idosa em instituição de longa permanência no contexto da pandemia covid-19. Método Trata-se de revisão de escopo baseada nas orientações do Manual para Revisões do Joanna Briggs Institute (JBI). A formulação da questão ocorreu a partir do acrônimo PCC, em que o “P” correspondeu a “pessoa idosa”, o “C” a “cuidados de enfermagem” e o “C” a “covid-19”. A busca das evidências cientificas foi realizada nas bases de dados LILACS, MEDLINE®, CINAHL® e Web of ScienceTM. Foram analisados artigos recuperados ao se empregar os descritores controlados e não controlados, e aqueles provenientes da literatura cinzenta, sites e repositórios. A análise deu-se por estatística descritiva e crítica dos estudos. Resultados A amostra final do estudo foi composta por 14 evidências cientificas. Verificou-se que a maioria das produções pertenciam a modalidade relatório técnico (35,7%) publicadas no Brasil (64,28%). Os cuidados de enfermagem foram organizados em: intervenções gerenciais; intervenções educacionais; intervenções assistenciais em especial aquelas voltadas à prevenção e controle da disseminação do SARS-CoV-2, residentes com quadro suspeito ou confirmado de covid-19 e ao corpo em caso de óbito; intervenções voltadas a facilitar a comunicação entre os residentes e seus familiares/amigos e entre esses e o enfermeiro; além de intervenções de apoio emocional aos profissionais/cuidadores e aos residentes. Conclusão Diante da pandemia covid-19, os cuidados de enfermagem são imprescindíveis para prevenir e controlar a disseminação do SARS-CoV-2.

Care-home Nurses' responses to the COVID-19 pandemic: Managing ethical conundrums at personal cost: A qualitative study.

The COVID-19 pandemic had an unprecedented effect on those living and working in care-homes for older people, as residents were particularly vulnerable to contracting the SARS-CoV-2 virus, associated with high morbidity and mortality. Often undervalued, care-home nurses (RNs) are leaders, managing complex care while working in isolation from their professional peers. The pandemic made this more apparent, when care and treatments for COVID-19 were initially unknown, isolation increased due to withdrawal of many professional health services, accompanied by staff shortages. To explore RNs' experiences of working in older people's care-homes during the COVID-19 pandemic. Qualitative interview study. Care-homes for older people in England and Scotland, UK. Recruitment via direct contact with care-homes, social media, and links provided by national partners, then purposive sampling for age, gender, type of care-home, and location. Data collected through one-to-one online interviews using topic guide developed collaboratively with care-home nurses, focusing on how COVID-19 impacted on nurses' resilience and mental wellbeing. Data analyzed thematically using Tronto's ethics of care framework to guide development of interpretative themes. Eighteen nurses (16 female; 16 adult, and two mental health nurses) were interviewed March-June 2021; majority aged 46-55 years; mean time registered with Nursing and Midwifery Council: 19 years; 17 had nursed residents with COVID-19. RNs' experiences resonated with Tronto's five tenets of ethical care: attentiveness, responsibility, competence, responsiveness, and solidarity. All nurses described being attentive to needs of others, but were less attentive to their own needs, which came at personal cost. RNs were aware of their professional and leadership responsibilities, being as responsive as they could be to resident needs, processing and sharing rapidly changing guidance and implementing appropriate infection control measures, but felt that relatives and regulatory bodies were not always appreciative. RNs developed enhanced clinical skills, increasing their professional standing, but reported having to compromise care, leading to moral distress. Broadly, participants reported a sense of solidarity across care-home staff and working together to cope with the crisis. Care-home nurses felt unprepared for managing the COVID-19 pandemic, many experienced moral distress. Supporting care-home nurses to recover from the pandemic is essential to maintain a healthy, stable workforce and needs to be specific to care-home RNs, recognizing their unique pandemic experiences. Support for RNs will likely benefit other care-home workers either directly through wider roll-out, or indirectly through improved wellbeing of nurse leaders. The COVID-19 pandemic, an international public health emergency, created many challenges for Registered Nurses (RNs) working in long-term care facilities for older people, as residents were particularly vulnerable to the impact of the SARS-CoV-2 virus. Care-home RNs faced challenges distinct from their hospital-based nursing peers and non-nursing social care colleagues due to their isolation, leadership roles, professional legal obligations, and ethical responsibilities, leading to psychological distress on the one hand, but also a newly found confidence in their existing and newly developed skills, and increased recognition by the wider health community of their specialisms.

