Care Home Facilities Research Articles

Gender differences in first episode psychosis: Some arguments to develop gender specific treatment strategies

IntroductionSome aspects of gender differences in patients with schizophrenia spectrum disorders (SSD) have been studied, especially in cross-sectional designs and with a short-term follow-up. However, only a few studies have considered the evolution during the follow-up of SSD patients according to their gender. In this study, we explore gender differences from the time of entry in an early intervention program for psychosis, up to three years follow-up. MethodsWe conducted a prospective study including a cohort of 474 patients treated at the Treatment and Early Intervention in Psychosis (TIPP) program, 319 men and 155 women, having presented a first episode of psychosis (FEP). Data regarding premorbid and baseline sociodemographic, psychopathological and patient functioning, were collected. These data were reassessed longitudinally after 2, 6, 12, 18, 24, 30 and 36 months after entry in TIPP. ResultsRegarding premorbid and baseline characteristics, woman developed threshold symptoms of a FEP 1 year later than men on average. Women were more likely to be married, men were more likely to live in pension or care home facility or to be homeless. Women displayed a higher rate of history of suicide attempts and exposure to childhood trauma, while men were more likely to have a forensic history, a history of abuse of alcohol and cannabis as well as a dependency to cannabis at the time of entry in TIPP. Regarding evolution, men were more prone to violent acts and were less likely to decrease their usage of substances. The longitudinal analysis highlighted that men displayed greater negative symptoms over the entire treatment period, lower functioning after 6 months and on all assessment points after. Both genders displayed similar rate of improvement in these 3 dimensions over time. ConclusionOur study confirms that there are some gender differences in the early phase of psychosis that may require differentiation of assessment and treatment to improve recovery.

COVID-19 response in a long-term care facility for people with epilepsy.

To assess asymptomatic rates and severity of SARS-CoV-2 infection in people with epilepsy and their healthcare workers in a long-term care facility which had implemented weekly surveillance testing between April 2020 and June 2022. Questionnaires focused on objective and subjective COVID-19 symptoms for people with epilepsy residing in and their healthcare workers at the Chalfont Centre for Epilepsy in June 2022. Demographic information, comorbidities, and seizure frequency were gathered from medical records. We also collected responses on objective and subjective COVID-19 symptoms from healthcare workers who participated in a prospective study assessing the reaction to COVID-19 vaccinations (SAFER). Fifty-five out of 89 (62%) residents tested positive at least once on weekly PCR testing for SARS-CoV-2 during the period of interest; 20 of those (37%) were asymptomatic. In comparison, of those 63 healthcare workers who tested positive at least once on weekly testing during the same period, only four (6%) were asymptomatic. Of the 159 healthcare workers who also participated in the SAFER study, 41 tested positive at least once, and seven (17%) were completely asymptomatic during infection with SARS-CoV-2. People with epilepsy living in a long-term care facility were more likely to present with asymptomatic SARS-CoV-2 infections than healthcare workers at the same facility. Despite possible bias in the reporting of subjective symptoms due to management-by-proxy, there is no evidence that vulnerable people living in an epilepsy long-term care facility showed reduced resilience towards infections. People with epilepsy living in care home facilities had a surprisingly high degree of asymptomatic infections with SARS-CoV-2. Very few residents had severe or fatal outcomes. This is in stark contrast to the widely reported bad outcomes for people without epilepsy in other care homes. People with epilepsy reported significantly less symptoms than their healthcare workers. No changes in seizure frequency during or after infection were observed.

Hearing acuity in nonagenarians aged 90 and 95 assessed in a home setting using standardized pure-tone audiometry

Objective Knowledge regarding hearing acuity in the nonagenarian age group is sparse. In this study we aimed to advance our understanding of hearing loss in the 10th decade of life. Design A cross-sectional study in which standardised hearing measurements were performed during home visits, which included care home facilities and nursing homes to maximise participation. Study sample Two unselected groups of individuals aged 90 (n = 42) and 95 (n = 49), sampled from the population-based Gothenburg H70 Birth Cohort Studies. Results 98% of the participants (95% CI [95, 100]) had some degree of hearing loss in their better ear, with 83% (95% CI [73, 89]) having a potentially disabling hearing loss of moderate degree or worse, according to WHO criteria. Furthermore, differences between the two age groups (five years apart) indicate an increasing hearing loss, primarily at frequencies ≥ 2 kHz. Conclusion Hearing loss was present in almost all of the participants in the nonagenarian age group and among a majority of them potentially to a degree that would warrant rehabilitation. Carrying out standardised hearing measurements in a home setting was feasible in this age group and enhanced the representativeness of the study population.