The implications of COVID-19 on health and social care personnel in long-term care facilities for older people: An international scoping review.

This scoping review mapped out the existing literature pertaining to health and social care personnel experiences during the coronavirus disease‐2019 (COVID‐19) pandemic and their work in a long‐term care setting for older people. This review identified the gaps in the implications of health and social care personnel's own health and well‐being during the pandemic as well as the ethical dilemmas inherent in providing care during the COVID‐19 pandemic. The authors utilised the PRISMA checklist for undertaking scoping reviews. The Databases Medline, PsychINFO, CINAHL, SCOPUS, Web of Science and Google Scholar were searched for relevant articles in English that were published between March 28, 2020 and June 1, 2022. This time period was selected to focus specifically on the COVID‐19 pandemic. In the context of this review, long‐term care facilities were defined to include institutions such as nursing homes, skilled nursing facilities, retirement homes and residential care homes. The gaps identified were a paucity of research on the experiences of health and social care personnel in long‐term care facilities, the impact on their mental health, and the wider challenges experienced during the COVID‐19 pandemic is discussed. The findings of this scoping review indicate a need for adequate preparedness during a pandemic within the health and social care sector to protect health and social care personnel and the individuals they care for.

From each according to means, to each according to needs? Distributional effects of abolishing asset-based payments for residential care in Austria

BackgroundMost countries in Europe require out-of-pocket payments (OPPs) for nursing homes based on users’ income and often assets. This was also the case in Austria until 2018 when asset-based contributions to residential care —denoted the ‘Pflegeregress’ – were abolished, leaving a shortfall in revenue. We aim to determine how the Pflegeregress was distributed across different groups in Austria prior to 2018, what the distributional consequences of its abolishment were, and what the distributional impact of different financing alternatives would be.MethodsCircumventing data availability issues, we construct a micro-simulation model using a matched administrative dataset on residential care users receiving the Austrian care allowance (Pflegegeldinformation, PFIF, HVB, and Pflegedienstleistungsstatistik, Statistik Austria) and survey data (SHARE, wave 6). Using this model, we estimate the expected duration of residential care and OPPs under the Pflegeregress of a representative sample of older people aged 65 + in Austria, as well as OPPs under budgetary neutral financing alternatives to the abolished asset-based contribution, namely an inheritance tax and a social insurance scheme. The distributional impact of abolishing the Pflegeregress and these alternative scenarios is assessed through a number of measures, such as ability to pay, Concentration Indices (CI) and a needs-standardized measure.ResultsWe find that lower income individuals and homeowners disproportionately contributed to asset-based OPPs for residential care prior to 2018, due in large part to their higher use of residential care and the low asset-exemption thresholds. These groups were therefore the largest beneficiaries of its abolishment. The alternative financing scenarios tested would result in a more progressive distribution of payments (i.e. concentrated on more affluent individuals).ConclusionOur findings indicate the limited ability of asset-based OPPs to target those with higher assets, thus questioning the fairness of these instruments for financing residential care facilities for older people in Austria. Findings also suggest that the parameterization of such OPPs (such as asset exemption thresholds) and patterns of residential care use are key variables for assessing the distribution of asset-based OPPs for residential care use. Policy alternatives that decouple payments from use would entail greater transfers from healthy to less healthier individuals.