A modified mental state assessment tool for impact analysis of virtual reality-based therapeutic interventions in patients with cognitive impairment.

This work has developed a modified mental state assessment tool for impact analysis of therapeutic interventions for patients with cognitive impairment. This work includes a pilot study to validate the proposed tool and assess the impact of virtual reality-based interventions on patient well-being, which includes assessment of cognitive ability and mood. The suggested tool's robustness and reliability are assessed in care home facilities with elderly residents over the age of 55. Because of the repetitive nature of the pilot study, test-retest strategy for Cronbach's alpha coefficient is employed to validate the internal consistency of the proposed tool over time. Qualitative and quantitative analyses are performed on the collected data to draw inferences on the impact of virtual reality-based interventions on patients with cognitive impairments. The Cronbach's alpha coefficient value shows that the proposed tool's resilience is comparable to that of its pre-intervention counterparts. The Cronbach's alpha coefficient values are determined for Pre-virtual reality and Post-virtual reality interventions, which include 116 virtual reality sessions for 52-participant, and three cohorts of virtual reality sessions for 21 participants. These values for a majority of the interventions remained within the acceptable range of 0.6-0.8. The proposed modified mental state assessment tool is observed to be a reliable tool for investigating the impact of virtual reality-based interventions on patients with cognitive impairments. One of the notable significance of the proposed tool is that this allows for resource allocation for such interventions to be tailored to the needs of the patient, leading to greater therapeutic efficacy and resource efficiency.

Does lower quality of life and daily living activity increase nutritional risk of elderly residing in care home facilities?

Aging is a predictable phenomenon that its prevalence is increasing dramatically in the world. There is an association between quality of life, functional independence, and nutritional risk in elderlies, so the aim of the current study is the evaluation of the quality of life and functional independence's effects on nutritional status. A total of 160 elderly people that had a hospitalization for at least 6months in the care home facilities were selected from 2 care home facility centers to participate in the study. Quantitative and qualitative data were gathered using questionnaires for demographic characteristics, health data, eating habits, quality of life (WHOQOL-BREF), functional assessment (Barthel Index), and mini-nutrition assessment (MNA) throughout the face-to-face interview. The overall quality of life score, age, weight, and BMI differed significantly between malnourished and well-nourished subjects. Also, the daily living activity score of subjects who were well-nourished was higher than malnourished participants. Higher daily living activity decreased the risk of being malnourished (OR malnutrition/well-nourished=0.306, P<0.001). There was also a significant relationship between BMI (OR malnutrition/well-nourished=0.731, P=0.001; OR at-risk/well-nourished=0.786, P=0.003) and marital status with MNA score (OR single/married=1.460, P=0.001 for malnutrition; OR single/married=1.183, P=0.004 for being at risk of malnutrition). The elderly living in nursing homes are exposed to nutritional risks and mental disorders. So with timely assessment and interventions to improve the quality of life and physical and mental health of elder dwellers, their malnutrition can be prevented.

Exploring the validity of identifying care home residents through a new national register.

Identifying permanent care home residents in Denmark by national registers is subject to error. The current register-based method has a sensitivity of 87% and a positive predictive value of 57%. The Danish National Health Data Authority has generated a new register named Care Home Data (in Danish: Plejehjemsdata) to increase the quality of register-based studies on care home residents. This study aimed to investigate the validity of Care Home Data. We generated the gold standard by retrieving information from the four municipalities of Southern Jutland on all individuals living permanently in a care home facility in 2019. Care Home Data generates information on care home residents by pairing addresses of every apartment in Danish care home facilities with the addresses of Danish citizens. The agreement between Care Home Data and the gold standard was analysed by calculating the sensitivity and positive predictive value. According to the municipalities, a total of 2081 individuals resided permanently in care home facilities in Southern Jutland in 2019 (gold standard). Care Home Data identified 2128 permanent care home residents; of which 2019 individuals were identified by both the municipalities and Care Home Data (true positives); 62 individuals were not identified by Care Home Data (false negatives), and 109 individuals identified by Care Home Data did not appear in data from the municipalities (false positives). This gave a sensitivity of Care Home Data of 97.0% and a positive predictive value of 94.9%. Care Home Data is a much improved tool for identifying citizens permanently residing in care homes with very high sensitivity and positive predictive value.