No evidence for ethnic discrimination in the nonprofit sector: an audit study of access to nursing homes

Discrimination curtails equal opportunities of minority groups to participate in society. Although various studies reveal discrimination in access to human services, studies of nonprofit organizations are rare. This is surprising because nonprofits are essential providers of public services in many countries. We expect institutional features of the nonprofit sector to curb discrimination in access to public services, including nonprofit’s social mission and financial non-distribution constraint. We implemented an audit study within long-term care facilities for older people (i.e., nursing homes) in Flanders (Belgium). We sent a request for admission information signed by either a Moroccan or a Belgian-sounding name to all Flemish nonprofit nursing homes, finding no evidence of discrimination in responses to our request. The absence of a profit motive, combined with a stronger sense of social mission, may account for the absence of ethnic discrimination in the nonprofit sector.

Understanding and Explaining How Staff Promote Quality for Older People Living in Long-Term Care Facilities

Little is known about how the workforce influences quality in long term care facilities for older people. Conceptually, quality is complex, often contested, and dynamic, has overlapping physical, social, psychological and emotional dimensions and can refer to both quality of life and quality of care. Assuming ‘more staff equates to better quality’ is intuitively appealing but research suggests that a more nuanced, non-linear, relationship exists. A programme of research in the UK is developing theoretical and empirical explanations of how staff promote quality for older people living in long-term care facilities. It shifts the debate from numbers of staff and their relationship to quality indicators toward recognising the ways in which staff more broadly influence quality. Our work will be useful for people and organisations making policy and delivering services on the best ways to deploy and support quality in long term care through the most valuable resource: its staff.

Care Facilities for Older People With Long-Term Substance Use: Promising Practices From Sweden

The stigma of alcohol and long-term substance use is well-known and may be even greater for older people. This is a presentation on “wet” eldercare facilities, i.e. care settings designed for older people with long-term substance use problems, where abstinence is abandoned for well-being. Wet eldercare facilities exist in several European countries and the Swedish ones have a hybrid formal organization: They target people over 50 years, but are regarded as nursing homes and residents lease their own flats inside the setting, which makes it correct to describe residents as tenants. Guided by symbolic interactionism, the aim is to analyze how residents in wet eldercare facilities manage to view these places in a positive light. Forty-two residents of four facilities were interviewed, revealing how the hybrid status of these places enabled residents to frame their situation as being “in the right place”, but for different reasons. Some framed the place as a nursing home, others as an ordinary flat. Although wet eldercare facilities are undisputedly linked to stigma and the inability to become sober, the formal hybrid organization enabled residents to construct less stigmatized characterizations of the place and of themselves. The study suggests that it is an (often-neglected) gerontological responsibility to counter stigma and improve the sense of dignity for older people living in stigmatized settings. Based on promising practices in the Swedish system, the study therefore presents strategies that enable older people to ascribe positive characteristics to themselves and to the place where they live.

177 REDUCTION OF RESTRICTIVE PRACTICES IN AN OLDER PERSON RESIDENTIAL CARE FACILITY; THE IMPACT ON HUMAN RIGHTS AND RESIDENT SAFETY

Abstract Background We are a 140 bed long term care residential care facility for older people. We strive to achieve a ‘Restraint Free Environment’ in accordance with Article 40.4 of the Irish Constitution and Articles 14 (liberty and security) and 15 (freedom from torture or cruel, inhuman or degrading treatment) of the UN Convention on Rights of Persons with Disabilities(1). Health Act 2007, Regulations 2013 defines restrictive practice as ‘the intentional restriction of a person’s voluntary movement or behaviour’. Use of restrictive practices is warranted when there is a real and substantial risk to a person and this risk cannot be addressed by non-restrictive means’ (HIQA, 2019) (2). Methods An extensive review of non pharmacological restrictive practices in the Organisation was undertaken. This included One to One supervision, use of bedrails, Exit Alarm mats and Electronic Monitoring bracelets. Bedrails were replaced for some residents with Safety Wedges and Ultra Low beds. Results Review of restraint interventions showed no clear link to prevention of falls or injuries as a result of restraint. Contrary there was evidence of breach of dignity and privacy for the residents. Based on the review, bedrail use was reduced radically between 2016 and 2021 by 79% (42–9). Falls rate remained consistent approximately 3.6–3.2 per 1,000 Occupied Bed Days. Exit Alarm mats, Electronic Monitoring bracelets and One to One supervision was discontinued. These were replaced with direct observation and two hourly anticipation of needs. Cost saving on One to One estimated to have been €25,000 in 2016 alone. Clear care planning of the resident’s needs are core. Conclusion We have demonstrated that we could successfully reduce restrictive practices, thus respecting Human Rights, with no compromise to resident safety.