Trouble-talk in therapist–resident encounters

This article focuses on what can be labelled ‘trouble- talk’, and in particular how it is initiated and responded to in therapist–resident encounters. It adopts the perspective of an individual with acquired brain injury. The study is based on a video ethnography of interaction, targeted at identifying trouble-talk and its interactional consequences, and it was carried out in a Danish care home facility for residents with this kind of injury. Encounters involving a case resident, an occupational therapist, a social worker (pædagog) and participant researchers were video recorded (totaling 30 hours) during fieldwork over one year, between 2012 and 2013. The dataset has been analyzed through a combination of discourse analysis and ethnomethodological conversation analysis. The findings show that when the resident takes initiatives and/or makes criticisms, this may be heard by the occupational therapist as complaints about institutional life in general and/or as talking gibberish. Such perceived trouble-talk is responded to by the occupational therapist with misalignment and repair work. In general, trouble-talk is co-constructed; however, it is accentuated by the occupational therapist’s response, which suggests an undesired institutional ramification. In promoting awareness of the impact of impairments on interaction, I discuss how trouble-talk is emergent in the interaction itself and in what ways it can be resolved or minimized.

Effectiveness and sustainability of volunteering with older people living in care homes: A mixed methods systematic review.

Older people living in care homes should be considered part of the wider local community; however, little is known about what enables them to connect with people not paid to look after them or family members. Volunteering can complement paid and familial support. While volunteering is common in community settings, care home residents are less likely to benefit from their input. We conducted a mixed methods systematic review and stakeholder consultation that aimed to identify volunteer activities in care homes and evidence for their effectiveness and sustainability. Databases were searched from 2000 to July 2021. Studies of all designs reporting volunteer-led activities with care home residents 65-years or over were included. Data on interventions, study population, study context, outcomes and implementation issues were extracted and synthesised. We identified 36 studies on the use, effectiveness and implementation of volunteering in care homes, although the overall strength of evidence was weak. Resident engagement and mood appeared to improve during volunteer-led activities, but there was little research examining the longer-term impact. Qualitative and stakeholder data suggest considerable investment is needed to initiate and maintain volunteering initiatives, but there are positive benefits for volunteers, residents and staff if an intervention is sustained. Financial cost for care home facilities is unclear. Interventions that address inequalities in accessing volunteer support within the resident population and between facilities should be considered.