Exploring work engagement in the context of person-centred practices: a qualitative study in municipal long-term care facilities for older people

Background: To provide high-quality and cost-effective person-centred care, organisations need employees who are committed to perform at their best. Employee work engagement, defined as a positive, fulfilling approach to work, is known to correlate favourably with employee wellbeing and performance and with the service climate. Extended understanding about the meaning of work engagement can promote the development of environments that are both conducive to person-centred practices and good places to work. Aim: To explore the meaning of work engagement in the context of person-centred practices in municipal healthcare facilities for older people. Methods: A total of 16 individual interviews were conducted with a purposive sample of registered nurses and nursing assistants working in municipal healthcare facilities for older people in Norway. Data were analysed using a stepwise-deductive-inductive approach. Findings were generated inductively from the themes that emerged in the interviews and were later reflected on in relation to both theory and practice. Findings: Work engagement is manifest at individual and collective levels, involving intrapersonal, interpersonal and social/group components. Engagement is experienced as contributing to employee work capacity and team effectiveness with respect to person-centred processes. Conclusion: At individual, collective and environmental levels, employee engagement facilitates the development of person-centred practices in organisations providing long-term care for older people, to the benefit of residents and staff. Implications for practice: • Work engagement should be recognised as a condition that fosters employees’ ability and willingness to suspend judgment and appreciate the service user’s perspective • Individual-level engagement is contagious, facilitating development of supportive work environments, which, in turn, enables person-centred practices • Engagement should be approached simultaneously as an intrapersonal, interpersonal, and social/group process, with individual- and group-level outcomes

First-Line Managers’ Leadership Behavior Profiles and Use of Gardens in Residential Care Facilities: An Interview Study

This study explored first-line managers’ leadership behavior profiles regarding their goals for utilizing the garden at residential care facilities for older people. Semi-structured interviews were conducted with a convenience sample of first-line managers (n = 12) in Sweden. Data were analyzed using deductive content analysis theoretically guided by the Three-dimensional Leadership Model. The results showed that the main leadership behavior profiles were related to the dimensions structure, relation and change. The managers emphasized workplace regulations and goals. They allowed staff to make decisions and encouraged them to see problems and opportunities.

Living, loving and letting go‐navigating the relational within palliative care of older people in long‐term care facilities: An action research study

Long term care facilities are important environments for the delivery of palliative care, which includes end of life care. Despite this, staff may feel this care focus is separate to their roles. Consequently, this study explores and makes visible how palliative care is understood in long term residential care facilities for older people. It focuses on how relationships with residents and families are experienced by nurses and health care assistants and how this influences the introduction and provision of palliative care to older people in long term care facilities. To develop an understanding of what palliative care means to staff caring for older people in residential care. A co-operative inquiry action research approach was used. A total of 18 healthcare assistants and 16 registered nurses in two older person long term care facilities participated in co-operative inquiry groups. Co-inquirers reflected on deaths that occurred over a 6-month period and generated narratives on their relationships in the context of palliative care. Three themes were identified to describe relationships which were immersed in an ethos of person-centred care. These were living, loving and letting go. Living rather than dying was the predominant focus of care. Loving described deep engagement with older people and families while letting go navigated the dying process. Staff in nursing homes experience deep attachments to residents when delivering palliative care and end of life care. There is a need to understand these relationships and how they impact on the understanding and integration of palliative care in older person residential care as well as acknowledging and addressing staff's grief processes to enhance resilience.