Modelling of hypothetical SARS-CoV-2 point of care tests for routine testing in residential care homes: rapid cost-effectiveness analysis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes coronavirus disease 2019 (COVID-19), which at the time of writing (January 2021) was responsible for more than 2.25 million deaths worldwide and over 100,000 deaths in the UK. SARS-CoV-2 appears to be highly transmissible and could rapidly spread in residential care homes. The work undertaken aimed to estimate the clinical effectiveness and cost-effectiveness of viral detection point-of-care tests for detecting SARS-CoV-2 compared with laboratory-based tests in the setting of a hypothetical care home facility for elderly residents. The perspective was that of the NHS in 2020. The setting was a hypothetical care home facility for elderly residents. Care homes with en suite rooms and with shared facilities were modelled separately. A discrete event simulation model was constructed to model individual residents and simulate the spread of SARS-CoV-2 once it had entered the residential care facility. The numbers of COVID-19-related deaths and critical cases were recorded in addition to the number of days spent in isolation. Thirteen strategies involving different hypothetical SARS-CoV-2 tests were modelled. Recently published desirable and acceptable target product profiles for SARS-CoV-2 point-of-care tests and for hospital-based SARS-CoV-2 tests were modelled. Scenario analyses modelled early release from isolation based on receipt of a negative SARS-CoV-2 test result and the impact of vaccination. Incremental analyses were undertaken using both incremental cost-effectiveness ratios and net monetary benefits. Cost-effectiveness results depended on the proportion of residential care facilities penetrated by SARS-CoV-2. SARS-CoV-2 point-of-care tests with desirable target product profiles appear to have high net monetary benefit values. In contrast, SARS-CoV-2 point-of-care tests with acceptable target product profiles had low net monetary benefit values because of unnecessary isolations. The benefit of allowing early release from isolation depended on whether or not the facility had en suite rooms. The greater the assumed efficacy of vaccination, the lower the net monetary benefit values associated with SARS-CoV-2 point-of-care tests, when assuming that a vaccine lowers the risk of contracting SARS-CoV-2. There is considerable uncertainty in the values for key parameters within the model, although calibration was undertaken in an attempt to mitigate this. Some degree of Monte Carlo sampling error persists because of the timelines of the project. The example care home simulated will also not match those of decision-makers deciding on the clinical effectiveness and cost-effectiveness of introducing SARS-CoV-2 point-of-care tests. Given these limitations, the results should be taken as indicative rather than definitive, particularly the cost-effectiveness results when the relative cost per SARS-CoV-2 point-of-care test is uncertain. SARS-CoV-2 point-of-care tests have considerable potential for benefit for use in residential care facilities, but whether or not this materialises depends on the diagnostic accuracy and costs of forthcoming SARS-CoV-2 point-of-care tests. More accurate results would be obtained when there is more certainty on the diagnostic accuracy of and the reduction in time to test result associated with SARS-CoV-2 point-of-care tests when used in the context of residential care facilities, the proportion of care home penetrated by SARS-CoV-2 and the levels of immunity once vaccination is administered. These parameters are currently uncertain. This report was commissioned by the National Institute for Health Research (NIHR) Evidence Synthesis programme as project number 132154. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 39. See the NIHR Journals Library website for further project information.

Anxiety, isolation and diminishing resources: the impact of COVID-19 pandemic on residential care home facilities for older people in south-east Nigeria

Purpose Institutionalized older adults in care homes and long-care facilities have been identified as being at greater risk of COVID-19 related morbidity and mortality. Thus, this paper aims to explore the impact of COVID-19 on care homes in south-east Nigeria given the recent increasing popularity of care homes in Nigeria. Design/methodology/approach The study adopted qualitative research method, and data was collected from 10 older residents and 5 caregivers using interviews from two care homes, while ensuring the safety of the researcher and participants. The collected data was analyzed using thematic analysis. Findings Findings revealed that the physical health impact of the COVID-19 pandemic is not a major problem in the homes. However, fear and anxiety, social disconnection and economic hardship were the major problems identified by the older residents and caregivers in the homes. Originality/value The popularity of care homes in Nigeria is growing as family structures continue to change. However, previous studies which have revealed devastating effect of COVID-19 on institutionalized older adults have been from the global north. This is the first study designed to bridge the gap in literature and contribute to knowledge on this topic from Nigeria and Sub-Saharan Africa.

The presence of care homes and excess deaths during the COVID-19 pandemic: Evidence from Italy.

This paper explores the relationship between the spatial distribution of excess deaths and the presence of care home facilities during the first wave of the COVID‐19 outbreak in Italy. Using registry‐based mortality data for Lombardy, one of the areas most severely hit by the pandemic we show that the presence of a care home in a municipality is associated with significantly higher excess death rates in the population. This effect appears to be driven by excess mortality in the elderly population of 70 years old and older. Our results are robust to controlling for the number of residents in each care home, suggesting that the presence of such facilities may have acted as one of factors contributing to the diffusion of COVID‐19 at the local level.

Short-Term Outcomes in Elderly Patients with SARS-CoV-2 Infections Discharged from Community Hospitals

Introduction: Clinical outcomes from very elderly hospitalised patients with SARS-COV-2 (Covid-19), are poor, with a reported in-patient mortality as high as 20%. Age, sex, comorbidities, ethnicity and deprivation have all been shown to correlate with worse outcomes in patients with Covid-19, however the outcomes of elderly hospitalised patients once discharged remains unknown. We looked at our cohort of very elderly patients treated within community hospital settings. Methods &amp; Results: A retrospective case note analysis was undertaken within our 222 bedded community hospital structure during the first wave of the pandemic from April to August 2020. A total of 129 patients were treated during this period. The average age of the patients was 78.8 ± 2.7 years. In patient mortality was 11% (14 patients). 83% of patients were discharged from the hospitals. 27% were discharged to care home facilities. At 90 days, 83% of patients were still alive but a third of these patients were re-admitted into hospital with various different diagnoses. Conclusion: Elderly patients who survived Covid-19 infection and left hospital have a relatively high mortality rate in the short-term. Also connected with this is a high morbidity rate and therefore care must be directed within primary care to ensure that this group stay out of hospitals.

Exploring the Relationship between Care Homes and Excess Deaths in the Covid-19 Pandemic: Evidence from Italy

We explore the relationship between the spatial distributions of excess deaths and care home facilities during the COVID-19 outbreak in Italy. Using registry-based mortality data (January 1st- March 31st, 2015-2020) for Lombardy, one of the areas hit most severely, we estimate that municipalities with care homes present significantly higher excess death rates among the elderly (+41%). We find that this effect is not driven by the size of care homes and of the vulnerable population that they host. Rather, our results suggest that the excess deaths did not occur only within care homes and these facilities acted as one of the possible catalysts in the diffusion of COVID-19 in the whole elderly population of their surrounding territory.

Preferences for Formal Social Care in Rural and Urban China: Evidence from a National Survey

ABSTRACTThis study investigates older people’s preferences for social care in rural and urban China. The data come from the China Longitudinal Aging Social Survey (CLASS) which collected information from a nationally representative sample of 10,682 Chinese older people aged 60 and over in 2014. Guided by the ecological model of aging, multilevel logistic regression analyses were conducted to identify the factors associated with preferred care arrangements. We found that older people in urban China are more likely than those in rural China to accept care home services or prefer government-provided care. Educational qualifications and the number of surviving children strongly and consistently predict older people’s preferences for formal care in both rural and urban China. Proximity to care home facilities and higher income are associated with an increase in the willingness to live in a care home in urban China, but they are not significant predictors of preferences for formal care in rural China. We argue that a one-size-fits-all social care policy may not be well-received in the Chinese older population. The government may want to consider social care policies where support is tailored to suit older people’s varied preferences.

THE PREVALENCE AND ASSOCIATES OF STRESS AND BURNOUT IN STAFF CARING FOR PEOPLE WITH DEMENTIA IN LONG-TERM CARE: A SYSTEMATIC REVIEW AND META-ANALYSIS

High vacancy and high turnover rates amongst care staff in care homes are associated with poorer quality of care and may be related to stress and burnout. We conducted a systematic review and the first meta-analysis to determine the level of stress and burnout and report its associated factors in staff caring for people living with dementia in 24-hour care settings. We electronically searched MEDLINE, PsycINFO and Web of Science databases from 2009 up to August 2017. Two raters independently graded the validity of studies using standardised criteria. We conducted a meta-analysis using a random effects model to determine the weighted mean burnout scores across comparable studies. We identified 2417 studies of which 17 met our inclusion criteria. Nine studies reported mean burnout scores in care staff working in either nursing or residential care home facilities in eight different countries. Meta-analysis of the four studies of 598 care staff that used the complete 22-item Maslach Burnout Inventory (MBI) found low mean emotional exhaustion levels; mean 15.0 (95% CI 14.5-15.5), moderate depersonalisation; mean 8.3 (95% CI 7.9-8.7) and low personal accomplishment; mean 22.0 (95% CI 21.6-22.4). Care worker factors reported to be associated with higher burnout and stress included: younger age, higher qualifications, not speaking English as a first language, feeling unsupported and rating leadership within the home as poor; there was also an association with caring for residents who exhibited aggressive behaviour. Current evidence suggests that most long-term care staff for people living with dementia do not experience high levels of burnout, but there is a lack of good quality longitudinal evidence with analysis of non-respondents. Further large prospective studies of burnout and stress levels in care staff are required to understand more about potentially modifiable institutional and staff risk factors for burnout and their correlation with staff turnover.

What matters most to people in retirement villages and their transition to residential aged care

INTRODUCTION: As older people age and become frail, their decline in independence and concomitant changing care needs may force them to move from retirement village to a residential aged care (RAC) facility. The purpose of this study was to identify factors that contribute to subjective wellbeing among older people living in retirement villages in Aotearoa New Zealand and to compare results with the data from the residents of the care home facilities co-located with the retirement villages.METHOD: This study is mainly quantitative in nature to examine what factors contributed to subjective wellbeing among older people living in retirement villages. Descriptive and regression analyses were used with data collected in 2016 from residents of two retirement villages (N = 163) from one aged residential care provider in Aotearoa New Zealand and they were then compared with already-published data on RAC residents. In addition, four village residents participated in semi-structured interviews. RESULTS: Results showed that retirement village residents reported being generally satisfied with their living environment and their overall wellbeing is positively influenced by their social and psychological milieu.CONCLUSIONS: This research provides insights on what matters most to retirement village residents’ subjective wellbeing, which includes a dignified environment enhancing positive mental health, relationship building and reducing loneliness and isolation. Results were also compared with feedback from care home residents co-located in the same estate to provide an indicative picture for comparison against other studies to inform and expand choices for older people to consider when relocating in late-life.

Integrating Community Health and Social Care Services in Fife

Introduction: Fife is the third largest local government region in Scotland with a growing population of 366,957, of which 18% are over the age of 65, and with a mix of urban communities and sparsely populated rural communities. Social care services are delivered by Fife Council and healthcare services by National Health Service Fife in a partnership working arrangement but with separate workforces, management structures and funding. Unplanned admissions to hospitals and care homes account for nearly 30% of the resources that Fife spends on health and social care for older people. To address these demographic and associated funding pressures, a programme to redesign and integrate community health and social care services was implemented. Description: The Scottish Government introduced a Reshaping Care for Older People programme to create a vision and offer some funding for service change. The programme aims to increase care in community settings resulting in reductions in demand for hospital inpatient and care home facilities. This should allow disinvestment to enable successful community services and projects to be sustained. The Government programme does not prescribe how community services should be redesigned, devolving responsibility and empowering organisations to do that with their local knowledge. In Fife, community service redesign is informed by Stakeholder Events where health and social care professionals are joined by third and independent sector, patient and carer representatives to map existing pathways and identify ways of integrating teams, reducing handovers and avoidable hospital and care home admissions. The aim is to empower teams to encourage patients and their carers to take control of their own health and wellbeing personal outcomes. The redesign has created an Integrated Community Assessment and Support Service (ICASS) combining professionals and blurring roles (nurses, physiotherapists, occupational therapists and care assistants) into multidisciplinary teams with shared care plans, resources and support systems. A number of related projects focus on prevention of admission (Hospital-at-home, day hospital rapid assessment, falls response, re-ablement, third sector capacity building, Local Area services Co-ordinators). Other projects focus on discharge planning and support (hospital discharge planning hubs, Short Term Assessment and Rehabilitation beds, special needs housing, discharge-to-assess, third sector supported discharge) Service managers facilitated integration and scaling up of services, developed a culture of integrated multi-disciplinary working in teams of co-located health and social care workers, created a generic support worker role, introduced performance management measures and consistent delivery processes across Fife. Evaluation is focussed on achieving personal outcomes, including conversations training for staff, and an IT patient management system that records outcomes goals. National tools such as Indicators of Relative Need (IoRNs) are used, and a university research project, PEPPERs, is measuring the effectiveness of proactive community interventions compared with unplanned hospital admissions in a randomised trial. Key findings: Successful integration of multidisciplinary ICASS teams and collocation of professionals has improved communication and empathy resulting in better co-ordinated patient care and more effort on prevention of admission to hospital. Assessing homecare needs at home or in STAR beds is reducing the costs of packages of care or care home admission. However this success is countered by accelerating growth in demand for services and increasing complexity of people living longer with multiple long term conditions. Highlights: Redesign of community services was already underway in 2011 when the Reshaping Care for Older People programme was launched and the process of evolution is continuing. The huge complexity of health and social care service integration needs a structured project management methodology to plan and implement change. Resistance to change in the workforce, and differences in practices between localities is being overcome with ongoing engagement, using reference groups, training needs analysis and upskilling, shadowing and mentoring. Clear communication of vision and change plans, and full engagement of the workforce in the change process is the key to success. Implementing change will take longer and cost more than you expect. Conclusion: Fife is continuously evolving and improving integrated community health and social care services that are focussed on proactively helping older people live safely and independently in their own homes for as long as possible. A new operational management structure for intermediate care that is scalable and transferrable across Fife communities, ensures a consistent service experience for patients across Fife . Community teams’ activities are shifting from responding to crisis to proactively managing frailty and long term conditions. To create a more enabling environment for integrated care, in April 2016 NHS Fife and Fife Council will launch a new Integration Authority with strategic priorities for prevention and early intervention, integrated and co-ordinated care, tackling health inequalities and improving mental health services. The journey continues…..

Reduction in methicillin-resistant Staphylococcus aureus colonisation: impact of a screening and decolonisation programme.

Patients in care homes are often at 'high risk' of being methicillin-resistant Staphylococcus aureus (MRSA) colonised. Here we report the prevalence of MRSA, the effect of MRSA screening and decolonisation in Wolverhampton care-home residents. Eighty-two care homes (1665 residents) were screened for MRSA, three times at 6-monthly intervals (referred to as phases one, two and three). Screening and decolonisation of MRSA-colonised residents led to a reduction in the prevalence of MRSA from 8.7% in phase one, 6.3% in phase 2 and 4.7% in phase three. Overall, the study suggests that care-home facilities in Wolverhampton are a significant reservoir for MRSA; screening and decolonisation has reduced the risk to residents going for procedures and has indirectly impacted on MRSA rates in the acute Trust.

Application of the IEC80001 standard towards integration of a real time alarm communication and management system

Purpose – The purpose of this paper is to report on use of the IEC80001 standard, Application of Risk Management for Information Technolody (IT) Networks Incorporating Medical Devices, to deploy a wireless alarm management solution in a long-term care home facility. Design/methodology/approach – The standard suggests the use of a unique responsibility matrix and a continuous quality improvement approach for analysis, evaluation and control of risks. A unique leadership committee and workgroup were formed to develop processes and procedures for integrating medical devices with IT systems; as well as execution of the project itself. The leadership committee oversaw the phased approach of assessing the technology, the clinical environment, proponent technology-based solutions and a specified risk management file. The project expanded its scope beyond the standard to include a risk focussed analysis of clinical workflow to evaluate the usability of the solution. Findings – The standard focussed approach identified numerous risks associated with the technical and network solution and the future state workflow. Medical devices proved to be the most limiting technology needing to be incorporated into the solution. Although faced with a daunting list of network related risks, it was concluded that all residual risks would have been acceptable. The analysis of the future state workflow identified various risks related to usability (human factors), battery management and the absence of additional operating dollars for supplementary staffing duties and new operational expenses. Originality/value – To the best of the authors knowledge, this paper is the first one to detail the process of following the IEC80001 standard in Canada. It offers insight into building an organizational framework around the standard and identifies gaps that should be considered by executive and project sponsors before proceeding with a project.

Administering questionnaires to older people: Rigid adherence to protocol may deny and disacknowledge emotional expression

This paper draws on data from a larger study conducted in care home facilities in: Seattle, USA; West Sussex and Surrey in the UK; and in the lower North Island in New Zealand. Two extracts from interactions between the researchers and an older person during the administration of The Philadelphia Geriatric Morale Scale in a care home facility in New Zealand were analysed following Houtkoop-Steenstra and using a Conversation Analysis (CA) approach. In the first extract the audio-recorded transcript was examined for events of institutional talk and rephrasing of questionnaire questions. We also examined the transcript for missed cues and the impact of closed questions when administrating questionnaires to older people living in care home facilities. We then present an extract where the researcher uses a conversational approach during the administration of the same questionnaire. We conclude that rigid adherence to interview protocols when administering questionnaires to older people who cannot complete these themselves disables the interviewer from interacting and engaging in a meaningful conversation or responding to cues that indicate distress or expressions of grief. The effect of this approach may deny and disacknowledge older persons' emotional experiences and for the older person the interview may not be a therapeutic encounter. Based on our analysis and experiences of conducting this research we support recommendations that a collaborative approach, allowing an interactional exchange between interviewer and respondent, be used when administering questionnaires to older people in care home facilities.